International Certification

More than 15 years of International Certification in Neurosonology NSRG, ESNCH


The project for an International Certification for Neurosonology was mooted by the officers and the executive committee of the NSRG during the 2005 meeting in Osaka, Japan. Later the European Society of Neurosonology and Cerebral Hemodynamics (ESNCH) joined this initiative. The goal is to increase the quality of the examination of the extra- and intracranial circulation using all modern sonographic modalities.

After establishing the format and conducting a pilot test during the ESNCH meeting in DĂĽsseldorf 2006, the first official Certification was offered during the ESNCH/NSRG meeting in Budapest 2007 (Chairs L. Csiba and L. Olah). Since then, certifications have been regularly offered at the annual meetings of the ESNCH and the biennial ones of the NSRG, as well in other international meetings and courses with an international teaching faculty.

Further development

For more than 15 years, our societies have offered the certifications one or 2-times/year in different places throughout the world: Europe, Asia and one in Santiago de Chile. So far more than 200 candidates from 30 countries passed successfully. The names are published on the website of both societies.

The aim

To certify theoretical knowledge at a teaching level and sufficient practical skill to perform the examination competently.

The format

Candidates take a MC-test with 40 questions. If they pass, they are asked to examine subjects or patients under the supervision of at least 2 examiners. Details are published on the web sites. In order to provide equal conditions, all tests are presented in English. Particular theoretical knowledge of physics and instrumentation is essential, as well as of clinically relevant anatomy, physiology and diagnostic criteria for sonographic findings.

Certification levels

Until 2021 the International Certification in Neurosonology certified neurosonologists only at a Teaching level. As of 2022 the Certificate will include two levels of certification: ESNCH Certified Expert in Neurosonology (equivalent to Teaching Level) and ESNCH Certified Neurosonologist (equivalent to Practical Level).

After completion of the Multiple-choice test, each candidate will be graded in one of three qualitative results:

  • Passed for ESNCH Certified Expert in Neurosonology if at least 30 questions are correct (requirement unchanged from previous editions of the Certification).
  • Passed for ESNCH Certified Neurosonologist if the candidate answers 25-29 questions correctly.
  • Failed.

All candidates that pass the Multiple-choice test will go on to the Hands-on examination, where a predefined jury will assess the candidates’ capacity to perform and interpret neurosonological exams. The requirements in the Hands-on examination for Teaching and Practical Level certification will be the same.

Candidates that complete the exam successfully will then be issued the International Certification for Neurosonology as ESNCH Certified Expert in Neurosonology or ESNCH Certified Neurosonologist, based on the results obtained.

Who can take part?

Every physician is allowed to participate. If someone is not confident of having reached the necessary level, he is still invited to take part in order to test himself. For passing, it is recommended to read the relevant literature beforehand. Because many candidates did participate just for information, the passing rate has been rather low, in the last years around 20% – 30%.

Why it is useful to take part?

By means of national certification systems, it is possible to get permission for applying the examination and being paid for following local regulations. But the NSRG/ESNCH certification is designed for worldwide implementation. Neurosonology is an established and valuable diagnostic tool but availability is still extremely variable in different countries. Those passing this certification are expected to promote and act as ambassadors for Neurosonology in the continent they are living in.

Quality control

After the first collection of MC-questions, new ones have been continuously added. They are accepted after a screening process and rated concerning difficulty and appropriateness by a commission composed of international experts in this field:

(C. Baracchini, E. Bartels, D. Evans, S. Horner, L. Olah, G. von Reutern; T. Rundek, K. Takase; N. Venketasubramanian (Ramani), U. Walter, V. Zetola).


Many have been supportive for this initiative and provided questions. Dr Ramani organized a series of certifications in Asia. We also have to thank all those senior experts who served as examiners, but most of all we appreciate the willingness of so many candidates to pass the test and therefore serve Project Neurosonology. A very special recognition is directed to Prof. Michael Gerhard von Reutern, that led the Commission until 2021, and has been the foundation and guarantee of its success for more than 15  years. His legacy, devotion and meticulousness in the Certification and Neurosonology will never be forgotten!

E. Bartels