Becoming a Sonographer

By: Elizabeth Burton, RDMS, RVT

Last Updated: Dec 20, 2018

A sonographer uses high frequency sound waves to create detailed images of various areas of the human anatomy. The sound waves bounce off of internal organs and return to an ultrasound device, which transforms them into real-time images. As an imaging modality, ultrasound has very specific uses, providing information that X-rays or other radiologic procedures often cannot.

Ultrasound is most commonly known for producing amazing pictures of a fetus in the womb, and is used to detect and monitor many types of pregnancy complications and fetal abnormalities. However, sonography is used for so much more than pregnancies. It is often a doctor’s first choice to view fluid-filled or soft tissue structures in the body, such as the heart, kidneys, liver, and most internal organs. It also is highly valuable when looking at blood vessels and detecting problems with blood flow and blockages within arteries and veins. The images that sonographers create help radiologists and other physicians pinpoint the locations of soft tissue problems that can’t be seen well using other medical imaging techniques. Because ultrasonography uses simple, high-frequency sound waves, it is safe to use on all patients, from pregnant women to babies, children, and the elderly.

Given that there are so many uses of ultrasound, sonographers usually specialize in one or two areas of the body, such as the abdomen, breast, urology, musculoskeletal system, or obstetrics and gynecology. They direct the ultrasound waves to the region under examination via a handheld device known as a transducer. Sonographers must be tech-savvy enough to apply this sophisticated technology to manipulate and optimize the images, yet also be personable enough to put patients at ease who might be nervous or uncomfortable. These professionals use their own judgment and understanding of pathology to record images that represent possible abnormalities. What looks like a grainy image to the rest of us provides a wealth of valuable information to a skilled sonographer.

Turning sound waves into images sounds like magic, but that’s what diagnostic medical sonographers do on a daily basis. Their skills and expertise help the medical team to safely and painlessly assess and diagnose medical conditions that otherwise could only be detected with more invasive and often risky procedures.

Workplace Details

Most sonographers (about 60 percent) work in hospitals. Often, hospital-based sonographers will get rotations of being on-call, which means they will have to be ready to return to the hospital at any hour of the night, weekend, or holiday if an emergency ultrasound is needed. Most other sonographers work in doctors’ offices, diagnostic facilities and outpatient centers where the hours are predictable and shifts can be anywhere from a few hours a week to full-time work, depending on the job.

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The U.S. Bureau of Labor Statistics reports sonographers’ annual median wage as $68,970. Salaries range from about $48,720 to over $97,390. The highest mean salaries are reported for sonographers working in outpatient care centers and specialty hospitals.

From 2014 to 2024, medical sonography jobs should grow much faster than the average for all U.S. occupations; the Bureau of Labor Statistics projects a growth rate of 26 percent. This substantial growth is due in part to the fact that ultrasound technology procedures are being ordered more frequently in the medical community as a first-line exam because they are radiation-free, less expensive, and less invasive than many other diagnostic tests. More job growth is expected in physicians’ offices and outpatient diagnostic centers. Sonographers with multiple certifications will have even more job opportunities.

Aspiring sonographers have a number of educational routes available which can be quite confusing. When looking at programs, the most important thing to verify is whether or not it is an accredited program. Unlike X-ray, ultrasound is considered non-hazardous, which unfortunately means that there isn’t enough state or federal regulation of ultrasound schools. A student may be drawn to a school that offers a part-time degree in a short period of time, but finding a job after graduation will be nearly impossible. Most employers will only hire sonographers who have attended an accredited program. Accreditation information can be found at the Commission on Accreditation of Allied Health Education Programs and the Joint Review Committee on Education in Diagnostic Medical Sonography. Verify that your school is on this list!

Many two-year colleges offer an associate degree program, which often follows completion of an X-ray or other allied health program. The associate degree path is the most common path for aspiring diagnostic medical sonographers. There are also four-year bachelor’s degree programs, which give students the most exposure to the various ultrasound specialties and a strong knowledge of other imaging modalities. If a student already has some healthcare education and experience, there are 12 to 15 month ultrasound-specific programs, often university- or hospital-based. Sonography programs include classes in related health topics such as anatomy and physiology, ultrasound physics, and clinical training in the interpretation of sonographic images.

In addition to classroom time, most accredited schools require and provide over 1,000 hours of on-site, hands-on clinical training, where students work side by side with qualified sonographers and doctors to learn the equipment, techniques, and necessary protocols to perform ultrasound examinations.

In some US states, sonographers can only practice ultrasound if they have a license that proves they graduated with a certificate from an ultrasound program.

Most employers are less interested in the certificate of graduation and will only hire students who have passed either the ARDMS (American Registry for Diagnostic Medical Sonography) or ARRT (American Registry of Radiologic Technologists) specialty exams. Once a student passes these exams, they are considered “registered” with the credential RDMS (Registered Diagnostic Medical Sonographer). Sonographers can obtain a single registered certification by passing an exam in any one of the multiple specialty areas, such as fetal ultrasound or adult echocardiography, or they can be registered in multiple specialties.

Since there are so many settings in which a sonographer can work, advancement potentials are limitless. In a hospital setting, sonographers can work up to lead and management roles in the department. Private practice sonographers also have management and administration potential. There are plenty of opportunities beyond patient care, such as becoming involved in ultrasound education or working directly for ultrasound equipment manufacturers in sales, training, and applications.

Many employers require that sonographers be certified, and some states require certification as a condition of licensure. It’s therefore important to choose an educational pathway that will allow you to sit for the certification exam - preferably right after graduation.

Beginning in 2018, the quickest way to become certified will be to complete a certificate program in diagnostic medical sonography accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). Community colleges, career schools, technical colleges, and hospitals all host accredited certificate programs.

The big advantage of a certificate is that it gets you working quickly and with fewer expenses. Sonography certificate programs can also be ideal for professionals who hold a degree in another allied health field. (Indeed, many are designed with these students in mind.)

The downside of a certificate is that you usually won’t earn college credit unless your program has an agreement with a local college or university. Not having a degree can also make it harder to find a job or move between jobs.

Before enrolling in a certificate program, students must fulfill prerequisites in college algebra, physics, communications, human anatomy, ethics, computers, and medical terminology. Coursework or clinical experience in patient care may also be required.

Sonography certificate programs can be generalist or focused on a modality like obstetrics or abdominal scanning. Expect courses in:

Accredited certificate programs also include extensive hands-on training at local clinics and hospitals.

This is currently the most common pathway for sonography certification. You can find AAS programs in sonography at universities and community and technical colleges. These can be generalist or focused on a modality like cardiac, OB/GYN, or vascular sonography.

The associate degree curriculum combines the typical sonography prerequisites (algebra, college physics, intro to patient care, etc.) with classroom and hands-on learning in sonography. The second year curriculum is very similar to that of the certificate program. In addition to the subjects listed above, expect to cover:

Associate degree students also complete clinical rotations at local hospitals and clinics. If your program is CAAHEP-accredited, your practicum classes will fulfill the experience requirement for certification.

Some associate degree programs have transfer agreements with bachelor’s programs in sonography. This can be helpful if your ultimate goal is to earn a four-year degree or attend graduate school.

Having a Bachelor of Science in Radiologic Science (BSRS) can make it easier to land sonography job. It also opens up doors to management, teaching, research, and graduate studies if those interest you.

Bachelor’s degree students typically take 2–3 years of general education and prerequisite classes followed by 1–2 years of sonography training. The final two years of the bachelor’s degree program are very similar to an associate degree curriculum.

In addition to the associate-level classes listed above, bachelor’s students might study:

The following organizations offer primary and advanced certifications for sonographers:

American Registry of Diagnostic Medical Sonography

• Registered Diagnostic Medical Sonographer (RDMS). Modalities: abdomen, breast, fetal echocardiography, OB/GYN, pediatrics
• Registered Diagnostic Cardiac Sonographer (RDCS). Modalities: adult echocardiography, fetal echocardiography, pediatric echocardiography
• Registered Vascular Technologist (RVT)
• Registered Musculoskeletal Sonographer (RMSKS)

American Registry of Radiologic Technologists

• Registered Radiologic Technologist, Sonography Certified (RT(S)). Advanced certifications: breast sonography, vascular sonography

Cardiovascular Credentialing International

• Registered Cardiac Sonographer (RCS)
• Advanced Cardiac Sonographer (ACS)
• Registered Congenital Cardiac Sonographer (RCCS)
• Registered Phlebology Sonographer (RPhS)
• Registered Vascular Specialist (RVS)