Castleport Test Prep

Free ARRT Nuclear Medicine Practice Test

This free ARRT nuclear medicine practice test includes fifty original, unofficial questions across Patient Care, Safety, Image Production, and Procedures, each with an explanation of why the right answer is right and why the others aren't. Every question tests content found in both ARRT's current content specifications and the ones that take effect February 1, 2027.

Question 1 of 50

Patient Care

An order reads "Lung perfusion scan," but the clinical indication on the same requisition says "evaluate delayed gastric emptying." The patient has arrived. What should the technologist do?

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Answer: B. Hold the study and contact the ordering provider to clarify the order before any radiopharmaceutical is given

Comparing the order with the clinical indication is part of verification. When the two don't match, the safe move is to stop and clarify with the ordering provider before giving anything. Doing the ordered study (A) may give the patient radiation for a test nobody needs. Changing the exam yourself (C) means acting without an order. Doing both (D) adds potentially unnecessary radiation exposure and still might not be what the provider wanted.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNM General Imaging 6.0

Question 2 of 50

Patient Care

A hospital is named in a lawsuit for an injury caused by the negligence of an employed technologist acting within the scope of the job. Which legal doctrine can make the employer responsible?

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Answer: A. Respondeat superior

Respondeat superior ("let the master answer") can hold an employer liable for an employee's wrongful acts within the scope of their work. Res ipsa loquitur ("the thing speaks for itself") lets negligence be inferred when an injury wouldn't normally happen without it (B). Informed consent is a patient right, not a liability rule (C). Beneficence is the ethical duty to act for the patient's benefit (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); Cornell LII: respondeat superior; Burlington Industries, Inc. v. Ellerth, 524 U.S. 742 (1998)

Question 3 of 50

Patient Care

A positioning sponge used for a patient colonized with MRSA isn't disinfected and is then used for the next patient, who later becomes colonized. This is an example of which mode of transmission?

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Answer: D. Indirect contact through a fomite (vehicle-borne)

A contaminated object that carries organisms from one person to another is a fomite. ARRT's outline files this under indirect, vehicle-borne transmission. Airborne spread involves tiny particles that stay suspended (A). Droplet spread involves larger respiratory droplets over short distances (B). Vector-borne spread needs an insect or animal carrier (C). The fix is cleaning and disinfecting patient-care equipment between patients.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); CDC Standard Precautions

Question 4 of 50

Patient Care

An inpatient with suspected active pulmonary tuberculosis needs a portable lung perfusion study in an airborne infection isolation room. What respiratory protection should staff wear?

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Answer: B. A fit-tested N95 (or higher-level) respirator

TB spreads through the air, so staff entering an airborne infection isolation room wear a NIOSH-approved respirator, such as a fit-tested N95. A surgical mask is meant for droplet precautions and doesn't seal against airborne particles (A). Gown and gloves address contact spread (C). A face shield guards against splashes, not airborne particles (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); CDC TB respiratory protection

Question 5 of 50

Patient Care

Minutes after an IV injection in the department, a patient develops hives, wheezing, and a drop in blood pressure. What is the technologist's best first action?

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Answer: C. Stop the procedure, call for emergency help per facility protocol, and stay with and monitor the patient

Hives with wheezing and low blood pressure point to a serious allergic reaction. Stop, activate the emergency response, and stay with the patient until help arrives. Continuing the scan delays care (A). Waiting 15 minutes is unsafe when breathing and blood pressure are affected (B). Discharging an unstable patient is dangerous (D). Documentation must not delay emergency care.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); RCUK anaphylaxis guideline: initial response

Question 6 of 50

Patient Care

An outpatient is scheduled for an I-123 thyroid uptake and scan and, separately, a CT with IV iodinated contrast. Both exams are elective, and neither is urgent. How should the two exams be sequenced?

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Answer: C. Thyroid uptake and scan first, then the contrast CT

IV iodinated contrast floods the body's iodide pool and can lower radioiodine uptake for weeks. The 2019 EANM/SNMMI guideline lists about 1 to 2 months for IV contrast. Doing the uptake first protects the result. Giving contrast before the thyroid uptake and scan are complete—whether the day before (A) or earlier the same day (B)—risks a falsely low uptake. Potassium iodide blocks thyroid uptake rather than restoring it (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); EANM/SNMMI thyroid uptake guideline

Safety

Question 7 of 50

Safety

Which of these is a deterministic (nonstochastic) effect of radiation?

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Answer: B. Cataract formation

Deterministic effects have a threshold, and their severity rises with dose. NRC uses cataract formation as its example. Cancer, including leukemia, and hereditary effects are stochastic (A, C, D). Their probability, not their severity, is assumed to rise with dose, with no threshold.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); 10 CFR 20.1003, Definitions

Question 8 of 50

Safety

Under NRC rules, a "radiation area" is an area accessible to individuals where radiation levels could result in a dose equivalent of more than:

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Answer: A. 0.05 mSv (5 mrem) in 1 hour at 30 cm from the source or from a surface the radiation penetrates

A radiation area is defined at more than 0.05 mSv (5 mrem) in 1 hour at 30 cm. Watch the unit conversion: 0.005 mSv is 0.5 mrem, ten times too low (B). 1 mSv (100 mrem) in 1 hour at 30 cm is the high radiation area threshold (C). 0.02 mSv (2 mrem) in any one hour is a separate limit for external radiation in an unrestricted area, excluding radiation from patients released under §35.75 (D).

Sources: 10 CFR 20.1003, Definitions; 10 CFR 20.1301, Dose limits for individual members of the public

Question 9 of 50

Safety

A technologist works for 15 minutes where a survey meter reads a steady 20 µSv/h. Ignoring any other source, what dose does the technologist receive during that time?

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Answer: C. 5 µSv

Dose = dose rate × time. 15 minutes is 0.25 hour, so 20 µSv/h × 0.25 h = 5 µSv. 300 µSv multiplies by 15 without converting minutes to hours (A). 1.33 µSv divides by 15 (B). 20 µSv assumes a full hour (D). This is why time is one of the three protection tools, along with distance and shielding.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); EPA, Protecting Yourself from Radiation

Question 10 of 50

Safety

Under 10 CFR 35.75, a patient who received a radiopharmaceutical may be released when the total effective dose equivalent to any other individual from exposure to the patient is not likely to exceed:

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Answer: D. 5 mSv (0.5 rem)

The release criterion is 5 mSv (0.5 rem) to any other person. 1 mSv (0.1 rem) is a different trigger (A). Above it, the patient must get instructions, including written instructions, for keeping others' dose as low as reasonably achievable, plus breastfeeding guidance if a nursing child could exceed 1 mSv. The other values aren't release criteria (B, C).

Sources: 10 CFR 35.75

Question 11 of 50

Safety

After a medical event is discovered, by when must an NRC licensee notify the NRC Operations Center by telephone?

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Answer: B. No later than the next calendar day

The phone call to the NRC Operations Center is due no later than the next calendar day after discovery. Fifteen days is the deadline for the written report (C). Notification to the referring physician and the patient is due within 24 hours. The exceptions in §35.3045(e) apply to patient notification, including when the referring physician personally undertakes it or judges it medically harmful. If the physician or patient cannot be reached within 24 hours, the patient must be notified as soon as possible afterward. One hour and 30 days aren't medical-event deadlines (A, D).

Sources: 10 CFR 35.3045

Question 12 of 50

Safety

Syringes contaminated with Tc-99m have been held in a decay-in-storage container. Before they can be disposed of without regard to their radioactivity under 10 CFR 35.92, what must be true?

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Answer: A. A surface survey, with an appropriate meter on its most sensitive scale and no shielding in between, can't distinguish the waste from background, and radiation labels are removed or obliterated unless the biomedical-waste exception applies

Decay-in-storage applies to material with a physical half-life of 120 days or less. Before disposal, survey the waste at its surface on the meter's most sensitive scale with nothing shielding it. It has to be indistinguishable from background, and radiation labels must be removed or obliterated (a narrow exception covers labels on items inside containers handled as biomedical waste). Holding waste for a set number of half-lives cannot replace the required survey (B). A wipe of the container checks removable contamination, not the waste itself (C). A signature can't replace the survey (D). Applicable sharps and biomedical-waste requirements still apply.

Sources: 10 CFR 35.92

Question 13 of 50

Safety

A package labeled RADIOACTIVE YELLOW-II containing a liquid radiopharmaceutical arrives at an NRC licensee's facility at 2:00 p.m., during normal working hours. Which statement is correct?

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Answer: C. Its external surfaces must be monitored for contamination no later than 3 hours after receipt

Labeled packages (White-I, Yellow-II, Yellow-III) are monitored for external contamination unless they contain only gas or special-form material. When the package arrives during normal working hours, that's due as soon as practical and no later than 3 hours after receipt. Yellow-II allows up to 50 mrem/h at the surface with a transport index of 1 or less. 200 mrem/h requires a Yellow-III label (A). This liquid-radiopharmaceutical package must be monitored (B). For packages received after normal working hours, required monitoring is due as soon as practical and no later than 3 hours after the beginning of the next working day (D).

Sources: 10 CFR 20.1906, Procedures for receiving and opening packages; 49 CFR 172.403, Class 7 (radioactive) material labels

Image Production

Question 14 of 50

Image Production

Which dose calibrator test compares readings of long-lived reference sources of different energies (for example, Co-57 and Cs-137) with their certified activities?

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Answer: D. Accuracy

Accuracy checks whether the calibrator reads the true activity of certified reference sources across photon energies. Constancy checks day-to-day reproducibility with a single long-lived source (A). Linearity checks performance across the range of activities used clinically (B). Geometry checks how readings change with sample volume and container type (C).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); AAPM Report 181

Question 15 of 50

Image Production

Which survey instrument is best at finding low-level contamination but less reliable for measuring high exposure rates accurately?

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Answer: A. Geiger-Muller (GM) survey meter

A GM detector produces a large pulse for every event it detects, which makes it very sensitive to small amounts of contamination. At high count rates, though, its dead time causes it to undercount. An ionization chamber measures exposure rate accurately over a wide range but is less sensitive at low levels (B). A dose calibrator measures the activity of a sample, not an area (C). A TLD is a personal dosimeter that's read later (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); CDC: How to Measure Radiation; GM detector dead-time study; AAPM Report 181

Question 16 of 50

Image Production

A gamma camera with a 512-mm field of view acquires a 128 × 128 matrix with no zoom. What is the pixel size?

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Answer: B. 4 mm

Pixel size = field of view ÷ matrix size = 512 mm ÷ 128 = 4 mm. 2 mm would need a 256 matrix (A). 8 mm would come from a 64 matrix (C). 0.25 mm inverts the division (D). Smaller pixels can show finer detail, but each pixel then collects fewer counts.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); IAEA SPECT QA

Question 17 of 50

Image Production

The morning extrinsic (system) flood on a gamma camera shows a new, sharply defined cold area that wasn't there yesterday. What is the best response?

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Answer: C. Don't image patients on that detector; repeat the flood, investigate the cause (for example, collimator damage or a detector fault), and notify service or the physicist per protocol

A new cold area can come from a damaged collimator or a detector problem, and either one can create a false defect in patient images. Stop using that detector and follow your escalation steps. Running an intrinsic flood (collimator off) helps sort it out: if the defect disappears without the collimator, the collimator is the likely cause. Imaging anyway risks a misdiagnosis (A). Swapping collimators doesn't fix a detector fault (B). A correction map can't repair hardware and may hide it (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); IAEA SPECT QA

Question 18 of 50

Image Production

Which collimator is most appropriate for I-131 whole-body imaging (main photopeak 364 keV)?

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Answer: D. High-energy parallel-hole

I-131's 364-keV photons pass through the thin septa of low-energy collimators, blurring the image and producing star artifacts. High-energy collimators have thicker septa built for these photons. Low-energy collimators (A, B) are designed for photons around 140 keV, like Tc-99m. A Tc-99m converging collimator has the same thin-septa problem (C).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); MIRD Pamphlet 24

Question 19 of 50

Image Production

Which SPECT quality control test checks that the camera's mechanical axis of rotation lines up with the center of the computer's image matrix, so reconstructed slices aren't blurred or distorted?

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Answer: A. Center of rotation

A center-of-rotation error misaligns the projections during reconstruction, which blurs and distorts the slices. Spatial linearity checks whether straight lines image as straight (B). Energy resolution describes how well the system separates photon energies (C). Chi-square tests the counting statistics of probes and well counters (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); IAEA SPECT QA

Question 20 of 50

Image Production

Within the CT scope of the ARRT Nuclear Medicine Technology exam, which uses of CT data are emphasized in PET/CT and SPECT/CT?

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Answer: A. Attenuation correction and anatomic localization

In the exam's hybrid imaging context, CT data correct the emission data for attenuation and show where uptake sits anatomically. ARRT says diagnostic CT isn't assessed on this exam (B). CT doesn't set radiopharmaceutical activity (C). It doesn't replace the scanner's own QC either (D); the outline lists separate CT QC items such as tube warm-up, CT number, and air calibration.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027)

Question 21 of 50

Image Production

A patient weighing 74 kg receives 370 MBq (10 mCi) of F-18 FDG, decay-corrected to scan time. A lesion's activity concentration is 15 kBq/mL. Assuming tissue density of 1 g/mL, what is the body-weight SUV?

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Answer: C. 3.0

SUV = tissue concentration ÷ (injected activity ÷ body weight). 370,000 kBq ÷ 74,000 g = 5 kBq/g, so SUV = 15 ÷ 5 = 3.0. 0.33 flips the ratio (A). 5.0 is the injected activity per gram, not the SUV (B). 15 is the raw concentration (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); EANM FDG guideline 2.0: SUV definition

Procedures: Radionuclides and Radiopharmaceuticals

Question 22 of 50

Procedures — Radionuclides and Radiopharmaceuticals

A prescription is written for 20 mCi. What is that activity in megabecquerels?

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Answer: C. 740 MBq

1 Ci = 3.7 × 10^10 Bq, so 1 mCi = 37 MBq. 20 × 37 = 740 MBq. 74 MBq is off by a factor of 10 (A). 0.54 divides instead of multiplying (B). 7,400 MBq is 200 mCi (D). The exam uses both SI and conventional units, so this conversion needs to be automatic.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); 10 CFR 20.1005, Units of radioactivity

Question 23 of 50

Procedures — Radionuclides and Radiopharmaceuticals

A Tc-99m vial contains 200 mCi (7,400 MBq) in 10 mL, calibrated at 0700. What volume delivers 25 mCi (925 MBq) at 1000? (Tc-99m T½ = 6.0 h)

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Answer: D. 1.77 mL

At 0700 the concentration is 20 mCi/mL. Three hours is half a half-life, so the decay factor is 0.5^(3/6) = 0.707 and the concentration drops to 14.14 mCi/mL. Volume = 25 ÷ 14.14 = 1.77 mL (in SI: 740 MBq/mL × 0.707 = 523 MBq/mL, and 925 ÷ 523 = 1.77 mL). 1.25 mL ignores decay (A). 0.88 mL divides by the wrong factor (B). 2.50 mL assumes half the activity is gone (C).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); HHS Radiation Emergency Medical Management, Half-life; AAPM Report 181

Question 24 of 50

Procedures — Radionuclides and Radiopharmaceuticals

Why does F-18 FDG accumulate in cells that use a lot of glucose?

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Answer: B. It enters the cell through glucose transporters and is phosphorylated by hexokinase, which traps it inside

FDG is a glucose analog. Glucose transporters carry it into the cell, and hexokinase phosphorylates it. The phosphorylated form can't easily leave the cell, so it builds up where glucose use is high. Capillary blockade describes MAA (A). Binding to hydroxyapatite (chemisorption) describes diphosphonate bone agents (C). Phagocytosis describes colloids such as sulfur colloid (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); FDG prescribing information; 2026 V/Q procedure standard; SNMMI bone guideline 4.0; Sulfur colloid prescribing information

Question 25 of 50

Procedures — Radionuclides and Radiopharmaceuticals

A department prepares Rb-82 chloride from a Sr-82/Rb-82 generator for cardiac PET. Under NRC rules, when must Sr-82 and Sr-85 breakthrough be measured?

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Answer: C. Before the first patient use of the day

NRC requires measuring Sr-82 and Sr-85 before the first patient use each day. The limits are 0.02 kBq of Sr-82 and 0.2 kBq of Sr-85 per MBq of Rb-82. The other choices check too rarely or only after harm could occur (A, B, D). Compare the Mo-99/Tc-99m generator rule, which requires measuring Mo-99 in every eluate.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); 10 CFR 35.204

Question 26 of 50

Procedures — Radionuclides and Radiopharmaceuticals

Whole-body images from a Tc-99m MDP bone scan show activity in the thyroid, salivary glands, and stomach. What is the most likely cause?

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Answer: B. Free Tc-99m pertechnetate

Free pertechnetate behaves much like iodide. The thyroid traps it, and gastric mucosa takes it up, so this pattern is a classic sign of poor labeling. Hydrolyzed-reduced technetium forms colloid-like particles that collect in the liver, spleen, and marrow (A). Mo-99 breakthrough is a radionuclidic impurity assessed with a molybdenum assay (C). Aluminum breakthrough is a chemical impurity assessed separately (D). The uptake pattern here specifically points to free pertechnetate.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); EANM/SNMMI thyroid uptake guideline; 2026 V/Q procedure standard; TechneLite prescribing information

Question 27 of 50

Procedures — Radionuclides and Radiopharmaceuticals

During preparation of a Tc-99m MDP kit, why should air not be introduced into the reaction vial?

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Answer: D. Oxygen oxidizes the stannous ion, leaving less to reduce pertechnetate, which can increase free pertechnetate

Stannous ion (Sn²⁺) reduces technetium from its +7 oxidation state in pertechnetate so the technetium can bind to the kit's ligand. Oxygen can use up stannous ion, so labeling efficiency can fall and free pertechnetate can rise. Air doesn't raise specific activity (A). Air has a chemical effect in this kit (B). Oxygen oxidizes; it doesn't reduce (C). Air-handling instructions are kit-specific.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNMMI bone guideline 4.0; MDP-25 prescribing information; TechneScan MAG3 prescribing information

Question 28 of 50

Procedures — Radionuclides and Radiopharmaceuticals

Tc-99m macroaggregated albumin (MAA) localizes in the lungs mainly by:

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Answer: A. Capillary blockade

MAA particles, roughly 10-100 µm, are too large to pass through the pulmonary capillaries. They lodge in a small fraction of arterioles and capillaries, mapping where blood flow goes. Phagocytosis is how sulfur colloid localizes (B). Active transport describes thyroid trapping of iodide and pertechnetate (C). Chemisorption is how diphosphonates bind to bone (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); 2026 V/Q procedure standard; SNMMI bone guideline 4.0; EANM/SNMMI thyroid uptake guideline; Sulfur colloid prescribing information

Procedures: Cardiac

Question 29 of 50

Procedures — Cardiac

After a rest injection of Tc-99m sestamibi, myocardial perfusion imaging usually doesn't start immediately. What is the main reason for the delay?

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Answer: B. Liver activity clears through the hepatobiliary system, so waiting improves the heart's contrast against nearby organs

Sestamibi's main clearance route is the hepatobiliary system. Liver activity falls fairly quickly (the label gives a liver biological half-life of about 30 minutes), and gallbladder activity reaches the intestines within an hour. The best imaging time balances heart count rate against activity in nearby organs, which can overlap the inferior wall. Myocardial uptake is rapid, not hours long (A). Decay isn't the goal (C). Caffeine matters before a vasodilator stress, not as a reason to wait after injection (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); Cardiolite label; Regadenoson prescribing information

Question 30 of 50

Procedures — Cardiac · Put in order

Put these regadenoson stress steps in the order given in the product label.

  • Inject the myocardial perfusion radiopharmaceutical
  • Inject regadenoson 0.4 mg IV over about 10 seconds
  • Wait 10-20 seconds after the flush
  • Give a 5 mL saline flush
Show answer and explanation for Question 30

Correct order: (1) inject regadenoson 0.4 mg IV over about 10 seconds; (2) give a 5 mL saline flush right away; (3) wait 10-20 seconds, timed from the end of the flush; (4) inject the radiopharmaceutical. The flush clears the line so the full dose reaches the bloodstream, and the radiotracer is timed to arrive during peak coronary hyperemia. ARRT's exam can include sort-into-order items like this.

Sources: Regadenoson prescribing information; ARRT 2026 handbook

Question 31 of 50

Procedures — Cardiac

On a gated equilibrium blood pool study (MUGA), which ECG signal should trigger each cardiac cycle?

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Answer: A. The R wave of the QRS complex

Gating uses the R wave, the sharpest and most reliable signal in the ECG, to start each cycle. Counts are then binned into frames across the R-R interval. The P and T waves are too small or variable to trigger reliably (B, C). Changes in heart rate are handled by an R-R acceptance window, not used as the trigger (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNMMI/EANM gated ERNA standard

Question 32 of 50

Procedures — Cardiac

For a planar gated blood pool study used to calculate LVEF, which view best separates the left and right ventricles?

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Answer: D. Left anterior oblique ("best septal" view)

The LAO view, roughly 45° and adjusted to the angle that best shows the interventricular septum, isolates the left ventricle for the region of interest. In the anterior view the ventricles overlap (A). RAO adds overlap (B). The left lateral view is useful for wall motion but doesn't separate the ventricles cleanly (C).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNMMI/EANM gated ERNA standard

Question 33 of 50

Procedures — Cardiac

A Tc-99m pyrophosphate (PYP) study for suspected transthyretin cardiac amyloidosis shows a 1-hour heart-to-contralateral-lung ratio of 1.6. Why is SPECT still performed?

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Answer: A. To confirm the uptake is in the myocardium rather than leftover blood-pool activity

At 1 hour, activity still in the blood pool can raise a planar ratio and create a false positive. The multisociety recommendations require SPECT (or SPECT/CT) in every study to confirm true myocardial uptake, and they don't recommend 1-hour planar-only imaging. AL amyloidosis also has to be ruled out with lab testing. This PYP amyloid study doesn't measure LVEF (B). SPECT is required regardless of the ratio (C). Renal clearance isn't the reason (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); ASNC PYP amyloid imaging practice points

Question 34 of 50

Procedures — Cardiac

On technically adequate, correctly aligned studies without an attenuation artifact, rest perfusion imaging shows a reduced-perfusion anterior segment. F-18 FDG PET shows preserved glucose uptake in that same segment. What does this pattern indicate?

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Answer: C. Viable myocardium (a perfusion-metabolism mismatch)

Reduced perfusion with preserved FDG uptake is a perfusion-metabolism mismatch, which means the myocardium is viable. When perfusion and FDG uptake are proportionally reduced (a match), the pattern indicates scar (A). Normal myocardium would not have the confirmed perfusion defect described here (B). The technical-quality conditions in the stem exclude attenuation artifact as the explanation (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); ASNC PET viability practice points

Procedures: Endocrine and Oncology

Question 35 of 50

Procedures — Endocrine and Oncology

A 24-hour I-123 thyroid uptake gives these count rates: neck 48,000 cpm; thigh 6,000 cpm; capsule standard in the neck phantom 140,400 cpm; room background 400 cpm. Measurements use matched probe geometry, and the standard represents the administered activity with physical decay accounted for at the counting time. What is the uptake?

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Answer: B. 30%

Uptake = (neck − thigh) ÷ (standard − room background) × 100 = (48,000 − 6,000) ÷ (140,400 − 400) × 100 = 42,000 ÷ 140,000 × 100 = 30%. 34% skips the thigh correction for body background (A). Neither 25% nor 43% follows this background-corrected ratio (C, D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); EANM/SNMMI thyroid uptake guideline

Question 36 of 50

Procedures — Endocrine and Oncology

A thyroid scan with Tc-99m pertechnetate reflects which thyroid function?

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Answer: C. Trapping only; pertechnetate isn't organified

The thyroid traps pertechnetate the way it traps iodide, but pertechnetate isn't organified, so it washes out of thyroid cells over time. A pertechnetate scan therefore shows trapping, not organification (A) or hormone release (B). TSH comes from the pituitary and isn't imaged by this study (D). Radioiodine is used when organification matters.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); EANM/SNMMI thyroid uptake guideline

Question 37 of 50

Procedures — Endocrine and Oncology

On dual-phase Tc-99m sestamibi parathyroid imaging, a parathyroid adenoma typically:

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Answer: A. Becomes more conspicuous on delayed images as thyroid activity washes out faster

Sestamibi usually washes out of thyroid tissue faster than out of abnormal parathyroid tissue, so a parathyroid lesion stands out more on delayed images. The guideline notes that about 10%-15% of lesions wash out as fast as thyroid, which is why the answer says "typically." Faster thyroid washout is the usual pattern being tested (B). A sestamibi-avid adenoma typically appears as increased uptake rather than a cold area (C). I-123 is sometimes added for thyroid subtraction but isn't required (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNM parathyroid guideline 4.0

Question 38 of 50

Procedures — Endocrine and Oncology

A woman of childbearing potential is scheduled for I-131 sodium iodide therapy for hyperthyroidism. Before administration, what does the product label require?

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Show answer and explanation for Question 38

Answer: B. A pregnancy test confirming she isn't pregnant

The label lists pregnancy as a contraindication and directs staff to obtain a pregnancy test and confirm the absence of pregnancy before therapy. A verbal statement isn't enough (A). The oral route doesn't change the fetal risk (C). The requirement applies to women of childbearing potential, whether or not they're breastfeeding (D). Breastfeeding is a separate contraindication.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); Sodium iodide I-131 therapeutic prescribing information

Question 39 of 50

Procedures — Endocrine and Oncology

Ga-68 dotatate PET is used mainly to image:

Choose one answer for Question 39
Show answer and explanation for Question 39

Answer: B. Somatostatin receptor-positive neuroendocrine tumors

Dotatate binds somatostatin receptors, especially subtype 2, which many neuroendocrine tumors overexpress. PSMA imaging uses different agents (A). Brain amyloid PET uses agents such as F-18 florbetapir (C). Dopamine transporter imaging uses I-123 ioflupane SPECT (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); NETSPOT label; Pylarify prescribing information; Amyvid prescribing information; DaTscan prescribing information

Question 40 of 50

Procedures — Endocrine and Oncology

Ra-223 dichloride (Xofigo) is indicated for:

Choose one answer for Question 40
Show answer and explanation for Question 40

Answer: D. Castration-resistant prostate cancer with symptomatic bone metastases and no known visceral metastatic disease

Ra-223 is an alpha emitter that acts like calcium and concentrates where bone turnover is high, such as bone metastases. Its short alpha range limits damage to nearby tissue. Thyroid remnant ablation uses I-131 sodium iodide (A). Hepatic arterial therapy uses Y-90 microspheres (B). Lu-177 dotatate is used for somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumors (C).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); Xofigo U.S. prescribing information; SNMMI procedure standard/EANM practice guideline for nuclear medicine evaluation and therapy of differentiated thyroid cancer; TheraSphere FDA instructions; Lutathera prescribing information

Procedures: Gastrointestinal and Genitourinary

Question 41 of 50

Procedures — Gastrointestinal and Genitourinary

A patient on total parenteral nutrition hasn't eaten in three days and is scheduled for hepatobiliary imaging for suspected acute cholecystitis. Why might the physician order sincalide before the Tc-99m mebrofenin injection?

Choose one answer for Question 41
Show answer and explanation for Question 41

Answer: D. Fasting longer than 24 hours can keep the gallbladder from filling; emptying it first lowers the risk of a false-positive study

After prolonged fasting, including patients on TPN, the gallbladder can stay full of concentrated bile and fail to fill with tracer, mimicking acute cholecystitis. Giving sincalide beforehand contracts the gallbladder so it can fill. Sincalide doesn't change hepatocyte uptake (A). It doesn't keep tracer out of the bowel (B). It doesn't remove the need for delayed or morphine imaging when the gallbladder still doesn't fill (C).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNM hepatobiliary guideline 4.0

Question 42 of 50

Procedures — Gastrointestinal and Genitourinary

Sixty minutes after Tc-99m mebrofenin injection, the liver, common bile duct, and small bowel are seen, but the gallbladder isn't. Acute cholecystitis is suspected. If the physician orders it, what is the usual next step?

Choose one answer for Question 42
Show answer and explanation for Question 42

Answer: C. Give morphine sulfate (0.04 mg/kg or a standard 2 mg IV) and continue imaging 30-60 more minutes

Morphine contracts the sphincter of Oddi, raising pressure in the biliary tree so a patent cystic duct lets tracer into the gallbladder. If the gallbladder still isn't seen 30 minutes after morphine, that supports acute cholecystitis. Sincalide contracts the gallbladder and won't help fill one that isn't visualized (A). Nonvisualization at 60 minutes requires further assessment; the study should not simply be reported as normal (B). A fatty meal stimulates emptying, so it isn't a filling test (D). Check contraindications such as morphine allergy first.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNM hepatobiliary guideline 4.0

Question 43 of 50

Procedures — Gastrointestinal and Genitourinary

Before a Meckel diverticulum study with Tc-99m pertechnetate, some protocols give an H2 blocker. What is its purpose?

Choose one answer for Question 43
Show answer and explanation for Question 43

Answer: C. To reduce release of pertechnetate from gastric mucosa into the bowel, which improves sensitivity

Ectopic gastric mucosa in a Meckel diverticulum takes up pertechnetate just as the stomach does. An H2 blocker cuts acid and pertechnetate secretion from that mucosa, so more tracer stays in the mucosa and less washes into the bowel, where it could blur the diverticulum. That improves sensitivity. Faster gastric emptying (A), thyroid blockade (B), and allergy prevention (D) are not the purpose of H2-blocker pretreatment in this protocol.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNMMI/EANM Meckel guideline 2.0

Question 44 of 50

Procedures — Gastrointestinal and Genitourinary

Which radiopharmaceutical localizes in ectopic gastric mucosa in a Meckel diverticulum?

Choose one answer for Question 44
Show answer and explanation for Question 44

Answer: D. Tc-99m sodium pertechnetate

The mucous cells of gastric mucosa take up pertechnetate by active transport, and that includes ectopic gastric mucosa in a Meckel diverticulum. Sulfur colloid maps the reticuloendothelial system (A). Labeled red cells are used to look for active GI bleeding (B). Mebrofenin evaluates the hepatobiliary system (C).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNMMI/EANM Meckel guideline 2.0; Sulfur colloid prescribing information; SNMMI/ACNM GI bleeding standard 3.0; SNM hepatobiliary guideline 4.0

Question 45 of 50

Procedures — Gastrointestinal and Genitourinary

A physician wants to evaluate the renal cortex for scarring. Which Tc-99m agent best fits that goal?

Choose one answer for Question 45
Show answer and explanation for Question 45

Answer: B. Tc-99m succimer (DMSA)

DMSA binds in the renal cortex, mainly the proximal tubules, and stays there for a long time, so it is the cortical imaging agent. MAG3 is cleared mostly by tubular secretion and is used for dynamic function studies (A). DTPA is cleared by glomerular filtration (C). Sulfur colloid isn't a renal agent (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNMMI/EANM renal guideline; Sulfur colloid prescribing information

Procedures: Other Imaging

Question 46 of 50

Procedures — Other Imaging

After a Tc-99m diphosphonate (MDP) injection, when are routine delayed bone images usually acquired?

Choose one answer for Question 46
Show answer and explanation for Question 46

Answer: D. About 2-4 hours after injection

Routine delayed images are usually acquired about 2-4 hours after injection. That gives bone time to take up the tracer and soft tissue time to clear, especially with good hydration and voiding before imaging. Flow images are acquired during injection, and blood-pool images follow immediately and within 10 minutes (A). Fifteen to thirty minutes is too early for routine delayed skeletal images (B). 24 hours is a special-case delay, not the routine (C).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNMMI bone guideline 4.0

Question 47 of 50

Procedures — Other Imaging

A technologist draws blood back into a syringe of Tc-99m MAA to check the IV before injecting. The perfusion images then show several small, intense hot spots in both lungs. What is the most likely explanation?

Choose one answer for Question 47
Show answer and explanation for Question 47

Answer: A. Particle aggregation or clotting in the syringe, which is a technical artifact

Blood drawn back into an MAA syringe can make particles clump. The clumps lodge as focal hot spots that don't reflect true perfusion. The 2026 V/Q procedure standard warns against drawing blood into the syringe and lists syringe clotting as a source of hot spots. The blood aspiration and punctate hot spots favor clumping over regional perfusion changes (B). Free pertechnetate shows up in the thyroid and stomach (C). A right-to-left shunt can produce extrapulmonary MAA uptake in the brain cortex (D).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); 2026 V/Q procedure standard

Question 48 of 50

Procedures — Other Imaging

In a room used for Xe-133 ventilation studies, why is a xenon trap or exhaust intake often placed near floor level?

Choose one answer for Question 48
Show answer and explanation for Question 48

Answer: D. Xe-133 is heavier than air, so gas that escapes tends to collect low

Xenon is heavier than air, so gas that leaks or is exhaled tends to settle low in the room. That's why the standard places a xenon trap at floor level, alongside a closed delivery system with a charcoal trap or dedicated exhaust, and why local rules may require negative room pressure. It doesn't rise (A). Location can't change a radionuclide's half-life (B). Aerosols are handled differently from gases (C).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); 2026 V/Q procedure standard

Question 49 of 50

Procedures — Other Imaging

On a technically adequate study for suspected death by neurologic criteria (brain death), performed with a brain-specific agent such as Tc-99m exametazime or bicisate, which delayed finding supports absent brain perfusion?

Choose one answer for Question 49
Show answer and explanation for Question 49

Answer: A. No tracer uptake in the brain on delayed planar or SPECT images

Brain-specific agents cross the blood-brain barrier and are held where there's perfusion, so no brain uptake supports absent brain perfusion in a technically adequate study. Any demonstrated or suspected intracranial flow or parenchymal uptake prevents an interpretation of absent perfusion. The guideline stresses that brain death is a clinical diagnosis; the scan can support it and should be read alongside other findings. Normal brain uptake argues against brain death (B, D). Cerebellar uptake means some intracranial perfusion is present (C).

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); SNMMI/EANM brain perfusion standard 3.0 (2025)

Question 50 of 50

Procedures — Other Imaging

Before I-123 ioflupane (DaTscan) is injected, potassium iodide or strong iodine solution is given. Why?

Choose one answer for Question 50
Show answer and explanation for Question 50

Answer: C. To block thyroid uptake of free radioiodine

The label calls for a thyroid-blocking agent (equivalent to 100 mg iodide) at least one hour before the dose, so free I-123 doesn't collect in the thyroid. It doesn't change striatal binding (A), protect the kidneys (B), or prevent seizures (D). SPECT imaging then starts 3-6 hours after injection.

Sources: ARRT NMT content specs (2022); ARRT NMT content specs (Feb 2027); DaTscan prescribing information

Review what you missed

Untimed; budget about 50 minutes if you want ARRT's pace of roughly one minute per question.

These results describe your answers to this practice set. They are not an ARRT scaled score or a prediction of passing.

Tally your results by category:

Category Questions Your score
Patient Care Q1–Q6 __ / 6
Safety Q7–Q13 __ / 7
Image Production Q14–Q21 __ / 8
Procedures: Radionuclides and Radiopharmaceuticals Q22–Q28 __ / 7
Procedures: Cardiac Q29–Q34 __ / 6
Procedures: Endocrine and Oncology Q35–Q40 __ / 6
Procedures: Gastrointestinal and Genitourinary Q41–Q45 __ / 5
Procedures: Other Imaging Q46–Q50 __ / 5
Total 50 __ / 50

Five to eight questions per category can point you toward a weak area, but that's too few to measure your ability precisely. Use the misses as a to-do list:

  1. Name the gap. For each miss, write down the concept, not just the question number. "Decay-corrected volume" is useful; "missed Q23" isn't.
  2. Sort the mistake. Was it a math or unit slip (minutes vs hours, mCi vs MBq), a missing fact, or a detail in the stem you skimmed past? Each needs a different fix.
  3. Explain it cold. Close the explanation and say the correct reasoning out loud or on paper. If you can't, review the source beside the question, use the ARRT outline for your exam date to check the topic's scope, then try the question again tomorrow.

Which ARRT nuclear medicine content spec applies to you?

Use the content specifications in effect on your exam date. ARRT's updated Nuclear Medicine Technology specifications take effect February 1, 2027 (ARRT notice, Apr 1, 2026).

Category Through Jan 31, 2027 Share From Feb 1, 2027 Share This practice set
Patient Care 24 12% 26 13% 6
Safety 25 12.5% 27 13.5% 7
Image Production 33 16.5% 30 15% 8
Procedures 118 59% 117 58.5% 29
— Radionuclides and Radiopharmaceuticals 28 28 7
— Cardiac 25 25 6
— Endocrine and Oncology 25 24 6
— Gastrointestinal and Genitourinary 18 20 5
— Other Imaging 22 20 5
Scored questions 200 200 50
Unscored pilot questions 30 30 —

ARRT counts come from page 1 of each official document: specs used through Jan 31, 2027 and specs effective Feb 1, 2027. Shares are each count divided by 200. The practice-set column is our own rounding to roughly match those shares. It isn't an official mini-exam.

What changes on February 1, 2027:

  • Patient Care adds medical equipment malfunctions, patient comfort and modesty, communicating critical findings to the care team, local reactions such as infiltration, and emergency medications.
  • Safety adds short-term versus long-term radiation exposure.
  • Image Production updates the informatics section.
  • Procedures removes sequestration and radiochromatography, moves neuroendocrine and adrenal imaging from Endocrine into Tumor, and removes PET/CT from the bone section.
  • The pharmaceutical list (Attachment A) drops several agents, including adenosine, dipyridamole, Tl-201, Ga-67 citrate, In-111 pentetreotide, F-18 sodium fluoride, F-18 fluciclovine, and I-131 MIBG. It adds Ga-68 gozetotide and F-18 piflufolastat (PSMA agents), Cu-64 dotatate, and Lu-177 vipivotide tetraxetan.

Every question above tests a topic or agent listed in both versions, so this set is useful whichever side of the date you test on. It doesn't cover the topics that are new in 2027, so if you test on or after February 1, also review those from the 2027 outline. Retaking after the switch? ARRT advises comparing the current specs with the ones you used last time.

What to expect on the ARRT Nuclear Medicine Technology exam

Exam detail What to expect
Questions 230: 200 scored plus 30 unscored pilot questions, mixed in randomly and not identified
Test time 230 minutes
Appointment 250 minutes, which adds an 8-minute tutorial, 2-minute nondisclosure agreement, and 10-minute survey
Question types Mostly multiple choice with one best answer; some may ask you to select multiple answers, sort options into order, select an image, or answer after a short video
Calculator Provided on screen or by the test center; you can't bring your own
Passing score Scaled score of 75 on a 1–99 scale
Attempts 3 attempts within 3 years of when your first exam window opens
Test administrator Pearson VUE

Source: ARRT 2026 Primary Eligibility Pathway Handbook, pages 14, 37, 40, 43, and 53–54. ARRT updates the handbook every year, so check the current edition before you test.

This practice set is shorter, untimed, and text-only, so it can't reproduce image or video items.

What does a passing score of 75 mean?

It's a scaled score, not 75% correct. ARRT converts your number of correct answers to a 1–99 scale so that 75 means the same level of performance across forms evaluated under the same passing standard, which is why the number of correct answers needed can vary slightly from form to form. ARRT has also updated the Nuclear Medicine Technology passing standard for candidates who test on or after February 1, 2027. The reported passing score stays 75. A percentage on this practice set doesn't convert to that scale.

Ready to apply or schedule? See how to apply for and schedule an ARRT exam. Already tested? See how to read your ARRT score report and ARRT retake rules.

Is this the same as the NMTCB exam?

No. ARRT awards the R.T.(N)(ARRT) credential through its certification and registration process, which includes its own exam. The Nuclear Medicine Technology Certification Board (NMTCB) is a separate organization that awards the CNMT credential through a different exam, with its own outline and scoring. The two cover a lot of the same science, but this set is mapped to ARRT's content specifications.

Common questions

Does ARRT endorse this practice test?

No. ARRT says it doesn't recommend or endorse any review programs, mock registries, or study guides, and it warns candidates about materials that use its name or claim to include ARRT questions. Its own advice is to use the content specifications as a guide to exam topics (handbook, p. 38).

Does passing the ARRT exam let me work in any state?

Not automatically. ARRT certification and state licensing are separate, and some states require their own license (handbook, p. 15). Check with the licensing agency in the state where you'll work.

Are these questions clinical protocols?

No. They teach the principles behind exam topics, using the cited regulations, product labels, and professional guidelines. In practice, follow your facility's procedures, your radiation safety program, and the orders of your supervising physician.

Sources and verification

Last verified: October 28, 2026 (Asia/Manila). The exam facts were checked against ARRT's two content specifications, ARRT's April and October 2026 notices, the ARRT Nuclear Medicine Technology credential page, and the 2026 handbook. Each question's answer and explanation were checked against the specific sources cited beside it, and all six calculations were recomputed. These checks used AI assistance; they are not a review by a credentialed technologist or physician.

Official exam and credential sources

Regulations

Prescribing information and device instructions

Professional guidelines and teaching references

By the Castleport Test Prep Editorial Team.

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) or the Nuclear Medicine Technology Certification Board (NMTCB). Exam and credential names identify the subjects discussed; trademarks belong to their respective owners. All practice questions on this page are original and unofficial, not actual or recalled exam questions.