International Certification

International Certification in Neurosonology

Introduction and history – More than 15 years of International Certification in Neurosonology

The project of an International Certification for Neurosonology was launched 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 aim is to improve the quality worldwide. The certificate was initially designed to indicate a high level of theoretical knowledge of the candidate and sufficient practical skill to be able to teach Neurosonology. In countries with established quality control and elaborated regulations outstanding personal qualification can be used to support accreditation on a national level. The following experts were nominated members of the international commission:

E. Bartels M. Jauss E.B. Ringelstein M. Matsumoto
M. Kaps L. Csiba G.-M. von Reutern K. Niederkorn
N.V. Ramani C. Baracchini C. Tegeler D. Ratanakorn
Uwe Walter

The first chairman of the project was Prof. Dr. Michael von Reutern, Germany and the Commission Vice Chair was Prof. Dr. Eva Bartels, Germany. They first discussed the format of the certification. The problem is that practical involvement and responsibilities for ultrasonic examinations are not the same in different regions of the world. The decision was made to offer first a Multiple Choice (MC)-examination and those who pass will than take an additional practical exam with patients or subjects. Members of the commission were asked the help to build up a database of MC-questions. Suitable questions were selected from the submitted ones and formatted. A trial examination to test the appropriateness and format was done during the ESNCH meeting in Düsseldorf, May 2006. The final format was decided afterwards and published.

The first official Certification was offered during the ESNCH/NSRG meeting in Budapest 2007 (L. Csiba and L. Olah), followed by the meeting of the ESNCH in Geneve Italy 2008 (M. del Sette) and Riga 2009 (G. Baltgaile). In addition a certification was offered at the end of the International course in Bertinoro, Italy (C. Baracchini et al.) during the 1st International Neurosonology Training Course in 2008. Dr. Ramani organized a test in Singapore and together with Dr. Navarro a second one in Kuala Lumpur in 2009. Further exams took place in the Neurosonology Teaching Course in Budapest (2010) and during ESNCH conferences in Madrid 2010, Munich 2011, Venice 2012, Porto 2013, Rome 2014, Zadar 2015, Budapest 2016, Berlin 2017, Prague 2018, Linz 2019 and Belgrade 2021.

Between 20% and 30% of candidates successfully passed the MC-test, all of them passed the following Hands-on test. This selection is due to the teaching level of questions including physics and instrumentation.

As of 2022 the Certificate will include two levels of certification:

  • ESNCH Certified Neurosonologist (Practical level)
  • ESNCH Certified Expert in Neurosonology (Teaching level), based on the results obtained.

It has also to be recognized that English terminology was an additional handicap for non-native speakers, which is the majority of candidates. In this issue the complete list of successfully participating and awarded physicians is published. Technicians were also accepted to take part at the MC-test receiving a special certificate. Some ranged among the best.

The Certification is offered during annual ESNCH meetings, as well as during biannual advanced courses of ESNCH. Additionally, it takes place under the umbrella of  the World Federation of  Neurology (WFN), during the meetings of the Neurosonology Specialty Group (formerly Neurosonology Research Group, NSRG) of the WFN.

Efforts are needed to brush up and enlarge the database of questions, which is not an easy task. Any submitted questions (4 answers, one correct) are welcome for consideration.

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 24-29 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

Chairman of the Commission for International Certification in Neurosonology