Castleport Test Prep

Free ARRT Mammography Practice Test: 50 Questions With Explanations

50 original practice questions mapped to ARRT's current Mammography content specifications (in effect since September 1, 2025). Pick your answer, then open the explanation under each question. Unofficial practice, free, no signup — these are not ARRT exam questions.

Practice questions

Question 1

Procedures · Positioning

You measure the posterior nipple line (PNL) on a patient's right MLO at 11.0 cm and on the right CC at 9.4 cm. What does this tell you?
Show answer and explanation for Question 1

Answer: B. The ACR positioning criterion is that the PNL on the CC falls within 1 cm of the PNL on the MLO. Here the CC is 1.6 cm short, so posterior tissue was most likely left on the chest wall. Fix it by raising the inframammary fold before setting receptor height and drawing posterior tissue forward before compression.

Why not the others: A invents a 2 cm allowance; the standard is 1 cm. C has it backwards — a longer MLO PNL shows the MLO reached deep tissue. D misses the point of the rule: the PNL comparison exists so two different projections can be checked for the same depth.

Source: ACR Learning Network, Mammography Positioning Review Guidelines; ACR Clinical Image Review Sheet.

Check answer gives practice feedback on one question and opens its explanation. Nothing is saved or totaled; keep your tally by hand in the Score your set table. A check made after you have already opened that answer is labeled assisted.

Want to read or print every answer at once? Show all 50 answers

All 50 answers are open. Return to the normal view

Question 2

Patient Care · Patient education

A 47-year-old patient at average risk asks how often the American Cancer Society recommends a screening mammogram for someone her age. Which answer matches the ACS guideline?
Show answer and explanation for Question 2

Answer: A. ACS recommends yearly mammograms for average-risk women 45 to 54. Women 40 to 44 have the option to start yearly screening, and women 55 and older can switch to every other year or keep going yearly.

Why not the others: B is the age-55-and-older option, not the 45–54 recommendation. C matches no ACS age band. D describes diagnostic care, not screening.

Exam tip: ARRT's outline names ACS and ACR guidelines specifically. Other organizations publish different schedules, so answer for the organization the question names.

Source: American Cancer Society, Recommendations for the Early Detection of Breast Cancer (last revised July 23, 2026).

Question 3

Image Production · Quality control

A weekly ACR digital mammography phantom image scores 3 fibers, 4 speck groups, and 3 masses. A bright horizontal band crosses the image and partly hides two of the speck groups. What is the result?
Show answer and explanation for Question 3

Answer: C. The ACR digital phantom passes only with at least 2 fibers, 3 speck groups, and 2 masses and no clinically significant artifacts. An artifact that obscures test objects is an automatic fail, no matter how good the object scores look.

Why not the others: A ignores the artifact half of the criterion. B and D let a failed unit keep imaging patients; a failed phantom needs corrective action before further clinical exams on that unit (see Question 21).

Source: ACR Digital Mammography Phantom Scoring Key (performance criteria and artifact fail rules).

Question 4

Procedures · Localization

A radiologist describes a mass in the right breast at 10 o'clock. Which quadrant is it in?
Show answer and explanation for Question 4

Answer: D. Breast clock positions are read as if you are facing the patient. On the right breast, 9 o'clock is lateral (outer) and 3 o'clock is medial (inner), so 10 o'clock is upper outer. On the left breast the same 10 o'clock would be upper inner.

Why not the others: A is the left-breast answer — the classic trap. B and C are below the nipple, but 10 o'clock sits above it.

Source: ARRT Mammography Content Specifications (localization terminology: clock position, quadrants); UCLA Health, Breast Lesion Localization.

Question 5

Patient Care · Pre-exam instructions

Why are patients asked to remove deodorant and antiperspirant before a mammogram?
Show answer and explanation for Question 5

Answer: B. Many antiperspirants contain aluminum compounds. Residue from deodorant, antiperspirant, powder, lotion, or similar products can appear as white spots on a mammogram and make the images harder to interpret.

Why not the others: A and C describe effects these products don't have in any meaningful way. D isn't the reason; the issue is that residue can appear on the mammogram.

Sources: American Cancer Society, Tips for Getting a Mammogram; RadiologyInfo.org, Mammography.

Question 6

Procedures · Additional views

A diagnostic workup calls for a 90-degree lateral of a finding that the CC shows in the medial breast. Which projection puts the finding closest to the image receptor?
Show answer and explanation for Question 6

Answer: B. In an LM, the beam enters the lateral side and exits the medial side, so the medial breast rests against the receptor. Less object-to-image distance means less geometric blur for a medial finding. Use the ML for lateral findings.

Why not the others: A places the lateral breast against the receptor. C is an oblique, not a true 90-degree lateral. D is a craniocaudal variation aimed at lateral tissue.

Source: IARC Atlas of Breast Cancer Early Detection, 90-degree lateral views.

Question 7

Image Production · Dose

Under MQSA, the average glandular dose for a single craniocaudal view of an FDA-accepted phantom simulating a standard breast must not exceed:
Show answer and explanation for Question 7

Answer: D. The federal limit is 3.0 mGy (0.3 rad) per exposure, measured with the facility's clinical technique for a standard breast. Digital and tomosynthesis systems are held to the same maximum.

Why not the others: A, B, and C aren't the regulatory limit. Note that the limit is a ceiling for a phantom measurement, not a description of every patient's dose.

Source: 21 CFR 900.12(e)(5)(vi) and (e)(6).

Question 8

Procedures · Pathology

A 52-year-old patient reports that over a few weeks her left breast became red across more than a third of its surface, swollen, and warm, with thickened skin that looks like an orange peel. No discrete lump is felt. Which malignancy fits this presentation best?
Show answer and explanation for Question 8

Answer: A. Inflammatory breast cancer develops quickly as cancer cells block lymph vessels in the skin. That produces redness over at least a third of the breast, edema, and pitted "orange peel" skin, often without a breast lump. It is always at least locally advanced at diagnosis.

Why not the others: B is confined to the nipple and areola. C usually causes no symptoms or mammographic signs on its own. D presents as a mass, which this patient doesn't have.

Source: American Cancer Society, Inflammatory Breast Cancer (last revised June 24, 2026).

Question 9

Procedures · Imaging examinations

A 58-year-old patient with a newly palpable lump in her left breast had a normal screening mammogram 11 months ago. Under MQSA's definitions, which exam fits her?
Show answer and explanation for Question 9

Answer: C. MQSA defines a screening mammogram as routine views of an asymptomatic patient. A diagnostic mammogram uses individualized views for a patient with breast symptoms, physical signs, or an abnormal screening result. A new palpable lump makes her symptomatic.

Why not the others: A and B treat a symptomatic patient as asymptomatic. D delays evaluation of a new symptom.

Source: 21 CFR 900.12(f)(1).

Question 10

Image Production · Quality control

During the compression force test, the unit's initial power-driven compression reaches 52 lb (about 231 N) before stopping. What does this mean?
Show answer and explanation for Question 10

Answer: D. The unit must be able to deliver at least 111 N (25 lb), and the maximum force from the initial power drive must fall between 111 N (25 lb) and 200 N (45 lb). A failed compression device test requires correction before further exams.

Why not the others: A checks only the minimum. B confuses clinical tolerance with an equipment limit. C is irrelevant; the limit protects every patient.

Source: 21 CFR 900.12(e)(4)(iii) and (e)(8)(ii)(A).

Question 11

Procedures · Pathology (BI-RADS)

Which calcification morphology does BI-RADS classify as suspicious?
Show answer and explanation for Question 11

Answer: D. Fine pleomorphic calcifications are in the suspicious group, along with amorphous and coarse heterogeneous forms. The others are typically benign: coarse calcifications (often from involuting fibroadenomas), vascular calcifications, and milk of calcium, which layers in tiny cysts.

Why not the others: A, B, and C are all on ARRT's typically benign list.

Source: ARRT Mammography Content Specifications (characteristics of calcifications: typically benign vs. suspicious morphology); Radiology Assistant, BI-RADS for Mammography.

Question 12

Patient Care · Patient results

A patient's mammogram receives a final assessment of "Suspicious." Under MQSA, how soon must the facility give her a lay-language summary of the report?
Show answer and explanation for Question 12

Answer: B. For "Suspicious" or "Highly Suggestive of Malignancy," the lay summary is due within 7 calendar days of the final interpretation. All other results follow the general 30-day rule.

Why not the others: D is the standard deadline, not the faster one for these assessments. A and C aren't MQSA deadlines for lay summaries (15 days is the deadline for transferring records on request).

Source: 21 CFR 900.12(c)(2) and (c)(4)(ii).

Question 13

Procedures · Positioning

Which finding best indicates a well-positioned MLO?
Show answer and explanation for Question 13

Answer: D. On a good MLO, the pectoral muscle reaches the PNL or lower, is wider at the top, and has a convex anterior border, showing the patient was relaxed and posterior tissue was included. The inframammary fold should be open and the breast lifted, not sagging.

Why not the others: A and B describe classic deficiencies. C fails the expectation that the nipple is in profile on at least one view of each breast.

Source: ACR Learning Network, Mammography Positioning Review Guidelines.

Question 14

Image Production · MQSA recordkeeping

A patient had a single mammogram at your facility and never returned. Absent a longer state requirement, how long must the facility keep her original images and report?
Show answer and explanation for Question 14

Answer: C. MQSA requires the longest of: at least 5 years, at least 10 years if the patient has no further mammograms at the facility, or any longer period set by state or local law. With no later exams, the 10-year rule applies.

Why not the others: B applies when the patient keeps coming back. A is the retention period for records of departed staff. D describes QC records, not patient images.

Source: 21 CFR 900.12(c)(4)(i).

Question 15

Procedures · Localization (triangulation)

A finding sits at the level of the nipple on the MLO. On the 90-degree ML, it projects clearly higher. Where is it most likely located?
Show answer and explanation for Question 15

Answer: C. Compared with the MLO, medial findings move up on a true lateral and lateral findings move down; central findings barely move. The memory aid is "muffins rise, lead falls" (medial rises, lateral falls).

Why not the others: A and D are lateral and would fall. B is central and would stay at about the same height.

Source: Radiopaedia, Triangulation; IARC Atlas, 90-degree lateral views.

Question 16

Patient Care · Risk assessment

Under ACS guidelines, which patient is in the high-risk group for whom yearly breast MRI plus a mammogram is recommended, typically starting at age 30?
Show answer and explanation for Question 16

Answer: A. ACS lists radiation therapy to the chest before age 30 among the high-risk criteria for annual MRI plus mammography.

Why not the others: ACS says the evidence is insufficient to recommend for or against MRI based on dense breasts alone (B) or a history of ALH (D). For lifetime risk below 15% (C), ACS recommends against MRI screening.

Source: American Cancer Society, Recommendations for the Early Detection of Breast Cancer (last revised July 23, 2026).

Question 17

Image Production · Technique

When you set up a magnification view, which equipment change is required?
Show answer and explanation for Question 17

Answer: A. Magnification lifts the breast away from the receptor, and that air gap reduces scatter, so the grid is removed. Magnification also enlarges focal-spot blur, so the small focal spot is used to keep the image sharp. MQSA requires magnification systems to work without the grid and to offer at least one magnification factor from 1.4 to 2.0.

Why not the others: B adds dose with no benefit given the air gap. C trades sharpness for speed — the wrong trade for magnification. D isn't how magnification is achieved; the breast is raised on a platform.

Source: 21 CFR 900.12(b)(4)(iii) and (b)(6).

Question 18

Procedures · BI-RADS density · Ordering question

Put these four breast density statements in order from least dense to most dense. (Write your answer as a sequence of letters.)

  • A. "The breasts are extremely dense, which lowers the sensitivity of mammography."
  • B. "The breasts are almost entirely fatty."
  • C. "The breasts are heterogeneously dense, which may obscure small masses."
  • D. "There are scattered areas of fibroglandular density."

Your sequence, least to most dense: 1st ____ 2nd ____ 3rd ____ 4th ____ (write the letters, then open the answer to compare).

Show answer and explanation for Question 18

Answer: B → D → C → A. These are the four density statements every mammography report must now use. BI-RADS labels the same four categories a, b, c, and d, in this order. The first two count as "not dense" for the patient's lay summary; the last two count as "dense."

Common mistake: Swapping D and C. "Scattered areas of fibroglandular density" sounds dense, but it's the second-least-dense category. "Heterogeneously dense" is where tissue starts to hide small masses.

Score it: count it correct only if the whole sequence is right.

Sources: 21 CFR 900.12(c)(1)(vi) and (c)(2)(iii)–(iv); American Cancer Society, Breast Density and Your Mammogram Report.

Question 19

Procedures · Patient variance (implants)

For the implant-displaced (ID) views on a patient with breast implants, the technologist should:
Show answer and explanation for Question 19

Answer: B. In ID views, the implant is displaced posteriorly and the breast tissue in front of it is pulled forward and compressed normally, which improves tissue visualization. They supplement the implant-included views, which use limited compression with the implant in the field. MQSA requires facilities to ask about implants before the exam and to use views that maximize visualization of breast tissue.

Why not the others: A risks implant damage and isn't the technique. C applies only to implant-included views. D defeats the purpose of ID views.

Source: 21 CFR 900.12(g); ARRT Mammography Content Specifications (patient variance: breast augmentation; implant displaced view).

Question 20

Patient Care · Patient communication

A patient called back after a screening mammogram asks you, "Does this mean I have cancer?" Which response is best?
Show answer and explanation for Question 20

Answer: D. It explains why additional imaging happens, stays truthful, and leaves interpretation to the radiologist and the patient's clinician, whose role is to explain findings.

Why not the others: A frightens the patient and implies a conclusion that hasn't been reached. C offers reassurance no one can promise yet. B is outside the technologist's role — interpretation belongs to the interpreting physician.

Source: ARRT Mammography Content Specifications (patient results: reasons for additional imaging; clinician's role in explaining results).

Question 21

Image Production · Quality control

The weekly phantom image fails on a digital mammography unit. When must corrective action be completed?
Show answer and explanation for Question 21

Answer: A. For digital systems, MQSA ties QC to the manufacturer's program (or an approved alternative), and failures of these tests require corrective action before further examinations with the failed component.

Why not the others: B is the timeline for certain other, less critical tests. C and D leave a failed unit in clinical use.

Source: 21 CFR 900.12(e)(6) and (e)(8)(ii)(A).

Question 22

Procedures · Internal anatomy

An infiltrating tumor that pulls on the breast's suspensory ligaments can cause skin dimpling or retraction. Those ligaments are the:
Show answer and explanation for Question 22

Answer: A. Cooper ligaments are fibrous bands running from the deep fascia through the breast to the skin. When a tumor shortens or tethers them, the overlying skin can dimple — one of the skin changes ARRT lists among signs and symptoms.

Why not the others: B are areolar glands. C are dilated duct segments behind the nipple. D is a fascial layer, not the suspensory ligaments.

Source: ARRT Mammography Content Specifications (internal anatomy: Cooper ligaments; signs and symptoms: dimpling).

Question 23

Procedures · Additional views

Which view is designed to show the lateral posterior breast, including tissue toward the axilla, in a craniocaudal projection?
Show answer and explanation for Question 23

Answer: C. The XCCL rotates the patient so the lateral breast is pulled onto the receptor in a craniocaudal projection, capturing lateral tissue a standard CC can miss.

Why not the others: A shows posteromedial tissue. B targets the axillary tail but uses an oblique, not a craniocaudal, projection. D is a true lateral.

Source: ARRT Mammography Content Specifications (views: XCCL, CV, AT, LM).

Question 24

Image Production · Quality assurance

The digital detector on a mammography unit is replaced after a failure. What must happen before the unit is used on patients again?
Show answer and explanation for Question 24

Answer: C. MQSA requires a mammography equipment evaluation whenever major components are changed or repaired. All problems must be corrected before the equipment goes back into service.

Why not the others: A is part of routine QC, not a substitute for the evaluation. B leaves a repaired unit unevaluated. D doesn't satisfy the physicist requirement.

Source: 21 CFR 900.12(e)(10).

Question 25

Patient Care · Treatment options

A patient's pathology shows HER2-positive invasive ductal carcinoma. Which treatment category targets that tumor characteristic?
Show answer and explanation for Question 25

Answer: B. HER2-positive cancers overproduce the HER2 protein, and anti-HER2/neu therapies are designed to target it. Hormone therapy (A) is matched to hormone receptor status — estrogen receptor (ER) and progesterone receptor (PR) positive tumors.

Why not the others: C is preventive surgery, not targeted treatment. D is a staging procedure for the lymph nodes.

Source: ARRT Mammography Content Specifications (breast cancer treatment options: hormone receptor status, anti-HER2/neu therapy).

Question 26

Procedures · Patient variance

A breastfeeding patient is scheduled for a diagnostic mammogram. What instruction best improves image quality and comfort?
Show answer and explanation for Question 26

Answer: B. The ACR and RSNA say breast imaging during lactation follows the same approach as for anyone else. Because milk-filled tissue is denser, nursing or pumping just before the exam may improve the mammogram's accuracy, and an emptier breast is usually easier to compress comfortably.

Why not the others: A and D delay needed imaging and interrupt feeding for no reason. C has no effect on breast density.

Sources: RadiologyInfo.org (ACR/RSNA), Breast Imaging of Pregnant and Lactating Women; ARRT content specifications (patient variance: lactating breast).

Question 27

Procedures · Internal anatomy

The extralobular terminal duct plus the lobule (intralobular terminal ducts and acini) form which structure, where most breast cancers are thought to begin?
Show answer and explanation for Question 27

Answer: D. The TDLU is the breast's basic functional unit. ARRT's outline breaks it into exactly these parts: the extralobular terminal duct, the intralobular terminal duct, and the acinus.

Why not the others: A is near the nipple. B is the fat plane behind the glandular tissue. C is on the areola.

Source: ARRT Mammography Content Specifications (internal anatomy: TDLU components).

Question 28

Image Production · Quality control

What is the purpose of the mammographer's compression thickness indicator test?
Show answer and explanation for Question 28

Answer: A. The compression thickness indicator test compares a measured object of known thickness with the thickness displayed by the mammography unit. Its objective is to verify that the indicated compressed thickness is within tolerance.

Why not the others: B is the compression force test. C is part of paddle/alignment evaluation, not thickness-indicator accuracy. D is a medical physicist kVp test.

Source: ACR 2018 Digital Mammography Quality Control Manual, Compression Thickness Indicator.

Question 29

Procedures · Additional views

A finding lies deep in the posteromedial breast near the sternum. Which view best demonstrates it?
Show answer and explanation for Question 29

Answer: A. The cleavage (valley) view images both breasts' medial tissue together, pulling posteromedial tissue near the sternum onto the receptor.

Why not the others: B and C target lateral tissue. D rolls tissue layers to separate overlap; it doesn't reach farther medially.

Source: ARRT Mammography Content Specifications (views: cleavage, XCCL, axillary tail, rolled).

Question 30

Patient Care · Risk factors

Which breast cancer risk factor does ARRT's outline classify as social rather than inherent?
Show answer and explanation for Question 30

Answer: C. ARRT groups lifestyle factors such as tobacco use, body weight, and excessive alcohol use as social risk factors, along with access to care and hormone use.

Why not the others: A, B, and D are on ARRT's inherent list (breast tissue density, genetic risk, previous chest radiation).

Source: ARRT Mammography Content Specifications (patient assessment: inherent vs. social risk factors).

Question 31

Image Production · Image identification

Under MQSA, where must the view and laterality marker appear on a mammographic image?
Show answer and explanation for Question 31

Answer: D. MQSA requires view and laterality near the axilla, using standardized codes, placed so they don't obscure anatomy.

Why not the others: A, B, and C aren't the required location.

Source: 21 CFR 900.12(c)(5)(iii).

Question 32

Procedures · BI-RADS assessment

Which MQSA final assessment category describes a finding that has a high probability of being benign?
Show answer and explanation for Question 32

Answer: D. "Probably Benign" is defined as findings with a high probability of being benign. "Benign" is a normal result with definitely benign findings present.

Why not the others: A means nothing to comment on. B is a confident benign call, not a probability. C means the workup isn't finished.

Source: 21 CFR 900.12(c)(1)(iv)–(v).

Question 33

Procedures · Additional views

A possible asymmetry appears on a screening CC but isn't clearly seen on the MLO. Which additional view is most useful for deciding whether it's real tissue or overlapping normal tissue?
Show answer and explanation for Question 33

Answer: C. Focal spot compression spreads overlapping tissue in a small area. A summation of normal tissue tends to disperse, while a true lesion persists.

Why not the others: A is for implant patients. B changes contrast but doesn't separate overlapping structures. D targets posteromedial tissue, not overlap.

Source: ARRT Mammography Content Specifications (views: spot compression).

Question 34

Procedures · Localization (rolled views)

On a CC view rolled with the superior breast rotated medially (RM), a finding shifts medially compared with its position on the standard CC. Where is it?
Show answer and explanation for Question 34

Answer: A. Rolling moves the top and bottom of the breast in opposite directions. If the superior breast is rolled medially, a superior finding moves medially; an inferior finding moves laterally.

Why not the others: B would shift the opposite way. C and D aren't supported by movement alone.

Source: UCLA Health, Breast Lesion Localization (rolled CC views).

Question 35

Procedures · Pathology categories · Select all that apply

ARRT's outline sorts breast pathology into benign, benign with upgrade potential, and malignant groups. Which of these does it place in the benign with upgrade potential group? Select all that apply.
Show answer and explanation for Question 35

Answer: A, C, and E. ARRT places radial scar, atypical ductal hyperplasia (ADH), and phyllodes tumor in its 'benign with upgrade potential' group. The same group also includes LCIS, ALH, papilloma with atypia, and flat epithelial atypia.

Why not the others: Fibroadenoma and lipoma are listed by ARRT in the benign pathology group, not the benign-with-upgrade-potential group.

Source: ARRT Mammography Content Specifications, p. 7 (benign; benign with upgrade potential; malignant pathology).

Question 36

Image Production · Medical outcomes audit

In the MQSA medical outcomes audit, "recall rate" means:
Show answer and explanation for Question 36

Answer: D. That's MQSA's definition. The audit must be analyzed at least once every 12 months.

Why not the others: A is positive predictive value. C is cancer detection rate. B is a repeat rate, which belongs to QC, not the outcomes audit.

Source: 21 CFR 900.12(f)(1)–(2).

Question 37

Procedures · Interventional procedures

When is the time-out performed for a stereotactic breast biopsy?
Show answer and explanation for Question 37

Answer: B. The time-out is the final pause immediately before the invasive procedure starts. The team actively confirms, at minimum, the correct patient, procedure, and site or side before proceeding.

Why not the others: A is too early to serve as the final verification. C and D occur after the point when the time-out is meant to prevent a wrong-patient, wrong-procedure, or wrong-site event.

Sources: The Joint Commission, Universal Protocol; ARRT Mammography Content Specifications (interventional procedures: time-out procedure).

Question 38

Patient Care · Breast density reporting

A patient's report says "There are scattered areas of fibroglandular density." What must her lay summary tell her about her breast tissue?
Show answer and explanation for Question 38

Answer: B. Under the federal rule effective September 10, 2024, "almost entirely fatty" and "scattered areas of fibroglandular density" both get the not dense statement in the lay summary. "Heterogeneously dense" and "extremely dense" get the dense statement, which also notes that other tests may help some people with dense tissue.

Why not the others: A is the trap — "fibroglandular density" sounds dense but falls in the not-dense group. C has no basis. D is wrong; the federal rule requires the density statement in the patient's lay summary.

Source: 21 CFR 900.12(c)(2)(iii)–(iv).

Question 39

Procedures · Procedure-associated imaging

After a stereotactic vacuum-assisted biopsy aimed at calcifications, why are the core specimens imaged?
Show answer and explanation for Question 39

Answer: D. Specimen radiography verifies that the tissue cores contain the calcifications targeted by the stereotactic biopsy.

Why not the others: A and C aren't what specimen imaging measures. B is determined by pathology, not by the specimen radiograph.

Source: ACR, Clinical Image Testing: Stereotactic Breast Biopsy (specimen image must demonstrate calcium).

Question 40

Procedures · Malignant pathology

A patient has crusted, scaly, red skin on one nipple and areola that hasn't improved with eczema treatment. If this is Paget disease of the breast, which statement is true?
Show answer and explanation for Question 40

Answer: B. Paget disease is a rare cancer involving the nipple and areola skin. In most cases it occurs along with underlying DCIS or invasive carcinoma in the same breast.

Why not the others: A is wrong — it is a type of breast cancer. C overstates it; imaging may or may not show an underlying mass. D is incorrect; it usually affects one breast.

Source: American Cancer Society, Paget Disease of the Breast (last revised June 24, 2026).

Question 41

Image Production · Quality assurance

For a digital mammography unit, which source does MQSA tie the facility's equipment QC program to?
Show answer and explanation for Question 41

Answer: B. For modalities other than screen-film, MQSA requires a QA program substantially the same as the one recommended by the image receptor manufacturer, with dose kept within the screen-film limit. FDA can approve alternative standards for these requirements.

Why not the others: A applies to screen-film units. C isn't a standard. D is one piece, not the whole program.

Source: 21 CFR 900.12(e)(6).

Question 42

Procedures · Patient variance

A patient's breast is too large to fit on the largest image receptor in the CC projection. What is the best approach?
Show answer and explanation for Question 42

Answer: A. Mosaic or tiled images, with overlap between them, ensure no tissue is left off.

Why not the others: B and D leave tissue unimaged. C can't fit more tissue onto the receptor and degrades compression.

Source: ARRT Mammography Content Specifications (patient variance: extremely large/small breast — mosaic, tiling, paddle selection).

Question 43

Procedures · Interventional procedures

After a biopsy marker (clip) is placed, a post-procedure mammogram confirms its deployment and position. Which MQSA assessment category is reserved for this exam?
Show answer and explanation for Question 43

Answer: D. MQSA added this category specifically for mammograms that confirm the deployment and position of a breast tissue marker.

Why not the others: A is for known cancers being evaluated before definitive therapy. B and C are unrelated to marker confirmation.

Source: 21 CFR 900.12(c)(1)(iv)(G).

Question 44

Procedures · Patient variance

A patient has a pacemaker in the left upper chest that limits the standard left MLO. A finding in the medial left breast needs a lateral projection. Which option fits best?
Show answer and explanation for Question 44

Answer: A. A 90-degree lateral is useful when a pacemaker or port limits the MLO, and the LM is the right choice for a medial finding because it places the medial breast against the receptor.

Why not the others: B leaves the finding unevaluated. C targets lateral tissue. D risks the device and the patient.

Source: IARC Atlas, 90-degree lateral views; ARRT Mammography Content Specifications (patient variance: implanted devices).

Question 45

Patient Care · Patient education

A patient asks whether monthly breast self-exams can replace her mammograms. Which response matches ACS guidance?
Show answer and explanation for Question 45

Answer: C. ACS says breast self-exams and clinical breast exams aren't sufficient for screening and are unlikely to find cancer early in average-risk people. It does encourage people to know what's normal for them and report changes promptly.

Why not the others: A and B overstate what physical exams can do. D goes beyond ACS guidance, which still supports breast awareness.

Source: American Cancer Society, Recommendations for the Early Detection of Breast Cancer (CBE and BSE section).

Question 46

Procedures · External anatomy

Which are the sebaceous glands of the areola that help lubricate and protect the nipple?
Show answer and explanation for Question 46

Answer: C. Montgomery glands are the areolar glands. Morgagni tubercles are the small raised bumps on the areola where those glands open — related, but the bumps rather than the glands.

Why not the others: A is the near-miss described above. B are suspensory ligaments. D are milk-producing units inside the lobules.

Source: ARRT Mammography Content Specifications (external anatomy: areola — Morgagni tubercles, Montgomery glands).

Question 47

Procedures · Interventional procedures

Before a stereotactic core biopsy, which part of the patient's history is most important to confirm and document?
Show answer and explanation for Question 47

Answer: C. Medication history matters before a needle biopsy because aspirin, blood thinners, and some herbal supplements can increase bleeding risk. ARRT also lists anticoagulation and allergies as pertinent history for interventional preparation.

Why not the others: A and D are imaging-history details rather than the key procedural-safety issue in these choices. B matters for mammography image quality but does not address biopsy bleeding risk.

Sources: RadiologyInfo.org, Stereotactic Breast Biopsy; ARRT Mammography Content Specifications (pertinent history: anticoagulation, allergies).

Question 48

Procedures · BI-RADS descriptors

Which mass descriptor raises the most concern for malignancy?
Show answer and explanation for Question 48

Answer: D. Spiculated margins — lines radiating from the mass — are strongly associated with invasive cancer.

Why not the others: A is the most reassuring margin. B suggests benign fat-containing lesions. C is a shape, not a margin, and isn't concerning on its own.

Source: ARRT Mammography Content Specifications (characteristics of masses: shape, margin, density); Radiology Assistant, BI-RADS for Mammography (2013 edition summary).

Question 49

Image Production · Image evaluation

On one CC view, fine linear structures and calcifications look blurred, while the same breast's MLO taken minutes later is sharp. What is the most likely cause, and the best fix?
Show answer and explanation for Question 49

Answer: B. Blur limited to one exposure points to motion. Adequate compression immobilizes the breast, and clear breathing instructions prevent movement during the exposure. Motion is a patient-related artifact and a reason for repeat imaging that ARRT expects you to explain to the patient.

Why not the others: A detector problem (A) wouldn't affect only one view. C and D don't cause motion blur.

Source: ARRT Mammography Content Specifications (image evaluation: patient-related artifacts — motion; explaining need for repeat imaging).

Question 50

Procedures · Procedure-associated imaging

After surgical excision following needle (wire) localization, what is the specimen radiograph used to confirm?
Show answer and explanation for Question 50

Answer: A. Specimen radiography documents that the targeted lesion and localization device were removed and gives the surgeon immediate information about whether additional tissue may be needed.

Why not the others: B is irrelevant. C requires node sampling. D is a pathology determination; a specimen radiograph cannot certify microscopic margin status.

Source: ACR Practice Parameter for Preoperative Image-Guided Localization in the Breast (Specimen Imaging).

Score your set

Give yourself one point per question. Questions 18 (ordering) and 35 (select all that apply) count only if your whole answer is right — no partial credit.

Area Questions Your score
Patient Care 2, 5, 12, 16, 20, 25, 30, 38, 45 __ / 9
Image Production 3, 7, 10, 14, 17, 21, 24, 28, 31, 36, 41, 49 __ / 12
Procedures — anatomy, physiology, and pathology 4, 8, 11, 15, 18, 22, 27, 32, 35, 40, 46, 48 __ / 12
Procedures — positioning and procedures 1, 6, 9, 13, 19, 23, 26, 29, 33, 34, 37, 39, 42, 43, 44, 47, 50 __ / 17
Total __ / 50

Your total is how you did on these 50 questions — nothing more. It isn't an ARRT scaled score and doesn't predict one. With only 9 to 17 questions per area, treat each area score as a pointer to where to look, not a measurement of your ability.

How to use this set

  1. Take it cold. Answer all 50 without notes, the way you would on test day.
  2. Read every explanation, including the ones you got right. A lucky guess and a solid answer look the same on a score sheet.
  3. Fill in the table above and find the area where you lost the most points.
  4. Go back to the source linked under each missed question, then read that section of ARRT's content outline (the "Where to review" table below maps it out).
  5. Redo only your misses a few days later, before you look at the explanation again.

How this set compares with the real exam

ARRT's current Mammography content specifications list 115 scored questions plus 30 unscored pilot questions. The 2026 Postprimary Handbook separately confirms 150 minutes of test time inside a 170-minute appointment. ARRT's current documents conflict on the printed total-item figure, so this page does not turn those component counts into a claimed total. Because pilot questions are not identified to candidates, treat every question as if it counts. (ARRT Mammography Content Specifications, p. 1; ARRT 2026 Postprimary Handbook, p. 47).

This 50-question set follows the exam's balance, which leans heavily on Procedures. It's proportional practice, not a full-length simulation.

Category (ARRT content specifications, effective Sept. 1, 2025) Scored questions on the exam Share of scored questions Questions in this set
Patient Care 20 17% 9
Image Production 30 26% 12
Procedures: anatomy, physiology, and pathology 26 23% 12
Procedures: positioning and procedures 39 34% 17
Total 115 100% 50

Exam facts worth knowing

  • Passing score: a total scaled score of 75 on a 1–99 scale. It is not 75% correct, and the number of correct answers needed can differ between exam versions. Some practice sites list "75% to pass" — that's wrong. (Handbook, pp. 56–57)
  • Question types: mostly multiple choice with one best answer. Some questions may ask you to select multiple answers, sort items into order, click a spot on an image, or answer after a short video clip. That's why this set includes one ordering question and one select-all question. (Handbook, p. 39)
  • Attempts: three attempts within three years of the date your first exam window opens, each with its own application and fee. (Handbook, p. 18)
  • Application fee: $225 for a postprimary application using an ARRT supporting credential. (ARRT application fees)
  • Eligibility: Mammography is a postprimary credential. You need ARRT certification and registration in Radiography, plus ARRT's structured education (at least 16 credits) and clinical experience requirements, completed within the 24 months before you apply. (Handbook, pp. 6–10)
  • Positioning and QC standards: ARRT expects positioning as presented in the ACR's 1999 Clinical Image Quality guidance, with about six questions on the standard CC and MLO views. QC questions follow the 2018 ACR Digital Mammography QC Manual: you need detailed knowledge of mammographer tests and basic knowledge of medical physicist tests. (Content specifications, pp. 5 and 8)

Last verified October 27, 2026, against ARRT's Mammography content specifications (implemented Sept. 1, 2025), the 2026 Postprimary Eligibility Pathway Handbook, and ARRT's application fee page.

What changed on September 1, 2025

If you're working from older practice material, these changes to the content specifications matter (ARRT announcement):

  • Added: synthesized imaging and PACS troubleshooting; EQUIP and breast density reporting requirements under MQSA; patient-related artifacts; more detail on how patients receive results and on social risk factors.
  • Removed: TRAM flap and latissimus dorsi flap (from Patient Care); sentinel node mapping, cyst aspiration, and fine needle aspiration biopsy (from Procedures).

A practice question that tests a removed topic as current content is out of date. Stereotactic and ultrasound-guided biopsy, wire localization, specimen imaging, and clip placement are still on the outline at a basic-knowledge level.

Where to review what you missed

If you missed questions on... Review this part of ARRT's content outline
ACS screening, risk factors, results, density notices Patient Care: patient education, patient assessment, patient results
MQSA rules (records, reports, deadlines, audit) Image Production: MQSA regulations
Phantom, compression, physicist tests Image Production: quality control (mammographer tests in detail; physicist tests for purpose and frequency)
Clock face, triangulation, rolled views Procedures: localization terminology
Calcifications, masses, BI-RADS, pathology groups Procedures: pathology and reporting terminology
Views, implants, devices, large breasts Procedures: views and patient variance
Biopsy prep, time-out, specimen imaging Procedures: interventional procedures

The content specifications are only eight pages. Reading the whole outline once is the fastest way to spot topics this set didn't reach.

Common questions

Are these real ARRT questions? No. Every question here is original, written by Castleport Test Prep from ARRT's published content outline and the sources linked under each answer. ARRT keeps its exam questions confidential, and its handbook warns candidates to be careful with materials that claim to include ARRT test questions.

Does ARRT recommend any study materials? No. ARRT says it doesn't recommend or endorse review programs, mock registries, or study guides. It points candidates to its content specifications as the best guide to what the exam covers (Handbook, p. 40).

I haven't scheduled yet. Where do I start? You apply through your ARRT account once your structured education and clinical experience are signed off, then schedule with Pearson VUE after your exam window opens. Our ARRT exam registration guide walks through each step.

What happens if I don't pass? You can reapply within your three-year, three-attempt eligibility period. ARRT advises comparing the current content specifications with the ones you studied, since the outline may have changed (Handbook, p. 60). See our ARRT exam retake policy guide.

How do I read my score report? You'll get a total scaled score and section scores (0.1–9.9) by content area. Section scores don't average into your total (Handbook, p. 56). See our ARRT exam results guide.

More free ARRT resources

Sources

Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by the American Registry of Radiologic Technologists (ARRT). Exam and credential names are used to identify their subjects; trademarks belong to their respective owners. These practice questions are original and unofficial, not ARRT exam questions. Practice results don't predict an ARRT score or guarantee a passing result.

By the Castleport Test Prep Editorial Team. Exam facts last verified October 27, 2026.

Free ARRT Mammography Practice Test: 50 Questions + Answers