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What is a Cardiac Sonographer?

A cardiac sonographer uses an ultrasound to identify heart issues—and help save lives.

older patient receiving cardiac sonogram from sonographer
Home » Specialties » Cardiovascular Sonographer

The Basics

  • What you’ll do: Use ultrasound technology to diagnose heart issues
  • Where you’ll work: Hospitals, private practices, diagnostic laboratories
  • Degree you’ll need: Associate or bachelor’s degree
  • Median annual salary: $70,380

The effectiveness of and options for cardiovascular care have grown exponentially in recent decades, which makes this one of the most exciting medical careers available. “In cardio, we have so many treatments that work. If somebody has a heart problem, chances are there’s something we can do for them,” says Jess Churchill, a registered diagnostic cardiac sonographer at a Boston hospital. “We can literally watch their heart get better year to year.”

This field is also growing in demand, in part because of health trends among adults and partly from the increasing use of ultrasound for heart care.

To become a cardiac sonographer, you’ll need to earn a two- or four-year degree, then pass a national board exam. Unlike other medical professions, such as nurses and chiropractors, certification is good in all states. That gives you flexibility for your career, too.

Steps to Becoming a Cardiac Sonographer

Cardiac sonographers perform ultrasounds of the heart and only the heart. (Other ultrasound professionals perform vascular, prenatal, or other imaging exams.) Professionals in this field, also called “echocardiography,” help physicians diagnose, monitor, and rule out problems such as cardiovascular disease or heart defects. They can also conduct imaging during heart procedures, called intraprocedural echoes, to help guide physicians in procedures such as a valve replacement.

If you pursue this career, you’ll follow these steps to become a cardiac sonographer.

  1. Find and complete an educational program (associate or bachelor’s degree)

    A two- or four-year degree in a field related to echocardiography will prepare you for the profession. This education includes classroom, lab, and clinical work. You can look for programs or majors in cardiac ultrasound, cardiovascular technology, or ultrasound. Note that ultrasound careers branch off in three directions: cardiac, vascular (veins and blood vessels), and general (which includes everything else, including fetal). Each has its own certification process.

  2. Pass a national or international board exam to become certified

    Cardiac sonographers must pass a board exam administered by the National Board of Echocardiography, Cardiovascular Credentialing International, or the American Registry for Diagnostic Medical Sonography. You will take an exam specific to the branch of echocardiography you have chosen—adult, pediatric, or fetal.

  3. Find a job that’s right for you

    Look for positions that match your priorities in setting, location, salary, benefits, and opportunity for growth.

  4. Keep up with your continuing education requirements

    To maintain your certification, you will need to take continuing education courses specific to echocardiography.

Cardiac Sonographer Job Duties

A cardiac sonographer works directly with patients. Churchill estimates that she spends six hours of an eight-hour shift working with patients and conducting ultrasounds.

Performing an ultrasound typically follows this process:

  1. Check in the patient.
  2. Ensure patient has changed into a medical gown and secured their belongings.
  3. Settle patient in a private ultrasound room, explain the test.
  4. Perform the cardiac ultrasound.
  5. Explain next steps.
  6. Ensure patient can change back into their clothes and collect their belongings.
  7. Clean and ready the ultrasound room for the next patient.

This process takes between 30 and 60 minutes.

The other portion of a cardiac sonographer’s workday centers on writing reports of ultrasound tests. This includes measurements, calculations, and a verbal description of what they saw. The physician will read these reports and watch videos to make a diagnosis and create a plan for the patient.

What Does a Cardiac Ultrasound Entail?

An ultrasound of the heart is like any other ultrasound: A sonographer applies gel to the area to be imaged. They then roll a probe—the tool that sends out sound waves that bounce off objects like the heart—over the area. The ultrasound machine interprets those waves as images. The sonographer takes still images, video, and notes throughout the exam.

A sonographer uses an imaging tool during the ultrasound to map the part of the body—like the heart—being examined.

All cardiac ultrasounds include standard “views” of the heart, or pictures and video clips at different angles. The bulk of the process is “targeting the exam to answer a specific question,” Churchill explains. “We cater the exam based on what brought in the patient.” Exams differ between someone with a heart murmur and another person with plaque buildup in the arteries, for example.

“It’s a common misconception that we don’t know what we’re looking at during an ultrasound, and that the doctor is going to interpret the images,” Churchill says. “In reality, we interpret what we see as we go. We change protocol to better evaluate what we find during the echo, in real time.”

Where Do Cardiac Sonographers Work?

Most cardiac sonographers work in hospitals. Cardiologists can order imaging for patients and work with cardiac sonographers to identify or rule out heart conditions.

Some cardiac sonographers work in surgical departments, where they may monitor patients’ hearts during procedures such as removing fluid around the heart.

Hospitals aren’t the only workplace option for cardiac sonographers. They can also work in private practices and diagnostic laboratories, especially those who specialize in cardiac health.

Most cardiac sonographers work in hospitals, but many work in private practices or diagnostic laboratories.

Finally, cardiac sonographers can work for companies that make ultrasound machines or software. These companies need a cardiac sonographer’s expertise to develop and test new technology. Companies also send cardiac sonographers to train hospital staff on new machines or software.

Adult, Pediatric, and Fetal Echocardiography: What’s the Difference?

“Scanning an adult heart is totally different from a fetus’s heart or a kid’s heart, and you’re looking for different heart problems,” Churchill says.

Curious about the differences between adult, pediatric, and fetal echocardiography?

Type of echocardiographyWhat is it?Looking for:
AdultEchoes of adults, aged 18 and olderHeart disease, heart murmurs, fluid around the heart, abnormal heart rhythms
PediatricEchoes of children from birth to 18Heart defects, monitoring ongoing heart conditions
FetalEchoes of a fetus before deliveryAbnormalities, such as a congenital heart defect, that need to be treated after delivery

Who Would Make a Good Cardiac Sonographer?

Like in most medical professions, the echocardiography field needs people of all backgrounds. A diverse staff benefits patients and the medical organization as a whole.

That said, certain traits and skills help cardiac sonographers thrive. A good cardiac sonographer is:

  • Observant: “It sometimes feels like you’re finding a needle in a haystack,” Churchill says. “You need to be able to see a little flash in an echo that is the difference between life and death for somebody.”
  • Personable: Cardiac sonographers spend a lot of time one-on-one with patients, so a “people person” does best in this field.

  • Empathetic: “Every person you see has a story,” Churchill says. “Many of them open up to us about their true feelings of what’s going on. We’re almost therapists.”

Many of these traits apply to other medical fields too, including the similar ultrasound technician job.

Why Can’t Sonographers Explain What They See to Patients?

If you’ve ever gotten an ultrasound, you might have felt frustrated if the sonographer didn’t tell you what they saw on the display screen. They’re not being rude; they’re just not allowed to share a diagnosis with you.

A physician makes the official call to decide on the diagnosis and treatment, so a sonographer can actually lose their job if they reveal too much.

It might feel as if sonographers are being evasive, but it’s actually in the patient’s best interest. If a sonographer shared their interpretation, the patient would have questions they couldn’t answer. The patient might have to wait a few hours, up to a few days, before talking with their doctor to learn next steps.

What Education Do I Need?

Once you’ve decided to pursue a career in cardiac sonography (instead of other ultrasound fields), you’ll need to find an education program that covers this specialty.

Note that echocardiography programs may also provide education for vascular sonography. It is possible to study and become certified in both.

An associate degree takes half the time of a bachelor’s, though getting a four-year degree can give job applicants an advantage.

Associate Degree

  • Curriculum:
  • Anatomy, function, and physiology of the heart
  • Cardiovascular pathology
  • How to use and maintain medical imaging equipment
  • Medical ethics
  • Patient care

Bachelor’s Degree

  • What to look for: Accreditation. Board exams may require that you have graduated from an accredited school.
  • Prerequisites: High school diploma, high school science courses, ACT or SAT scores. Programs may also require letters of recommendation and personal essays.
  • Time to complete: 4 years
  • Extracurricular requirements: Clinical hours working in a hospital or physician’s office
  • You should also know: It is not uncommon for students to complete an associate degree and then transfer to a bachelor’s program.
  • Curriculum: Similar to courses in an associate degree program, plus:
  • Sonographic imaging
  • Physics of ultrasounds
  • Optional classes in fetal or pediatric echocardiology
  • Lab courses for hands-on practice

Cardiac Sonographer Certification

To earn a certification as a cardiac sonographer, you’ll need to meet prerequisites before taking the exam. These prerequisites include completing an ultrasound-related program or another patient-care program (such as registered nurse or radiologic technician.)

Once you’ve satisfied all requirements (which you should double-check before applying), you’ll take and pass a standardized exam. You have several options for certifications and the organizations that grant them.

OrganizationTest NameCertification Granted
Cardiovascular Credentialing InternationalRegistered Cardiac Sonographer ExaminationRCS
National Board of Echocardiography (for physicians only)Examination of Special Competence in Adult Echocardiography (ASCeXAM)Testamur (a certificate proving an exam has been passed)
American Registry for Diagnostic Medical SonographySonography Principles & Instrumentation Examination, plus a specialty exam (in adult, pediatric, or fetal echocardiography)RDCS

A certification is not technically required to work as a cardiac sonographer. That said, you would face significant challenges finding a job if you are not certified.

A certification shows you have mastered the knowledge and skills needed to work in echocardiography. What’s more, some insurance companies no longer cover imaging procedures not performed by certified sonographers.

When you pass these examinations, your certification is valid across the United States. In the case of the Registered Cardiac Sonographer Examination, you can work internationally, too.

What About Online Programs?

Are there echocardiography programs online? Yes and no.

Several reputable schools do offer a bachelor’s degree in a field related to echocardiography. These require students to already be certified sonographers.

You might wonder what the point is of earning a bachelor’s degree if you already have an associate degree and have earned certification. Advancing your education can help you learn more advanced skills and concepts, which may qualify you for more competitive jobs. A degree may also help you increase your pay. A bachelor’s degree, whether earned in person or online, can also help you in pursuing advanced education such as a master’s degree.

If you don’t yet have a certification in sonography, you’ll want to enroll in an in-person program. You’ll need a lot of hands-on practice, from doing imaging exams on your classmates during labs to completing clinical hours in a hospital, to gain the expertise needed in this field.

There are also online options for continuing education credits, which are required to maintain a certification.

What Can I Earn?

As with nearly every profession, salaries vary across the U.S. for cardiac sonographers. The median annual salary for diagnostic medical sonographers (including cardiac sonographers) was $70,380 in 2020, according to the BLS.

As you investigate where you want to work, consider the average salary of a cardiac sonographer from place to place.

Salary by State

As you can probably guess, average salaries for cardiac sonographers differ among states. The dollar amount you earn should be one—but not the only—factor in evaluating compensation.

You will also want to keep in mind:

  • Benefits, such as health insurance or matching 401(k) contributions
  • Cost of living
  • Potential for upward mobility
Diagnostic Medical Sonographers

National data

Median Salary: $75,920

Bottom 10%: $53,790

Top 10%: $105,340

Projected job growth: 16.8%

State data

State Median Salary Bottom 10% Top 10%
Alabama $58,230 $40,610 $78,070
Alaska $96,490 $72,420 $124,810
Arizona $87,030 $57,190 $107,200
Arkansas $62,560 $45,650 $87,410
California $104,390 $69,060 $159,260
Colorado $87,030 $67,510 $108,070
Connecticut $85,960 $60,700 $112,640
Delaware $73,730 $56,620 $97,370
District of Columbia $95,530 $73,230 $113,680
Florida $68,710 $48,000 $87,450
Georgia $61,810 $35,530 $84,460
Hawaii $102,900 $78,970 $127,800
Idaho $77,950 $60,110 $101,460
Illinois $78,700 $54,920 $103,560
Indiana $71,800 $54,040 $97,930
Iowa $70,960 $54,920 $95,160
Kansas $77,290 $57,570 $100,360
Kentucky $66,240 $52,010 $86,380
Louisiana $62,660 $44,440 $83,290
Maine $77,690 $56,770 $104,220
Maryland $78,760 $62,460 $100,940
Massachusetts $87,510 $65,630 $117,050
Michigan $65,860 $52,270 $82,010
Minnesota $82,220 $68,100 $103,520
Mississippi $62,690 $44,470 $81,500
Missouri $73,710 $55,370 $97,300
Montana $75,830 $56,920 $98,790
Nebraska $67,980 $54,310 $84,720
Nevada $79,510 $65,310 $101,820
New Hampshire $82,360 $59,790 $103,020
New Jersey $81,720 $61,520 $103,860
New Mexico $73,630 $57,470 $91,820
New York $80,260 $55,240 $103,620
North Carolina $70,400 $54,010 $92,690
North Dakota $72,490 $56,420 $91,670
Ohio $66,670 $53,590 $84,080
Oklahoma $71,810 $51,050 $94,780
Oregon $92,980 $70,830 $113,340
Pennsylvania $66,750 $50,050 $92,010
Rhode Island $93,620 $69,540 $119,460
South Carolina $69,040 $51,790 $86,570
South Dakota $64,790 $47,830 $81,960
Tennessee $65,720 $44,670 $86,960
Texas $72,570 $53,090 $95,090
Utah $79,410 $39,480 $103,610
Vermont $81,740 $60,870 $100,990
Virginia $77,810 $53,970 $102,650
Washington $93,390 $69,830 $119,860
West Virginia $61,040 $47,730 $80,690
Wisconsin $87,440 $68,380 $107,310
Wyoming $74,410 $36,610 $97,140

Source: U.S. Bureau of Labor Statistics (BLS) 2020 median salary; projected job growth through 2029. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

Highest Paying Metro Areas

In general, cities and the metropolitan areas that surround them pay more than suburban and rural areas. Not all cities pay alike, though.

It is interesting to note that all the top-paying metropolitan areas are within California. Here are the top five, according to the BLS.

Metro AreaAverage Salary
Sacramento, California$138,130
Santa Rosa, California$126,610
Stockton, California$121,710
San Francisco, California$121,210
San Jose, California$119,980

Salary by Workplace

While hospitals are the most common setting for cardiac sonographers, they’re not the only one.

Professionals can also work in private medical offices, outpatient clinics, and diagnostic labs. As you might suspect, salaries differ among these settings, according to BLS data.

WorkplaceAverage Salary
Outpatient care centers$96,780
Physicians’ offices$75,270
Medical and diagnostic laboratories$71,650

Cardiac Sonographer Job Outlook

As a general rule, medical professions are growing in the U.S. This is true for cardiac sonographers—in a dramatic way.

Employment of diagnostic medical sonographers (which include cardiac sonographers) is projected to grow 12% by 2029, according to the BLS. That impressive growth rate is more than four times greater than the average for all jobs in the U.S.

Job growth in echocardiography can be attributed to several factors.

Aging population:

As the American population ages, it will need care for conditions more common in older people, including cardiovascular disease.

Increasing heart disease:

Cardiovascular disease is projected to increase through 2030, according to research published in the journal Health Affairs.

Alternative to other imaging:

Medical providers are ordering more ultrasounds as an alternative to other imaging options, such as MRI or CT scan. Ultrasounds are less expensive than imaging alternatives, show the heart functioning in real time, and don’t expose patients to radiation.

“More sonographers are entering the field, but still not enough to meet demand,” Churchill says. That is good news for people who want to enter the job market in this growing profession.

catherine gregory

Written and reported by:
Catherine Ryan Gregory
Contributing Writer

With professional insight from:
Jess Churchill, RDC
Cardiac Sonographer