This RCIS study guide sets your prep against the five domains of the outline CCI publishes: put four of ten study weeks into diagnostic procedures (40% of scored items) and three into interventional procedures (34%), then give one week to emergencies, one to pre- and post-procedural work, and the last to timed runs. Below you get the blueprint, the plan week by week, the knowledge you need in plain words, an honest map of books and courses, and four emergency cases to test yourself on.
The RCIS (Registered Cardiovascular Invasive Specialist) exam has 170 questions: 150 scored questions and 20 unscored pretest questions, unmarked and mixed in at random. You cannot tell the pretest items apart, so every case gets your full attention. The scored items are split across five domains, and the split is the most useful number you will read this week:
| Domain | Weight | ≈ scored items | What it centers on |
|---|---|---|---|
| A · Pre-Procedural Activities | 8% | about 12 | Room and table setup, sterile field, patient prep, the time-out, consent and lab checks |
| B · Diagnostic Procedures | 40% | about 60 | Pressures and waveforms, hemodynamic math, angiography, ECG, imaging, radiation safety, drugs, access |
| C · Interventional Procedures | 34% | about 51 | Balloons and stents, closure devices, circulatory support, temporary pacing, structural and peripheral work |
| D · Emergency Procedures and Protocols | 13% | 19–20 | Emergency presentations, complications during the case, the defibrillator and code equipment |
| E · Post-Procedural Activities | 5% | 7–8 | Sheath removal and hemostasis, access-site complications, patient teaching, handoff |
Item counts are simple arithmetic on the domain percentages. CCI publishes weights per domain only, not per task.
The two domains that carry three quarters of the score each have a full guide with its own 12-case run. Start there. The other three are mapped below and will get guides later; until then, the plan in the next section covers them.
A, Pre-procedural (8%): getting the room, the patient and the paperwork right before the first puncture. D, Emergency (13%): recognizing what is going wrong mid-case and the first action. E, Post-procedural (5%): closing the access site and handing the patient over safely. Together they are 26% of the score, about 39 items, which is too many to skip and too few to start with.
The plan below assumes about 6 hours a week: four weekday sessions of 60 minutes and one 2-hour block on the weekend, 60 hours in total. The week split mirrors the blueprint on purpose: 4 weeks of B against its 40%, 3 weeks of C against its 34%.
Days 1–3: take a baseline
Run the 60-case practice test cold, without notes. Write down your score per domain. That sheet decides where the spare hours in weeks 1–9 go.
Weeks 1–2: hemodynamic math and waveforms (B)
Build one formula sheet: Fick and thermodilution output, cardiac index, SVR and PVR in Wood units and dyn·s·cm⁻⁵, Gorlin and Hakki valve area, Qp:Qs. Work 10 calculations a day from raw numbers. Add normal pressures chamber by chamber and the a, c and v waves.
Weeks 3–4: the rest of diagnostic (B)
Angiographic views and coronary anatomy, 12-lead ECG patterns, FFR and iFR cut-offs, IVUS and OCT, radiation safety, contrast and anticoagulant drugs, femoral and radial access. Finish with the 12-case run in the diagnostic guide.
Weeks 5–7: interventional (C)
Stents and balloons, bifurcation techniques, atherectomy, closure-device mechanics, IABP timing, Impella and ECMO, temporary pacing settings, TAVR and other structural work, peripheral procedures. Close with the interventional guide run.
Week 8: emergencies (D)
Perforation grades and first actions, no-reflow drugs, stent thrombosis, VF and the defibrillator, anaphylaxis versus vasovagal. Use the four cases at the bottom of this page, then the 12 emergency items in the worked questions.
Week 9: pre- and post-procedural (A and E)
Time-out content, who obtains consent, fasting and lab checks, the femoral landmark under fluoroscopy, sheath removal and ACT, radial band deflation, pseudoaneurysm versus AV fistula versus retroperitoneal bleed.
Week 10: timed runs
The exam gives you 2 hours 50 minutes of question time for 170 items, about 60 seconds a case. Do two full timed runs at that pace and read every option note on the cases you missed. For an outside read of your weak areas, the option is CCI's online self-assessment exam ($55), which reports percent correct by area but does not let you review items (CCI, checked September 2026).
CCI's outline ends with a single knowledge list that applies to every task. Translated into what you actually do on a test item, it comes down to nine areas:
| Area | What an item asks you to do | Domain |
|---|---|---|
| Hemodynamic math | Compute output, resistance, valve area or shunt ratio from a set of numbers, with units | B |
| Waveforms and pressures | Name the chamber from a described trace, spot a large v wave, tell constriction from restriction | B |
| Imaging and radiation | Pick the view for a vessel; know that magnification, a tube close to the patient or a detector far from them raise dose, and that doubling distance cuts it to a quarter | B |
| ECG | Localize an infarct, recognize bundle branch block and ischemia | B |
| Pharmacology | Heparin and ACT targets, antiplatelet loading, protamine, vasoactive and contrast-reaction drugs, and when to anticipate each | B, D |
| Devices | Stents, closure devices, IABP timing, Impella and ECMO, temporary pacing output and sensitivity | C |
| Complications | First action for perforation, no-reflow, dissection, VF on the table | D |
| Sterile technique and checks | Field setup, time-out, consent, fasting, labs | A |
| Hemostasis | Manual and device closure, radial bands, recognizing access-site bleeding | E |
Systemic vascular resistanceWorking
SVR = 17 WU, or 1,360 dyn·s·cm⁻⁵
That sits above the 800–1,200 dyn·s·cm⁻⁵ most texts give as normal. The two slips that cost the point: subtracting PCWP (that belongs to PVR) and leaving the answer in Wood units when the options are in dyn·s·cm⁻⁵.
The exam is mostly single-best-answer items with four options, plus multiple-response, hot-spot and drag-and-place items. Most items put you in the room: a monitor reading, a set of pressures, a step in the case, and the question of what happens next. Flashcards cannot train that, but they are the fastest way to load the facts the scenarios lean on.
CCI names four reference texts for the RCIS: Grossman & Baim (Moscucci), Darovic's Hemodynamic Monitoring, the Kern/Sorajja/Lim Cardiac Catheterization Handbook, and Watson & Gorski's Invasive Cardiology (CCI self-assessment page). None of them is an exam-prep book; they are the clinical sources the items are checked against.
| Reference text | Use it for |
|---|---|
| Grossman & Baim's Cardiac Catheterization, Angiography, and Intervention (Moscucci) | Depth on hemodynamics, angiography and interventional technique; a reference, not a cover-to-cover read |
| Darovic, Hemodynamic Monitoring | Pressure measurement and waveform interpretation |
| Kern, Sorajja & Lim, The Cardiac Catheterization Handbook | Compact procedural reference for formulas, catheters and views |
| Watson & Gorski, Invasive Cardiology | Written for cath lab staff; the broadest single review of the four |
These are the RCIS test prep books, courses and study material candidates search for by name. We describe what each one is; we have no tie to any of them and do not rank them.
| Resource | What it is | Type |
|---|---|---|
| Todd's Cardiovascular Review Books (J. Wesley Todd) | Five-volume printed review series for the invasive registry exams: basics, diagnostic techniques, hemodynamic calculations, interventions and practice exams, with explanations | Book |
| Glowacki & Sommers RCIS review | Two-day live review course on hemodynamics and calculations, pharmacology, equipment and X-ray safety | Course |
| Springboard Healthcare, RCIS Prep+ | Paid online exam simulator: practice tests drawn from a question bank, sold as a one-year subscription | Question bank |
| Quizlet sets | Free flashcards made by users, usually grouped by topic; quality varies set by set | Flashcards |
| CCI self-assessment exam | Scores you by content area; no item review | Practice exam |
Pick a structured exam review course if you need an outside schedule, if your baseline run puts diagnostic math at the bottom of the five domains, or if you are coming from outside the lab and want someone to explain waveforms live. Self-study is enough if you scrub cases every week, your baseline is even across domains, and you will actually keep to the 10-week plan. Either way, the free pieces on this site, this guide, the practice test and the worked questions, cover the drilling half of the job. The format and scoring are on the exam page.
CCI publishes the content outline with domain weights, names four reference texts and sells an online self-assessment. It does not issue a step-by-step plan. This page is a free RCIS study guide built on that outline: blueprint, 10-week plan, knowledge map and resources.
About 10 weeks at 6 hours a week, roughly 60 hours, if you know cath lab routine. Experienced staff can compress to 8 weeks; students and people new to the lab should add a week or two to hemodynamic math.
Start with the texts CCI itself lists: Grossman & Baim (Moscucci), Darovic's Hemodynamic Monitoring, the Kern/Sorajja/Lim Cardiac Catheterization Handbook, and Watson & Gorski's Invasive Cardiology. Use them as references for the topics your practice runs expose. For a book written around the exam, Todd's Cardiovascular Review Books are one long-running series aimed at the invasive registry; check that any book you buy reflects the July 2024 outline.
It is worth it if you need structure or live help with waveforms and calculations. If you work cases every week and your baseline is even across domains, books plus scenario questions are usually enough.
Take a baseline run, spend four weeks on diagnostic procedures and three on interventional, then one each on emergencies and on pre- and post-procedural care, and finish with two timed runs at about 60 seconds a case.
You need a scaled score of 650. Only the 150 scored items count, and the scaled score is not a percentage of correct answers.
Work the free case run here, then carry the full RCIS bank with you: the app sorts questions by the same five domains and keeps the explanation for every option.