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Diagnostic Ultrasound Subspecialty

Diagnostic Ultrasound for neuromusculoskeletal disorders can often compete with other forms of diagnostic imaging such as MRI or radiographs for a small fraction of the cost. Machines now costing less than $5,000 USD now produce acceptable quality images allowing for quick and cost-effective diagnosis of tendinopathies, myopathies, fasciopathies, neuropathies, and more. The biggest hurdle in adoption by healthcare practitioners is training, hence IANM’s creation of a diagnostic ultrasound certification (CNMS®) and a fellowship program.

Education Opportunities

The approved and recommended educational program is offered by Dr. Brandon Ramakko and can be found at: https://msk-pocus-training.trainercentralsite.com/ and can be purchased in parts or in its entirety in a bundle. For 2025, there are discounts available for diplomates of the IANM which can be found here.

Other high-quality sources of ultrasound education will be accepted towards completion. Such as from the Gulfcoast Ultrasound Institute: https://www.gcus.com/ 

Certificate Requirements

Requirements for the certification is to be a doctoral level health professional capable of legally using ultrasound imaging for diagnosis. The certification requires completing the 80-hour educational program which includes courses with quizzes (>70% necessary to pass), a practical exam, and 150 cases analyzed. Once completed, you will be eligible to write the IANM specialty certificate exam for the certified in neuromusculoskeletal sonography (CNMS®) certification.

Fellowship Requirements

Fellows must be Board Certified by IANM in Neuromusculoskeletal Medicine or its equivalent. Earning the CNMS® certification is a requirement for completing the fellowship, but the education and fellowship can be completed concurrently. The fellowship requires partnering with a mentor. Dr. Ramakko offers mentoring sessions, subject to availability, but the mentor can be any approved individual. Approved individuals would meet one of the qualifications in the following list:

  • PgCert (1 year Post grad) + 1 year experience, PGDip (2 years post grad), or MSc (3 years post grad) in MSK Ultrasound in the UK/european system, or
  • Board certified radiologist with 2+ years of MSK ultrasound experience, or
  • RMSK holder with 2+ years of ultrasound experience, or
  • CNMS holder with 2+ years ultrasound experience or who has completed the fellowship, or
  • Someone approved by the IANM subspecialty board/chair

The mentee must perform 150 exams on patients and the mentor must comment and give feedback. There must be discussions of key regions so that the mentor can provide guidance or feedback. The regions are: shoulder, elbow, wrist, hand+fingers, hip/thigh, knee, leg+ankle, foot and useful non-msk POCUS (like DVT screening). Interventional procedures and Acute Trauma should also be included if relevant. Progress will be assessed on a rubric out of 5.  Level 3 is basic competency. Level 4 is expert level. Level 5 is being a leader in the field. The mentee should complete level 3 at a minimum for each region. At least one goal from level 4 (such as incorporating the latest research into practice) for each region and at least one goal in level 5 (such as publishing a peer reviewed paper involving diagnostic ultrasound) should be completed.

The IANM recommends mentors have a minimum of 16 contact hours with mentees. Dr. Ramakko’s mentorship package contains 20 contact hours for example. There should be documented evidence of meetings and discussed content. For example, the IANM recommends discussing at least 4 peer reviewed papers.

Examinations

The IANM CNMS® examination information can be found here.

The Practical Exam can be found at https://msk-pocus-training.trainercentralsite.com/course/advanced-msk-ultrasound-practical-exam and can be challenged before completing all of the educational content. The test is designed to be formative – not just checking your progress, but helping you in developing your expertise via feedback.

MOC

The IANM must maintain certain standards to maintain its high level of credibility; thus, maintenance of credentials is required. Fellows must be diplomates and must maintain membership and pay their diplomate dues, and complete the MOC for the DIANM credential. To maintain the CNMS credential, a yearly maintenance fee must be paid to the IANM plus submission of evidence of completing at least 4 hours of ultrasound imaging educational activities (which can include the fellowship), or the specific MOC activities, other acceptable programs, and programs offered via Dr. Ramakko. Those with similar credentials (like the RMSK) with MOC requirements that exceed these requirements may just submit proof of maintenance of that credential. The MOC yearly activities by Dr. Ramakko will be a mixture of case studies to analyze, research papers to read, and/or a lecture, roughly equivalent to 2 hours of content, suitable for experts in diagnostic ultrasound.