Mammography Exam

The Mammography Exam is a computer-based exam delivered at Pearson VUE test centers. You may take it after you hold ARRT certification and registration in Radiography, complete the structured education and clinical experience requirements, meet the ARRT ethics requirements and receive approval of your application. Fees and requirements can change, so confirm every detail on the ARRT website before you apply.

Key Facts About the Mammography Exam

The Mammography Exam is open only through the ARRT postprimary pathway. To be eligible, you must meet all of the following requirements:

• Hold ARRT certification and registration in Radiography (R). Radiography is the only supporting category for Mammography.
• Earn at least 16 structured education credits, with at least one credit in each major content category, within the 24 months before you apply.
• Document the required clinical experience, completed within the 24 months before you apply.
• Meet the ARRT ethics requirements.

The clinical experience requirements are specific. You must independently perform mammograms on 75 patients (real patients, not phantoms), participate in all of the mammographer QC tests from the ACR Digital Mammography Quality Control Manual or the manufacturer's QC program, take part in one image-evaluation session of 10 or more cases with an MQSA-qualified interpreting physician (including EQUIP corrective action), and complete at least five elective procedures, such as needle localization, specimen imaging, breast MRI, breast ultrasound, stereotactic biopsy with clip placement, implant imaging, diagnostic mammograms and screening recalls. You must be MQSA compliant before you perform the required mammograms, and ARRT limits how many procedures can be counted on a single day. Your clinical experience is verified through your ARRT account, so log it carefully as you go.

Log in to your ARRT account, record your structured education and clinical experience, complete the postprimary application and pay the application fee. Fees are not refunded or transferred. When ARRT approves the application, it posts a Candidate Status Report and opens a 365-day examination window. Schedule your appointment with Pearson VUE inside that window, choosing the earliest date that still lets you finish your review. Arrive 30 minutes early and bring two valid forms of identification that show the exact name on your application. If your identification and your application do not match, you may not be allowed to test.

The content specifications come from the ARRT practice analysis, a national study of what mammographers actually do. In the most recent update, ARRT added patient education on how results are received, more detail on inherent and social risk factors, synthesized imaging, PACS troubleshooting, MQSA breast density reporting, EQUIP and patient-related artifacts, and more detail on patient preparation for interventional procedures. It removed TRAM and latissimus dorsi flap content, sentinel node mapping, cyst aspiration and fine needle aspiration biopsy. The total of 115 scored items did not change, and the number of pilot items rose from 25 to 30. This guide follows the current version.

Official Content Categories

Communication and patient education, including pre-exam instructions, how results are received, explaining repeats and additional imaging, and screening guidelines from the major organizations; breast cancer risk assessment, including inherent and social risk factors, signs and symptoms, clinical history and prior studies; and treatment options, including surgical and nonsurgical treatment and reconstruction. Covered in Sections 1 and 2.

Equipment design; digital acquisition, display and informatics, including synthesized imaging and PACS troubleshooting; MQSA regulations, including breast density reporting; quality control, with the mammographer tests in detail and the medical physicist tests at a basic level, following the ACR Digital Mammography Quality Control Manual; and technique and image evaluation, including technical factors, image quality criteria, EQUIP and artifacts. Covered in Sections 3, 4, 5 and 6.

Breast anatomy, physiology and cytology; breast pathology, including benign and malignant findings and high-risk lesions with upgrade potential; and BI-RADS terminology and assessment categories. Covered in Sections 7 and 8.

The largest subcategory: standard and additional views, ACR positioning criteria (about six items focus on evaluating CC and MLO images), positioning for special patients and implants, other imaging methods such as ultrasound and MRI at a basic level, and interventional procedures, including biopsy, localization, specimen handling and patient preparation. Covered in Sections 9, 10, 11 and 12.

You take the Mammography Exam on a computer at a Pearson VUE test center. Your appointment lasts 170 minutes. That time includes a short tutorial, a nondisclosure agreement and a brief survey at the end, and the exam itself has a 150-minute limit for 140 items. Questions appear in random order rather than grouped by content area, so a QC question may be followed by a positioning question and then a pathology question. The 30 pilot items are mixed in and are not identified, so treat every question as if it counts.

On-screen basic and scientific calculators are available during the exam, and you may request a basic four-function calculator at the test center. Personal calculators are not allowed. The calculations on this exam are short, such as a magnification factor, a repeat rate, a PNL comparison or a QC tolerance check, and this guide teaches each one by hand so that you understand what the number means.

ARRT does not publish how many items use images, video or formats other than multiple choice, so be ready for any of them. In this guide, images are described in words and every practice question uses the four-option format, so you can practice the same reasoning. About half of the practice questions are scenarios (a patient situation, a QC result or a positioning fault) and about half test precise knowledge such as QC frequencies, MQSA timelines and BI-RADS categories.

ARRT reports results as a scaled score from 1 to 99, and the passing score is a total scaled score of 75. The standard is criterion-referenced: you are measured against a fixed standard of competence, not against other candidates. Only the 115 scored items count toward your result. Your score report also lists section scores from 0.1 to 9.9 for each content area. These section scores are feedback only and do not decide whether you pass, but they show where to focus if you need to retest.

A preliminary score appears on the screen at the end of the exam. The official score report is posted to your ARRT account after ARRT verifies the result. If you believe your most recent attempt was scored incorrectly, you can request a score appeal (a rescore) within 14 calendar days of your score report. The appeal carries a nonrefundable fee; check the current amount with ARRT.

You have three attempts to pass, all within three years of the date your first examination window opens. Each attempt requires a new application and a new fee. If you do not pass within three attempts or three years, you must requalify, which means completing new clinical experience and earning 16 new structured education credits before you can apply again. Use the section scores on your report to plan your review, and return to the guide sections behind your weakest areas before your next attempt.

Your Mammography credential is added to your ARRT record, and you may use the designation R.T.(R)(M). Check whether your state requires a separate license or permit for mammography, and give your facility a copy of your credential for its MQSA personnel records. Remember that MQSA has its own qualification rules. Before you work independently you need 40 contact hours of mammography training, including at least 25 examinations under direct supervision, and before you use a new modality such as digital breast tomosynthesis you need 8 hours of training in that modality. Many candidates meet these requirements during the clinical experience they completed for ARRT, but confirm the documentation with your lead interpreting physician or QC technologist.

Two sets of requirements apply after you pass, and you must meet both.

ARRT requirements:

• Renew your ARRT registration every year and continue to meet the ARRT ethics requirements.
• Earn 24 continuing education credits in each two-year biennium.
• Complete the Continuing Qualifications Requirements (CQR) every 10 years if your credential was earned under CQR.

Federal MQSA requirements (21 CFR 900.12) for every mammographer:

• Earn 15 continuing education units in mammography every 36 months.
• Perform at least 200 mammograms every 24 months to stay qualified.
• Complete 8 hours of training before you begin using a new mammographic modality.

If you fall short of the MQSA continuing requirements, you cannot perform mammograms independently until you requalify under the rule, so track your exam counts and continuing education with your facility. Confirm current ARRT renewal and CE details on the ARRT website, and confirm MQSA details with your facility and the FDA.