ARRT Mammography Registry Exam Prep

Answer: C. The CC's PNL should be within 1 cm of the MLO's PNL. 10.2 cm is 0.8 cm short, so it passes. D (1.5 cm short) and A (3.0 cm short) suggest posterior tissue was left off the CC. B is 1.5 cm longer, which also falls outside the 1 cm window, so that pair doesn't meet the criterion either.

Source: ACR Learning Network, Mammography Positioning Review Guidelines, Major criteria: Posterior Nipple Line. MAM-PP-01

Answer: B. A good MLO shows the pectoralis down to the PNL or below, wider superiorly and narrowing inferiorly. C describes inadequate muscle: narrow, concave, and more than 1 cm short of the PNL. D means posterior tissue is missing. A fails a separate major criterion: the nipple must be in profile on at least one view of each breast.

Source: ACR Learning Network, Mammography Positioning Review Guidelines, Major criteria: nipple in profile; minor criteria: amount of pectoralis major muscle. MAM-PP-02

Answer: D. The LM places the medial breast against the image receptor. That keeps a medial lesion close to the receptor, which cuts object-to-image distance and the blur that comes with it. ML (A) is the choice for lateral lesions. XCCL (B) and the axillary tail view (C) are aimed at lateral and axillary tissue.

Source: IARC Atlas of Breast Cancer Early Detection, 90° lateral views. MAM-PP-03

Answer: A. Systems used for magnification must be able to work with the grid removed; the air gap handles scatter, so B is backward. Systems must offer at least one magnification value between 1.4 and 2.0, which rules out C. Systems used for noninterventional problem-solving procedures must have magnification available, so D is wrong.

Source: 21 CFR 900.12, (b)(4)(iii) and (b)(6). MAM-PP-04

Answer: C. MQSA requires facilities to ask about implants before the exam and, unless contraindicated or modified by a physician, to use views that maximize visualization of breast tissue. The ARRT outline lists implant-displaced views and breast augmentation under patient variance. D and A each fail the regulation's requirement to maximize visualization of breast tissue. B substitutes another modality without support from the facts in the stem.

Source: 21 CFR 900.12, (g); ARRT Mammography Content Specifications, Procedures 2.A.10 and 2.B.9, p. 8. MAM-PP-05

Answer: D. MQSA requires each facility to set up and follow a documented system for cleaning and disinfecting mammography equipment after contact with blood or other potentially infectious materials, in line with applicable regulations and the manufacturer's recommended procedures. A can damage equipment or break the manufacturer's instructions. B delays disinfection. C isn't a documented system.

Source: 21 CFR 900.12, (e)(13). MAM-PP-06

Answer: B. On a medially rolled CC, a lesion in the superior half moves medially with the roll, while a lesion in the inferior half appears more lateral. That's how rolled views localize a finding seen on only one standard view.

Source: UCLA Health Radiology, Breast Lesion Localization, Rolled CC views. MAM-PP-07

Answer: A. MQSA defines a screening mammogram as routine views of a patient with no symptoms, and a diagnostic mammogram as individualized views of a patient with breast symptoms, physical signs of breast disease, or abnormal screening findings. A palpable lump is a symptom, so B and C are wrong. D skips the mammogram the referral asked for.

Source: 21 CFR 900.12, (f)(1). MAM-PP-08

Answer: D. Going from the MLO to a true lateral, medial lesions move up and lateral lesions move down ("muffins rise, lead falls"). A central lesion barely changes height, so B is wrong. Triangulating with the CC, MLO, and a 90° lateral localizes it without ultrasound, so C is wrong.

Source: IARC Atlas of Breast Cancer Early Detection, 90° lateral views; UCLA Health Radiology, Breast Lesion Localization. MAM-APP-01

Answer: B. Category 3 findings carry less than a 2% likelihood of malignancy and are usually managed with short-interval follow-up, often at 6 months. Biopsy (C) is for categories 4 and 5. Routine screening (D) fits categories 1 and 2. A describes category 0, "incomplete."

Source: ACR BI-RADS current release; Breast Imaging Reporting and Data System v2025: Key Updates in Mammography, Category 3. MAM-APP-02

Further citation details: Current release: BI-RADS v2025; Category 3 (Probably Benign)

Answer: A. Milk of calcium settles in the dependent part of tiny cysts. A horizontal-beam 90° lateral shows it as sharp, curved or linear "teacup" shapes, while the CC sees it from above as smudges. The other views don't use a horizontal beam, so they can't show the layering. The ARRT outline lists milk of calcium among typically benign calcifications.

Source: IARC Atlas of Breast Cancer Early Detection, 90° lateral views; ARRT Mammography Content Specifications, Procedures 1.E.1.d, p. 7. MAM-APP-03

Answer: C. Despite the name, LCIS is grouped with ADH, ALH, papilloma with atypia, flat epithelial atypia, radial scar, and phyllodes tumor as benign with upgrade potential. DCIS, invasive lobular carcinoma, and Paget disease are listed as malignant.

Source: ARRT Mammography Content Specifications, Procedures 1.E.3 and 1.E.4, p. 7. MAM-APP-04

Answer: B. Clock positions are read as if you're facing the patient, so the two breasts mirror each other. In the right breast, the outer half runs from 6 to 12 o'clock and the upper half from 9 to 3, so 10:00 is upper outer. In the left breast, 10:00 would be upper inner (C).

Source: UCLA Health Radiology, Breast Lesion Localization, Quadrants on CC and MLO. MAM-APP-05

Answer: D. The outline lists amorphous, heterogeneous, and fine pleomorphic as suspicious morphology. Skin, vascular, coarse, milk of calcium, and dystrophic calcifications are listed as typically benign.

Source: ARRT Mammography Content Specifications, Procedures 1.E.1.d, p. 7. MAM-APP-06

Answer: A. ACR's unit checklist for the 2018 manual lists phantom image quality as weekly. Monthly (B) is the compression thickness indicator, visual checklist, and acquisition workstation monitor QC. Quarterly (C) is the facility QC review. Semiannual (D) is compression. The phantom passes with at least 2 fibers, 3 speck groups, and 2 masses.

Source: ACR Digital Mammography Unit QC Summary Checklist; ACR webinar: The 2018 ACR Digital Mammography QC Manual (Berns), Phantom pass criteria slide. MAM-IP-01

Answer: C. Under MQSA, a failed phantom image quality test, and failures in a digital unit's QC program, must be corrected before more exams are performed with that component. The 30-day window in D applies only to tests that aren't on that list. A and B keep imaging patients on equipment that just failed an image-quality test.

Source: 21 CFR 900.12, (e)(8)(ii)(A)-(B). MAM-IP-02

Answer: D. The regulation requires compression of at least 111 N (25 lb) and an initial power-drive maximum between 111 N (25 lb) and 200 N (45 lb). A states only half the rule. B confuses fine adjustment with the power-drive limit. C uses a limit that doesn't exist.

Source: 21 CFR 900.12, (e)(4)(iii); ACR Digital Mammography Unit QC Summary Checklist, Compression (semiannual). MAM-IP-03

Answer: B. The facility QC review is the quarterly item. The compression thickness indicator (C) and acquisition workstation monitor QC (A) are monthly; compression (D) is semiannual. Repeat analysis is listed as optional and as needed in the 2018 digital program, which trips up anyone who learned the old film-screen schedule.

Source: ACR Digital Mammography Unit QC Summary Checklist. MAM-IP-04

Answer: C. The limit is 3.0 mGy per exposure, measured by the medical physicist using the facility's clinical technique for a standard breast. The same maximum applies to digital and other non-screen-film systems. The outline expects only basic knowledge of physicist tests, and dose is one worth memorizing.

Source: 21 CFR 900.12, (e)(5)(vi) and (e)(6). MAM-IP-05

Answer: A. Every lay summary now includes a density statement. "Almost entirely fatty" and "scattered areas of fibroglandular density" trigger the not-dense statement. "Heterogeneously dense" and "extremely dense" trigger the dense statement, which adds that other imaging tests may help some people (B). C is wrong under the current federal rule because every lay summary includes a density statement. D is a clinical decision, not required lay-summary wording.

Source: 21 CFR 900.12, (c)(1)(vi) and (c)(2)(iii)-(iv). MAM-IP-06

Answer: B. Original mammograms and reports must be kept for the longest of: at least 5 years; at least 10 years if the facility performs no more mammograms on the patient; or any longer state or local requirement. C is the minimum when the patient keeps coming back. D is how long serious consumer complaints are kept, and A is how long records of departed staff are kept. Both are real MQSA numbers, just for different records.

Source: 21 CFR 900.12, (c)(4)(i), (h)(2), (a)(4). MAM-IP-07

Answer: D. ACS recommends yearly mammograms for average-risk women ages 45 to 54. Every other year (A) is an option ACS gives at 55 and older. B isn't ACS guidance; ACS even gives women 40 to 44 the option to start yearly screening. C adds something ACS doesn't recommend: clinical breast exams aren't recommended for screening average-risk women at any age.

Source: American Cancer Society screening recommendations, Average-risk guidelines; CBE and BSE. MAM-PC-01

Answer: C. The ARRT outline separates the mammographer's job, explaining how results arrive and why more imaging might be needed, from the clinician's role in explaining results and findings. D and B interpret images, which isn't the technologist's role, and a "looks normal" comment can turn out wrong. A is right about scope but skips the patient education. Federal rules back up the process: the facility must send a lay summary within 30 days, or within 7 days if the assessment is Suspicious or Highly Suggestive of Malignancy.

Source: ARRT Mammography Content Specifications, Patient Care A.4, p. 2; 21 CFR 900.12, (c)(2). MAM-PC-02

Answer: A. The outline lists previous chest radiation under inherent risk factors, along with age, personal and genetic history, and breast density. B, C, and D fall under social (lifestyle) risk factors. ACS also counts chest radiation before age 30 as a high-risk factor.

Source: ARRT Mammography Content Specifications, Patient Care B.1, p. 2; American Cancer Society screening recommendations, High-risk guidelines. MAM-PC-03

Answer: B. MQSA requires a procedure to ask whether the patient has breast implants before the exam. Removing deodorant (C) is a standard pre-exam instruction and appears in the ARRT outline, but it isn't the inquiry MQSA mandates. D and A aren't MQSA requirements.

Source: 21 CFR 900.12, (g)(1). MAM-PC-04