ARRT Practice Test 2026 - Free Radiologic Technology Exam Questions

Before you open a practice test, answer one question: which ARRT exam are you taking? The American Registry of Radiologic Technologists certifies professionals across more than 15 distinct disciplines, and the content varies dramatically between them. An MRI exam tests magnetic resonance physics. A radiography exam tests positioning and image production. These two exams share almost no content. A candidate who searches for "ARRT practice test" without knowing their specific exam is mixing materials from different certifications.

This post maps the ARRT discipline structure, focuses on the primary radiography (R) credential that most candidates pursue first, and gives you 20 practice questions weighted to the official ARRT R exam content specifications.

ARRT Exam Disciplines: Know Which One You Are Taking

ARRT credentials fall into two categories: primary pathways (no prior credential required) and post-primary specialties (require an existing ARRT credential).

Primary Pathway Disciplines

Discipline	Abbreviation	What It Tests
Radiography	R	Anatomy, positioning, image production, radiation protection, patient care
Radiation Therapy	T	Treatment planning, dosimetry, radiation oncology
Nuclear Medicine Technology	N	Radiopharmaceuticals, imaging procedures, radiation safety
MRI	MR	Magnetic resonance physics, pulse sequences, safety screening
Sonography	S	Ultrasound physics, transducer selection, anatomy

Post-Primary Specialties (Require Prior ARRT Credential)

CT, Mammography, Cardiac-Interventional Radiography, Vascular-Interventional Radiography, Bone Densitometry, Quality Management, Radiologist Assistant, and Medical Dosimetry are all post-primary specialties. You cannot sit for these without an existing ARRT credential in a primary pathway discipline.

Primary Radiography (R) Exam Blueprint

The radiography exam contains 200 questions, of which 180 are scored. The content is distributed across five areas:

Content Area	Approximate Weight
Radiographic Procedures (Anatomy and Positioning)	30%
Image Production	26%
Radiation Protection	17%
Patient Care and Education	15%
Equipment Operation and Quality Control	12%

Positioning and image production together account for 56 percent of the exam. A candidate who masters these two areas is already more than halfway to passing.

ARRT Radiography Practice Questions

Radiographic Procedures: Anatomy and Positioning

Question 1
A PA chest radiograph is requested. The patient is positioned correctly when:

A. The patient's chin rests on top of the IR
B. The patient's arms are akimbo (hands on hips with elbows forward)
C. The midsagittal plane is angled 10 degrees toward the tube
D. The patient is in a lateral decubitus position

Answer: B. For a PA chest, the patient's hands are placed on the hips with elbows rotated forward (akimbo position). This moves the scapulae laterally out of the lung fields. The chin is elevated so it does not superimpose the apex of the lungs. The midsagittal plane is perpendicular to the IR, not angled. Lateral decubitus is a separate projection used to detect free air or fluid.

Question 2
On an AP projection of the lumbar spine, which structure is used to confirm proper patient positioning when the spine is not rotated?

A. The transverse processes should be equal in length bilaterally
B. The spinous processes should appear lateral to the vertebral bodies
C. The pedicles should be projected off the vertebral body margins
D. The intervertebral disc spaces should appear closed

Answer: A. On a true AP lumbar spine, the spinous processes are centered within the vertebral bodies and the transverse processes appear equal in length on both sides. If the spine is rotated, the transverse processes will appear asymmetrical. Spinous processes lateral to the body, pedicles off the margins, and closed disc spaces all indicate rotation or incorrect projection.

Question 3
An AP pelvis is requested. The technologist should internally rotate the patient's feet approximately:

A. 5 degrees
B. 15 to 20 degrees
C. 30 to 35 degrees
D. 45 degrees

Answer: B. Internal rotation of 15 to 20 degrees places the femoral necks parallel to the image receptor, demonstrating the femoral necks in their true length without foreshortening. Less rotation does not sufficiently compensate for the natural angle of the femoral neck. Greater rotation causes superimposition of the lesser trochanters and other distortion.

Question 4
For a PA projection of the hand, the central ray is directed to the:

A. Third metacarpophalangeal (MCP) joint
B. Third proximal interphalangeal (PIP) joint
C. Midshaft of the third metacarpal
D. Wrist at the level of the navicular

Answer: A. For a PA hand projection, the central ray is directed perpendicular to the third MCP joint, which is the center of the area of interest. This placement ensures all metacarpals and phalanges are included with minimal distortion. The PIP joint is too distal. Midshaft metacarpal and the wrist would exclude the distal digits or the MCP joints respectively.

Question 5
A lateral projection of the cervical spine demonstrates the articular pillars are not superimposed. The most likely cause is:

A. The chin is tucked toward the chest
B. The patient is rotated
C. The patient's shoulders are not depressed equally
D. The central ray is angled too cephalad

Answer: B. Failure to superimpose the articular pillars on a lateral cervical spine projection indicates patient rotation. A true lateral requires the midsagittal plane parallel to the IR. Chin tuck affects C1-C2 visualization but does not cause articular pillar separation. Unequal shoulder depression affects the lower cervical vertebrae being seen through the shoulders, not articular pillar superimposition. Central ray angulation affects open disc spaces and vertebral body alignment.

Question 6
For an AP oblique projection of the foot (medial rotation), the affected foot is rotated:

A. 30 to 40 degrees medially
B. 45 degrees medially
C. 30 to 40 degrees laterally
D. 60 degrees medially

Answer: B. The AP oblique foot with medial rotation requires 45 degrees of medial rotation. This projection demonstrates the bases of the second through fifth metatarsals, the interspaces between the first and second and third through fifth metatarsals, and the cuboid and navicular free of superimposition. 30 to 40 degrees of medial rotation is used for the AP oblique of the toes.

Image Production

Question 7
A radiograph of the knee is produced with 70 kVp and 10 mAs. The image appears underexposed. To correct the exposure while maintaining the same mAs, the technologist should:

A. Increase kVp by 15 percent
B. Decrease kVp by 15 percent
C. Double the mAs
D. Halve the mAs

Answer: A. The 15 percent kVp rule states that increasing kVp by 15 percent doubles the exposure at the image receptor, equivalent to doubling the mAs. This corrects underexposure while keeping mAs constant. Decreasing kVp by 15 percent would halve the exposure, worsening underexposure. Doubling mAs is the alternative approach that also corrects underexposure but changes the mAs rather than the kVp.

Question 8
Which factor has the greatest effect on recorded detail (spatial resolution) in screen-film radiography?

A. Milliamperage
B. Object-to-image receptor distance (OID)
C. Kilovoltage
D. Source-to-image receptor distance (SID)

Answer: B. OID is the primary factor affecting recorded detail. Increasing OID increases geometric unsharpness (penumbra), which reduces spatial resolution. Milliamperage affects density but not resolution. kVp affects contrast and penetration. SID affects magnification and detail; increasing SID decreases geometric unsharpness and improves detail, but the effect of OID on the penumbra is the dominant variable tested here.

Question 9
An image is produced using a grid with a grid ratio of 12:1. Compared to a 6:1 grid, the 12:1 grid will:

A. Transmit more scatter radiation
B. Require a greater exposure increase (Bucky factor) to maintain density
C. Produce an image with less contrast
D. Allow more latitude in lateral decentering

Answer: B. Higher grid ratios absorb more scatter radiation but also absorb more primary radiation, requiring an increased exposure (higher Bucky factor) to achieve the same image density. A 12:1 grid transmits less scatter than a 6:1 grid, producing higher contrast. Higher grid ratios are also less forgiving of lateral decentering errors.

Question 10
A grid cutoff artifact appears on a radiograph as a uniform decrease in density across the entire image. The most likely cause is:

A. Lateral decentering
B. Upside-down focused grid
C. Excessive SID with a focused grid
D. Off-level grid

Answer: D. An off-level grid (tilted) produces uniform density decrease across the entire image because the grid strips are no longer aligned with the diverging primary beam at any point. An upside-down focused grid produces a density decrease in the periphery with relative sparing at the center. Lateral decentering causes unilateral density loss. Excessive SID with a focused grid causes bilateral peripheral density loss.

Question 11
A radiograph taken at 40 inch SID produces an image with a specific magnification factor. If the SID is increased to 72 inches with all other factors unchanged, image magnification will:

A. Increase
B. Decrease
C. Remain the same
D. Double

Answer: B. Magnification factor equals SID divided by SOD (source-to-object distance). Increasing SID while keeping OID the same increases SOD proportionally more, which decreases the magnification factor. Longer SIDs produce images closer to true object size. This is why 72-inch SID is standard for chest radiography: it minimizes cardiac magnification.

Radiation Protection

Question 12
The annual occupational effective dose limit for radiation workers is:

A. 1 mSv (100 mrem)
B. 5 mSv (500 mrem)
C. 50 mSv (5,000 mrem)
D. 100 mSv (10,000 mrem)

Answer: C. The NCRP recommended annual occupational effective dose limit is 50 mSv (5,000 mrem). The 1 mSv limit applies to the general public. The 5 mSv limit is the annual recommended limit for the general public in planned special exposure situations or for the fetus of a declared pregnant worker. 100 mSv is the 5-year cumulative limit in some frameworks but not the annual limit.

Question 13
A radiographer is working in a fluoroscopy suite. To minimize their occupational dose, the technologist should:

A. Stand as close to the patient as possible to monitor the procedure
B. Maximize distance from the patient and the x-ray tube
C. Position themselves directly across from the x-ray tube under the table
D. Remove the apron when not directly in the primary beam

Answer: B. Distance is the most effective radiation protection tool. Scatter radiation intensity decreases with the square of the distance (inverse square law). The position directly across from the x-ray tube receives the highest scatter exposure. The lead apron should be worn at all times during fluoroscopy procedures, not only when in the primary beam. Proximity to the patient increases scatter exposure.

Question 14
Gonadal shielding should be used when the gonads are within how many centimeters of the primary beam edge?

A. 2 cm
B. 5 cm
C. 10 cm
D. 15 cm

Answer: B. According to NCRP guidelines, gonadal shielding is recommended when the gonads are within 5 cm of the primary beam edge. This threshold accounts for scattered radiation that extends beyond the collimated field boundary and ensures shielding is applied when meaningful gonadal dose is likely.

Equipment Operation and Quality Control

Question 15
A spinning top test is used to evaluate which equipment characteristic?

A. Milliamperage accuracy
B. Timer accuracy for single-phase equipment
C. kVp accuracy
D. Focal spot size

Answer: B. The spinning top test evaluates timer accuracy in single-phase x-ray equipment. The number of dots on the test image corresponds to the number of x-ray pulses produced during the exposure time. For single-phase full-wave rectified equipment producing 120 pulses per second, a 1/10 second exposure should produce 12 dots. For three-phase equipment, a motorized spinning top or synchronous timer test is used instead. mAs stations, kVp, and focal spot size are evaluated with different instruments.

Question 16
An x-ray tube's anode heat storage capacity is rated in:

A. Milliampere-seconds (mAs)
B. Kilowatts (kW)
C. Heat units (HU)
D. Roentgens per minute

Answer: C. Anode heat storage capacity is measured in heat units (HU). For single-phase equipment: HU = kVp x mA x time. For three-phase or high-frequency equipment, a correction factor of 1.35 is applied. Milliampere-seconds describes exposure quantity. Kilowatts describe tube power rating. Roentgens per minute is a unit of radiation exposure rate, not heat storage.

Patient Care and Education

Question 17
A patient who received IV iodinated contrast begins experiencing generalized urticaria (hives) and mild pruritus within minutes of injection. This reaction is classified as:

A. Vasovagal reaction
B. Mild allergic-like reaction
C. Anaphylactic shock
D. Contrast nephropathy

Answer: B. Generalized urticaria and pruritus without cardiovascular or respiratory compromise constitute a mild allergic-like reaction to iodinated contrast. These reactions typically resolve spontaneously or with antihistamine treatment and do not require epinephrine. Vasovagal reactions involve hypotension and bradycardia without urticaria. Anaphylactic shock involves hypotension, bronchospasm, and loss of consciousness. Contrast nephropathy is a delayed renal complication, not an immediate cutaneous reaction.

Question 18
A patient scheduled for an upper GI series asks the technologist what will happen during the exam. The technologist should:

A. Tell the patient that explaining the procedure is the radiologist's responsibility
B. Explain the procedure in medical terminology so the patient understands the technical components
C. Provide a clear, lay-language explanation of what the patient will experience and what is expected of them
D. Decline to answer and refer all questions to nursing staff

Answer: C. Patient education is within the radiographer's scope of practice and is essential for patient cooperation and informed consent. Explanations should use clear, accessible language without medical jargon. Deferring all explanations to the radiologist or nursing staff is not appropriate for procedure-specific patient preparation. Using technical terminology without ensuring patient comprehension defeats the purpose of the explanation.

Question 19
When transferring a non-weight-bearing patient from a wheelchair to the radiographic table, the radiographer should:

A. Lock the wheelchair wheels and position the chair perpendicular to the table
B. Have the patient stand briefly while pivoting to the table
C. Lock the wheelchair wheels and position the chair parallel to and against the table
D. Perform the transfer alone to avoid involving extra staff

Answer: C. Safe transfer technique requires the wheelchair wheels locked and the chair positioned parallel to and as close as possible to the table. This minimizes the distance and pivot required, reducing fall risk. Perpendicular positioning increases the transfer distance. A non-weight-bearing patient should not be asked to stand and pivot. Complex transfers should involve adequate staff to ensure patient safety.

Question 20
A patient's medical record indicates a documented allergy to shellfish. The patient is scheduled for a CT scan with IV iodinated contrast. The radiographer should:

A. Proceed with the contrast injection because shellfish allergy does not predict contrast reactions
B. Substitute barium sulfate for the iodinated contrast
C. Notify the radiologist before proceeding so risk can be assessed and premedication considered
D. Cancel the exam and reschedule without contrast

Answer: C. Shellfish allergy was historically considered a contraindication to iodinated contrast. Current evidence shows that shellfish allergy does not directly predict iodinated contrast reactions, but a documented allergy to any substance increases the overall risk of contrast reactions. The radiographer's responsibility is to alert the radiologist to the allergy before proceeding. The radiologist will assess the risk-benefit ratio and determine whether premedication or a different contrast agent is warranted. Canceling without consultation or proceeding without notification both bypass the appropriate clinical decision-making process.

How Educato Helps You Prepare for the ARRT

Educato's ARRT radiography prep covers all five exam content areas with adaptive practice questions, detailed rationale for every answer, and progress tracking so you know which domains need the most attention before your exam date.