Nuclear Medicine Technology Exam

The NMTCB Nuclear Medicine Technology Examination is a computer-based exam delivered at IQT (Iso-Quality Testing) testing centers. You may take it after you graduate from a recognized nuclear medicine technology program and your program director verifies that you completed all graduation requirements.

To be eligible, you must meet these requirements:

• Graduate from a nuclear medicine technology program recognized by the NMTCB, or from an accredited program recognized by the Joint Review Committee on Educational Programs in Nuclear Medicine Technology (JRCNMT), the Armed Forces Military Training Commands, the Canadian Association of Medical Radiation Technologists (CAMRT) or the Australian and New Zealand Society of Nuclear Medicine (ANZSNM).
• Have your program director verify that you met all graduation requirements.
• Complete all eligibility requirements within five years after you finish your program.

A small number of candidates are made eligible by appeal to the board. The older on-the-job training pathway is no longer offered.

Apply online through the NMTCB website, enter your school name and school code, and pay the $200 examination processing fee. Applications should arrive at least two months before the date you want to test, and they are processed in the order received. You will receive an acknowledgment email; if you do not hear from the NMTCB within three weeks, contact the office. After your program director verifies your graduation, the NMTCB emails you a username, a password and instructions for scheduling with IQT.

Many programs use the Early Scheduling option. The program director sends the class's applications, with an early scheduling form, at least two months before the program ends, so you can book a seat before graduation. Your exam date must still fall after you graduate.

Once you are authorized, you have a three-month window to schedule and take the exam. If you miss the window, a $100 reactivation fee applies, and a no-show costs $200 to reactivate. A one-time three-month extension is available for $100. Make any changes by logging in to your account several days before your appointment, and check the current change deadline and any IQT rescheduling fee when you book.

The content comes from the NMTCB job task analysis, a national survey of what nuclear medicine technologists actually do, and is published as the Components of Preparedness. The exam covers five domains.

Radionuclide properties, modes of decay, x-ray production, decay calculations, counting statistics, interactions of radiation with matter, and how gas-filled, scintillation and solid-state detectors work. Covered in Section 1.

Biological effects, ALARA with time, distance and shielding calculations, surveys and wipe tests, personnel monitoring, dose limits, NRC compliance (posting, spills, waste, records, leak tests, written directives, medical events), DOT shipping and package receipt, and other rules including OSHA, EPA, HIPAA, FDA and USP chapters 797 and 825. Covered in Sections 2 and 3.

Generator elution and quality control, dose calibrator use, kit preparation and radiochemical purity testing, every major diagnostic, PET and therapeutic agent, adjunct and interventional drugs, blood cell labeling, and administration routes and techniques. Covered in Sections 4 and 5.

Dose calibrators, survey meters, well counters and probes, gamma cameras, SPECT and SPECT/CT, PET and PET/CT, CT quality control, computers and networks, and auxiliary laboratory and patient-care equipment. Covered in Sections 6 and 7.

Imaging and non-imaging procedures for every body system, scheduling, patient preparation, education and care, dose administration, positioning and acquisition, image evaluation and processing, exercise and pharmacologic stress testing, and radionuclide therapy. Covered in Sections 8 to 12.

The exam is a computer adaptive test designed to make one decision: whether your performance is above or below the passing standard. Every candidate answers 90 questions, but each candidate sees a different set. The computer chooses each question for how well it separates candidates near the passing standard, based on the question's difficulty and other statistics, and the scoring adjusts for the difficulty of the questions you received, so a candidate who draws harder questions needs fewer correct answers to pass. Testing ends when you have answered 90 questions or the time limit is reached.

You cannot skip a question, and once you move on you cannot return to it. You can change your answer while the question is on the screen. The computer scores it when you go to the next question, so make your final choice before you click.

• Single-best-answer multiple choice. The NMTCB says questions have four or five options, and its official sample questions all have five. The practice tests in this guide use five options for every question.
• Application questions that describe a department situation and ask what it means, what caused it or what to do next.
• Calculation questions: decay, dose volume, effective half-life, inverse square and shielding, Mo-99 breakthrough, counting statistics, energy resolution, uptake, ejection fraction, emptying and clearance values.
• Some questions are written as a sentence with a blank to complete.
• Images and QC results are often described in words, and in this guide they always are.

Bring a simple calculator that meets the rules, and practice with it. Scratch paper is provided at the testing center.

The exam is criterion referenced: you pass by meeting the standard, not by beating other candidates. Scores are reported on a scale of 200 to 500, and the passing score is 375. There is no penalty for guessing, so answer every question. Unscored pretest questions are mixed in and are not identified, so treat every question as if it counts.

You see a preliminary pass or fail result at the testing center. Official results are mailed about three weeks later and are never given by phone. Passing candidates receive a certificate packet. Candidates who do not pass receive a score report that ranks performance by content area, which shows where to focus before the next attempt. In the latest NMTCB annual report, about 90% of first-time program graduates passed.

• After a first or second unsuccessful attempt, you may reapply as soon as two weeks after the date of the attempt.
• After a third unsuccessful attempt, you must document at least 15 contact hours each in radiopharmacy, nuclear medicine instrumentation and radiation safety from accredited institutions, accredited programs or NMTCB-recognized continuing education. You then have three more attempts.
• After six unsuccessful attempts, you must complete an approved nuclear medicine technology program again before you can retest.

Each attempt requires a new application and fee. A rescore can be requested in writing within two months of the official score report for $50.

You may use the CNMT credential after your name. Check your state's licensure rules: some states license nuclear medicine technologists separately and require you to apply after you pass. Your employer will also verify your certification and may require competency checks on its own equipment and procedures.

CNMT certification is renewed every year with an attestation of your continuing education status. You need 24 hours of approved continuing education in each two-year cycle, which is based on your birth month; a new certificant's first cycle is prorated at one hour per month. Keep your own records, because certificants are selected at random for audit.