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The Endocrine Certification in Neck Ultrasound Program is governed by the ACE Neck Ultrasound
Certification Council The Council reserves the right to expand the testing content for the CCE and ECNU
validation process as new information or procedures arise over time and become incorporated into the scope
of thyroid ultrasound practice Candidates for ECNU will be notified in advance of any changes.

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TABLE OF CONTENTS

I. ENDOCRINE CERTIFICATION IN NECK ULTRASOUND.................... 3

1.1. Background .................................................................................................... 3
1.2. The ECNU Credential and Its Importance .................................................... 3

II. PATHWAY TO PHYSICIAN CERTIFICATION...................................... 4

2.1. Time Frame for Completing the ECNU Program ......................................... 4

III. CERTIFICATION FEES ....................................................................... 5

IV. CANDIDATE ELIGIBILITY CRITERIA.................................................. 5

V. THE VALIDITY OF THE ECNU DESIGNATION ................................... 8

VI. THE COMPREHENSIVE CERTIFICATION

EXAMINATION (CCE) PROCESS ....................................................... 8
6.1. Deadlines........................................................................................................ 8
6.2. Examination Fees........................................................................................... 8
6.3. Examination Application Procedure .............................................................. 9
6.4. Examination Schedule ................................................................................. 10
6.5. Required Identification ................................................................................. 10
6.6. Testing Center Rules ................................................................................... 10
6.7. Emergencies ................................................................................................ 10
6.8. No Show, Late Arrival, Inclement Weather, and Rescheduling................. 11
6.9. Conduct during the Examination ................................................................. 11

VII. THE EXAMINATION STRUCTURE.................................................... 12

7.1. Content Outline ............................................................................................ 12
7.2. Examination Specifications .......................................................................... 12
7.3. Sample Questions........................................................................................ 12
7.4. References ................................................................................................... 13

VIII. EXAMINATION RESULTS ................................................................. 14

8.1. Notification of Results .................................................................................. 14
8.2. Cut Score (Passing Score) .......................................................................... 14
8.3. Scoring Procedures ..................................................................................... 14
8.4. Questions about the Examination................................................................ 15
8.5. Reexamination Information.......................................................................... 16
8.6. Appeals......................................................................................................... 16

IX. THE VALIDATION OF COMPETENCY PROCESS (VCP).................. 16

9.1. Background .................................................................................................. 16
9.2. VCP Fees ..................................................................................................... 17
9.3. Instructions for Ultrasound Procedure Reports .......................................... 17
9.3.1. General Instructions ........................................................................... 17
9.3.2. Format for Images and Reports ........................................................ 18
9.3.3. Scoring Procedures and Content Criteria for Reports and Images . 19
9.4. Failure to Meet the VCP Instructions for Ultrasound Procedure Reports.. 21
9.5. Attestation of Ultrasound Procedures ......................................................... 21
9.6. Submission of VCP Requirements.............................................................. 21
9.7. Notification of Results .................................................................................. 22

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TABLE OF CONTENTS
(Continued)

X. FAILURE TO COMPLETE THE CERTIFICATION PROCESS............ 22

XI. RECERTIFICATION........................................................................... 22

XII. APPLICATION INSTRUCTIONS ........................................................ 23

XIII. CONTACT INFORMATION................................................................ 24

XIV. APPENDICES.................................................................................... 25
Appendix I – Standardized Abbreviations........................................................... 26
Appendix II – ACE Glossary of Ultrasound Terminology................................... 27
Appendix III – Frequently Asked Questions........................................................ 33
ECNU Program Application Form ...................................................................... 39
Validation of Competency Process (VCP) Form ............................................... 44
Special Testing Accommodations (STA) for Candidates with
Disabilities Request ............................................................................................. 47
Partial List of Approved CME Courses ............................................................... 49

Nondiscrimination Policy
The American College of Endocrinology (ACE) does not discriminate among applicants on the basis of age,
gender, race, religion, national origin, disability, sexual orientation or marital status. The Comprehensive
Certification Examination (CCE) will be offered to candidates in environments that meet the standards
established by the American Disability Act (ADA).

Please save this Candidate Handbook for future reference.

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I. ENDOCRINE CERTIFICATION IN NECK ULTRASOUND

1.1. BACKGROUND

The American Association of Clinical Endocrinologists (AACE) represents subspecialty physicians who are
recognized for their expertise in the care of patients with thyroid and parathyroid diseases. These clinicians
routinely perform consultations and diagnostic evaluations for patients with thyroid and parathyroid disorders,
which include both diagnostic ultrasonography (US) and ultrasound-guided fine needle aspiration (UGFNA).
The American College of Endocrinology (ACE), which is the educational and scientific arm of AACE, recognizes
that the certification process for US and UGFNA provides assurance for optimal quality in patient treatment
outcomes.

This handbook has been developed to provide you with the information you will need to apply for the ACE
Endocrine Certification in Neck Ultrasound (ECNU) Program. ACE recognizes the responsibility you take in
participating in this certification program, and it is our aim to provide you with a smooth and positive application
process. If you have further questions after reading this Handbook, please contact the Certification Coordinator
via e-mail [email protected], or phone (904) 353-7878, ext.145. You can also visit the ECNU site at
http://www.aace.com/college/ECNU/.

1.2. THE ECNU CREDENTIAL AND ITS IMPORTANCE

Endocrine Certification in Neck Ultrasound (ECNU) is a professional certification in the field of neck
ultrasonography for endocrinologists who perform consultations and diagnostic evaluations for thyroid and
parathyroid disorders through both diagnostic ultrasound and ultrasound-guided fine needle aspiration
(UGFNA). The ECNU credential signifies that an individual has passed the Comprehensive Certification
Examination (CCE) and successfully completed the Validation of Competency Process (VCP). Successful
candidates can use the ECNU designation after their names.
Volunteer content experts from ACE worked for several years to develop the ECNU Program. The foundation
of the examination is the practice/job analysis conducted by subject matter experts comprised of
endocrinologists experienced in ultrasound and sonographers certified by the American Registry of Diagnostic
Medical Sonographers (ARDMS), who identified the areas of knowledge and application of knowledge required
of individuals practicing neck ultrasonography and ultrasound-guided FNA procedures. An outline of the
content areas covered on the examination can be found under section 7.1 of this Handbook.

ECNU is recognized by the American Institute of Ultrasound in Medicine (AIUM), one of the preeminent,
national accreditation bodies for ultrasound practices, and allows those with the ECNU credential to be directors
of ultrasound laboratories and apply for AIUM Practice Accreditation. The AIUM ultrasound practice
accreditation is a peer review process that examines practices against nationally recognized standards of
excellence in training and qualifications of personnel, quality of ultrasound examinations, maintenance and
calibration of machines, quality of reports, implementation of protection policies, and regular quality assurance
activities. The AIUM recognizes successful completion of the ECNU Program as evidence of sufficient physician
training in thyroid/parathyroid ultrasound, and certification in this area may become increasingly important for
reimbursement from Medicare and third party payors.

Participation in the ECNU Program is voluntary and open to anyone meeting the eligibility requirements.
Membership in the American Association of Clinical Endocrinologists (AACE) is not required. AACE members
who apply for the ECNU Program enjoy a significant discount on their certification fees.

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II. PATHWAY TO PHYSICIAN CERTIFICATION

The ECNU Program is comprised of the following steps. Please note that all candidates must satisfy both Step 1 and
Step 2 in order to receive the ECNU designation.

STEP 1: Comprehensive Certification Examination (CCE)

The Comprehensive Certification Examination is a multiple-choice, computer-based examination that covers major topic
areas in neck ultrasound. Achieving a passing grade on the CCE will entitle the candidate to continue to the Validation
of Competency Process (VCP). If the candidate fails the CCE, he/she must retake and successfully pass the
examination prior to continuing to the VCP. To better prepare for the examination, candidates must participate in a
Thyroid Ultrasound Course (minimum of 15.0 AMA PRA Category 1 Credits™) within the past 3 years, prior to taking the
CCE. A partial list of approved Neck Ultrasound Courses can be found at http://www.aace.com/college/ECNU/ or in the
Appendix section of this Handbook.

STEP 2: Validation of Competency Process (VCP)

The Validation of Competency Process assesses the physician’s demonstrated competency, activity, and level of skills
to interpret and report complete diagnostic ultrasound examinations (either performed by a supervised ARDMS-certified
sonographer or personally by the physician), and to perform and report UGFNA procedures.

The VCP requires submission of a total of fifteen (15) ultrasound (US) studies and reports, and must be submitted in
accordance to the VCP Instructions for Ultrasound Procedure Reports.

Refer to the Validation of Competency Process (VCP) section of this Handbook for detailed requirements and
instructions regarding the validation process (Section IX).

STEP 3: ECNU Program Completion (Issuance of ECNU Certificate and ECNU Designation)

Endocrine Certification in Neck Ultrasound (ECNU) is a professional designation awarded to individuals who meet
specified knowledge requirements, measured through a standardized examination and validation of competency
process in diagnostic ultrasound and ultrasound-guided fine needle aspiration (UGFNA).

 Upon successfully completing the VCP, the candidate will have earned the right to use the ECNU designation
after his/her name.
 A formal letter, ECNU Certificate, and ECNU lapel pin, will be sent to candidates who have successfully
completed the ECNU Program.
 Certification is valid for 10 years.

2.1. TIME FRAME FOR COMPLETING THE ECNU PROGRAM

Upon written notification of achieving a passing score on the Comprehensive Certification Examination (CCE),
candidates are given 12 months to complete the ECNU Program by successfully completing the Validation of
Competency Process (VCP).

The 12 months time frame begins upon the candidates’ receipt of their score report. The 12 months timeframe
does not begin on the date that candidates took the examination at a Prometric™ test center.

Example: If you took the CCE on November 27, 2010 and you received your score report on January 8, 2011, your
deadline for VCP submission will be January 8, 2012.

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IMPORTANT

Starting with the June 2010 CCE, the Council will no longer grant extensions to the 12 months time
frame required for completing the VCP. It is the sole responsibility of the candidate to fulfill the
requirements of the ECNU Program in its entirety. Failure to complete the VCP within 12 months of
passing the CCE will result in the loss of certification eligibility, and the individual must reapply for the
ECNU Program and pay the required fees.

III. CERTIFICATION FEES

The ECNU Program is comprised of two major steps – Step 1: the Comprehensive Certification Examination (CCE)
and Step 2: the Validation of Competency Process (VCP). Candidates who wish to obtain the ECNU designation
must complete the certification program and pay the fees for both the CCE and the VCP. The fee structure for the
ECNU Program is as follows:

CATEGORY CCE VCP TOTAL

AACE Member $350 $900 $1,250
Non-AACE Member $550 $1,000 $1,550
*Fellows/Retired AACE Members $250 $800 $1,050
*NOTE FOR FELLOWS: A letter from Department Chair verifying status must accompany application. Fellow’s fees only apply if candidate is in his/her
final year of fellowship program. Fellows who have completed the fellowship program will be charged the AACE Member rate.

IMPORTANT

 Fees for CCE and VCP will be collected separately.

 Your first payment will be for the CCE, and this must be submitted with your ECNU Program Application.

 Do not submit the VCP fee until you receive official written notification from ACE that you passed the CCE.
VCP payments submitted to ACE prior to passing the CCE will be returned to the candidate.

IV. CANDIDATE ELIGIBILITY CRITERIA

The ECNU Program is open to both AACE and non-AACE members. The ACE Neck Ultrasound Certification Council
has established the eligibility criteria to qualify for the ECNU Program. Candidates applying for the ECNU Program may
qualify through one (1) of the three (3) routes outlined on the next page, and must satisfy all requirements for the chosen
route in order to be eligible for ECNU.

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ROUTE 1: Endocrinologists with formal training in the subspecialty of endocrinology with attainment of board
eligibility/board certification status;*full time activity in the various fields of endocrinology, metabolism and
diabetes as a clinician, academician, research physician or any combination of these.

*Full time activity refers to full time focus, not the hours spent in practice in a day/week. For example, an endocrinologist may work part-time, but
dedicates 100% of his/her activities in the various fields of endocrinology, metabolism, and diabetes.

If applying under this route, you must:

1.a. Have attended CME-accredited Thyroid Ultrasound Course(s) in which you have received at least 15.0
hours of AMA PRA Category 1 Credits™ within the past 3 years prior to applying to the ECNU
Program. CME hours can be obtained from one or multiple courses, and can be earned from an AACE
or other organizations’ Thyroid Ultrasound Course(s). Copy/copies of CME certificate(s) must be
submitted with the ECNU Program Application.

1.b. Be currently performing at least 100 ultrasound studies per year (70% diagnostic; 30% UGFNA).
Studies should include parathyroid ultrasound and thyroid cancer lymph node mapping in the
neck. A signed Attestation is required upon application.

1.c. Have submitted a complete ECNU Program Application. Refer to the Appendix section of this Handbook
for the ECNU Program Application form and documentation requirements. You can also download the
application form from the AACE website: http://www.aace.com/college/ECNU/.

ROUTE 2: Endocrinologists who completed their endocrinology training prior to the initial 1972 endocrinology
subspecialty certification exam of the American Board of Internal Medicine (ABIM). Documentation confirming
eligibility will be required.

If applying under this route, you must:

2.a. Have attended CME-accredited Thyroid Ultrasound Course(s) in which you have received at least 15.0
hours of AMA PRA Category 1 Credits™ within the past 3 years prior to applying to the ECNU Program.
CME hours can be obtained from one or multiple courses, and can be earned from an AACE or other
organizations’ Thyroid Ultrasound Course(s). Copy/copies of CME certificate(s) must be submitted
with the ECNU Program Application.

2.b. Be currently performing at least 100 ultrasound studies per year (70% diagnostic; 30% UGFNA).
Studies should include parathyroid ultrasound and thyroid cancer lymph node mapping in the
neck. A signed Attestation is required upon application.

2.c. Have submitted a complete ECNU Program Application. Refer to the Appendix section of this Handbook
for the ECNU Program Application form and documentation requirements. You can also download the
application form from the AACE website: http://www.aace.com/college/ECNU/.

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ROUTE 3: Endocrinology fellows/trainees: Physicians in their final year of endocrinology training or in

additional, post-endocrinology training or research may apply for the ECNU Program with written verification of
status from their program director.

If applying under this route, you must:

3.a. Have attended CME-accredited Thyroid Ultrasound Course(s) in which they have received at least 15.0
hours of AMA PRA Category 1 Credits™ within the past 3 years prior to applying to the ECNU Program.
CME hours can be obtained from one or multiple courses, and can be earned from an AACE or other
organizations’ Thyroid Ultrasound Course(s). Copy/copies of CME certificate(s) must be submitted
with the ECNU Program Application.

Note: Fellows who have attended Endocrine University® within the past 3 years may use the CME credits obtained
from the Neck Ultrasound and UGFNA portion of the curriculum. If the CME credits are less than the 15-hour
requirement for ECNU, additional CME hours must be provided.

3.b. Submit notarized, validated imaging logs (signed by an office manager) of at least 50 ultrasound studies
(70% diagnostic; 30% UGFNA). Studies should include parathyroid ultrasound and thyroid cancer
lymph node mapping in the neck. Logs submitted to the ACE Office should be HIPAA-compliant and
should include the following information: total number of exams performed, date of service, type of exam,
location, results/diagnosis and recommendations. Logs must be submitted with the ECNU Program
Application.

3.c. Submit a signed attestation confirming that you have performed at least 50 of the required ultrasound
studies at the time of your ECNU Application, and that the remaining 50 ultrasound studies be completed
within the 12-month period after passing the Comprehensive Certification Examination (CCE).

3.d. Submit in writing, a letter from your program director, verifying your status as an Endocrinology Fellow.

3.e. Have submitted a complete ECNU Program Application. Refer to the Appendix section of this Handbook
for the ECNU Program Application form and documentation requirements. You can also download the
application form from the AACE website: http://www.aace.com/college/ECNU/.

IMPORTANT
BEFORE YOU PROCEED WITH YOUR APPLICATION…

 Please read all steps and required documentation to complete the ECNU Program (Step 1:
CCE; Step 2: VCP).

 Candidates for Routes 1 & 2 should perform at least 100 ultrasound studies (70% diagnostic;
30% UGFNA) per year, in order to successfully meet the requirements of the ECNU Program.

 Candidates for Route 3 should have performed at least 50 ultrasound studies (70% diagnostic;
30% UGFNA) at the time of ECNU application, and should attest that the remaining 50
ultrasound studies will be completed within the 12-month period after passing the CCE.

 Please note that if you are currently not performing the minimum number of ultrasound studies
required under your chosen route, please do not apply to the ECNU Program at this time.

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--FOR ENDOCRINOLOGY FELLOWS--

 If you have completed an endocrine fellowship program, but have not taken the endocrinology
board, a certificate of fellowship program completion must be submitted with your application.

V. THE VALIDITY OF THE ECNU DESIGNATION

The ECNU designation is valid for ten (10) years. The ECNU recertification period will begin the first January
after the year in which the ECNU designation is awarded. The certificant will have until January 1, ten (10) years
later to complete the recertification requirements.

EXAMPLE
If you obtained your ECNU designation May 14, 2010, your recertification period will begin
January 1, 2011 and you will need to complete all recertification requirements prior to January
1, 2021, when your certification will expire.

VI. THE COMPREHENSIVE CERTIFICATION EXAMINATION (CCE) PROCESS

6.1. DEADLINES
 Application Deadline: Monday, October 18, 2010

Completed applications must be submitted and all fees paid by the deadline to be eligible for the examination.
Incomplete applications will not be processed and will be returned to the applicant. The CCE is computer-
based and offered at Prometric™ sites conveniently located throughout the United States.

The test window is November 5 – November 24, 2010. Upon acceptance of application, a written notification in
a form of an Authorization to Test (ATT) letter will be mailed to the candidate, and the candidate will schedule
the examination with Prometric™, the test vendor. Information regarding examination scheduling will be
included in the candidate’s ATT letter. For more information on Prometric™, please go to www.prometric.com.

6.2. EXAMINATION FEES

Examination fees are paid to ACE either online or by mail, depending on how the application is submitted. Fees
must accompany the completed ECNU Program Application form and supporting documentation. The
following fees only apply to the Comprehensive Certification Examination (CCE):

 AACE Member: $350

 Non-AACE Member: $550
 *Fellows/Retired AACE Members: $250
*NOTE FOR FELLOWS: A letter from Department Chair verifying status must accompany application. Fellow’s fees only apply if
candidate is in his/her final year of fellowship program. Fellows who have completed the fellowship program will be charged the AACE
Member rate.

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IMPORTANT
 Full payment in the form of check or credit card must be submitted with the application. Online credit
card payment is also available by visiting www.aace.com/college/ECNU and completing the online
application process. Applications will not be processed until fee has been received by the Certification
Coordinator.

 Complete the payment application found in Section 6 of the ECNU Program Application form. Please
make checks payable to the American College of Endocrinology (ACE), not AACE.

 Fees are non-refundable in the event that you do not complete and submit your application and
required documentation by the application deadline.

 If you submitted an ECNU application with payment, but failed to schedule your CCE without notifying
ACE of your decision to postpone taking the exam, your fee will be non-refundable.

6.3 EXAMINATION APPLICATION PROCEDURE

1. Candidate must complete the ECNU Program Application. Applications must be typed or clearly printed,
and must be complete with examination fee and signatures on the Attestation and Confidentiality
Statements. All required documentation must be submitted with the application (e.g., CME
certificates/letters for 15.0 hours of CME credits obtained from one or more Thyroid Ultrasound Courses
within the past 3 years, written verification of fellowship status, etc.) Incomplete applications and supporting
documentation will be returned unprocessed. Fees are non-refundable.
2. ACE will acknowledge receipt of candidate’s application via e-mail, within 5 business days of receipt of the
application in the ACE Office.
3. ACE will review all applications. Once the candidate’s application has been reviewed and accepted,
candidates will be sent an Authorization to Test (ATT) letter, no later than two weeks before the test
window. Instructions on how to schedule an exam with Prometric™ will be included with the ATT.
4. Candidate must complete the online registration process with Prometric™. Once completed, an electronic
confirmation will be sent to the candidate containing the candidate’s name, authorization number, address
of the nearest test center, the date and time of the test, and name of the test.
Note: If a candidate loses the confirmation or has not received a confirmation two weeks before the test
date, he/she should contact Prometric™ at 1-800-479-6376.

Examination Application Process at A Glance

Candidate completes application form  Candidate submits application, examination fees, and all required CME
documentation to ACE  ACE acknowledges receipt of application via e-mail  ACE reviews application  ACE
sends ATT to accepted candidates  Candidate registers for exam with Prometric™  Prometric™ sends electronic
confirmation to candidate  Candidate takes examination at Prometric™ site

Submit all applications and examination fees to:

Laurie Calderone
Certification Coordinator
American College of Endocrinology
245 Riverside Avenue
Suite 200
Jacksonville, FL 32202
Fax: (904) 404-4205

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6.4. EXAMINATION SCHEDULE

Candidates must report to the test center no later than 15 minutes before the scheduled time of the
examination. You will have two (2) hours to complete the examination. There are no scheduled breaks.

6.5. REQUIRED IDENTIFICATION

The following must be presented, in order to take the exam:

 One form of photo ID: current, non-expired driver’s license, passport, medical license (only if medical
license is a photo ID), or other government-issued photo ID
 Authorization to Test (ATT) letter: The name and address on the photo ID must match the name and
address listed on the ATT.

IMPORTANT
Candidates without an Authorization to Test (ATT) letter and valid photo ID will NOT be permitted to enter the test
center, and their examination fees will be forfeited.

6.6. TESTING CENTER RULES

The following rules are enforced at all test administrations:

 All candidates must have proper photo ID to be admitted to take the exam.
 Candidates will be admitted only to their assigned test center.
 Candidates arriving less than 15 minutes prior to the scheduled time of the exam will not be admitted.
 No guests are permitted in the examination rooms.
 No reference materials, books, papers, or personal items (purses, briefcases, coats, etc.) are allowed in
the examination room.
 No electronic devices are permitted in the assessment site, including telephones, signaling devices such as
pagers and alarms, personal digital assistants (PDAs) and other hand-held computers.
 No weapons or instruments that may reasonably be used as weapons may be brought into the examination
room.
 No test materials, documents, or memoranda of any sort are to be taken from the examination room.
 Candidates may not communicate with other candidates during the examination. Test Center
Administrators (TCA) are authorized to maintain secure and proper test administration procedures,
including relocation of candidates.
 No questions concerning the content of the examination may be asked during the testing period.
 Candidates will be provided with a survey at the end of the exam to comment on the exam administration.
 Food and beverages are not permitted in the assessment center. Tobacco products and gum may not be
used during the examination.
 Breaks are not scheduled during the exam. Candidates are permitted to take breaks on an individual basis,
but no additional time is allotted to candidates who take breaks, for completing the exam. Candidates who
must leave the testing room must receive permission from the Test Center Administrator and may be
escorted while outside the testing room.
 Candidates will not be allowed to talk during rest room trips. Those who violate this requirement will be
denied re-admittance to the testing room, forfeit all fees, and will not have their exam scored.
 Test Center Administrators cannot take and/or relay phone messages to candidates during the testing
period.

6.7. EMERGENCIES

Every attempt will be made to administer all examinations as scheduled. However, should any problems occur,
due to the testing vendor, the examination will be rescheduled at no cost to the candidate.

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6.8. NO SHOW, LATE ARRIVAL, INCLEMENT WEATHER, AND RESCHEDULING

Candidates who have scheduled with Prometric™, and are unable to sit for the examination at the assigned
time must notify Prometric™ (the testing vendor) in advance of the scheduled examination date. The ACE
office cannot schedule and/or make changes to the candidate’s appointment, so candidates must make and
confirm all changes through Prometric™.

IMPORTANT
 If advance notice is received 48 hours prior to scheduled test, the candidate may have the registration
moved to another exam administration for a fee of $25 OR cancel the examination with a refund of the
examination fee minus a $150 administrative fee.

 If notice is not received 48 hours prior to the scheduled exam or candidate fails to show for their scheduled
exam, the registration will NOT be moved to another exam administration, nor is the examination fee
refunded.

 Candidates will not be permitted to take the exam if they arrive less than fifteen (15) minutes before the
scheduled time of the exam. The examination fee will be forfeited.

 If the exam cannot be administered, or if a candidate is unable to arrive at a designated exam site due to
inclement weather, terrorist acts, natural disaster, or other unforeseen emergencies beyond the control of the
test vendor and the candidate, as determined by the ACE Certification Council, the candidate may receive an
extended testing window (to be determined on an individual basis) and will be allowed to reschedule the exam
without being charged a reexamination fee. Candidates will be responsible for their own associated expenses
for future testing (travel, hotel, food, etc.).

6.9. CONDUCT DURING THE EXAMINATION

Any individual found by the ACE Neck Ultrasound Certification Council, at its sole discretion, to have engaged in
conduct which subverts or attempts to subvert the examination process may have his or her scores on the
examination withheld and/or declared invalid, and/or be subject to the imposition of other appropriate sanctions
by the Council.
Conduct which subverts or attempts to subvert the examination process includes:

 Conduct which violates the security of the examination materials, such as removing from the examination
room any of the examination materials; reproducing or reconstructing any portion of the licensing
examination; aiding by any means in the reproduction or reconstruction of any portion of the licensing
examination; selling, distributing, buying, receiving or having unauthorized possession of any portion of a
current or future examination.

 Conduct which violates the standard of test administration, such as communicating verbally or otherwise with
any other examinee during the administration of the examination; copying answers from another examinee
or permitting one's answers to be copied by another examinee during the administration of the examination;
having in one's possession during the administration of the examination any book, notes, written or printed
materials, or data of any kind, other than the examination materials distributed or specifically listed as
approved materials for the examination room.

 Conduct which violates the credentialing process such as falsifying or misrepresenting educational
credentials or other information required for admission to the examination; impersonating an examinee, or
having an impersonator take the examination on one's own behalf.

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VII. THE EXAMINATION STRUCTURE
ACE offers the Comprehensive Certification Examination (CCE) for endocrinologists in neck ultrasonography who
perform consultations and diagnostic evaluations for thyroid and parathyroid disorders through both diagnostic
ultrasound and ultrasound-guided fine needle aspiration (UGFNA).

7.1. CONTENT OUTLINE

The examination will cover the following major topic areas:

I. Principles of Ultrasound Imaging – 15%
II. Neck Anatomy – 15%
III. Thyroid Pathology – 34%
IV. Parathyroid Pathology – 10%
V. Lymph Node Pathology – 10%
VI. Ultrasound-Guided Fine Needle Aspiration (UGFNA) – 16%

7.2. EXAMINATION SPECIFICATIONS

The CCE is a multiple-choice, computer-based examination consisting of 100 questions. Candidates should
answer each question by selecting the best alternative from the four choices presented. Each correctly
answered question is one point, and points are not deducted for incorrect answers. There is no extra penalty for
wrong answers or for guessing on the examination, so you should answer every question. Candidates are given
two (2) hours to complete the examination.

7.3. SAMPLE QUESTIONS (Correct answers are in bold)

1. A 45-year-old patient is found to have a 1 cm nodule in the thyroid. Which of the following ultrasound
characteristics would necessitate an ultrasound-guided FNA?
(A) Nodule is 30% cystic
(B) Nodule has increased vascularity
(C) Nodule has comet tail signs
(D) Nodule has eggshell calcifications

2. A 25-year-old patient is seen for follow-up three years after having a total thyroidectomy for papillary thyroid
cancer. An ultrasound reveals a lymph node without a hilum in the lateral neck at Level 2. What
ultrasound characteristic of the lymph node would NOT warrant an ultrasound-guided FNA?
(A) Size is 1.5 X 0.6 cm
(B) Coarse calcifications
(C) Enhancement distally
(D) Vascularity in the periphery

3. A patient presents with serum calcium of 12 mg% and a PTH of 125. Ultrasound shows a mass posterior
to the thyroid. What ultrasound characteristic would the endocrinologist expect to find?
(A) Mass is hyper echoic
(B) Power Doppler shows mass is a vascular
(C) A hyper-echoic line separates mass from thyroid
(D) Mass is heterogeneous

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7.4. REFERENCES

The examination questions are mapped to the references listed below:

Reference List

1. AACE Ultrasound Course Syllabus

2. Ahuja A; Evans R. Practical Head and Neck Ultrasound. 2000. Greenwich Medical Media.

3. Baskin HJ. New Applications of Thyroid and Parathyroid Ultrasound. Minerva Endocrinol
2004:29:195-206

4. Baskin HJ, Duick DS and Levine RA. Thyroid Ultrasound and Ultrasound-Guided FNA.
Springer Publishing. 2008.

5. Caruso D.; Mazzaferri E. Fine Needle Aspiration Biopsy in the Management of Thyroid
Nodules. Endocrinologists 1991; 1:194-202.

6. Ahuja A, Ying M. (2002) An Overview of Neck Node Sonography. Investigative Radiology 37;
333-342.

7. Papini E, Guglielmi R, Bianchini A, Crescenzi A, Taccogna O, Nardi F, (2002) Risk Of

Malignancy In Nonpalpable Thyroid Nodules: Predictive Value Of Ultrasound And Color-
Doppler Features. J Clin Endo Metab 87:1941-1946.

8. Frasoldati A, Presenti M, Gallo M, Coroggio A, Salvo D, Valcavi R. (2003) Diagnosis Of Neck

Recurrences In Patients With Differentiated Thyroid Carcinoma. Cancer 97; 90-96.

9. Mandel S. Diagnostic Use of Ultrasonography in Patients with Nodular Thyroid Disease.

Endocrine Practice 2004;10:246-252.

10. Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid
Cancer. Thyroid 2006; 2.

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VIII. EXAMINATION RESULTS

8.1. NOTIFICATION OF RESULTS

Candidates will be officially notified of the Comprehensive Certification Examination (CCE) results via postal
mail, within approximately four to six weeks following the close of the examination window. No results will be
provided by telephone, fax, or e-mail. Scores will be released ONLY to the individual candidate. Requests to
release examination scores via e-mail or phone will not be considered.

IMPORTANT
If you wish to authorize a person to inquire regarding the status of your application and/or results, a
copy of the proof of power of attorney must be submitted to the ACE Office. Only persons
authorized as power of attorney may act on behalf of a candidate. Inquiries from unauthorized
individuals will not be considered.

8.2. CUT SCORE (PASSING SCORE)

The passing score, or cut score, was established through a Passing Score study. ACE has contracted with
Prometric™ to conduct the study and convene a panel of subject matter experts (SMEs) in the field of thyroid
ultrasound. During the process, the panel was presented with the final standard of minimal knowledge, skills,
and abilities composed of specific statements about what the candidate needed to know to be considered
minimally acceptable for certification, as developed in the test development process. After reaching consensus
on the definition of the minimally qualified candidate, the panel rated each question in reference to the
proportion of minimally qualified candidates that will get the answer right.

A summary report documenting the methods and results of the standard setting study was then presented to
the Certification Council. The report outlines the discussion conducted with the panel of experts regarding
selection of the recommended cut score for the exam. Upon approval of the recommended cut score by the
Certification Council, the minimum score necessary to pass the CCE was established. The passing score is
reflective of what a candidate needs to know and be able to know at a minimum, to pass the examination.

When the relative merits and drawbacks of various cut score possibilities are evaluated, it is important
to consider that each possible cut score will have some degree of decision error.

 Setting a cut score too low undermines the purpose of credential testing by permitting a large number of
people who are not minimally competent to practice in the field.
 Setting a cut score too high helps ensure no true “not qualified” pass, but creates an injustice by preventing a
large number of candidates who are minimally competent from becoming credentialed after preparation for the
test.

8.3. SCORING PROCEDURES

The minimum passing score for the Comprehensive Certification Examination (CCE) is a scaled score. All
questions on the examination are weighted equally during scoring. The use of scaled scores is an established
practice for many state and national examinations. It allows the use of a passing score, which can remain
constant from one examination to the next. While this procedure does not affect whether an examinee passes
or fails, it will better enable comparison of the results from one administration to another.

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The CCE scale score range is 200 to 800 and a total scaled score of 500 is needed to pass the examination.

If you pass the examination, your results will NOT include a numeric scale score. It will only contain a statement
that you passed. The examination is designed as a minimum competency test for credentialing purposes and is
not intended to distinguish between passing scores. This policy is established as a safeguard against misuse of
the examination scores by passing candidates.

If you fail the examination, your results will include your total failing scale score. Your failing score report will
also contain diagnostic levels in each of six sub score categories based on the six content areas outlined in this
Handbook.

THE SIX SUBSCORE AREAS ARE AS FOLLOWS:

I. Principles of Ultrasound Imaging

II. Neck Anatomy
III. Thyroid Pathology
IV. Parathyroid Pathology
V. Lymph Node Pathology
VI. Ultrasound-Guided Fine Needle Aspiration (UGFNA)

Sub score results are reported in three diagnostic levels: Proficient, Marginal, or Deficient. To avoid confusion
with total examination scores, the percentage of questions you answered correctly in each sub score area is not
reported. Pass/fail decisions are not made using sub scores because sub scores alone do not provide sufficient
information for pass/fail decisions.

DIAGNOSTIC LEVEL DESCRIPTIONS

 Deficient: The score you obtained is below an acceptable level; substantial study of this content
area is recommended prior to retaking the examination.
 Marginal: The score you obtained is marginally unacceptable. Your understanding in this domain
does not appear to be strong, and additional study is suggested.
 Proficient: The score you obtained in this domain is at or above the acceptable level; you have
demonstrated an acceptable understanding of the domain. A review of this area may be helpful to
you prior to retaking the examination.

8.4. QUESTIONS ABOUT THE EXAMINATION

Candidates have two options to raise questions regarding the examination:

 Candidates will receive a survey at the end of the examination, and may use this opportunity to express
comments and questions about the examination.
 Candidates may forward their comments in writing, to ACE (c/o Certification Coordinator) within 10 business
days after the examination.

IMPORTANT
All questions regarding the examination will be reviewed by the Certification Council, and
candidates will receive an individual response following the Council review.

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8.5. REEXAMINATION INFORMATION

If a candidate fails the CCE, he/she may retake the examination the next time it is offered by ACE. Such
registration will be subject to the current guidelines and fees established by ACE.

8.6. APPEALS

All appeals regarding examination scores must follow these procedures:

 Appeals must be filed within 15 business days of receipt of the score report.
 An appeal letter must be sent to ACE via postal mail, stating the specific issue/concern and the reason(s)
for the appeal. Letters sent via e-mail or fax will not be processed.
 Certification Coordinator will acknowledge receipt of the appeal letter within 3 business days of receipt from
candidate.
 The Certification Council will review the appeal letter, and a response will be forwarded within 15 business
days of receipt of the appeal letter. The response will outline the reasons for the approval/denial of the
request.

Please send appeal letter to:

Laurie Calderone
Certification Coordinator
American College of Endocrinology
245 Riverside Avenue, Suite 200
Jacksonville, FL 32202

IX. THE VALIDATION OF COMPETENCY PROCESS (VCP)

9.1. BACKGROUND

The Validation of Competency Process assesses the physician’s demonstrated competency, activity, and level
of skills to interpret and report complete diagnostic ultrasound examinations (either performed by a supervised
ARDMS-certified sonographer or personally by the physician), and to perform and report UGFNA procedures.

Successful completion of the Comprehensive Certification Examination (CCE) will entitle the candidate to
continue to the Validation of Competency Process (VCP). If the candidate fails the CCE, he/she must retake
and successfully pass the examination prior to continuing to the VCP. Documentation and fees submitted for
VCP will be returned unprocessed if the candidate has not passed the CCE.

There are two segments to the Validation of Competency Process:

 Proper submission of diagnostic-quality ultrasound (US) images with interpretation, (submitted in
CD or USB Flash Drive, in PowerPoint format).
 Signed attestation of the total number of US examinations and UGFNA procedures performed by
the candidate in the twelve (12) months preceding submission of the required images and reports.

IMPORTANT
®
All images and reports must be submitted in PowerPoint format and stored in CD or
USB Flash Drive. Paper images or reports will NOT be accepted.

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9.2. VCP FEES
AACE Member: $900
Non-AACE Member: $1,000
Fellow/Retired AACE Members: $800

IMPORTANT
 Full payment must be submitted with ultrasound reports and completed VCP Form. Reports
will not be graded until fee has been received by the Certification Coordinator. Do not send
advance payment for VCP. Your payment must be sent along with your complete VCP
Package.

 Complete the VCP payment found in Section 2 of the Validation of Competency Process
Form. Please make checks payable to the American College of Endocrinology (ACE), not
AACE.

 Online credit card payment is available by visiting www.aace.com/college/ECNU and

completing the online payment process.

 For AACE Members Paying Online: In order to receive the member rate for the VCP fee, you
must log on to the AACE website using your member log in ID, before completing the online
payment process for VCP.

9.3. INSTRUCTIONS FOR ULTRASOUND PROCEDURE REPORTS

9.3.1. GENERAL INSTRUCTIONS

Ultrasound examinations may be performed by either the ECNU-qualified endocrinologist or by an

ARDMS-certified sonographer under the direct supervision of the ECNU-qualified endocrinologist.
Although the static images may be obtained by the physician or ARDMS-certified sonographer,
it is necessary that the physician participate in and view the images in real-time ultrasound.

Upon notification of successful completion of the CCE, the qualified candidate must submit appropriate
ultrasound images for evaluation purposes within the ensuing twelve (12) month period. Ultrasound
studies performed prior to passing the CCE may be submitted provided that they meet the criteria for
submission, and the studies submitted were conducted in a time frame not to exceed twelve (12)
months prior to passing the CCE.

Example: If you passed the CCE in December 2009, you may submit ultrasound studies performed
between December 2008 and December 2009.

IMPORTANT
In accordance with HIPAA regulations, all patient identifying information must be removed from
the images and/or patient and cytology reports, prior to submission to the ACE Office.
Patient identifying information includes name, address, phone number, birth date, and social
security number. Images and reports with patient identifying information will not be accepted
and will be returned to the candidate unprocessed.

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9.3.2. FORMAT FOR IMAGES AND REPORTS

Ultrasound images for evaluation must be technically acceptable, properly annotated, and submitted in
®
CD or USB Flash Drive of stored images in PowerPoint format only. Images and reports
submitted on paper will not be accepted, and will be returned to the candidate ungraded. All submitted
ultrasound examinations must be in accordance with the VCP Instructions for Ultrasound Procedure
Reports.

A. WHAT TO SUBMIT

A total of fifteen (15) separate US cases and reports, with a different patient for each case.
These must include:

1. Ten (10) diagnostic US studies comprised of the following:

a. Five (5) must demonstrate a thyroid nodule(s)
b. Two (2) must demonstrate parathyroid adenoma pathology
c. Two (2) must demonstrate a malignant lymph node(s)
d. One (1) must demonstrate autoimmune or Hashimoto’s thyroiditis findings

2. Five (5) UGFNA procedures (must include cytology report)

B. HOW TO LABEL YOUR REPORTS

Each page and each corresponding image must be labeled in the manner listed below. All
cytology reports must also be labeled. VCP Packages that are not labeled in this required format
will be returned to the candidate.

 Cases 1-5: Thyroid Nodule US For example: Page 1 of your

report is on Thyroid Nodule US,
 Cases 6-7: Parathyroid Adenoma make sure you label the top page
 Cases 8-9: Malignant Lymph Node as follows: Case 1: Thyroid
 Case 10: Hashimoto’s Thyroid Case Nodule US
 Cases 11-15: UGFNA

C. WHAT INFORMATION TO INCLUDE IN ALL REPORTS

While some may use a checklist to record ultrasound features, the Ultrasound Reports must
be in a narrative form. They should be concise and contain all pertinent positive and
negative findings. Reports and accompanying cytology/pathology reports must be in English.

All reports must be typed and contain the following information:

1. Measurement (Longitudinal X Anterior-Posterior X Transverse) of each

thyroid lobe & isthmus Anterior-Posterior
2. The indication for performing the exam.
3. A diagnostic impression or differential diagnosis.
4. Disposition/plan indicating specifically what is to be done with the information obtained
from the US (e.g., surgery, follow-up in six months, FNA, etc.). Terms like “Clinical
correlation” are NOT acceptable.
5. Signature of the endocrinologist.

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9.3.3. SCORING PROCEDURES AND CONTENT CRITERIA FOR REPORTS AND IMAGES

Certification status will be determined on a pass/fail basis. In addition to the requirements listed for all
Ultrasound Reports, there are additional requirements for each category. These are listed below.

All reports will be reviewed by the ECNU Validation Panel and will be graded according to the criteria
specified under each category (e.g., Thyroid Diagnostic US Reports, Parathyroid Adenoma Cases,
etc.). Points will be deducted from images and reports missing the required information.

A. THYROID DIAGNOSTIC US REPORTS: 5 nodules required

Thyroid Diagnostic US reports must contain the following criteria:

1. Indication for performing examination

2. Measurement (Longitudinal x Anterior-Posterior x Transverse) of each thyroid lobe &
isthmus Anterior-Posterior
3. Measurement (Longitudinal x Anterior-Posterior x Transverse) of dominant and/or
suspicious nodule(s)
4. Description of thyroid parenchyma (homogeneous, heterogeneous, fibrosis,
pseudonodules, etc.)
5. Evaluation of nodules
a. Describe echogenicity of nodule(s)
b. Description of nodule margins (irregular, smooth, halo, invasion, etc.)
c. Description of Grade (I thru IV) of vascularity with Doppler image
6. Description and characterization of any abnormal findings
a. Calcifications (presence or absence of)
b. Cysts- Description (Simple, complex, mural components)
c. Comet tails
d. Posterior Acoustic Enhancement
7. Description of surrounding lymph nodes in neck area
8. Diagnostic impression
9. Recommendations for additional studies, procedures or treatment provided

IMPORTANT
At least one (1) Doppler image (Black & White acceptable) MUST accompany each
thyroid nodule case.

B. PARATHYROID ADENOMA CASES: 2 required

Parathyroid Adenoma cases must contain the following criteria:

1. Indication for performing examination

2. Location of parathyroid
3. Measurement of parathyroid adenoma (Longitudinal x Anterior-Posterior x Transverse)
4. Echogenicity (hypoechoic, homogeneous) of parathyroid
5. Doppler image of parathyroid
6. Comment on vascularity of parathyroid
7. Parathyroid must be verified by surgery or FNA (PTH in needle washout)
8. Diagnostic impression
9. Recommendation for additional studies, procedures or treatment provided

IMPORTANT
At least one (1) Doppler image (Black & White acceptable) MUST accompany each
parathyroid case.

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C. MALIGNANT LYMPH NODE US REPORTS: 2 required

Malignant Lymph Node US reports must contain the following criteria:

1. Indication for performing examination. The indication should state on which side of the
thyroid the primary malignancy occurred (right, left, or bilateral). If this is not known
(primary occurred years earlier and records not available), this should be stated.
2. Location (Compartment I thru VI, right or left)
3. Measurement of short and long axis in transverse (provide the S: L ratio)
4. Comment on echogenicity
5. Evaluation of vascularity (central or peripheral)
6. Provide Doppler image
7. Comment on presence or absence of Hilar line, calcifications and Cystic Necrosis
8. Malignant Lymph Node must be verified by surgery or FNA (Tg in needle washout)
9. Diagnostic impression
10. Recommendations for additional studies, procedures or treatment provided

IMPORTANT
At least one (1) Doppler image (Black & White acceptable) MUST accompany each malignant
lymph node case.

D. HASHIMOTO’S THYROID CASE: 1 required

Hashimoto’s Thyroid case must contain the following criteria:

1. Indication for performing examination

2. Measurement (Longitudinal x Anterior-Posterior x Transverse) of each lobe,
Isthmus Anterior-Posterior
3. Comment on echogenicity
4. Comment on vascularity
5. Description of parenchyma (fibrosis, pseudonodules, etc.)
6. Diagnostic impression
7. Recommendations for additional studies, procedures or treatment provided

E. ULTRASOUND GUIDED FNA REPORTS: 5 required

Ultrasound Guided FNA reports must contain the following criteria:

1. Indication for performing examination

2. Image marked clearly showing needle bevel in target
3. Cytologist report provided showing adequate cells
4. Diagnostic impressions provided based on cytologist report
5. Recommendations for additional studies, procedures or treatment provided

REMINDER
 At least one (1) Doppler image (Black & White acceptable) MUST accompany each thyroid
nodule, parathyroid and malignant lymph node cases. Doppler image is not required for
Hashimoto’s Thyroid Case and UGFNA.

 In accordance with HIPAA regulations, all patient identifying information must be removed from
the images and/or reports, prior to submission to the ACE Office. Patient identifying
information includes name, address, phone number, birth date, and social security number.
Images and reports with patient identifying information will not be accepted and will be returned
to the candidate unprocessed.

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9.4. FAILURE TO MEET THE VCP INSTRUCTIONS FOR ULTRASOUND PROCEDURE REPORTS

IMPORTANT
The VCP Panel will reject images and reports that do not meet the criteria specified under the Instructions
for Ultrasound Procedure Reports.

The VCP Panel has the right to request additional information about images and reports that do not meet
the specified criteria for grading.

The VCP package containing the rejected images will be returned ungraded, and the candidate will be
asked to submit corrected images within ninety (90) days of receipt of the rejected VCP package.

If the candidate does not submit the images within ninety (90) days, or still does not pass the VCP after
resubmission of corrected images, he/she may complete the entire VCP again (including payment of fees
and submission of all reports), provided that the candidate completes the certification process within the
required twelve (12) month period after notification of successfully completing the CCE.

9.5. ATTESTATION OF ULTRASOUND PROCEDURES

A signed attestation form of the total number of US examinations and UGFNA procedures performed in the
twelve (12) month period preceding submission of the required images and reports according to the following:

1. 100 total US studies (70% diagnostic; 30% UGFNA) if performed under the supervision of an ECNU-
qualified endocrinologist
2. 125 total US studies (70% diagnostic; 30% UGFNA) if performed without the supervision of an ECNU-
qualified endocrinologist

A verification process will be performed through the random selection of candidates testing for ECNU
certification each year. The verification process is structured to be in compliance with HIPAA regulations.
Selected individuals will be required to submit the following for review by the Certification Council:

1. Imaging logs (including date of service and type of exam)

2. Code-specific billing statements or chart notes to verify the total number of exams performed and
specific types of exams performed
3. Validation by an office manager with a notarized signature to attest that all information is accurate

9.6. SUBMISSION OF VCP REQUIREMENTS

Submission of the VCP requirements must be contained in one (1) complete package, resulting in one (1)
mailing. If your VCP package is missing any of the required components, it will not be graded.

IMPORTANT
A complete VCP package must include:
A. Completed/signed VCP Form (see Appendix section)
 Section 1: Candidate Information
 Section 2: VCP Payment
 Section 3: Attestation of Ultrasound Procedures
B. CD or USB Flash Drive containing the fifteen (15) ultrasound cases with
®
accompanying patient and cytology reports, in PowerPoint format only

Submit VCP package and fee to:

Certification Coordinator
American College of Endocrinology
245 Riverside Avenue
Suite 200
Jacksonville, FL 32202

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9.7. NOTIFICATION OF RESULTS

Upon successful completion of the VCP, you will receive your official notification of certification via postal mail
approximately six (6) to eight (8) weeks after submission of your completed VCP package.

The ACE confidentiality policy ensures that candidate VCP results are held confidential; therefore, results
CANNOT be given out over the telephone. DO NOT CALL OR E-MAIL THE ACE OFFICE FOR THIS
INFORMATION.

IMPORTANT
Ultrasound images and reports submitted for the VCP will not be returned to the candidate.
The ACE office will archive the images and reports for a period of six (6) months. After that
time, all submitted images and reports will be destroyed.

X. FAILURE TO COMPLETE THE CERTIFICATION PROCESS

It is the sole responsibility of the candidate to submit all VCP requirements and supporting documentation in
order to complete the certification process.

Upon written notification of successful completion of the CCE, candidates are given 12 months to complete
the ECNU Program. Starting with the June 2010 CCE, the Council will no longer grant extensions to this
12 months time frame required for completing the Validation of Competency Process.

The 12 months timeframe begins upon the candidates’ receipt of their score reports. The 12 months timeframe
does not begin on the date that candidates took the examination at a Prometric™ test center. Example: You
took the CCE on November 27, 2009 and you received your score report on January 8, 2010. Your deadline for
VCP submission will be January 8, 2011.

Failure to complete the entire certification process within the required twelve (12) month period after
notification of successfully completing the CCE will result in the loss of certification eligibility, and the individual
must reapply for the ECNU Program and pay the required fees.

XI. RECERTIFICATION
Recertification is required at ten (10) year intervals effective as of the date of ECNU certification. Recertification is
inherent in the process of documenting both continuing clinical activity in diagnostic US and UGFNA procedures and
maintenance of high level skills in this activity. To complete the recertification process, the candidate must complete the
following:

1. Perform a minimum of 70 diagnostic US examinations and 30 UGFNA procedures annually.

2. Provide written attestation to the total number of all diagnostic US examinations and UGFNA procedures
performed within the twelve (12) months preceding the recertification process.
3. Present documentation verifying the completion of a minimum of 25 CME hours of AMA recognized
Category 1 CME in ultrasound performed at each five (5) year segment during the prior ten (10) year
interval (equaling 50 or more total CME credit hours during the ten (10) year cycle). Documentation must
be in the form of certificates or letters issued by the accrediting organization.
Note: Approved ultrasound course subjects for CME credit include: thyroidology, parathyroidology, thyroid
and endocrine cancer, advanced procedures (interventional ultrasonography, PEI, etc.) Doppler
applications in neck ultrasound and vascular ultrasonography.
4. Pass a computer-based Recertification Examination (RE).

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It is the sole responsibility of the candidate to verify and to successfully complete the requirements for a ten (10) year
ECNU Recertification Certificate. Failure to complete the recertification process at each ten (10) year interval will result
in revocation of the ECNU certification.
During any 10-year recertification cycle, it is the responsibility of a certificant to maintain a current address and contact
information with the ACE office. Changes to a certificant’s professional information will be updated regularly in the ACE
Certification Registry.

Detailed recertification guidelines and application information will be posted on the AACE website in the near future.

XII. APPLICATION INSTRUCTIONS

Complete the ECNU Application Form (see Appendix section). The form is also available for download at
www.aace.com/college/ECNU.

General Instructions:
 Please type or handwrite applications in a legible manner. If application is incomplete or illegible, it will be returned
to the applicant and will cause a delay in processing.
 All application materials and required documents must be sent to ACE before the given deadline.
 The application review process cannot be conducted by ACE until all components of the application and associated
documentation and fees have been received.

Itemized Instructions:
The following provides detailed instructions for each section on the application:

Section 1: Candidate Information

 Name – Please print your name as it appears on your Driver’s License or photo ID. This name will be used in your
Authorization to Test (ATT) letter.
 AACE Membership Number (If applicable)
 Home Address – All correspondences from ACE, including the authorization letter, will be sent to this address.
 Phone/Fax/E-mail – Include city and country and city codes on phone and fax numbers. Please print clearly.
 Organization/Company – Please name the organization/company of your primary practice setting (where you
spend the most time per week).
 Job Title – Please specify your current position or job title in the above organization/company (e.g., Associate
Professor, Clinical Director, etc.).
 Special Testing Accommodations (STA) Request: please see Appendix section for the STA Request form. If
applicable, complete and submit this form with your application.

Section 2: Attestation of Ultrasound Studies – It is important that you read and understand the attestation statements
before signing.
2.1. Must be completed by Routes 1 and 2 applicants
2.2. Must be completed by Route 3 applicants

Section 3: Continuing Medical Education (CME) Credits – Please list the Thyroid Ultrasound Courses that you have
attended prior to submitting your application. Candidates must have at least 15.0 hours of AMA PRA Category 1
Credits™ obtained from one or multiple thyroid ultrasound courses within the past 3 years prior to applying to the ECNU
Program. Copy/copies of CME certificate(s) and/or letters from accrediting organization(s) must be submitted with your
application.

Section 4: Candidate Attestation Statement and Section 5: Candidate Confidentiality Agreement – It is important
that you read and understand the declaration statements before signing.

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Section 6: Application Payment – The appropriate fee must be sent with the application. Your application will not be
processed until payment has been received. Application fee is non-refundable if complete application and required
documentation are not received by the application deadline.

Section 7: Submitting Your Application – Please forward your application and supporting documentation to the
address provided. It is recommended that the application package be sent via USPS certified mail, or via a traceable
mailing method.

XIII. CONTACT INFORMATION

QUESTIONS?
Please contact the Certification Coordinator for information regarding the ACE Endocrine Certification in Neck
Ultrasound (ECNU) Program.

Laurie Calderone
Certification Coordinator
American College of Endocrinology
245 Riverside Avenue, Suite 200
Jacksonville, FL 32202
E-mail: [email protected]
Phone: (904) 353-7878 ext. 145
Fax: (904) 404-4205

CHANGE OF ADDRESS
If an address change occurs after submission of your application, please send written notification to:

Laurie Calderone
Certification Coordinator
American College of Endocrinology
245 Riverside Avenue, Suite 200
Jacksonville, FL 32202
E-mail: [email protected]

CHANGE OR CORRECTION OF NAME

Please send a copy of the notarized document to the following address within 30 days after the name change becomes
effective:

Laurie Calderone
Certification Coordinator
American College of Endocrinology
245 Riverside Avenue, Suite 200
Jacksonville, FL 32202
E-mail: [email protected]

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APPENDICES
APPENDIX I: Standardized Abbreviations ..................................................................... Page 26
APPENDIX II: ACE Glossary of Ultrasound Terminology................................................ Page 27-32
APPENDIX III: Frequently Asked Questions .................................................................. Page 33-38
ECNU Program Application Form .................................................................................. Page 39-43
Validation of Competency Process Form....................................................................... Page 44-46
Special Testing Accommodations (STA) for Candidates with Disabilities
Request Form ................................................................................................... Page 47-48
Partial List of Approved CME Courses .......................................................................... Page 49

Please note that the forms provided with this handbook can also be
downloaded from the AACE website.
Please visit http://www.aace.com/college/ECNU/.

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APPENDIX I

STANDARDIZED ABBREVIATIONS

AACE American Association of Clinical Endocrinologists

ACE American College of Endocrinology

AIUM American Institute of Ultrasound in Medicine

CT Computerized Tomography

FNA Fine Needle Aspiration

123
I Radioiodine 123
131
I Radioiodine 131

INR International normalized ratio (Protime)

MEN Multiple Endocrine Neoplasia

MRI Magnetic Resonance Imaging

PE Physical Exam

PET Positron Emission Tomography

PTH Parathyroid Hormone

Tc-99m Sestamibi scan Technetium-99m sestamibi scan

TSH Thyroid Stimulating Hormone

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APPENDIX II
ACE Glossary of Ultrasound Terminology
Acoustic Impedance
Product of density and velocity of sound in a particular material. The amount of reflection of a sound beam
is determined by the difference in the impedances of the two tissues. ¹

Acoustic Power
Quantity of energy generated by the transducer, expressed in watts. Also transmit power. ¹

Acoustic Scattering
Reflections from small objects that are the size of the wavelength or smaller. ²

Acoustic Shadow
Loss of echo signals from distal structures due to attenuation of overlying structures. ²

Acoustic velocity
The speed of sound through a medium as determined by the stiffness and density of the medium.
Also: speed of sound; propagation speed; sound velocity. ³

Aliasing
A technical artifact occurring when the frequency change is so large that it exceeds the sampling view and
pulse repetition frequency. The frequency display wraps around so that the signal is seen at both the top
and bottom of the image. ¹

Amplitude
Strength or height of the wave, measured in decibels. ¹

Amplitude mode (A-mode)

A one-dimensional image displaying the amplitude strength of the returning echo signals along the vertical
axis and the time (the distance from the transducer) along the horizontal axis. ¹

Anechoic
Refers to a structure that returns no echoes. This could be a simple cyst or cystic structure such as the gall
bladder, urinary bladder, or chambers of the heart. Also, sonolucent, echo-free, echolucent, transonic. 

Attenuation
Reduction in amplitude and intensity with increasing distance traveled due to scatter, reflection and
absorption. Dependent on frequency; higher frequencies give less penetration. ²

Axial Resolution
Depth resolution; ability to separate two objects lying in tandem along the axis of the beam. ²

Azimuthal
The dimension perpendicular to the image slice, the thickness of the slice of anatomy. 5

Bandwidth
The frequency range represented in a pulse from the transducer; quality factor. ²

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APPENDIX II
ACE Glossary of Ultrasound Terminology Continued
B-Scan
A two-dimensional cross-sectional image displayed on a screen in which the brightness of echoes and their
position on the screen are determined by the movement of a transducer and the time it takes the echoes to
return to the transducer. Also static scan. ¹

Cineloop
The system memory stores the most recent sequence of images in a series of frames before the freeze
button is pressed allowing a continuous loop of images to be reviewed. ¹

Color Flow Doppler

Operating mode in which a two-dimensional image is generated that portrays moving reflectors in color
simultaneously with B-mode images. ²

Complex
Refers to a structure that is heterogeneous and may contain both cystic (fluid-filled) and solid components. ¹

Compression
6
Regions of high pressure and density as sound travels through a medium.

Crystal
The active transducer component that actually generates and receives ultrasonic energy by converting
electrical impulses into sound waves and vice versa. ¹

Cystic
A sac or pouch with a definite wall that contains fluid or semisolid material 7

Decibel (db)
A unit used to express the intensity of amplitude of sound waves; does not specify voltage. ¹

Density
6
Concentration of matter (mass per unit volume).

Doppler Shift
The perceived frequency change that occurs dependent upon whether the source and listener are moving
toward or away from one another. ²

Dynamic Range
(Log Compression). The range of intensity from the largest to the smallest echo that the system can
display.8

Echo
Reflected sound. ³

Echogenic
Capable of producing echoes. Correlate with the terms hyperechoic, hypoechoic and anechoic which refer
to the quantity of echoes produced. 9

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APPENDIX II
ACE Glossary of Ultrasound Terminology Continued
Echopenic
Few echoes within a structure; less echogenic. Echo-poor. ¹

Echolucent
Without internal echoes; anechoic. ¹

Edge Enhancement
An electronic postprocessing function which makes contours of structures within the image more distinct and
clear. 

Electronic Focusing
Each crystal element within a group is pulsed separately to focus the beam at a particular area of interest. ¹

Enhancement
Because sound traveling through a fluid-filled structure is barely attenuated, the structures distal to a cystic
lesion appear to have more echoes than neighboring areas. Also called through transmission. ¹

Far Gain
Control that affects the strength of the distant echoes in the image. ¹

Focal Zone
The depth of the sound beam where resolution is the highest. ¹

Focusing
The act of narrowing the beam to a small width at a set depth. ¹

Footprint
Shape of the transducer that is in contact with the patient. ¹

Frame rate
Rate at which the image is refreshed in a real-time system display.¹

Frequency
The number of times in a given interval of time that a particular action occurs. ¹

Gain
Regulates the amplification (brightness) of returning echoes to compensate for loss of transmitted sound
caused by absorption and reflection. ¹

Gray Scale
Display mode in which echo intensity is recorded as degrees of brightness or shades of gray. 9

Hertz
Unit for wave frequency (cycles per second); pulse repetition frequency (pulses per second); frame rate
(frames per second). ³

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APPENDIX II
ACE Glossary of Ultrasound Terminology Continued
Heterogeneous
9
Refers to an uneven echo pattern or reflections of varying echodensities.

Homogeneous
9
Refers to an even echo pattern or reflections that are relative and uniform in composition.

Hyperechoic
A relative term that refers to the echoes returned from a structure. Hyperechoic refers to a lesion or tumor
which produces a stronger echo than surrounding structures or tissues. 

Hypoechoic
Refers to structures that contain fewer or weaker echoes than surrounding tissues. 

Interface
Surface forming the boundary between media having different properties. ²

Isoechoic
Refers to a lesion or tumor which produces an echo of the same strength as that of the surrounding
structures or tissues. 

Kilohertz
1000 hertz or 10³ cycles/s ²

Lateral Resolution
Ability to separate two objects that are positioned perpendicular to the axis of the ultrasound beam. Related
to beam width. ²

Linear Array
Many small electronically coordinated transducers producing a rectangular image. ¹

Megahertz
1,000,000 hertz ²

Near Gain
The amplification of echoes returning from the near field. ¹

Noise
Artifactual echoes resulting from too much gain rather than echoes from true anatomic structures. ¹

Overall Gain Control

Single gain control that increases amplification at all depths. ²

Phased Array
Electronically steered system where many small transducers are electronically coordinated to produce a
focus wave front. ¹

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APPENDIX II
ACE Glossary of Ultrasound Terminology Continued
Piezoelectric Effect
Electric current created by pressure forces. Certain types of ceramic materials can convert pressure to
electricity and vice versa. Transducer elements utilize this phenomenon, which is also referred to as
piezoelectricity. 

Persistence
The accumulation of echo information over a specified period of time. ¹

Power Doppler
The presentation of two-dimensional Doppler information by color-encoding the strength of the Doppler
shifts. Power Doppler is free of aliasing and angle dependence and is more sensitive to slow flow and flow
in small or deep vessels. 6

Pulse-echo Principal
Sending pulses of ultrasound into the body so that they react with tissue and return reflections. ²

Pulse Repetition Frequency (PRF)

6
The number of times per second that a transmit-receive cycle occurs.

Refraction
Bending of waves as they pass from one medium to another. ²

Resolution
Ability to distinguish between two adjacent structures (interfaces). ¹

Reverberation
The phenomenon of multiple back-and-forth reflections created by two strong reflectors that causes the
echoes to be misplaced in the display thereby representing a false image; ring-down effect. ²

Scattering
Redirection of ultrasound from a reflector which is small compared to the wave length of the beam. This
occurs with rough surfaces or heterogeneous substances such as a solid organ. 

Shadowing
Failure of the sound beam to pass through an object. ¹

Slice thickness
Elevational resolution. The size of the beam perpendicular to the image plane. ²

Sonodense
A structure that transmits sound poorly. ¹

Spatial Resolution
How closely positioned two reflectors can be to one another and still be identified as separate reflectors on
an image display. Reflector resolution. ²

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APPENDIX II
ACE Glossary of Ultrasound Terminology Continued
Spekle
Interference effects of the scattered sound from the distribution of scatterers in the tissue that is not related
to the scattering properties of tissue (echo texture). Produces granular appearance. 9

Specular Reflectors
Reflections from surfaces, which are smooth, compared to the wavelength of sound thereby creating a bright
echo on the monitor. ¹

Stiffness
6
Resistance of a material to compression. Hardness.

Temporal Resolution
The ability of a display to distinguish closely spaced events in time and to present rapidly moving structures
correctly. Improves with frame rate. 6

Texture
The echo pattern within an organ. ¹

Time Gain Compensation (TGC) or Depth Gain Compensation

Control that compensates for the loss (attenuation) of the sound beam as it passes through tissue. ¹

Transducer
An electromechanical device that is part of an ultrasound system. The device that contacts the patient and
converts electrical energy into mechanical energy and vice versa. ²

Wavelength
Distance a wave travels in a single cycle. As frequency becomes higher, wavelength becomes smaller.¹

ACE Glossary of Ultrasound Terminology Bibliography

¹ Sanders, RC, Clinical Sonography. Boston, Little, Brown and Company, 1991

² Zagzebski, JA, Essentials of Ultrasound Physics, St. Louis, Mosby, 1996

³ Reynolds, T, Ultrasound Physics A Registry Exam Preparation Guide, Phoenix, Arizona Heart Institute Foundation,
1996
4
Higashi, Y et al. Introduction to Abdominal Ultrasonography. Marceline MO, Walsworth Publishing Co., 1991
5
Seeds, JW, et al. Practical Sonography in Obstetrics and Gynecology. Philadelphia, Lippincott-Raven, 1996
6
Kremkau, FW. Diagnostic Ultrasound Principles and Instrumentation, St. Louis, Saunders Elsevier, 2006
7
Henningsen, C. Clinical Guide to Ultrasonography, St. Louis, Mosby, 2004
8
Curry, AC and Tempkin, BB, Ultrasonography: An Introduction to Normal Structure and Functional Anatomy,
Philadelphia, WB Saunders, 1995
9
Tempkin, BB. Ultrasound Scanning, Philadelphia, W.B. Saunders, 1999

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APPENDIX III

Endocrine Certification in Neck Ultrasound (ECNU) Program

Frequently Asked Questions

What is the ECNU Program?
ECNU stands for Endocrine Certification in Neck Ultrasound.

Endocrine Certification in Neck Ultrasound (ECNU) is a professional certification in the field of neck ultrasonography for
endocrinologists who perform consultations and diagnostic evaluations for thyroid and parathyroid disorders through
both diagnostic ultrasound and ultrasound-guided fine needle aspiration (UGFNA). The ECNU credential signifies that
an individual has passed the Comprehensive Certification Examination (CCE) and successfully completed the Validation
of Competency Process (VCP). Successful candidates can use the ECNU designation after their names.

Why is it important that I participate in the ECNU Program?

ECNU is recognized by the American Institute of Ultrasound in Medicine (AIUM), one of the preeminent, national
accreditation bodies for ultrasound practices, and allows those with the ECNU credential to be directors of ultrasound
laboratories and apply for AIUM Practice Accreditation. Also, it is expected that achieving ECNU certification will
become increasingly important in the future for reimbursement from Medicare and third party payors.

Who is eligible to participate in the ECNU Program?

The ECNU Program is open to both AACE and non-AACE members. The ACE Neck Ultrasound Certification Council
has established the eligibility criteria to qualify for the ECNU Program. Candidates applying for the ECNU Program may
qualify through one (1) of the three (3) routes outlined below, and must satisfy all requirements for the chosen route in
order to be eligible for ECNU.

ROUTE 1: Endocrinologists with formal training in the subspecialty of endocrinology with attainment of board
eligibility/board certification status;*full time activity in the various fields of endocrinology, metabolism and
diabetes as a clinician, academician, research physician or any combination of these.

*Full time activity refers to full time focus, not the hours spent in practice in a day/week. For example, an endocrinologist may work part-time, but
dedicates 100% of his/her activities in the various fields of endocrinology, metabolism, and diabetes.

If applying under this route, you must:

1.a. Have attended CME-accredited Thyroid Ultrasound Course(s) in which you have received at least 15.0
hours of AMA PRA Category 1 Credits™ within the past 3 years prior to applying to the ECNU
Program. CME hours can be obtained from one or multiple courses, and can be earned from an AACE
or other organizations’ Thyroid Ultrasound Course(s). Copy/copies of CME certificate(s) must be
submitted with the ECNU Program Application.

1.b. Be currently performing at least 100 ultrasound studies per year (70% diagnostic; 30% UGFNA).
Studies should include parathyroid ultrasound and thyroid cancer lymph node mapping in the
neck. A signed Attestation is required upon application.

1.c. Have submitted a complete ECNU Program Application. Refer to the Appendix section of this Handbook
for the ECNU Program Application form and documentation requirements. You can also download the
application form from the AACE website: http://www.aace.com/college/ECNU/.

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ROUTE 2: Endocrinologists who completed their endocrinology training prior to the initial 1972 endocrinology
subspecialty certification exam of the American Board of Internal Medicine (ABIM). Documentation confirming
eligibility will be required.

If applying under this route, you must:

2.a. Have attended CME-accredited Thyroid Ultrasound Course(s) in which you have received at least 15.0
hours of AMA PRA Category 1 Credits™ within the past 3 years prior to applying to the ECNU Program.
CME hours can be obtained from one or multiple courses, and can be earned from an AACE or other
organizations’ Thyroid Ultrasound Course(s). Copy/copies of CME certificate(s) must be submitted
with the ECNU Program Application.

2.b. Be currently performing at least 100 ultrasound studies per year (70% diagnostic; 30% UGFNA).
Studies should include parathyroid ultrasound and thyroid cancer lymph node mapping in the
neck. A signed Attestation is required upon application.

2.c. Have submitted a complete ECNU Program Application. Refer to the Appendix section of this Handbook
for the ECNU Program Application form and documentation requirements. You can also download the
application form from the AACE website: http://www.aace.com/college/ECNU/.

ROUTE 3: Endocrinology fellows/trainees: Physicians in their final year of endocrinology training or in

additional, post-endocrinology training or research may apply for the ECNU Program with written verification of
status from their program director.

If applying under this route, you must:

3.a. Have attended CME-accredited Thyroid Ultrasound Course(s) in which they have received at least 15.0
hours of AMA PRA Category 1 Credits™ within the past 3 years prior to applying to the ECNU Program.
CME hours can be obtained from one or multiple courses, and can be earned from an AACE or other
organizations’ Thyroid Ultrasound Course(s). Copy/copies of CME certificate(s) must be submitted
with the ECNU Program Application.

Note: Fellows who have attended Endocrine University® within the past 3 years may use the CME credits obtained
from the Neck Ultrasound and UGFNA portion of the curriculum. If the CME credits are less than the 15-hour
requirement for ECNU, additional CME hours must be provided.

3.b. Submit notarized, validated imaging logs (signed by an office manager) of at least 50 ultrasound studies
(70% diagnostic; 30% UGFNA). Studies should include parathyroid ultrasound and thyroid cancer
lymph node mapping in the neck. Logs submitted to the ACE Office should be HIPAA-compliant and
should include the following information: total number of exams performed, date of service, type of exam,
location, results/diagnosis and recommendations. Logs must be submitted with the ECNU Program
Application.

3.c. Submit a signed attestation confirming that you have performed at least 50 of the required ultrasound
studies at the time of your ECNU Application, and that the remaining 50 ultrasound studies be completed
within the 12-month period after passing the Comprehensive Certification Examination (CCE).

3.d. Submit in writing, a letter from your program director, verifying your status as an Endocrinology Fellow.

3.e. Have submitted a complete ECNU Program Application. Refer to the Appendix section of this Handbook
for the ECNU Program Application form and documentation requirements. You can also download the
application form from the AACE website: http://www.aace.com/college/ECNU/.

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Who is not eligible to participate in the ECNU Program?
Non-endocrinologists (i.e., Endocrine Surgeons, Cytopathologists, ENTs), Technologists, Nurse Practitioners, Physician
Assistants, or other allied health professionals are NOT eligible to participate in the ECNU Program at this time.
I have attended an AACE Thyroid Ultrasound Course in the past. Am I considered “certified” in
thyroid ultrasound if I took the AACE Thyroid Course?
No, completion of the AACE Course does not mean an individual is certified in Thyroid Ultrasound. The AACE Thyroid
Course was accredited for AMA PRA Category 1 Credit™, and participants who completed the AACE Course were
awarded AMA PRA Category 1 Credits™ and issued a CME credit certificate. To receive the ECNU designation, one
must complete the ECNU Program.

What is the pathway to certification for the ECNU Program?

The ECNU Program is comprised of the following steps:

STEP 1: Comprehensive Certification Examination (CCE)

The CCE is a multiple choice, computer-based examination. Achieving a passing grade on the examination will entitle
the candidate to continue to the Validation of Competency Process (VCP). If the candidate fails the CCE, he/she must
retake and successfully pass the examination prior to continuing to the VCP. To better prepare for the examination,
candidates must participate in a Thyroid Ultrasound Course (minimum of 15.0 AMA PRA Category 1 Credits™) within
the past 3 years, prior to taking the CCE.

STEP 2: Validation of Competency Process (VCP)

The Validation of Competency Process assesses the physician’s demonstrated competency, activity, and level of skills
to interpret and report complete diagnostic ultrasound examinations (either performed by a supervised ARDMS-certified
sonographer or personally by the physician), and to perform and report UGFNA procedures.

The VCP requires submission of a total of fifteen (15) ultrasound (US) studies and reports, and must be submitted in
accordance to the VCP Instructions for Ultrasound Procedure Reports.

Detailed requirements and instructions regarding the validation process are outlined in the Candidate Handbook, and will
be made available via the AACE website.

STEP 3: ECNU Program Completion (Issuance of ECNU Certificate and ECNU Designation)
Endocrine Certification in Neck Ultrasound (ECNU) is a professional designation awarded to individuals who meet
specified knowledge requirements, measured through a standardized examination and validation of competency
process in diagnostic ultrasound and ultrasound-guided fine needle aspiration (UGFNA).

 Upon successfully completing the VCP, the candidate will have earned the right to use the ECNU designation
after his/her name.
 A formal letter, ECNU Certificate, and ECNU lapel pin will be sent to candidates who have successfully
completed the ECNU Program.
 Certification is valid for 10 years.

What if I do not pass the CCE?

You can register to re-take the examination at another scheduled testing window.

How many times can I sit for the CCE?

There is no limit to the number times you can sit for the CCE.

When and where can I take the CCE?

The CCE will be offered twice a year using computer-based testing (CBT), each with a two or three week testing
TM
window. It will be administered at Prometric testing centers located throughout the United States.

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Is the examination scored immediately?
The examination scoring process can take up to six (6) weeks. After scoring is complete, the candidates will receive
their score report by mail.

If you pass the examination, your results will NOT include a numeric scale score. It will only contain a statement that you
passed. The examination is designed as a minimum competency test for credentialing purposes and is not intended to
distinguish between passing scores. This policy is established as a safeguard against misuse of the examination scores
by passing candidates.

If you fail the examination, your results will include your total failing scale score. Your failing score report will also
contain diagnostic levels in each of six subscore categories based on the six content areas outlined in the Candidate
Handbook.

Where can I find the study materials for the CCE?

There are no official study materials for the Comprehensive Certification Examination (CCE); however, you may use the
reference list found in the Candidate Handbook. The examination questions are mapped to these references.

What topics will be covered in the examination?

The examination will cover the following major topic areas:
I. Principles of Ultrasound Imaging – 15%
II. Neck Anatomy – 15%
III. Thyroid Pathology – 34%
IV. Parathyroid Pathology – 10%
V. Lymph Node Pathology – 10%
VI. Ultrasound-Guided Fine Needle Aspiration (UGFNA) – 16%

How much will it cost to participate in the ECNU Program?

The ECNU Program is comprised of two major steps – Step 1: the Comprehensive Certification Examination (CCE) and
Step 2: the Validation of Competency Process (VCP). Candidates who wish to obtain ECNU designation must complete
the certification program and pay the fees for both the CCE and the VCP. The fee structure for the ECNU Program is as
follows:

CATEGORY CCE VCP TOTAL

AACE Member $350 $900 $1,250
Non-AACE Member $550 $1,000 $1,550
*Fellows/Retired AACE Members $250 $800 $1,050
*NOTE FOR FELLOWS: A letter from Department Chair verifying status must accompany application. Fellow’s fees only apply if candidate is in his/her
final year of fellowship program. Fellows who have completed the fellowship program will be charged the AACE Member rate.

How will the fees be collected for CCE and VCP? Do I need to pay the total amount when I apply for
the ECNU Program?
Fees for CCE and VCP will be collected separately. Your first payment will be for the CCE, and this must be submitted
with your ECNU Program Application. Do not pay for the VCP fee until you receive official written notification from ACE
that you passed the CCE.

How do I apply for the ECNU Program?

Please read the Candidate Handbook (http://www.aace.com/college/ECNU/) to learn more about the ECNU Program,
and to find out if you are eligible to apply. ECNU Program Application form can be downloaded from the AACE website.

36
 2010 (ACE) American College of Endocrinology  Jacksonville, FL

36
© 2010 (ACE) American College of Endocrinology • Jacksonville, FL
 E C N U C a n d i d at e H a n d b o o k November 2010
ECNU Candidate Handbook – November 2010
Applications can be submitted ECNU Candidate
to ACE Handbook
either online or by postal–mail,
November
depending2010
on your preference.
Applications can be submitted to ACE either online or by postal mail, depending on your preference.
1. Paper Application
1. Paper Application
You can download the paper application from the AACE website during the application period. For your reference, all
You
formscan
aredownload the paper
also included in theapplication
Candidatefrom the AACE website during the application period. For your reference, all
Handbook.
forms are also included in the Candidate Handbook.
Paper applicants must include their payment with the application, may use a credit card or personal check as form of
Paper applicants
payment. Pleasemust
makeinclude
checkstheir payment
payable with
to the the application,
American Collegemay use a credit card
of Endocrinology or personal
(ACE). Checkscheck
must as
be form of
in U.S.
payment.
dollars andPlease
drawn make checks
on a U.S. payable to the American College of Endocrinology (ACE). Checks must be in U.S.
bank.
dollars and drawn on a U.S. bank.
An application cannot be processed until all fees are paid in full. For a detailed fee structure, see the payment section of
An
the application
application.cannot be processed until all fees are paid in full. For a detailed fee structure, see the payment section of
the application.
2. Online Application
2. Online Application
You can access the online application via the AACE website. The link will be provided during the application period.
You canapplicants
Online access themustonline application
provide via the AACE
a valid (working) website.
e-mail address The
thatlink will be provided
is capable during
of receiving the application
e-mail from ACE. period.
Online applicants must provide a valid (working) e-mail address that is capable of receiving e-mail from ACE.
Proceed through each screen of the application, carefully following the on-screen instructions and providing the
Proceed
informationthrough each
required. screen of
Applicants the complete
must application, carefullyoffollowing
all sections the onlinethe on-screenIncomplete
application. instructions and providing
applications will notthe
be
processed. required. Applicants must complete all sections of the online application. Incomplete applications will not be
information
processed.
What happens next after I submit my ECNU application?
What happens next after I submit my ECNU application?

Examination Application Process At A Glance

Examination
Candidate completes application Application
form  Candidate Process
submits At Aand
application Glance
all required documentation to
Candidate
ACE  ACE completes application
acknowledges form
receipt of  Candidate
application viasubmits application
e-mail  and all
ACE reviews required documentation
application  ACE sends to
ACE  ACE to
Authorization acknowledges receipt
Test (ATT) letter of application
to accepted via e-mail
candidates  ACE reviews
 Candidate application
registers ACE
for examwith sends
Prometric™
Authorization to Test (ATT) letter to accepted candidates  Candidate registers for exam with
 Prometric™ sends electronic confirmation to candidate  Candidate takes examination at Prometric™ Prometric™
sitePrometric™ sends electronic confirmation to candidate  Candidate takes examination at Prometric™

site

Upon confirmation of eligibility to take the CCE, the candidate will receive an Authorization to Test (ATT) letter, via postal
Upon confirmation
mail. The ATT letterof authorizes
eligibility to the
takecandidate
the CCE, tothetake
candidate willand
the CCE, receive an Authorization
will include to Test
the following (ATT) letter, via postal
information:
mail. The
TheATT letterinformation
contact authorizes for candidateTMto, so
the Prometric take
thethe CCE, and
candidate canwill include an
schedule theexamination
following information:
based on the identified
TM
 The contact
testing windowinformation for Prometric , so the candidate can schedule an examination based on the identified
TM
testing window
 Details on how to schedule an examination date with Prometric
TM
 Details on how
Information to schedule
on how an examination
to reschedule or cancel date with Prometric
an examination, should that become necessary
 Information on how to reschedule or cancel an examination, should that become necessary
Who is PrometricTM?
TM
Who is Prometric
Prometric
TM
?
is a wholly-owned, independently operated subsidiary or Education Testing Service (ETS). Prometric
TM
TM TM
Prometric is a wholly-owned,
provides computer independently
based testing operated
sites, allowing subsidiary
the greatest or Education
access possibleTesting
to takeService
the ACE(ETS). Prometric
Comprehensive
provides computer
Certification based(CCE).
Examination testing sites,
For moreallowing the on
information greatest accessplease
Prometric™, possible to www.prometric.com
go to take the ACE Comprehensive
Certification Examination (CCE). For more information on Prometric™, please go to www.prometric.com
How do I find a PrometricTM testing center?
TM
How do I find
Information a Prometric
on how to register at atesting center?
Prometric
TM
testing center will be included with your Authorization to test (ATT) letter.
TM
Information on how to register at a Prometric testing center will be included with your Authorization to test (ATT) letter.
How long is the ECNU designation valid?
How long designation
The ECNU is the ECNU designation
is valid for ten (10)valid?
years. Your recertification period will begin the first January after the year in
The ECNU
which designation
the ECNU is validisfor
designation ten (10) The
awarded. years. Your recertification
certificant period
will have until will begin
January 1, ten the
(10)first January
years after
later to the yearthe
complete in
which the ECNU
recertification designation is awarded. The certificant will have until January 1, ten (10) years later to complete the
requirements.
recertification requirements.
37
© 2010 (ACE) American College 37
of Endocrinology • Jacksonville, FL
37of Endocrinology  Jacksonville, FL
 2010 (ACE) American College
 2010 (ACE) American College of Endocrinology  Jacksonville, FL
 E C N U C a n d i d at e H a n d b o o k November 2010
ECNU Candidate Handbook – November 2010
For example, if you obtained your ECNU designation May 14, 2010 your recertification period will begin January 1, 2011
and you will need to complete all recertification requirements prior to January 1, 2021, when your certification will expire.

Additional information regarding the ECNU recertification process will be posted on the AACE website in the near future,
so please continue checking http://www.aace.com/college/ECNU/.

Where can I find more information regarding the ECNU Program?

To learn more about the ECNU Program, please go to http://www.aace.com/college/ECNU/. The 2010 ECNU
Candidate Handbook is also available for download on the AACE website.

When is the next CCE test window and when will ACE start accepting applications?

Test Window:
The next test window is November 5, 2010 – November 24, 2010. Upon notification of acceptance, the candidate will
TM
schedule the examination with Prometric , the test vendor.

Application Deadline:
All application information and requirements will be posted on the AACE website on August 30, 2010, and you can
complete the application process from August 30, 2010 – October 18, 2010. The deadline for submission is Monday,
October 18, 2010. Application must be submitted and all fees paid by the deadline to be eligible for the examination.

Questions about the ECNU Program?

Please contact the CERTIFICATION COORDINATOR for information regarding the ACE Endocrine Certification in Neck
Ultrasound (ECNU) Program.

Laurie Calderone
Certification Coordinator
American College of Endocrinology
245 Riverside Avenue
Suite 200
Jacksonville, FL 32202
E-mail: [email protected]
Phone: (904) 353-7878 ext. 145
Fax: (904) 404-4205

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© 2010 (ACE) American College 38
of Endocrinology • Jacksonville, FL
 2010 (ACE) American College of Endocrinology  Jacksonville, FL
 E C N U C a n d i d at e H a n d b o o k November 2010
ECNU Candidate Handbook – November 2010
ECNU Candidate Handbook – November 2010
2010 Endocrine Certification in Neck
2010 Endocrine Certification in Neck
Ultrasound (ECNU) Program Application
Ultrasound (ECNU) Program Application
Application Deadline: October 18, 2010
Application Deadline: October 18, 2010
To apply and be accepted for the ECNU Program, the following is required:
PPlease
To apply and be accepted for the ECNU Program, the following is required:
PPlease
 Meet eligibility criteria for the ECNU Program (choose from 3 routes)
 Completed Candidate
Meet eligibility Information
criteria for the ECNU(Section
Program1 (choose
of this form)
from 3 routes)
 Signed Attestation
Completed Candidate of Ultrasound
InformationStudies
(Section (Section
1 of this2 form)
of this form)
 CME certificate(s)
Signed Attestation and/or letters from
of Ultrasound accredited
Studies 2 of this form) as proof that you have received at least 15.0 hours of AMA PRA
(Sectionorganization(s)
 Category I Credits™
CME certificate(s) and/or
fromletters
one orfrom
more accredited organization(s)
Thyroid Ultrasound as proof
Course(s) that
within you
the have
past received
3 years 3 of15.0
at least
(Section hours of AMA PRA
this form)
 Signed
Category I Credits™
Candidate Attestation
from oneStatement (Section
or more Thyroid 4 of this form)
Ultrasound Course(s) within the past 3 years (Section 3 of this form)
 Signed Candidate Confidentiality Agreement
Attestation Statement (Section
(Section 4 of 5this
of form)
this form)
 Examination Fee (see
Signed Candidate Section 6 of
Confidentiality this form for
Agreement details)5 of this form)
(Section
 For Fellows: Fee
Examination Written
(seeletter from6 program
Section of this formdirector verifying status as Endocrinology Fellow
for details)
Written letter
 For Fellows: Notarized, from program
validated imagingdirector
logs of verifying
at least 50 status studies Fellow
as Endocrinology
ultrasound
 For Fellows: Notarized, validated imaging logs of at least 50 ultrasound studies
This application form consists of seven (7) sections (Section 1. Candidate Information; Section 2. Attestation of
This application
Ultrasound formSection
Studies; consists3.ofCME
seven (7) sections
Credits; (Section
Section 1. Candidate
4. Candidate Information;
Attestation Section
Statement; Section2. Attestation
5. Candidateof
Ultrasound Studies;
Confidentiality Section
Agreement; 3. CME
Section Credits; Section
6. Application 4. Candidate
Payment; Attestation
and Section Statement;
7. Submitting Section 5. Incomplete
Your Application). Candidate
Confidentiality be returnedSection
applications willAgreement; 6. Application Payment; and Section 7. Submitting Your Application). Incomplete
unprocessed.
applications will be returned unprocessed.
SECTION 1: CANDIDATE INFORMATION
SECTION 1: CANDIDATE INFORMATION
Name:
Name: FIRST MIDDLE LAST
FIRST MIDDLE LAST

Route # for which you qualify to apply for ECNU:

Route # for which you qualify to apply for ECNU:
Home Address (Do not use PO Box)
Home Address (Do not use PO Box)

City: State:
City: State:

Zip/Postal Code: Country:

Zip/Postal Code: Country:

Phone: Fax: E-mail:

Phone: Fax: E-mail:

Organization/Company: Job Title:

Organization/Company: Job Title:

Check one that applies:  First Time Applicant  Previously Applied but  Repeat Test Taker
Check one that applies:  First Time Applicant Previously Applied but
 withdrew/canceled  Repeat Test Taker
withdrew/canceled
39
39
© 2010 (ACE) American College 39
 2010 (ACE) American College
of of Endocrinology
Endocrinology  Jacksonville,
• Jacksonville, FLFL
 2010 (ACE) American College of Endocrinology  Jacksonville, FL
 E C N U C a n d i d at e H a n d b o o k November 2010
ECNU Candidate Handbook – November 2010
Page 2 of 5--- ECNU Program Application

Special Testing Accommodations (STA) for Candidates with Disabilities Request:

If you have special testing requirements, please complete the STA Request Form, and attach with your application.
Candidates will be sent a Notice of Approval from ACE included with your Authorization to Test (ATT) letter.

SECTION 2: ATTESTATION OF ULTRASOUND STUDIES

Note: If you are applying under Routes 1 or 2, please skip section 2.2. and complete only section 2.1. If you are
applying under Route 3, please skip section 2.1. and complete only section 2.2.

2.1. The following attestation must be completed by Routes 1 & 2 applicants. Please read the following statement.
By signing the attestation, you are agreeing to abide by this statement.

 I attest that I am currently performing at least 100 ultrasound studies per year (70% diagnostic; 30%
UGFNA). These studies include parathyroid ultrasound and thyroid cancer lymph node mapping in the
neck.

Signature: _________________________________________ Date: _____________________________

2.2. The following attestation must be completed by Route 3 applicants (Endocrinology Fellows/Trainees). Please
read the following statement. By signing the attestation, you are agreeing to abide by this statement.

 I attest that I have performed at least 50 of the required ultrasound studies at the time of my ECNU
Application, and that the remaining 50 ultrasound studies will be completed within the 12-month period
after passing the Comprehensive Certification Examination (CCE).

Signature: _________________________________________ Date: _____________________________

SECTION 3: CONTINUING MEDICAL EDUCATION (CME) CREDITS

All candidates must complete this section.

List the total number of CME hours accrued in the area of Thyroid Ultrasound. You must have received at least 15.0
hours of AMA PRA Category 1 Credits™ within the past 3 years to be eligible for the ECNU Program. CME certificates
or letter from accrediting organization MUST be submitted with this application.

Course Title Course Date Sponsoring Organization CME Hours

Earned

___________
Total CME Hours
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© 2010 (ACE) American College 40
of Endocrinology • Jacksonville, FL
 2010 (ACE) American College of Endocrinology  Jacksonville, FL
 E C N U C a n d i d at e H a n d b o o k November 2010

ECNU Candidate Handbook – November 2010

Page 3 of 5--- ECNU Program Application

SECTION 4: CANDIDATE ATTESTATION STATEMENT

All candidates must read and sign the following statement. By signing the agreement, you are agreeing to abide by this
statement.
I hereby apply for the Endocrine Certification in Neck Ultrasound (ECNU) credential. I understand that my certification depends on my
ability to meet all requirements and qualifications. I certify that the information contained in this application is true, complete, and
correct to the best of my knowledge and is made in good faith. I further understand that if any information is later determined to be
false, ACE reserves the right to revoke any certification that has been granted on the basis thereof.

I hereby release, discharge, and exonerate ACE, its directors, officers, members, examiners, representatives, and agents, from any
actions, suits, obligations, damages, claims or demands arising out of, or in connection with, any aspect of the application process,
including results or any other decision that may result in a decision to not issue me a certificate.

I understand that individuals who apply for the ECNU Program, or are currently certified by ACE, are subject to the certification policies
and procedures of ACE and its Certification Council. In order to maintain my certification, I understand that from time-to-time, ACE
may amend its requirements, fees, policies, and procedures for certification and recertification.

During my certification and recertification cycle, I agree to notify ACE in writing immediately if I fail to comply with the requirements of
the ECNU Program. I also agree to notify ACE in writing of any address or name changes within thirty (30) days after the change
becomes effective. If requested to do so, ACE may verify my certification status.

I attest that I meet the eligibility criteria for the ECNU Program, including 15.0 hours of AMA PRA Category 1 Credits ™ obtained from
a Thyroid Ultrasound Course(s) within the past 3 years. I further attest that I have performed the required ultrasound studies at the time
of my ECNU application.

I attest that I have reviewed and understand this handbook.

I acknowledge that I have read and agree to the Attestation Statement.

Signature: _________________________________________ Date: _____________________________

SECTION 5: CANDIDATE CONFIDENTIALITY AGREEMENT

All candidates must sign the Candidate Confidentiality Agreement. The agreement follows:

I understand, acknowledge, and agree:

1. That the questions and answers of the Comprehensive Certification Examination (CCE) are the exclusive and
confidential property of ACE and are protected by ACE intellectual property rights;
2. That I may not disclose the exam questions or answer or discuss any of the content of the exam materials with any
person, without prior written permission and approval of ACE;
3. Not to remove from the examination room any exam materials of any kind provided to you or any other material related to
the examination, including any notes or scrap paper;
4. Not to copy or attempt to make copies (written, photocopied, or otherwise) of any examination material, any examination
questions or answers;
5. Not to sell, license, distribute, give away, or obtain from any other source other than ACE the examination materials,
questions or answers;
6. I agree that my obligations under this Agreement shall continue to be in effect after the examination and, if applicable,
after termination of my certification, regardless of the reason or reasons for termination, and whether such termination is
voluntary or involuntary.

Signature: _________________________________________ Date: ________________________________

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© 2010 (ACE) American College of Endocrinology • Jacksonville, FL
41
 2010 (ACE) American College of Endocrinology  Jacksonville, FL
 E C N U C a n d i d at e H a n d b o o k November 2010
ECNU Candidate Handbook – November 2010
Page 4 of 5--- ECNU Program Application

SECTION 6: APPLICATION PAYMENT

The appropriate fee must be sent with this application. Fees are non-refundable (e.g., in the event you do not complete
and submit your application by October 18, 2010).

Comprehensive Certification Examination (CCE) Fees:

 AACE Member: $350

 Non-AACE Member: $550
 *Fellows/Retired AACE Member: $250
*NOTE FOR FELLOWS: A letter from Department Chair verifying status must accompany application.

Candidate’s Complete Name: _________________________________________________________________

AACE Member Number: (If applicable): ___________________________________________________________________________

Choose a Payment Method:  Check  Visa  MasterCard  AMEX  Discovery

Checks must be made payable to the American College of Endocrinology (ACE)

Credit Card Number: ________________________________________________________________________

Expiration Date: (mm/yr): ____________________________________________________________________

Credit Card Holder’s Name: ___________________________________________________________________

Card Holder’s Complete Address (required): ______________________________________________________

__________________________________________________________________________________________

Signature of Cardholder (required): _____________________________ Total Payment: __________________

I authorize the $_________ CCE Fee to be charged to my credit card.

42
© 2010 (ACE) American College 42
of Endocrinology • Jacksonville, FL
 2010 (ACE) American College of Endocrinology  Jacksonville, FL
 E C N U C a n d i d at e H a n d b o o k November 2010
ECNU Candidate Handbook – November 2010

Page 5 of 5--- ECNU Program Application

SECTION 7: SUBMITTING YOUR APPLICATION

Thank you for applying for the ECNU Program. Please forward your application, payment form/examination fee,
and other supporting documentation to the mailing address shown below. We recommend that the application
package be sent via USPS certified mail, or via a traceable mailing method (e.g., UPS, FedEx, etc.).

Laurie Calderone
Certification Coordinator
American College of Endocrinology
245 Riverside Avenue, Suite 200
Jacksonville, FL 32202

CANDIDATE APPLICATION CHECKLIST

 Completed ECNU Program Application Form

 Signed Attestations (Sections 2, 3, 4, and 5)
 CME Certificates/Transcripts/Letter from Accrediting Organization(s)
 Payment Application for Examination Fee
 Fellowship Letter from Department Chair Verifying Status (If applicable)
 Imaging logs (if applying under Route 3)

43
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 2010 (ACE) American College of Endocrinology
© 2010 (ACE) American College of Endocrinology  Jacksonville,
• Jacksonville, FL FL
 E C N U C a n d i d at e H a n d b o o k November 2010
ECNU Candidate Handbook – November 2010

Endocrine Certification in Neck Ultrasound (ECNU) Program

Validation of Competency Process (VCP) Form

To continue to the Validation of Competency Process (VCP), the following is required:

 Successful completion of Comprehensive Certification Examination (CCE). Documentation and fees submitted for VCP will be
returned unprocessed if the candidate has not passed the CCE.
 This completed VCP Form, including the Candidate Information page
 VCP Fee: see payment section of this form for details
 Completed/Signed Attestation of Ultrasound Procedures Form
 15 ultrasound images and reports (see detailed requirements for images and reports). All patient identifying information must be
removed from the images and/or reports, prior to submission to the ACE Office. Images and reports with patient identifying
information will be returned to the candidate.

The 3-page VCP Form consists of three (3) sections (Section 1. Candidate Information, Section 2. VCP Payment,
and Section 3. Attestation of Ultrasound Procedures). Incomplete applications will be returned unprocessed.

SECTION 1: CANDIDATE INFORMATION

Name:
FIRST MIDDLE LAST

CCE Authorization Number:

Can be found on your CCE score report

Home Address

City: State:

Zip/Postal Code: Country:

Phone: Fax: E-mail:

Organization/Company:

Job Title:

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© 2010 (ACE) American College of Endocrinology • Jacksonville, FL
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 2010 (ACE) American College of Endocrinology  Jacksonville, FL
 E C N U C a n d i d at e H a n d b o o k November 2010
ECNU Candidate Handbook – November 2010
ECNU Candidate Handbook – November 2010 Page 2 of 3--- VCP Form
Page 2 of 3--- VCP Form
SECTION 2: VCP PAYMENT
SECTION 2: VCP PAYMENT
The appropriate fee must be sent with your complete VCP package.
The appropriate fee must be sent with your complete VCP package.
Validation of Competency Process (VCP) Fees:
Validation of Competency Process (VCP) Fees:
 AACE Member: $900
 Non-AACE Member:
AACE Member: $900$1,000
 Non-AACE Member:
*Fellows/Retired AACE Member: $800
$1,000
 *Fellows/Retired AACE Member: $800

Candidate’s Complete Name: _________________________________________________________________

Candidate’s Complete Name: _________________________________________________________________
AACE Member Number: (If applicable): ____________________________________________________________________
AACE Member Number: (If applicable): ____________________________________________________________________
Choose a Payment Method:  Check  Visa  MasterCard  AMEX  Discovery
Choose a Payment
Checks must be made payable to the American College of Endocrinology (ACE) Discovery
Method:  Check  Visa  MasterCard  AMEX 
Checks must be made payable to the American College of Endocrinology (ACE)

Credit Card Number: ________________________________________________________________________

Credit Card Number: ________________________________________________________________________
Expiration Date: (mm/yy): ____________________________________________________________________
Expiration Date: (mm/yy): ____________________________________________________________________
Credit Card Holder’s Name: ___________________________________________________________________
Credit Card Holder’s Name: ___________________________________________________________________
Card Holder’s Complete Address (required): ______________________________________________________
Card Holder’s Complete Address (required): ______________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Signature of Cardholder (required): _____________________________ Total Payment: __________________
Signature of Cardholder (required): _____________________________ Total Payment: __________________
I authorize the $_________ VCP Fee to be charged to my credit card.
I authorize the $_________ VCP Fee to be charged to my credit card.

CANDIDATE VCP CHECKLIST

CANDIDATE VCP CHECKLIST

 Complete VCP Form, including the Candidate Information page

 Complete VCP Form, including the Candidate Information page
 Signed Attestation for Ultrasound Procedures Form
 Signed Attestation for Ultrasound Procedures Form
 Payment Application for VCP Fee
 Payment Application for VCP Fee
 15 ultrasound Cases and Reports (CD or USB Flash Drive of stored images with patient and
 15 ultrasound Cases and Reports (CD or USB Flash Drive of stored images with patient and
cytology reports, in PowerPoint® format only)
®
cytology reports, in PowerPoint format only)
 All patient identifying information removed from the images and reports prior to submission
 All patient identifying information removed from the images and reports prior to submission

45
© 2010 (ACE) American College 45
of Endocrinology • Jacksonville, FL
 2010 (ACE) American 45
College of Endocrinology  Jacksonville, FL
 2010 (ACE) American College of Endocrinology  Jacksonville, FL
 E C N U C a n d i d at e H a n d b o o k November 2010

ECNU Candidate Handbook – November 2010

Page 3 of 3--- VCP Form

SECTION 3: Attestation of Ultrasound Procedures

This attestation must be submitted with your VCP package. Please read the following statement. By signing
the attestation, you are agreeing to abide by this statement.

During the past twelve (12) months*, I attest that I have performed: (please check the
appropriate box)

 100 total ultrasound studies (70% diagnostic; 30% UGFNA) if performed under the
supervision of an ECNU-qualified endocrinologist

 125 total ultrasound studies (70% diagnostic; 30% UGFNA) if performed without the
supervision of an ECNU-qualified endocrinologist

Candidate Signature Date

*EXAMPLE: If you are signing the Attestation Form on December 3, 2009, you are attesting that you have
performed the appropriate number of ultrasound studies between December 3, 2008 and December 3,
2009.

Please mail your completed VCP package via certified USPS

mail, or via a traceable mailing method to:

Certification Coordinator
American College of Endocrinology
245 Riverside Avenue, Suite 200
Jacksonville, FL 32202

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© 2010 (ACE) American College of Endocrinology • Jacksonville, FL
46
 2010 (ACE) American College of Endocrinology  Jacksonville, FL
 ECNU Candidate Handbook – November 2010
E C N U C a n d i d at e H a n d b o o k November 2010
Endocrine Certification in Neck Ultrasound (ECNU) Program

Special Testing Accommodations (STA)

for Candidates with Disabilities Request

SECTION 1: To be completed by ECNU Candidate

First Name: ____________________________Middle: ________________Last:__________________________

Address (do not use a PO Box): _________________________________________________________________

City: ________________________________________________________State: _________________________

Zip/Postal Code: ___________________________ Country: __________________________________________

E-mail: _____________________________________________ Daytime Phone: __________________________

Are you repeating the ACE Comprehensive Certification Examination (CCE)?  Yes  No

If yes, did you receive special accommodations before?  Yes  No  N/A

Please describe your disability:

What accommodation(s) are you requesting from ACE?

I understand that ACE will use the information obtained by this authorization to determine eligibility for a reasonable accommodation in
regard to the ACE Comprehensive Certification Examination (CCE), by reason of my disability. I understand that ACE reserves the right
to make additional inquiries regarding my disability and previous accommodations before making a determination as to whether to
provide the accommodations I have requested above. Under penalty of perjury, I declare that the foregoing statements, and those in
any required accompanying documents or statements, are true. I understand that false information may be cause for denial or
revocation of certification. I hereby certify that I personally completed Section 1 of this form, and that I may be asked to verify this
information at any time.

Candidate Signature: ______________________________________________ Date: ______________________________

I hereby authorize and request the health care professional indentified in Section 2 to release the information requested by ACE relating
to my disability and the accommodation appropriate to my disability to sit for the ACE Comprehensive Certification Examination (CCE).

Candidate Signature: ______________________________________________ Date: ______________________________

47
 2010 (ACE) American47
College of Endocrinology  Jacksonville, FL

© 2010 (ACE) American College of Endocrinology • Jacksonville, FL

 E C N U CECNU
a n dCandidate
i d at eHandbook
H a n d –bNovember 2010
o o k November 2010
Page 2 of 2--- STA for Candidates with Disabilities Request
Endocrine Certification in Neck Ultrasound (ECNU) Program

Special Testing Accommodations (STA)

for Candidates with Disabilities Request

SECTION 2: To be completed by healthcare professional

Name:
Title/Occupation:
Dear Healthcare Professional:
Address:
The individual identified above is requesting
accommodation to sit for the ACE Comprehensive City:
Certification Examination (CCE). ACE’s policy requires that
candidates requesting special testing accommodation State/Province:
submit current documentation of the disability from an
Zip/Postal Code:
individual qualified to assess the disability. The individual
listed above is requesting that you provide such Country:
documentation. You must complete the following:
Phone:
1. The remainder of this form (Section 2).
Fax:
2. An evaluation, on professional letterhead, that
includes the following information. If submitting Are you licensed/certified in an area that allows you to diagnose
an existing report, it must have been written within
the disability?  Yes  No
the past three (3) years.

a. Confirmation of diagnosis and functional If yes, please provide your:

impairment Jurisdiction:
 Date (month/day/year) of first consultation
 Date (month/day/year) the individual was last seen License/Certification Number:
by you
 Diagnosis, summary history, and course of the If no, please identify the credentials that allow you to diagnose
disability the disability:
 Individual’s current functioning and limitations in
major life activities
 Diagnostic tests administered, scores, and
interpretation of scores
Please read and sign the following declaration:
b. Confirmation of Treatment
 Name and title of the professional I hereby certify that the above information is true and is given
 Duration of treatment pursuant to the authorization to release information by my patient.
 Outcomes of treatment Under penalty of perjury, I declare that the foregoing statements
and those in any required accompanying documentation are true.
c. Recommended Accommodation I hereby certify that I personally completed Section 2 of this form,
 The healthcare provider’s specific recommendation and that I may be asked to verify the above information at any
for accommodation(s) that directly relates to the
time.
impairment, and is supported by functional
information in the evaluation. The file is considered
incomplete if this specific recommendation is not
included. Signature: ________________________________________

Print Name: _______________________________________

Date: ____________________________________________

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 2010 (ACE) American 48
College of Endocrinology  Jacksonville, FL
© 2010 (ACE) American College of Endocrinology • Jacksonville, FL
 ECNU Candidate Handbook – November 2010
E C N U C a n d i d at e H a n d b o o k November 2010
Endocrine Certification in Neck Ultrasound (ECNU) Program
Partial List of Approved Neck Ultrasound
CME Courses
OPTIONS FOR CME COURSES
Please note that course titles for the following educational offerings may change, so please check the
organization’s website to get the most recent course listing and titles.

 ACE – Endocrine University for Fellows (http://www.aace.com/): 2 days devoted to thyroid and
ultrasound
 AACE - Advances in Differentiated Thyroid Cancer (DTC) Management (http://www.aace.com/)
 AACE – Diagnostic Endocrine Neck Ultrasound and UGFNA Course (http://www.aace.com/)
 AACE – Advances in Diagnostic and Interventional Endocrine Neck Ultrasound
(http://www.aace.com/)
 AACE - Diagnostic and Therapeutic Advances in Ultrasound and other Modalities for the Treatment
of Thyroid and Parathyroid Disorders (http://www.aace.com/)
 AIUM – Update on Thyroid and Parathyroid Ultrasound: Imaging and Intervention
(http://www.aium.org/)
 AIUM – Differentiation of Thyroid Nodules with Micro Calcifications: Role of Suspicious Sonographic
Findings (http://www.aium.org/)
 AIUM – Ultrasonographic Differentiation of Benign from Malignant Neck Lymphadenopathy in
Thyroid Cancer (http://www.aium.org/)
 AIUM – Sonographic Features of the Follicular Variant of Papillary Thyroid Carcinoma
(http://www.aium.org/)
 AIUM – Hurthle Cell Neoplasms of the Thyroid: Sonographic Appearance and Histologic
Characteristics (http://www.aium.org/)
 American Thyroid Assoc.- Annual Meeting and lectures (http://www.thyroid.org/)
 Beth Israel Medical Center – Annual Controversies in the Management of Thyroid and Parathyroid
Disease (http://www.wehealny.org/)
 Beth Israel Medical Center – Multidisciplinary Management of Head and Neck Cancer and Thyroid
and Parathyroid Diseases (http://www.wehealny.org/)
 The Endocrine Society – Thyroid Sonography Hands-On Workshop (Held during Annual Meeting)
(http://www.endo-society.org/)
 The Endocrine Society – Advanced Thyroid Ultrasound Workshop (Thyroid Ultrasound and
Ultrasound-Guided FNA of Thyroid Nodule) (http://www.endo-society.org/)
 The Endocrine Society – “ Thyroid Sonography Workshop”- Clinical Endocrinology Update
(http://www.endo-society.org/)
 Radiological Society of North America – Ultrasound Features of Thyroid Malignancy: Pearls and
Pitfalls (http://www.rsna.org/)
 University of Miami School of Medicine- “Thyroid Ultrasound Course” (http://www.med.miami.edu/)

OTHER EDUCATIONAL SITES

Please check the following sites for various CME courses related to Neck Ultrasound:
 http://www.biosound.com/
 http://cme.alphamedpress.org/
 http://www.sonocredits.com/

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 2010 (ACE) American49
College of Endocrinology  Jacksonville, FL

© 2010 (ACE) American College of Endocrinology • Jacksonville, FL