Free ARDMS SPI Practice Test
50 free, original practice questions for the ARDMS Sonography Principles and Instrumentation (SPI) exam, weighted to the current content outline (v24.1), with an answer and explanation under every question.
Unofficial practice: these are not real exam questions, and your percent correct is not an SPI score.
Domain 1: Perform Ultrasound Examinations (11 questions)
Question 1 · Perform Ultrasound Examinations · Task 1.C
An echo returns to the transducer 52 microseconds after the pulse was sent. Assuming the standard soft-tissue speed of 1,540 m/s, how deep is the reflector?
Show answer and explanation
Answer: B. 4.0 cm
The machine times the round trip, so depth = (speed × time) ÷ 2. 1,540 m/s × 0.000052 s = 0.080 m out and back. Half of that is 0.040 m, or 4.0 cm. The working shortcut is about 13 microseconds of round-trip time per centimeter of depth (52 ÷ 13 = 4).
Why the others don't fit:
- A: Halves the distance twice.
- C: Just moves the decimal in 52. It isn't a physics result.
- D: Forgets that the 52 microseconds covers the trip out and back.
Source: BMUS / King's College London, Colin Deane, Ultrasound Interactions (Lecture 3), PDF pp. 37–38, pulse travel time and distance; IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 42; calculation shown above.
Question 2 · Perform Ultrasound Examinations · Task 1.C
Red blood cells are far smaller than the wavelength of a diagnostic ultrasound beam. Which interaction best describes how they send sound back to the transducer?
Show answer and explanation
Answer: C. Scattering in many directions (Rayleigh scattering)
When a target is much smaller than the wavelength, sound scatters in many directions, and those echoes are much weaker than a mirror-like reflection. Red blood cells are the classic example, which is why blood usually looks dark on B-mode.
Why the others don't fit:
- A: Specular reflection needs a large, smooth interface, like the diaphragm.
- B: Refraction is the beam bending at an oblique boundary between media with different sound speeds.
- D: Shadowing happens behind strong reflectors or attenuators such as bone or stones, not blood.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 20; BMUS / King's College London, Colin Deane, Ultrasound Interactions (Lecture 3), PDF pp. 18–20, scattering and Rayleigh scattering.
Question 3 · Perform Ultrasound Examinations · Task 1.E
You are imaging a large, smooth interface such as the boundary between the liver and diaphragm. At what beam angle will that interface return the strongest echo?
Show answer and explanation
Answer: A. Perpendicular (90°) to the interface
A smooth (specular) reflector bounces sound away at an angle equal to the angle it arrived. At 90°, the echo comes straight back to the transducer. At an oblique angle, more of it reflects away and the interface looks dimmer.
Why the others don't fit:
- B: Sends part of the reflection away from the transducer.
- C: Sends even more of the reflection away.
- D: Has it backwards: angle dependence is the defining trait of specular reflectors.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slides 11–12; BMUS / King's College London, Colin Deane, Ultrasound Interactions (Lecture 3), PDF pp. 9–15, specular reflection and directional sensitivity.
Question 4 · Perform Ultrasound Examinations · Task 1.D
Deep to a bright superficial interface you see several evenly spaced, parallel bright lines that fade with depth. The spacing equals the distance from the transducer to that first interface. Which artifact is this?
Show answer and explanation
Answer: D. Reverberation
Sound bounces back and forth between the transducer face and a strong, smooth reflector. Each extra round trip is displayed deeper, giving lines spaced at the transducer-to-reflector distance. Lung A-lines are a normal example.
Why the others don't fit:
- A: Mirror image duplicates a structure on the far side of a strong reflector. It doesn't make a ladder of lines.
- B: Refraction causes edge shadows or displaced structures.
- C: Enhancement is a bright band behind a low-attenuation structure, not repeating lines.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 110–111, reverberation; American College of Emergency Physicians, Sonoguide: Lung, II. Common LUS Principles and Artifacts: A-Lines.
Question 5 · Perform Ultrasound Examinations · Task 1.D
A bright echogenic focus in the gallbladder has a dark, echo-free band directly behind it. What best explains the dark band?
Show answer and explanation
Answer: B. The focus reflects or attenuates nearly all of the beam, so little sound reaches the tissue behind it
This is acoustic shadowing. Strong reflection and attenuation leave little energy to image what lies deeper.
Why the others don't fit:
- A: A speed difference alone doesn't produce a clean shadow.
- C: Too much far-field TGC would brighten the deep image, not darken it.
- D: Aliasing is a Doppler artifact. This is a gray-scale image.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF p. 115, shadowing; BMUS / King's College London, Colin Deane, Artefacts, Part 2 (Lecture 7b), PDF pp. 2–6, acoustic shadowing.
Question 6 · Perform Ultrasound Examinations · Task 1.D
While imaging the liver from the right upper quadrant, you see liver tissue displayed on the far side of (above) the diaphragm. Which artifact explains this?
Show answer and explanation
Answer: C. Mirror image
The diaphragm acts as a strong, smooth reflector. Sound bounces off it, reaches liver tissue, and returns along the same path. The machine assumes a straight round trip, so it places that delayed echo deeper, beyond the diaphragm, creating a copy of the liver.
Why the others don't fit:
- A: Reverberation produces evenly spaced repeating lines.
- B: Ring-down is a bright streak caused by resonating gas bubbles.
- D: Enhancement brightens tissue behind fluid. It doesn't duplicate anatomy.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 113–114, mirror image; BMUS / King's College London, Colin Deane, Artefacts, Part 1 (Lecture 7a), PDF p. 25, ring down.
Question 7 · Perform Ultrasound Examinations · Task 1.D
Thin dark bands extend downward from the side edges of a round, fluid-filled gallbladder imaged in short axis. No stones are at those edges. What is the most likely cause?
Show answer and explanation
Answer: A. Refraction at the curved wall (edge artifact)
When the beam meets a curved boundary at an oblique angle and the sound speed changes, the transmitted beam bends. Echoes from just beyond the edge don't return as expected, so a shadow follows the edges. Round structures like the gallbladder are the classic place to see it.
Why the others don't fit:
- B: Reverberation creates repeating lines.
- C: Mirror image duplicates structures behind a strong reflector.
- D: Enhancement is brightening directly behind fluid, not dark edge bands.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 12; BMUS / King's College London, Colin Deane, Artefacts, Part 1 (Lecture 7a), PDF pp. 27–35, refraction and edge shadowing.
Question 8 · Perform Ultrasound Examinations · Task 1.F
Which on-screen output index estimates the likelihood of non-thermal (mechanical) bioeffects such as cavitation?
Show answer and explanation
Answer: D. Mechanical index (MI)
The two main bioeffect mechanisms are heating and cavitation. MI is built from the peak rarefactional pressure and frequency to reflect the relative risk of cavitation. TI is a calculated estimate of heating potential, not a direct temperature reading.
Why the others don't fit:
- A: TI relates to heating, not cavitation.
- B: Frame rate is an image-timing setting, not a safety index.
- C: Dynamic range is a gray-scale display setting, not a safety index.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slides 44, 48–49; AIUM, Statement on Biological Effects of Ultrasound in Vivo (2021), Nonthermal effects introductory paragraph; Biological Effects of Heat, point 2.
Question 9 · Perform Ultrasound Examinations · Task 1.F
During a long obstetric exam, which action best applies the ALARA principle?
Show answer and explanation
Answer: C. Use the lowest output setting that still gives a diagnostic image, and lift the transducer when stationary imaging isn't needed
ALARA means "as low as reasonably achievable": the lowest acoustic output that still produces diagnostic-quality images, less dwell time on any one spot, and no more scanning time than the diagnosis needs.
Why the others don't fit:
- A: Raises the energy delivered to the patient.
- B: Adds dwell time on fetal calcified structures, which AIUM singles out for special care.
- D: Adds exposure with no diagnostic benefit.
Source: AIUM, ALARA Principle (reapproved Aug 17, 2026), items 2, 4, 5, 6.
Question 10 · Perform Ultrasound Examinations · Task 1.K
A patient arrives for an outpatient exam. Before scanning, what is the best way to verify identity?
Show answer and explanation
Answer: C. Have the patient state at least two identifiers, such as full name and date of birth, and match them to the order
The Joint Commission's patient-identification goal calls for at least two patient identifiers when providing care, treatment, or services. Acceptable identifiers are person-specific, such as name and an assigned ID number.
Why the others don't fit:
- A: A room number identifies a place, not a person.
- B: A yes/no answer to a supplied name does not establish two patient identifiers.
- D: Checking the exam matters, but it doesn't confirm who the patient is.
Source: Joint Commission, 2026 National Patient Safety Goals for the Ambulatory Health Care Program, PDF p. 1, NPSG.01.01.01, rationale and EP 1; WHO Collaborating Centre for Patient Safety Solutions, Patient Identification, PDF pp. 1–2, Suggested actions 1(a)–(b); Opportunities for Patient and Family Involvement.
Question 11 · Perform Ultrasound Examinations · Task 1.B
Which habit best reduces a sonographer's risk of work-related musculoskeletal injury?
Show answer and explanation
Answer: B. At the start of each exam, position the patient and adjust the bed and monitor so you can scan without overreaching or twisting, and build in short breaks
AIUM's current statement calls for ergonomically correct scanning technique, microbreaks, and appropriate patient positioning and equipment adjustments at the start of each exam. Setting up first is what lets you scan with less reach, twist, and sustained force.
Why the others don't fit:
- A: Adds sustained reach.
- C: Adds sustained force.
- D: Holds the wrist out of a neutral position.
Domain 2: Manage Ultrasound Transducers (4 questions)
Question 12 · Manage Ultrasound Transducers · Task 2.B
In a patient with a large body habitus, the far-field liver is poorly seen even after TGC adjustments. Which change most improves penetration?
Show answer and explanation
Answer: D. Switch to a lower transmit frequency
Higher-frequency sound is attenuated faster and penetrates less. Lower frequencies reach deeper, at the cost of resolution. For a deep target, trade some detail for penetration.
Why the others don't fit:
- A: Makes penetration worse.
- B: Changes lateral detail and frame rate, not how deep sound reaches.
- C: Changes focusing and frame rate, not penetration.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slides 4, 16; Siemens Healthineers, ACUSON P500 Quick Reference Guide, Release 3.0, p. 34, MultiHertz frequency/penetration trade-off; p. 35, line density/frame rate.
Question 13 · Manage Ultrasound Transducers · Task 2.A
For otherwise identical pulsed imaging transducers made from the same piezoelectric material, which change to the element produces a higher resonant frequency?
Show answer and explanation
Answer: A. A thinner element
The element's resonant frequency is the speed of sound in the element divided by twice its thickness. Make it thinner and the frequency rises.
Why the others don't fit:
- B: Lowers the frequency.
- C: Affects beam shape, not the element's thickness-based frequency.
- D: Gel couples sound into the skin. It doesn't set the transducer's frequency.
Question 14 · Manage Ultrasound Transducers · Task 2.A
Which transducer is best suited to imaging the heart through a narrow window between the ribs?
Show answer and explanation
Answer: B. Phased array
A phased array steers beams electronically from a small footprint, producing a sector image that fits between ribs.
Why the others don't fit:
- A: A conventional linear array produces a rectangular field rather than a sector expanding from the small window.
- C: Endocavity transducers are designed for internal exams.
- D: A small-parts linear array is optimized for superficial targets rather than a wide cardiac sector through a narrow window.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 11–16, linear/curvilinear/phased arrays; BMUS / King's College London, Colin Deane, Transducers and Beamforming (Lecture 4), PDF pp. 17–19, array clinical uses and footprint.
Question 15 · Manage Ultrasound Transducers · Task 2.A
Which transducer component reduces the reflection between the transducer and the patient, increasing sensitivity to weak echoes?
Show answer and explanation
Answer: C. Matching layer
The matching layer sits on the front face of the element and reduces the reflection coefficient between transducer and tissue, so more sound gets in and more weak echoes get back.
Why the others don't fit:
- A: The backing layer absorbs sound from the back face and damps ringing, which shortens the pulse.
- B: The lens focuses the beam in the elevation (slice-thickness) direction.
- D: The element converts electrical energy to sound and back. It doesn't reduce the interface reflection.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slides 23–26; BMUS / King's College London, Colin Deane, Transducers and Beamforming (Lecture 4), PDF p. 15, transducer components.
Domain 3: Optimize Sonographic Images (13 questions)
Question 16 · Optimize Sonographic Images · Task 3.A
A pulse contains 3 cycles, and each cycle has a wavelength of 0.3 mm. What is the axial resolution?
Show answer and explanation
Answer: C. 0.45 mm
Spatial pulse length = cycles × wavelength = 3 × 0.3 mm = 0.9 mm. Axial resolution = half the spatial pulse length = 0.45 mm. Smaller numbers mean better resolution.
Why the others don't fit:
- A: Halves the wavelength instead of the pulse length.
- B: Is one wavelength.
- D: Is the full pulse length. You still have to halve it.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 27; calculation shown above.
Question 17 · Optimize Sonographic Images · Task 3.B
Two small structures sitting side by side within the imaging plane at 6 cm depth blur into one. The transmit focus is set at 2 cm. What is the best first adjustment?
Show answer and explanation
Answer: B. Move the transmit focus to about 6 cm
Side-by-side detail is lateral resolution, which depends on beam width. The beam is narrowest at the focal zone, so lateral resolution is best there.
Why the others don't fit:
- A: Brightens the image but doesn't narrow the beam.
- C: Brightens the image and raises exposure without narrowing the beam.
- D: Shrinks the structures on screen and lowers frame rate.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slides 30–32; BMUS / King's College London, Colin Deane, Transducers and Beamforming (Lecture 4), PDF p. 25, effect of focal depth on lateral resolution.
Question 18 · Optimize Sonographic Images · Task 3.C
A small cyst that was simple on prior exams now appears partly filled with low-level echoes. The echoes come from tissue just above and below the imaging plane. Which resolution limit explains this?
Show answer and explanation
Answer: C. Elevational (slice thickness) resolution
The beam has thickness perpendicular to the image plane. Tissue inside that thickness is averaged into the image, so echoes from just above or below a small cyst can fill it in. This section-thickness (partial-volume) artifact is smallest at the elevational focus.
Why the others don't fit:
- A: Concerns structures lined up along the beam path.
- B: Concerns structures side by side within the plane.
- D: Concerns showing motion over time.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 34–36, elevation focus; BMUS / King's College London, Colin Deane, Artefacts, Part 2 (Lecture 7b), PDF pp. 25–26, slice thickness artifacts.
Question 19 · Optimize Sonographic Images · Task 3.D
During a fetal heart exam, valve motion looks choppy. Which change raises frame rate and improves temporal resolution?
Show answer and explanation
Answer: C. Narrow the sector and reduce depth to just the region of interest
Frame rate falls as depth, number of scan lines, and number of focal zones increase. Tightening the field to what you need gives the system fewer, shorter lines to build each frame.
Why the others don't fit:
- A: Lowers frame rate.
- B: Lowers frame rate.
- D: Lowers frame rate.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 40, 43–44, multiple transmit zones and frame-rate dependencies; BMUS / King's College London, Colin Deane, Transducers and Beamforming (Lecture 4), PDF pp. 38–39, frame rate and scan parameters.
Question 20 · Optimize Sonographic Images · Task 3.H
The imaging depth is 15 cm. Assuming 1,540 m/s, what is the approximate maximum pulse repetition frequency (PRF) that lets echoes from the deepest point return before the next pulse is sent?
Show answer and explanation
Answer: B. 5.1 kHz
PRFmax = c ÷ (2 × depth). 154,000 cm/s ÷ (2 × 15 cm) = 154,000 ÷ 30 ≈ 5,133 Hz, about 5.1 kHz. Deeper imaging forces a lower PRF because each pulse must travel out and back.
Why the others don't fit:
- A: Divides by 2 one time too many.
- C: Forgets the round trip (divides by 15, not 30).
- D: A factor-of-10 unit slip.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 42; calculation shown above.
Question 21 · Optimize Sonographic Images · Task 3.H
A system uses a PRF of 5,000 Hz, 128 scan lines per frame, and one focal zone. Assume one transmitted pulse per scan line and ignore processing overhead. What is the approximate frame rate?
Show answer and explanation
Answer: D. 39 frames per second
Each line needs one pulse, so frame rate = PRF ÷ lines per frame = 5,000 ÷ 128 ≈ 39 frames per second.
Why the others don't fit:
- A: Halves the result.
- B: Doubles the result.
- C: Uses the wrong relationship: frame rate is PRF divided by lines per frame.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF p. 44, frame-rate dependencies; calculation shown above.
Question 22 · Optimize Sonographic Images · Task 3.F
The near and middle parts of the image are evenly bright, but the deep part is uniformly too dark across its full width. What is the best adjustment?
Show answer and explanation
Answer: C. Increase TGC at the deeper depths only
Time gain compensation adjusts amplification by depth to offset attenuation. When only the deep image is dark, fix only the deep image.
Why the others don't fit:
- A: Brightens everything and raises patient exposure.
- B: Brightens the near field too, which was already right.
- D: Affects motion, not brightness.
Question 23 · Optimize Sonographic Images · Task 3.G
A transducer transmits at 2.5 MHz. What is the frequency of the second harmonic used in tissue harmonic imaging?
Show answer and explanation
Answer: A. 5.0 MHz
As the wave travels, nonlinear propagation distorts it and adds harmonics, which are whole-number multiples of the transmitted frequency. The second harmonic is 2 × 2.5 = 5.0 MHz.
Why the others don't fit:
- B: Half the fundamental is not a harmonic.
- C: Is the transmitted (fundamental) frequency.
- D: Is the third harmonic.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slides 21–22; IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 75–78, harmonic imaging; calculation shown above.
Question 24 · Optimize Sonographic Images · Task 3.I
An image is too dark overall. Under ALARA, which control should you try first?
Show answer and explanation
Answer: D. Increase receiver gain
Receiver gain amplifies echoes after they return, so it brightens the image without sending more energy into the patient. ALARA practice keeps output at the lowest setting that gives a diagnostic image and uses receiver gain to build the image before turning output up.
Why the others don't fit:
- A: Raises acoustic exposure.
- B: Lowers penetration, which can make a deep image darker.
- C: Changes lateral resolution and frame rate, not overall brightness.
Source: AIUM, ALARA Principle (reapproved Aug 17, 2026), item 2; IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 47, 53–55, receiver amplification and gain.
Question 25 · Optimize Sonographic Images · Task 3.P
Which mode best documents the rapid motion of a heart valve leaflet over time along one line of sight?
Show answer and explanation
Answer: A. M-mode
M-mode sends a single beam along one line and records echoes along it over time, giving very high temporal resolution for fast motion like valve leaflets.
Why the others don't fit:
- B: Shows the presence of blood flow, not leaflet motion timing.
- C: Adds volume information at the cost of speed.
- D: Shows blood flow direction, not leaflet timing along one line.
Source: Siemens Healthineers, Introduction to Ultrasonography, pp. 23–24, M-mode; IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 43–44, number of lines and frame time.
Question 26 · Optimize Sonographic Images · Task 3.B / 3.D
You add three more transmit focal zones. What is the expected trade-off?
Show answer and explanation
Answer: A. Better lateral resolution over a greater depth range, but a lower frame rate
Lateral resolution is best at a focal zone, so more focal zones keep the beam narrow over more depths. Each zone needs its own transmit pulses, so frame rate drops.
Why the others don't fit:
- B: Axial resolution depends on pulse length, not focusing, and frame rate falls.
- C: Reverses both effects.
- D: Both change.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 38–44, multiple transmit focal zones and frame rate; IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 27, axial pulse-length dependence.
Question 27 · Optimize Sonographic Images · Task 3.M
After persistence (frame averaging) was turned up, fast-moving valve leaflets look smeared. What is the best adjustment?
Show answer and explanation
Answer: A. Reduce persistence
Persistence averages successive frames to smooth speckle and noise. That works on still or slow-moving tissue, but larger motion gets blurred. Lower persistence when motion matters.
Why the others don't fit:
- B: Changes brightness, not frame averaging.
- C: Changes brightness and raises exposure.
- D: Lowers frame rate, which makes motion look worse.
Source: Siemens Healthineers, ACUSON P500 Quick Reference Guide, Release 3.0, p. 35, persistence; BMUS / King's College London, Colin Deane, Artefacts, Part 2 (Lecture 7b), PDF p. 17, speckle and frame averaging.
Question 28 · Optimize Sonographic Images · Task 3.F
Tissue deep to a full urinary bladder looks much brighter than tissue at the same depth beside the bladder. What is the best adjustment to evaluate the deep tissue?
Show answer and explanation
Answer: C. Decrease TGC at that depth
Fluid attenuates less than the surrounding tissue, so tissue behind the bladder receives extra sound and looks too bright (posterior acoustic enhancement). Turning TGC down at that depth reduces the excess brightness, but it also darkens adjacent tissue at the same depth; it does not remove the underlying attenuation difference.
Why the others don't fit:
- A: Makes the problem worse.
- B: Makes the problem worse.
- D: Shows flow. It doesn't fix gray-scale brightness.
Source: BMUS / King's College London, Colin Deane, Artefacts, Part 2 (Lecture 7b), PDF pp. 8–10, enhancement and TGC adjustment; IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 115–117, shadowing/enhancement and limits of gain compensation.
Domain 4: Apply Doppler Concepts (17 questions)
Question 29 · Apply Doppler Concepts · Task 4.A
A patent vessel runs exactly perpendicular to the beam and shows no color fill. What is the best fix?
Show answer and explanation
Answer: D. Steer the color box or angle the transducer so the beam meets the vessel at less than 90°
The Doppler shift is proportional to the cosine of the beam-to-flow angle. At 90° the cosine is zero, so there is no shift to display even though blood is moving. Changing the angle produces a nonzero Doppler shift. No color at 90° does not prove absent flow.
Why the others don't fit:
- A: Adds noise. There is still no shift to detect.
- B: Removes low-frequency signals and makes slow flow harder to see.
- C: Doesn't change the cosine of 90°.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 34; Siemens Healthineers, ACUSON P500 Quick Reference Guide, Release 3.0, p. 46, wall filter.
Question 30 · Apply Doppler Concepts · Task 4.A
Why is the Doppler angle kept at 60° or less for angle-corrected carotid velocity measurements?
Show answer and explanation
Answer: A. Above 60°, the cosine changes steeply, so small angle-correction errors cause large velocity errors
Velocity is calculated by dividing by the cosine of the angle. As the angle approaches 90°, the cosine approaches zero, so a few degrees of error in angle correction produce a big velocity error.
Why the others don't fit:
- B: Aliasing depends on the shift and the PRF, not on angle alone.
- C: Larger angles produce smaller shifts.
- D: Spectral velocity calculations use the angle directly.
Source: Society for Vascular Ultrasound, Extracranial Cerebrovascular Duplex Ultrasound, PDF p. 5, Doppler angle; IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 34.
Question 31 · Apply Doppler Concepts · Task 4.O
Transmitted frequency is 5 MHz, blood velocity is 0.77 m/s, and the Doppler angle is 60°. Using c = 1,540 m/s and cos 60° = 0.5, what is the Doppler shift?
Show answer and explanation
Answer: B. 2.5 kHz
Doppler shift = (2 × f × v × cos θ) ÷ c = (2 × 5,000,000 × 0.77 × 0.5) ÷ 1,540 = 3,850,000 ÷ 1,540 = 2,500 Hz.
Why the others don't fit:
- A: Drops the factor of 2.
- C: Ignores the cos 60° factor.
- D: Doubles instead of halving for the angle.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 34; calculation shown above.
Question 32 · Apply Doppler Concepts · Task 4.F
Pulsed-wave Doppler is running at a PRF of 6 kHz. Which Doppler shift will alias?
Show answer and explanation
Answer: D. 3.6 kHz
The Nyquist limit is PRF ÷ 2 = 3 kHz. Only a shift above 3 kHz exceeds it and wraps around.
Why the others don't fit:
- A: Below 3 kHz.
- B: Below 3 kHz.
- C: Below 3 kHz.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 41; calculation shown above.
Question 33 · Apply Doppler Concepts · Task 4.F
A spectral waveform from a high-velocity arterial segment wraps around below the baseline. The scale is already at its maximum for this depth. Flow is entirely toward the transducer, with shifts from 0 to 4 kHz; PRF is 6 kHz and the centered display spans −3 to +3 kHz. Which next step most directly displays the peaks without wraparound?
Show answer and explanation
Answer: A. Lower (shift) the baseline
Shifting the baseline gives more of the displayed range to the direction of flow. It doesn't raise the PRF or the Nyquist limit itself, but it can display peaks that only slightly exceed one side. Here, shifting the displayed range to −1 to +5 kHz fits the 0 to 4 kHz signal without changing the 6 kHz total span. If that still isn't enough in another case, continuous-wave Doppler has no Nyquist limit.
Why the others don't fit:
- B: Removes low-frequency signal, not high-velocity peaks.
- C: Brightens the trace without changing the velocity range.
- D: A higher transmit frequency produces a larger shift, which makes aliasing worse.
Source: Siemens Healthineers, ACUSON P500 Quick Reference Guide, Release 3.0, p. 46, baseline and scale; ASE, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults, PDF p. 14, Table 1.18, baseline; IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 41; calculation shown above.
Question 34 · Apply Doppler Concepts · Task 4.G
You need the peak velocity of a very fast jet that still aliases in pulsed-wave Doppler after adjusting scale and baseline. Which mode should you use?
Show answer and explanation
Answer: B. Continuous-wave Doppler
Continuous-wave Doppler transmits and receives continuously, so there is no PRF and no Nyquist limit on the velocities it records.
Why the others don't fit:
- A: Shows that flow is present, not its velocity.
- C: Lowering the scale makes aliasing worse.
- D: Is a gray-scale technique.
Source: ASE, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults, PDF p. 14, Section III.B.6, CW Doppler; IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slides 35–38.
Question 35 · Apply Doppler Concepts · Task 4.G
What is the main limitation of continuous-wave Doppler?
Show answer and explanation
Answer: D. It can't tell where along the beam the signal came from (range ambiguity)
CW uses separate transmitting and receiving crystals and records signals in the overlap of the two beams. That's the price of avoiding the pulsed-Doppler Nyquist limit: you can't localize the depth of the signal.
Why the others don't fit:
- A: CW doesn't alias.
- B: CW is a spectral Doppler mode.
- C: CW has no PRF.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slides 35, 38; ASE, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults, PDF pp. 14–15, CW Doppler range ambiguity.
Question 36 · Apply Doppler Concepts · Task 4.C / 4.H
An artery and a vein lie along the same beam line at different depths. To record a spectral waveform only from the artery, you should:
Show answer and explanation
Answer: B. Use pulsed-wave Doppler with the sample gate placed in the artery
Pulsed-wave Doppler records shifts only from the sample gate you place on the image, so it can isolate one vessel at one depth.
Why the others don't fit:
- A: Records both vessels together.
- C: Shows that flow is present, not a vessel-specific waveform.
- D: Removes slow flow but doesn't separate the vessels.
Source: IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides), slide 38; ASE, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults, PDF p. 13, Section III.B.6, PW Doppler.
Question 37 · Apply Doppler Concepts · Task 4.B
The wall filter is set high, and slow venous flow is missing from the spectrum. Why?
Show answer and explanation
Answer: A. The wall filter removes low-frequency Doppler signals, which include slow flow
The wall filter exists to remove low-frequency "thump" from moving vessel walls. Set too high, it removes genuine slow flow too. For venous work, keep it as low as practical.
Why the others don't fit:
- B: The Nyquist limit depends on PRF.
- C: It removes low frequencies. It doesn't amplify them.
- D: It affects spectral Doppler too.
Source: Siemens Healthineers, ACUSON P500 Quick Reference Guide, Release 3.0, p. 46, wall filter; ASE, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults, PDF p. 10, Section III.B.4, wall filters.
Question 38 · Apply Doppler Concepts · Task 4.J
Which statement about conventional nondirectional power Doppler is correct?
Show answer and explanation
Answer: D. It maps total Doppler signal power, is more sensitive to slow flow, and doesn't show direction or velocity
Power Doppler displays the total power of the Doppler signal rather than its mean frequency. It is more sensitive to slow flow than conventional color Doppler and less angle-dependent. Aliasing does not change the total power being displayed. The trade-offs: no direction or velocity, and more flash artifact from motion.
Why the others don't fit:
- A: Power Doppler doesn't show direction.
- B: Aliasing does not change the total Doppler power being displayed.
- C: It gives no velocity.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 97–99, power Doppler; Siemens Healthineers, ACUSON Origin Vascular Applications, software 2.0, slides 42–45 and 49, motion artifacts and conventional/directional power.
Question 39 · Apply Doppler Concepts · Task 4.E / 4.I
On a color map explicitly set so red represents flow toward the transducer, a vein fills with smooth, uniform red, and the scale is well above the flow velocity. What does the red indicate?
Show answer and explanation
Answer: B. Flow in that vein is toward the transducer
Color shows direction relative to the transducer, not artery versus vein. On this map, positive shifts (toward the transducer) are red. Maps can be inverted, so always read the color bar.
Why the others don't fit:
- A: Color Doppler doesn't measure oxygen.
- C: A single red hue does not establish turbulent flow.
- D: With the scale well above the velocity, the flow isn't exceeding the Nyquist limit.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 95–96, color Doppler; Siemens Healthineers, ACUSON P500 Quick Reference Guide, Release 3.0, p. 38, color invert; ASE, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults, PDF p. 17, color maps.
Question 40 · Apply Doppler Concepts · Task 4.S
Slow portal venous flow doesn't fill with color. The color scale is set at 60 cm/s. What is the best adjustment?
Show answer and explanation
Answer: B. Lower the color scale
Match the scale (PRF) to the vessel. The working rule is to use the lowest PRF that doesn't alias. A scale set for fast arterial flow is too insensitive for slow venous flow.
Why the others don't fit:
- A: Makes slow flow even harder to show.
- C: Removes low-frequency signals.
- D: Adds unnecessary imaging depth instead of matching the color scale to slow flow.
Source: Siemens Healthineers, ACUSON Origin Vascular Applications, software 2.0, slides 40, 43–45, scale and slow flow; ASE, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults, PDF p. 17, color Doppler velocity scale.
Question 41 · Apply Doppler Concepts · Task 4.M
A peak jet velocity of 3 m/s is measured, and the velocity before the narrowing is well under 1 m/s. Using the simplified Bernoulli equation, what is the estimated peak instantaneous pressure gradient?
Show answer and explanation
Answer: A. 36 mmHg
Simplified Bernoulli: pressure gradient = 4v² = 4 × 3² = 4 × 9 = 36 mmHg, with v in m/s. The simplification is only reasonable when the upstream velocity is low, which the stem gives you.
Why the others don't fit:
- B: Forgets the 4.
- C: Forgets to square the velocity.
- D: Squares the entire 4v term instead of only the velocity: (4 × 3)².
Source: EACVI/ASE, Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis, PDF p. 7 (printed p. 378), pressure-gradient equations and assumptions; calculation shown above.
Question 42 · Apply Doppler Concepts · Task 4.M
Volume flow is constant. An unbranched vessel narrows from 1.0 cm² to 0.5 cm² in cross-sectional area, and the cross-sectional mean velocity before the narrowing is 40 cm/s. Assuming steady, incompressible flow, what is the mean velocity in the narrowed segment?
Show answer and explanation
Answer: C. 80 cm/s
Continuity: mean velocity₁ × area₁ = mean velocity₂ × area₂. 40 × 1.0 = v × 0.5, so v = 80 cm/s. Halve the area and mean velocity doubles in this constant-flow model.
Why the others don't fit:
- A: Has the relationship backwards.
- B: Ignores the narrowing.
- D: Treats velocity as changing with the square of the area.
Source: OpenStax, College Physics 2e, 12.1 Flow Rate and Its Relation to Velocity, equations 12.4 and 12.7; calculation shown above.
Question 43 · Apply Doppler Concepts · Task 4.K
Just beyond a tight stenosis, the clear window under the systolic peak of the spectral waveform fills in. Gain and sample-gate size are appropriately set. What is the best explanation?
Show answer and explanation
Answer: C. Disturbed flow with a wide range of velocities (spectral broadening)
High-velocity flow through a stenosis can become turbulent. Red cells move at many different speeds at once, which fills in the spectral window. Sample-volume and gain settings can also broaden a spectrum, so broadening alone does not prove stenosis.
Why the others don't fit:
- A: Removes signal near the baseline. It doesn't fill the window.
- B: Plug flow keeps velocities similar, leaving a clear window.
- D: Aliasing wraps the peak to the opposite side of the baseline.
Source: Philips, Lumify Ultrasound System User Manual, PDF p. 143, Acoustic Artifacts: spectral broadening; ASE, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults, PDF pp. 10–11, sample volume and gain.
Question 44 · Apply Doppler Concepts · Task 4.L
You want myocardial wall velocity at the mitral annulus. With standard blood-flow Doppler settings, the wall motion barely registers. Why does tissue Doppler imaging work where those settings don't?
Show answer and explanation
Answer: C. Tissue Doppler uses filtering and gain settings suited to low-velocity, high-amplitude tissue signals
Myocardium moves at centimeters per second and gives high-amplitude echoes. Standard blood-flow settings filter those low-velocity tissue signals out. Tissue Doppler uses filtering and gain settings that retain the tissue signal.
Why the others don't fit:
- A: Raising the wall filter removes exactly the slow tissue signal you want.
- B: Tissue Doppler can use pulsed spectral or color Doppler; it does not require CW to avoid aliasing.
- D: That describes power Doppler.
Source: IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides), PDF pp. 103–104, tissue Doppler; ASE, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults, PDF p. 15, Section III.B.7, Doppler tissue imaging.
Question 45 · Apply Doppler Concepts · Task 4.N
Rapidly alternating color appears directly behind a bright, rough echogenic focus in the kidney. Which artifact is this?
Show answer and explanation
Answer: B. Twinkling artifact
Twinkling is a focus of alternating colors behind a rough reflective object such as a stone. It can mimic turbulent flow and can help flag small stones.
Why the others don't fit:
- A: Aliasing is wraparound in real flow that exceeds the Nyquist limit.
- C: Mirror image duplicates anatomy or flow behind a strong reflector.
- D: Flash comes from tissue or transducer motion over a broad area.
Source: Bacha et al., Relation of Color Doppler Twinkling Artifact and Scale or Pulse Repetition Frequency, Introduction: artifact appearance; Discussion: equipment-dependent settings; Siemens Healthineers, ACUSON Origin Vascular Applications, software 2.0, slide 42, color motion/flash artifact.
Domain 5: Provide Clinical Safety & Quality Assurance (5 questions)
Question 46 · Provide Clinical Safety & Quality Assurance · Task 5.A
An endovaginal exam was performed with a single-use transducer cover that stayed intact. How should the transducer be prepared before the next patient?
Show answer and explanation
Answer: D. Clean it, then perform high-level disinfection, and use a new single-use cover for the next exam
AIUM requires high-level disinfection of internal transducers between patients plus a single-use cover during each exam. Covers can fail without anyone noticing, so an intact-looking cover doesn't change the protocol. Cleaning comes first because soil interferes with disinfection. Use a disinfectant compatible with the manufacturer's instructions.
Why the others don't fit:
- A: Is the standard for external transducers on intact skin.
- B: Is not disinfection.
- C: Makes reprocessing depend on a visible tear.
Question 47 · Provide Clinical Safety & Quality Assurance · Task 5.A
A transducer was used for an abdominal exam on clean, intact skin. What is the appropriate reprocessing?
Show answer and explanation
Answer: B. Cleaning followed by low-level disinfection
External transducers that touch only intact skin are noncritical devices. AIUM calls for cleaning after every use followed by low-level disinfection.
Why the others don't fit:
- A: Is required for internal transducers.
- C: Is for devices that enter sterile tissue.
- D: Removing gel alone does not disinfect the transducer.
Question 48 · Provide Clinical Safety & Quality Assurance · Task 5.C
During a pre-scan check, you find a crack in a transducer's housing near the lens. What should you do?
Show answer and explanation
Answer: D. Remove it from service and report it
AIUM recommends regular inspection of the connector, cable, housing, and lens. Damaged transducers can degrade resolution and penetration, cause Doppler errors, and harbor contamination; one outbreak was traced to a defect in a TEE transducer.
Why the others don't fit:
- A: Keeps a damaged device in use.
- B: Keeps a damaged device in use.
- C: Disinfection does not repair damaged housing.
Source: AIUM, Guidelines for Cleaning and Preparing Ultrasound Transducers (2025 revision), Summary; Sections II and V; Philips, Lumify Ultrasound System User Manual, PDF p. 28, damaged-transducer warning.
Question 49 · Provide Clinical Safety & Quality Assurance · Task 5.B / 5.E
On a routine tissue-mimicking phantom check, a new vertical dark stripe appears that wasn't on the documented baseline image, and it moves with the transducer. What is the appropriate next step?
Show answer and explanation
Answer: A. Document the finding and send the transducer for performance evaluation under your QA procedure
AIUM advises users to check transducer performance regularly by monitoring for element dropout, and notes phantom imaging can reveal degradation. A new, reproducible stripe that follows the transducer is a reason to document and evaluate, not to compensate with settings.
Why the others don't fit:
- B: Masks the problem without fixing it.
- C: Defective transducers can lead to a wrong or missed diagnosis.
- D: Masks the problem without fixing it.
Source: AIUM, Transducer Testing and Repair (revised 2024), recommendations 3 and 5; AIUM, Guidelines for Cleaning and Preparing Ultrasound Transducers (2025 revision), Summary.
Question 50 · Provide Clinical Safety & Quality Assurance · Task 5.F
In a hypothetical study, a new ultrasound protocol is compared against a reference standard in 150 patients: 45 true positives, 5 false negatives, 80 true negatives, and 20 false positives. What is the specificity?
Show answer and explanation
Answer: D. 80.0%
Specificity = true negatives ÷ (true negatives + false positives) = 80 ÷ (80 + 20) = 80%. It answers: of the people without the condition, how many tested negative?
Why the others don't fit:
- A: Is positive predictive value: 45 ÷ (45 + 20).
- B: Is sensitivity: 45 ÷ (45 + 5).
- C: Is negative predictive value: 80 ÷ (80 + 5).
Source: FDA, Statistical Guidance on Reporting Results from Studies Evaluating Diagnostic Tests (2007), Appendix 7.1 and Glossary; calculation shown above.
Score your set
Check each answer against the explanation under the question, or use this key. Count your correct answers per domain.
Count unanswered questions as incorrect. For a percentage, divide your correct answers by 50 and multiply by 100.
| Question | Answer | Domain | Topic |
|---|---|---|---|
| 1 | B | 1 | Range equation |
| 2 | C | 1 | Scattering vs. specular reflection |
| 3 | A | 1 | Specular reflector angle |
| 4 | D | 1 | Reverberation |
| 5 | B | 1 | Acoustic shadowing |
| 6 | C | 1 | Mirror image |
| 7 | A | 1 | Refraction (edge) artifact |
| 8 | D | 1 | Mechanical vs. thermal index |
| 9 | C | 1 | ALARA |
| 10 | C | 1 | Patient identification |
| 11 | B | 1 | Ergonomics |
| 12 | D | 2 | Frequency vs. penetration |
| 13 | A | 2 | Element thickness and frequency |
| 14 | B | 2 | Array selection |
| 15 | C | 2 | Transducer components |
| 16 | C | 3 | Axial resolution calculation |
| 17 | B | 3 | Lateral resolution and focus |
| 18 | C | 3 | Elevational resolution |
| 19 | C | 3 | Temporal resolution |
| 20 | B | 3 | Maximum PRF and depth |
| 21 | D | 3 | Frame rate calculation |
| 22 | C | 3 | TGC |
| 23 | A | 3 | Harmonic imaging |
| 24 | D | 3 | Output power vs. receiver gain |
| 25 | A | 3 | M-mode |
| 26 | A | 3 | Focal zones trade-off |
| 27 | A | 3 | Persistence (frame averaging) |
| 28 | C | 3 | Enhancement and TGC |
| 29 | D | 4 | Doppler angle at 90° |
| 30 | A | 4 | Angle ≤ 60° |
| 31 | B | 4 | Doppler equation |
| 32 | D | 4 | Nyquist limit |
| 33 | A | 4 | Aliasing correction |
| 34 | B | 4 | Continuous-wave Doppler use |
| 35 | D | 4 | Range ambiguity |
| 36 | B | 4 | Pulsed-wave sample gate |
| 37 | A | 4 | Wall filter |
| 38 | D | 4 | Power Doppler |
| 39 | B | 4 | Color map direction |
| 40 | B | 4 | Color scale |
| 41 | A | 4 | Simplified Bernoulli |
| 42 | C | 4 | Continuity |
| 43 | C | 4 | Spectral broadening |
| 44 | C | 4 | Tissue Doppler |
| 45 | B | 4 | Twinkling artifact |
| 46 | D | 5 | Internal transducer reprocessing |
| 47 | B | 5 | External transducer reprocessing |
| 48 | D | 5 | Damaged transducer |
| 49 | A | 5 | Element dropout QA |
| 50 | D | 5 | Specificity |
| Domain | Questions in this set | My correct answers | Weight on the real SPI (v24.1) |
|---|---|---|---|
| 1. Perform Ultrasound Examinations | 11 | ___ / 11 | 23% |
| 2. Manage Ultrasound Transducers | 4 | ___ / 4 | 7% |
| 3. Optimize Sonographic Images | 13 | ___ / 13 | 26% |
| 4. Apply Doppler Concepts | 17 | ___ / 17 | 34% |
| 5. Provide Clinical Safety & Quality Assurance | 5 | ___ / 5 | 10% |
| Total | 50 | ___ / 50 | 100% |
Your result describes these 50 practice questions. It is not an ARDMS scaled score, and it can't predict whether you'll reach the passing score of 555. Domains 2 and 5 have only 4–5 questions here, so one miss swings that row a lot; treat small rows as a hint, not a verdict.
Turn your misses into a review list
A wrong answer is only useful if you know which step went wrong. For every question you missed, and every one you got right by guessing, fill in one row:
| Question | The step or assumption I got wrong | The corrected rule or calculation | What I'll check next |
|---|---|---|---|
| ___ | ___ | ___ | ___ |
| ___ | ___ | ___ | ___ |
| ___ | ___ | ___ | ___ |
- Name the error type. You can sort misses into a few buckets: a formula step (forgetting the round trip, the cosine, or the ÷2), a control mix-up (gain vs. output power, wall filter vs. scale, baseline vs. PRF), or an artifact named from the wrong clue.
- Write the fix in your own words using the explanation and source under the question.
- Start with Doppler if you're unsure where to begin. It's the largest domain on the real exam (34%).
- Come back in a few days and answer your missed questions before opening the explanation. Getting a remembered answer right isn't new evidence; explaining why is.
Formulas used in this test
| What | Formula | Question |
|---|---|---|
| Reflector depth (range equation) | depth = (speed × round-trip time) ÷ 2; about 13 µs per cm in soft tissue | 1 |
| Axial resolution | ½ × spatial pulse length (cycles × wavelength) | 16 |
| Maximum PRF for a depth | PRFmax = c ÷ (2 × depth) | 20 |
| Frame rate | PRF ÷ lines per frame, for one pulse per scan line, one transmit focal zone, and no processing overhead | 21 |
| Doppler shift | (2 × f × v × cos θ) ÷ c | 31 |
| Nyquist limit | PRF ÷ 2 | 32 |
| Simplified Bernoulli | estimated peak instantaneous gradient (mmHg) = 4v² (v is peak jet velocity in m/s; upstream velocity low) | 41 |
| Continuity | mean velocity₁ × cross-sectional area₁ = mean velocity₂ × cross-sectional area₂, for constant incompressible volume flow | 42 |
| Specificity | TN ÷ (TN + FP) × 100% | 50 |
| Sensitivity | TP ÷ (TP + FN) × 100% | 50 |
What this practice set covers
The SPI exam is built from the SPI Content Outline, Version 24.1 (PDF), which lists five domains and their weights. We matched those weights as closely as whole questions allow.
| Official domain | Official weight | Questions here | Share of this set |
|---|---|---|---|
| Perform Ultrasound Examinations | 23% | 11 | 22% |
| Manage Ultrasound Transducers | 7% | 4 | 8% |
| Optimize Sonographic Images | 26% | 13 | 26% |
| Apply Doppler Concepts | 34% | 17 | 34% |
| Provide Clinical Safety & Quality Assurance | 10% | 5 | 10% |
Fifty questions sample the outline; they don't cover every task statement. Contrast agents, 3D/4D acquisition, and several processing controls get little or no space here, and that doesn't mean they're unimportant. These are also text-only multiple-choice questions; this set does not practice interpreting ultrasound images.
The real SPI exam: quick facts
| Exam fact | Official detail |
|---|---|
| Who gives it | ARDMS (part of Inteleos), delivered by Pearson VUE |
| Why it matters | Every ARDMS credential (RDMS, RDCS, RVT, RMSKS) requires meeting eligibility requirements and passing SPI plus a matching specialty exam under the calendar-year 5-year rule, in either order |
| Length | About 110 multiple-choice questions over two hours; the official page also lists a five-minute survey |
| Blueprint | SPI Content Outline v24.1, five domains (weights in the table above) |
| Passing score | 555 or higher on a 300–700 scaled score. It isn't a percentage and isn't curved |
| Fee | $275, which includes a $100 non-refundable processing fee. Test centers outside the US, Canada, or Mexico add a $50 non-refundable fee |
| Results | Score report at the test center after the exam and in your Pearson account; posted to your Inteleos portal within one week |
| If you don't pass | You can reapply after 3 days, but you must wait 60 days before retesting |
Sources: Inteleos SPI exam page, Inteleos exam fee schedule (PDF), Inteleos passing standard, Pearson ARDMS credentials and examinations.
Last verified October 28, 2026: exam format, scoring, fee, results, retake timing, credentialing rule, historical pass-rate figures, and content outline version, checked against the official sources linked on this page.
Questions people ask
Are these real SPI questions? No. We wrote every question for practice and tied each explanation to a published teaching source. Using unauthorized exam material or review courses claiming to include live questions violates Inteleos exam-security rules and can lead to invalidated scores or revoked credentials.
Is this a full-length SPI practice test? No. It's a 50-question set weighted like the real exam, which has about 110 questions. If you want a timed attempt, an optional 55-minute target is for this practice set only; it is not an official SPI time limit.
What percentage do I need to pass the SPI? The official scoring page gives no fixed percent-correct cutoff. ARDMS reports a scaled score from 300 to 700, and 555 passes. Points don't convert to a percent correct, which is why we don't convert your result here (passing standard).
How many people pass the SPI? The most recent year shown on the Inteleos SPI page, 2023, lists a 72% pass rate for first-time takers and 65% overall (Inteleos SPI exam page).
Next steps
- Re-do your misses using the review list above, then take the whole set again in one sitting.
- Read the task statements in the SPI Content Outline v24.1 (PDF).
- See the testing interface through the free sample-test tutorial listed on Pearson's ARDMS page.
- Check current requirements and apply on the Inteleos SPI exam page.
Sources
Official exam information
- Inteleos. Sonography Principles and Instrumentation (SPI) exam page
- ARDMS. SPI Examination Content Outline, Version 24.1 (PDF)
- Inteleos. Exam Fee Schedule (PDF)
- Inteleos. Passing Standard
- Inteleos. 5-Year Rule
- Inteleos. Exam Security
- Pearson. ARDMS Examination Testing
Teaching references used in the explanations
- IAEA, Diagnostic Radiology Physics, Ch. 12 Physics of Ultrasound (slides)
- AIUM, ALARA Principle (reapproved Aug 17, 2026)
- AIUM, Statement on Biological Effects of Ultrasound in Vivo (2021)
- AIUM, Guidelines for Cleaning and Preparing Ultrasound Transducers (2025 revision)
- AIUM, Transducer Testing and Repair (revised 2024)
- AIUM, Statement on Preventing Work-related Musculoskeletal Disorders (Jun 15, 2026)
- FDA, Statistical Guidance on Reporting Results from Studies Evaluating Diagnostic Tests (2007)
- Joint Commission, 2026 National Patient Safety Goals for the Ambulatory Health Care Program
- IAEA, Diagnostic Radiology Physics, Ch. 13 Ultrasound Imaging (slides)
- BMUS / King's College London, Colin Deane, Ultrasound Interactions (Lecture 3)
- BMUS / King's College London, Colin Deane, Transducers and Beamforming (Lecture 4)
- BMUS / King's College London, Colin Deane, Artefacts, Part 1 (Lecture 7a)
- BMUS / King's College London, Colin Deane, Artefacts, Part 2 (Lecture 7b)
- Siemens Healthineers, ACUSON P500 Quick Reference Guide, Release 3.0
- Siemens Healthineers, Introduction to Ultrasonography
- WHO Collaborating Centre for Patient Safety Solutions, Patient Identification
- American College of Emergency Physicians, Sonoguide: Lung
- Siemens Healthineers, ACUSON Origin Vascular Applications, software 2.0
- Philips, Lumify Ultrasound System User Manual
- Society for Vascular Ultrasound, Extracranial Cerebrovascular Duplex Ultrasound
- ASE, Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults
- EACVI/ASE, Recommendations on the Echocardiographic Assessment of Aortic Valve Stenosis
- OpenStax, College Physics 2e, 12.1 Flow Rate and Its Relation to Velocity
- Bacha et al., Relation of Color Doppler Twinkling Artifact and Scale or Pulse Repetition Frequency
By the Castleport Test Prep Editorial Team.
How we made this page. The Castleport Test Prep Editorial Team wrote these questions and checked each explanation against the teaching source cited beneath it, and checked the official exam facts against the ARDMS/Inteleos pages listed above on October 28, 2026. AI-assisted tools were used in developing and auditing this page. This is editorial source-checking, not review by a credentialed sonographer. Read more about how we develop and check practice material.
Independence and trademarks. Castleport Test Prep is an independent publisher. We are not affiliated with, endorsed by, or approved by the American Registry for Diagnostic Medical Sonography (ARDMS) or Inteleos. These original practice questions are unofficial and are not actual exam questions. Exam and credential names are used only to identify their subjects, and trademarks belong to their respective owners. Practicing here does not guarantee a passing score or a credential.