IAC certification is a continual process and must be maintained by the facility: it may include audits or site visits by the IAC. There are several states in which Medicare and/or private insurance carriers require accreditation (credentials) of the laboratory and/or sonographer for reimbursement of echocardiograms. There are two credentialing bodies in the United States for sonographers, the Cardiovascular Credentialing International (CCI), established in 1968, and the American Registry for Diagnostic Medical Sonography (ARDMS), established in 1975. Both CCI and ARDMS have earned the prestigious ANSI-ISO 17024 accreditation for certifying bodies from the International Organization for Standardization (ISO). Accreditation is granted through the American National Standards Institute (ANSI). Recognition of ARDMS programs in providing credentials has also earned the ARDMS accreditation with the National Commission for Certifying Agencies (NCCA). The NCCA is the accrediting arm of the National Organization for Competency Assurance (NOCA). Under both credentialing bodies, sonographers must first document completion of prerequisite requirements, which contain both didactic and hands-on experience in the field of ultrasound. Applicants must then take a comprehensive exam demonstrating knowledge in both the physics of ultrasound and the clinical competency related to their specialty. Credentialed sonographers are then required to maintain competency in their field by obtaining a certain number of Continuing Medical Education credits, or CME's. In 2009, New Mexico and Oregon became the first two states to require licensure of sonographers. The American Society of Echocardiography (ASE) is a professional organization made up of physicians, sonographers, nurses, and scientists involved in the field of echocardiography. One of the most important roles that the ASE plays is providing their recommendations through the ASE Guidelines and Standards, providing resource and educational opportunities for sonographers and physicians in the field. There have been various institutes who are working on use of Artificial intelligence in Echo but they are at a very early stage and still needs full development. Terminology The most commonly used terminology in echocardiography diagnostics are: BSA – body surface area DT – deceleration time IVRT – isovolumic relaxation time LA – left atrium RA – right atrium LV – left ventricle RV – right ventricle LVOT – left ventricular outflow tract RVOT – right ventricular outflow tract PHT – pressure half time TAPSE – tricuspid annular plane systolic excursion VC – vena contracta EDD – end diastolic diameter ESD – end systolic diameter IVSd – interventricular septal end diastole PWd – posterior