The short answer
Study to the published weights, not to a textbook's table of contents. Diagnostic procedures are 40% of the RCIS exam and interventional procedures are 34% — together nearly three-quarters of your score. Emergencies are 13%, pre-procedural activities 8%, and post-procedural activities 5%. Pair one content resource with heavy timed question practice, and finish on full-length timed mock exams.
The blueprint, and what it implies
| Domain | Weight | Roughly, of 150 scored items |
|---|---|---|
| Conducting Diagnostic Procedures | 40% | The largest block by a wide margin |
| Conducting Interventional Procedures | 34% | The second largest |
| Responding to Emergency Procedures and Protocols | 13% | Small but disproportionately missed |
| Conducting Pre-Procedural Activities | 8% | Cheap points if you learn them |
| Conducting Post-Procedural Activities | 5% | The smallest block |
Domain names and weights per CCI's official RCIS credential page, retrieved 2026-08-15. CCI can revise its blueprint — confirm the current weights before you build a plan around them.
The implication is blunt. A candidate who is superb on closure devices and shaky on hemodynamics has made a bad trade; the reverse costs almost nothing. Being weak anywhere inside that 74% is what fails people.
One thing this guide will not do is tell you how many questions each domain contains. CCI publishes percentages, not item counts per domain, and the exam contains 20 unscored pretest items whose distribution is not published. Treat the percentages as your allocation guide and leave it there.
Domain 1 — Conducting Diagnostic Procedures
40% of the exam — the biggest block
What to know
- Hemodynamics until it is automatic. Normal pressures in every chamber and great vessel, and waveform recognition on sight: right atrial a, c, and v waves, RV pressure, PA pressure and the dicrotic notch, wedge pressure, and LVEDP read at the z-point.
- Calculations. Cardiac output by thermodilution and Fick, including the Stewart-Hamilton equation; valve area; and shunt calculations. Know what each variable does to the answer, not just the formula.
- Coronary anatomy and angiographic projections. Which vessel each view opens: the LAD and its septals and diagonals, the circumflex and obtuse marginals, the RCA, the PDA and dominance, the left main, and the RAO caudal spider view.
- Which artery feeds what. The SA node, the AV node, and the bundle branches — a recurring source of questions that link anatomy to conduction.
- Contrast and radiation. Contrast agents and contrast reactions, dose-reduction principles, and imaging-chain fundamentals.
- Valve and structural assessment, including the aortic root and sinuses of Valsalva.
If you can only fix one thing, fix waveform recognition. It is the highest-density topic in the highest-weighted domain, and it is testable in a way that rewards study rather than tenure.
Domain 2 — Conducting Interventional Procedures
34% of the exam
What to know
- PCI equipment and selection logic. Guide catheters, wires, balloons, and stents — and, more importantly, why one is chosen over another for a given lesion.
- Lesion-modification tools and when each applies: atherectomy, cutting balloons, scoring balloons, super-high-pressure balloons, and lithotripsy and laser.
- Adjunctive imaging and physiology. IVUS and OCT, including the MLD MAX workflow, plus FFR and iFR.
- Pharmacology. Anticoagulants and antiplatelets, their reversal agents — protamine, andexanet alfa, vitamin K and 4F-PCC — vasoactive drips, and sedation agents with their antagonists (midazolam and flumazenil, fentanyl and naloxone).
- Structural and peripheral intervention at the level the blueprint expects, including carotid stenting, iliac, femoropopliteal, and below-the-knee disease, and TEER candidacy.
Domain 3 — Responding to Emergency Procedures and Protocols
13% of the exam — small, and missed more than its size suggests
What to know
- Complication recognition. Tamponade, coronary perforation and its Ellis grades, no-reflow, and abrupt closure.
- Access-site emergencies. Retroperitoneal hematoma, pseudoaneurysm, and AV fistula — especially the presentations that are easy to miss.
- Arrhythmia response and wide-complex tachycardia differentiation, plus ACLS-level management.
- Mechanical circulatory support. IABP timing and waveform errors, percutaneous VADs, and VA-ECMO.
- Drugs in a crisis: epinephrine, nitroprusside, and the reversal agents above.
- STEMI mimics — a recurring trap.
This domain punches above its weight for a specific reason: many candidates have never personally managed a tamponade or a perforation, so there is no experience to fall back on. It has to be learned deliberately.
Domains 4 and 5 — Pre- and Post-Procedural Activities
8% and 5% — 13% combined, and the cheapest points on the exam
Pre-procedural (8%)
- Patient assessment, labs, and NPO status
- Informed consent and the universal protocol time-out
- Allergy and contrast premedication, medication review, sterile prep, and equipment checks
Post-procedural (5%)
- Sheath management, manual compression, and vascular closure devices
- Complication surveillance, patient education, and documentation
Do not skip these because they are small. Combined they are 13% of the exam, they are almost entirely memorizable, and they are the most reliably winnable points available. Candidates skip them precisely because they feel routine at work — which is exactly why they are worth a weekend.
How to sequence the work
The order matters more than the calendar. We deliberately do not put a fixed number of weeks on this, because how long you need depends on how much of the blueprint your particular lab already exposes you to.
- Baseline first. Take a blueprint-matched diagnostic before you plan anything. Knowing your weakest domain is worth more than any generic timeline. If you want this sequence laid out on a calendar, the 8-week RCIS study plan does exactly that.
- Foundations. Cardiac anatomy and coronary circulation, the cardiac cycle, ECG basics, radiation safety, and contrast.
- The 74%. Spend the bulk of your time on diagnostic and interventional content. Hemodynamics until waveforms are instant.
- Emergencies and the bookends. The 13% emergency domain, then the pre- and post-procedural material.
- Full-length timed mocks. Under test conditions, not on the sofa. Review every missed question until you can explain why the right answer is right — not merely recognize it.
- Re-drill your two weakest domains in the final stretch.
Why your practice percentage is the wrong number to chase
The RCIS passing standard is a total scaled score of 650, not a percentage of questions correct. Scaled scoring calibrates the bar to each form's difficulty, so there is no fixed "percent correct" that guarantees a pass.
The practical consequence for test prep: stop asking "what percent am I getting?" and start asking "am I consistently passing full-length, timed, blueprint-matched mock exams?" A percentage on a random 20-question set tells you very little, because the mix was not the exam's mix. More on this on the RCIS passing score, and on the odds generally on the RCIS exam pass rate.
If you have worked in the lab for years
Study anyway, and study the parts your lab does not do. Experience builds pattern recognition; the exam tests mechanism. A high-volume PCI lab that rarely does shunt runs or right-heart studies leaves a real gap on a 40% diagnostic domain, and the person most likely to be blindsided by it is the one with the longest service.
Start with a baseline, not a book
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What should I study for the RCIS exam?
Study to CCI's blueprint weights: diagnostic procedures 40%, interventional procedures 34%, emergencies 13%, pre-procedural 8%, post-procedural 5%. The first two are nearly three-quarters of the exam.
Is there a free RCIS study guide?
This page is one. Cardiac Codex also publishes free RCIS practice questions with worked explanations and a free scored diagnostic, with no email required to start.
What is the best way to study for the RCIS?
Pair one content resource with heavy timed question practice, weight your time to the blueprint, and finish with full-length timed mock exams under test conditions.
How long should I study for the RCIS exam?
It depends on how much of the blueprint your daily work covers. Take a diagnostic to find your weak domains, then plan backward from consistent passing performance on full-length timed mocks.
Does cath lab experience replace studying?
No. Experience builds pattern recognition; the exam tests mechanism and the parts of the blueprint your lab may rarely perform.