About The Fluoroscopy Exam

ARRT's Fluoroscopy Examination is designed for candidates who have relevant foundational qualifications, such as physicians, radiologic technologists, physician's assistants, and physician extenders. This also includes education and clinical competency for the specific fluoroscopy procedures they will be performing. The Fluoroscopy Examination is not intended for limited x-ray machine operators, medical assistants, chiropractic technicians, or other ancillary medical personnel.

How long is the exam?
You are given 2 hours to complete the exam.

How many questions are on the fluoroscopy exam?
There are about 90 scored questions, but the total number of test questions varies since ARRT includes non-scored questions as a means of improving future exams. For example, the test may have 120 questions. You should try your best on every question because you cannot tell which questions are scored or not.

Do I lose points if I answer a question incorrectly?
No, your exam score is based on the total number of correct answers, so you should answer every question, even if you have to guess. There is no penalty for guessing.

When will I know my score?
This depends on your state licensing agency, which will let you know your examination results. The ARRT does not release the scores. It could take 4 to 6 weeks before you receive the results of your examination. You will also be given your score by category, so that you know which categories you need to work on.

How many questions do I need to answer correctly to pass?
Total scores are reported on a scale that ranges from 1 to 99. The total scaled score does not equal the number or percentage of questions answered correctly. A total scaled score of 75 is required to pass the exam. For our practice exams, we recommend you get at least 80% consistently to be ready for the real exam.

Exam Content Outline

These are the Fluoroscopy Exam categories and estimated number of scored questions for each. Keep in mind that there are likely a number of non-scored questions on the actual exam.

1. Patient Interactions and Management (9 questions)

A. Patient Identification and Procedure Verification

B. Components of Informed Consent

C. Risk versus Benefit

D. (NEW) Patient Education

1. (NEW) explanation

2. (NEW) respond to inquiries (not limited to: e.g., radiation dose, types of radiation)

E. Procedural Understanding to Reduce Exposure

F. Procedure Radiation Exposure (NCRP #160)

G. Cumulative Dose Education

H. Pregnancy Status (e.g., tests and limitations)

I. Contrast Reactions

1. allergy history (e.g., appropriate pre-medication

2. types of reactions (mild to severe)

J. Patient Record Information

1. patient dose/technical factors

2. (NEW) adverse reactions

3. picture archiving and communication systems (PACS)

4. hospital information systems (HIS)

5. radiology information systems (RIS)

6. (NEW) electronic medical record (EMR) or electronic health record (EHR) systems

K. Standards of Care

L. HIPAA

1. Radiation Physics and Radiobiology (22 questions)

A. Radiation Physics

1. photon interactions with matter

a. Compton effect

b. photoelectric absorption

c. coherent (classical) scatter

d. attenuation by various tissues

2. x-ray production

a. source of free electrons (e.g., thermionic emission)

b. acceleration of electrons

c. focusing of electrons

d. deceleration of electrons

e. target interaction (e.g., x-ray spectrum)

3. x-ray beam

a. frequency and wavelength

b. beam characteristics

c. scatter

d. inverse square law

e. fundamental properties (e.g., travel in straight lines, ionize matter)

B. Radiation Biology

1. radiosensitivity

a. dose-response relationships

b. relative tissue radiosensitivity (e.g., LET, RBE)

c. cell survival and recovery

d. oxygen effect

2. somatic effects

a. short-term versus long-term effects

b. acute versus chronic effects

c. carcinogenesis

d. organ and tissue response (e.g., eye, thyroid, breast, bone marrow, skin, gonadal)

3. embryonic and fetal risks

4. genetic effects

2. Radiation Protection (24 questions)

A. Minimizing Patient Exposure

1. exposure factors

a. fluoroscopy time

b. automatic brightness control (ABC)

c. automatic exposure rate control (AERC)

2. shielding

a. rationale for use

b. types

c. placement

3. beam restriction

a. purpose of primary beam restriction

b. collimators

4. filtration

a. effect on skin and organ exposure

b. effect on average beam energy

c. NCRP recommendations (NCRP #102, minimum filtration in useful beam)

5. equipment features

a. last image hold

b. cumulative timer

c. magnification mode

d. dose mode

6. pediatric dose reduction

7. (NEW) grids

8. (NEW) receptor positioning

9. patient positioning

a. impact on dose

b. patient immobilization devices

10. (NEW) does or time documentation

11. (NEW) dose area product (DAP) meter

12. (NEW) air kerma display

13. (NEW) minimum source-to-skin distance (21 CFR)

B. Personnel Protection

1. sources of radiation exposure

a. primary x-ray beam

b. secondary radiation

c. patient as source

2. basic methods of protection

a. time

b. distance

c. shielding

3. protective devices

a. protective drapes

b. Bucky slot cover

c. shields (e.g., aprons, gloves, eye, face, floating, thyroid)

d. attenuation properties

e. (NEW) cumulative timer

f. (NEW) remote-controlled fluoroscopy

4. minimum lead equivalent (NCRP #102)

5. (NEW) guidelines for fluoroscopy and mobile units (NCRP #102, 21 CFR)

a. (NEW) fluoroscopy exposure rates (e.g., normal, high-level control)

b. (NEW) exposure switch guidelines

6. recommendations for personnel monitoring (NCRP #116)

a. occupational exposure

b. public exposure

c. embryo/fetus exposure

d. ALARA and dose equivalent limits

e. evaluation and maintenance of personnel dosimetry records

7. units of measurement

a. absorbed dose

b. dose equivalent

c. exposure

d. effective dose

e. (NEW) air kerma

8. dosimeters

a. types

b. proper use

1. Equipment Operation (22 questions)

A. Technical Factors

1. mA

2. kVp

3. object-to-image distance (OID)

4. source-to-image distance (SID)

5. focal spot size

6. grids

7. filtration

8. beam restriction

9. automatic brightness control (ABC)

10. automatic exposure rate control (AERC)

11. anatomic alignment

12. exposure compensation

13. magnification mode

14. spot imaging (digital spot)

15. high level control (boost, high dose rate)

16. pulse rate

B. Image Receptors

1. image intensifier

2. flat panel detector

C. Image Display

1. viewing conditions (e.g., luminance, ambient lighting, eye physiology, ergonomics)

2. spatial resolution (e.g., pixel size, pixel pitch

3. contrast resolution/dynamic range

4. DICOM gray scale function

5. (NEW) brightness and contrast

D. Recording Systems

1. digital subtraction angiography (DSA)

2. image capture

3. spot imaging (digital spot)

E. (NEW) Imaging Informatics

1. (NEW) digital imaging and communications in medicine (DICOM)

2. (NEW) picture archiving and communication systems (PACS)

3. (NEW) radiology information system (RIS) (e.g., modality worklist)

4. (NEW) hospital information system (HIS)

5. (NEW) electronic medical records (EMR) or electronic health records (EHR)

2. Image Evaluation and Quality Control (13 questions)

A. Digital Image Characteristics

1. spatial resolution (equipment related)

a. sampling frequency

b. detector element size (DEL) (e.g., size, pitch, fill factor)

c. receptor size and matrix size

d. (NEW) pixel characteristics (e.g., size, pitch)

2. image signal (exposure related)

a. quantum mottle (quantum noise)

b. (NEW) dynamic range

c. signal to noise ratio (SNR)

d. contrast to noise ratio (CNR)

3. (NEW) contract resolution (equipment related)

a. (NEW) bit depth

b. (NEW) modulation transfer function (MTF)

c. (NEW) detective quantum efficiency (DQE)

B. Criteria for Image Evaluation

1. demonstration of anatomical structures (e.g., positioning, motion)

2. identification markers (radiographic or electronic) (e.g., anatomical, patient, date)

3. patient considerations (e.g., pathologic conditions)

4. (NEW) quantum mottle (quantum noise)

5. (NEW) gross exposure error (e.g., loss of contrast, saturation)

6. (NEW) contrast

7. (NEW) spatial resolution

8. (NEW) distortion (e.g., size, shape)

9. image artifacts (e.g., grid lines, dead pixels, distortion)

C. Recognition and Reporting of Malfunctions

1. quality control

a. (NEW) display monitor (e.g., grayscale standard display function, luminance

b. shielding accessory testing (e.g., lead apron and glove testing)

c. exposure rate output

d. spot imager

e. image quality (e.g., resolution)

2. recording and reporting of overexposure

Useful Resources

ARRT Links

* As of February 2017, large sections of the ARRT website are under construction and much of the information they provided for their fluoroscopy exam is currently not available or difficult to find.*

California ARRT Fluoroscopy Licensing Exam Information
ARRT Fluoroscopy Licensing Exam Information (new for 2018)
ARRT Fluoroscopy Licensing Exam Information (2017 and earlier)
ARRT Fluoroscopy State Licensing Information
ARRT Exam Handbook
Scheduling an exam at a Pearson VUE Center

ARRT Recommended Resources

Syllabus on Fluoroscopy - Radiation Protection 6th Edition