- Exam Snapshot: The Numbers You Must Know
- Domain Breakdown at a Glance
- Physical Principles & Instrumentation Cheat Sheet
- Valvular Heart Disease Quick Reference
- Chamber Size & Function Fast Facts
- Congenital, Masses, and Miscellaneous Rapid Review
- Registration and Test-Day Mechanics
- Final-Week Review Schedule
- FAQ
- The 2026 ASCeXAM sits on Tuesday, July 14, 2026, with registration closing May 7, 2026.
- 200 items across 5 blocks of 40 questions, each block timed at 54 minutes - no carryover time between sections.
- Physical Principles, Instrumentation, and Examination Principles is the single largest domain, spanning 17 subtopics.
- Passing is criterion-referenced against a fixed knowledge standard, not a curve against other candidates.
Exam Snapshot: The Numbers You Must Know
Before diving into content, memorize the logistics cold. The National Board of Echocardiography (NBE), a physician-led not-for-profit founded in December 1998 and headquartered in Raleigh, NC, administers the ASCeXAM through Pearson VUE - either in person at one of over 230 Pearson Professional Centers in the US (plus 3,000+ international sites) or remotely via Pearson OnVUE. These figures matter because they shape how you plan travel, testing accommodations, and your final review window.
| Item | Detail |
|---|---|
| Test Date | Tuesday, July 14, 2026 (one day per year) |
| Registration Deadline | May 7, 2026 |
| Registration Fee | $1,295 USD |
| Cancellation Refund | Fee paid minus $200 (no deferments) |
| Total Questions | 200 items in 5 blocks of 40 |
| Time per Block | 54 minutes |
| Total Item Time | 4 hours 30 minutes |
| Maximum Seat Time | 5 hours 20 minutes (includes breaks, NDA, tutorial, survey) |
| Score Release | Approximately 10-12 weeks post-exam |
For a deeper look at how these dates and deadlines fit into your annual planning, see ASCeXAM Exam Dates 2026: Testing Windows, Deadlines & Scheduling. And if you're still confirming whether you qualify to sit for the exam at all, review ASCeXAM Requirements 2026: Eligibility, Prerequisites & How to Qualify before you register.
Domain Breakdown at a Glance
The current content outline (dated 1/2025) organizes the exam into six domains. Weighting is not evenly distributed, and Domain 1 dominates.
Domain 1: Physical Principles, Instrumentation, Examination Principles
The largest and most heavily tested domain, covering 17 subtopics.
- Ultrasound physics fundamentals
- Doppler instrumentation and artifact recognition
- 3D echocardiography principles
- Laboratory accreditation standards
Domain 2: Valvular Heart Disease
Stenotic and regurgitant lesion grading, prosthetic valve evaluation, and quantitative Doppler criteria.
Domain 3: Chamber Size and Function
Left and right ventricular systolic/diastolic function, chamber quantification, and normal reference ranges.
Domain 4: Congenital Heart Disease
Adult congenital lesions most likely to appear on echo in a general cardiology or lab setting.
Domain 5: Cardiac Masses, Pericardial Disease, Contrast and New Applications
Tumor versus thrombus differentiation, pericardial effusion/tamponade physiology, and contrast agent use.
Domain 6: Miscellaneous Topics (Role of Echo)
Clinical scenarios testing when and why echo is the appropriate diagnostic tool.
For the full expansion of every subtopic within each of these six areas, cross-reference ASCeXAM Exam Domains 2026: Complete Guide to All 6 Content Areas. If you're trying to gauge how tough this content actually is relative to other board exams, How Hard Is the ASCeXAM Exam? Complete Difficulty Guide 2026 breaks down the difficulty factors in detail.
Physical Principles & Instrumentation Cheat Sheet
Because Domain 1 carries the heaviest weight, your one-page review should devote proportionally more space here than to any other domain. Key facts to have automatic recall of on test day:
- Ultrasound wave basics: relationship between frequency, wavelength, and axial resolution; higher frequency improves resolution but reduces penetration.
- Doppler principles: the Doppler equation, aliasing and Nyquist limit, and when to switch from pulsed-wave to continuous-wave Doppler.
- Artifacts: reverberation, mirror-image, shadowing, and near-field clutter - and how to distinguish true pathology from artifact on a still frame.
- 3D echocardiography: acquisition modes, spatial vs. temporal resolution tradeoffs, and appropriate clinical indications.
- Machine settings: gain, compression, dynamic range, and their effect on image interpretation questions.
- Laboratory accreditation: quality assurance concepts and accreditation body requirements that show up as isolated recall items.
Key Takeaway
Treat Domain 1 as the backbone of your review - if you only have time to master one area cold, this is it, given its 17-subtopic breadth and outsized presence on the item bank.
Valvular Heart Disease Quick Reference
Domain 2 questions tend to be image- or waveform-based, testing whether you can apply quantitative criteria rather than just recite definitions. Must-know reference points:
- Continuity equation for aortic valve area calculation
- PISA method for regurgitant orifice area and regurgitant volume
- Severity grading thresholds for aortic stenosis, mitral regurgitation, and aortic regurgitation
- Prosthetic valve evaluation - differentiating normal transprosthetic gradients from pathologic obstruction
- Rheumatic versus degenerative valve disease patterns on 2D imaging
Expect vignette-style stems that pair a brief clinical history with a Doppler tracing or M-mode image, asking you to select the most likely diagnosis or next step.
Chamber Size & Function Fast Facts
Domain 3 leans heavily on quantification formulas and normal reference ranges. Have these locked in:
- Biplane Simpson's method for LV ejection fraction
- Diastolic function grading using E/A ratio, e', and E/e'
- RV function indices: TAPSE, fractional area change, and RV strain concepts
- Chamber quantification cutoffs by sex-specific normal ranges
- Strain imaging basics and when global longitudinal strain changes management
Congenital, Masses, and Miscellaneous Rapid Review
These three domains are smaller individually but collectively meaningful. Don't neglect them in favor of over-studying Domain 1.
Domain 4: Congenital Heart Disease
- Atrial septal defect types and shunt physiology on color Doppler
- Bicuspid aortic valve and associated aortopathy
- Patent foramen ovale versus ASD differentiation with bubble study
Domain 5: Cardiac Masses, Pericardial Disease, Contrast and New Applications
- Thrombus vs. tumor vs. vegetation - mobility, attachment site, and echogenicity clues
- Pericardial effusion grading and tamponade physiology (respirophasic flow variation)
- Contrast echocardiography indications for LV opacification and endocardial border definition
Domain 6: Miscellaneous Topics (Role of Echo)
- Appropriate use criteria - when echo is indicated versus when it isn't
- Comparative role of echo relative to other imaging modalities in specific clinical scenarios
Registration and Test-Day Mechanics
Content knowledge alone won't get you through if you mishandle the administrative side. Key mechanics to review before your test date:
- Eligibility documentation: North American-trained physicians submit a valid unexpired medical license or a notarized Letter of Good Standing from an ACGME-accredited program director; non-North American-trained physicians submit a valid license plus a Medical Council letter or certificate of good standing (dated within 12 months) if their license has no expiration date. All documents must be in English or accompanied by a certified translation at your own expense.
- Two forms of original valid ID are required at check-in - no exceptions.
- No calculators or reference materials are permitted in the testing room.
- Certification levels: Transthoracic (t), Transthoracic plus Transesophageal (te), Transthoracic plus Stress (ts), and Comprehensive (c) - confirm which level applies to your practice before registering.
- Post-pass obligations: passing physicians must enroll in Maintenance of Testamur in Echocardiography (MOTE) the following January - free the first year, then $85 annually, with requirements due December 31 each year. Recertification exams were discontinued starting July 2024 and replaced by MOCE.
For the complete fee structure, including what happens if you need to cancel, see ASCeXAM Certification Cost 2026: Complete Pricing Breakdown. And if you're weighing whether the entire certification pathway justifies the cost and time, Is the ASCeXAM Certification Worth It? Complete ROI Analysis 2026 lays out the tradeoffs.
Key Takeaway
ABIM board-certified physicians who pass the ASCeXAM may earn 20 ABIM MOC points - a detail worth confirming with your program if you're pursuing dual credit.
Final-Week Review Schedule
In the last stretch before July 14, 2026, structure your remaining review time around domain weight rather than personal comfort with a topic. This is the one place a generic study framework earns its keep - applied specifically to the ASCeXAM outline.
Domain 1 Deep Dive
- Work through all 17 subtopics in Physical Principles, Instrumentation, and Examination Principles
- Drill Doppler equation and artifact-recognition image sets
Valves & Chambers
- Rebuild quantification formulas from memory (continuity equation, Simpson's method, PISA)
- Practice image-based vignettes for Domains 2 and 3
Congenital, Masses & Miscellaneous
- Review shunt physiology and mass differentiation criteria
- Run timed practice blocks of 40 questions in 54 minutes to simulate pacing
Full Simulation & Logistics Check
- Take a full 5-block practice simulation with pooled break placement
- Confirm ID documents, testing location or OnVUE setup, and registration status
For a broader, week-by-week strategy that extends beyond this final month, the ASCeXAM Study Guide 2026: How to Pass on Your First Attempt walks through a full-cycle preparation timeline. You can also run realistic timed blocks on our ASCeXAM practice test platform to build stamina for the 54-minute-per-block format before test day.
FAQ
The exam contains 200 total items split into 5 blocks of 40 questions each, with 54 minutes allotted per block - 4 hours 30 minutes of item time overall, plus break and administrative time bringing the maximum seat time to 5 hours 20 minutes.
Physical Principles, Instrumentation, and Examination Principles is the largest domain, spanning 17 subtopics from ultrasound physics through 3D echocardiography and lab accreditation. It deserves the biggest share of your review time.
No. No calculator or reference materials are permitted during the ASCeXAM. You'll need formulas like the continuity equation, PISA, and Simpson's method memorized cold.
No. Passing is criterion-referenced against a minimum knowledge standard set by the NBE, not against how other candidates perform. Your score report lists the passing threshold and your performance by content area.
Physicians who pass must enroll in Maintenance of Testamur in Echocardiography (MOTE) the following January - free the first year, then $85 annually, with requirements due December 31 each year. Recertification exams were discontinued in July 2024 and replaced by MOCE.