- Credential Snapshot: What This RTM Actually Is
- Exam Format and Logistics at a Glance
- The Three Domains and Their Question Counts
- Scoring and Pass-Rate Facts That Get Misread
- Eligibility and Clinical Requirements Checklist
- Fees, Attempts and Application Mechanics
- Concrete Topics to Master by Domain
- Keeping the Credential Active
- A Domain-Weighted Study Sequence
- Frequently Asked Questions
- RTM here means Registered Technologist - Mammography, an ARRT postprimary credential delivered at Pearson VUE centers.
- The exam has 145 questions: 115 scored, 30 unscored pilot items, with 150 minutes of answering time.
- Procedures carries 65 of the 115 scored questions, so it is the domain that decides your result.
- A passing score is 75 on the 1-99 scaled range, not 75% of questions correct.
Credential Snapshot: What This RTM Actually Is
Before memorizing anything, lock down what you are studying. On this site, RTM stands for Registered Technologist - Mammography. The credential is issued by the American Registry of Radiologic Technologists (ARRT). ARRT's official discipline name is simply Mammography (M); "RTM" is the abbreviation this site uses for it. Other credentials elsewhere share the same three letters, so be careful when searching: only ARRT's mammography material applies to your exam. If you need a plain-language orientation first, see What Is RTM? or What Does RTM Stand For?.
Mammography is a postprimary credential. That means you do not enter it from scratch; you add it to an existing ARRT Radiography certification and registration. This single fact shapes everything else on the cheat sheet, from eligibility to the structure of your clinical logbook.
Exam Format and Logistics at a Glance
| Item | Fact |
|---|---|
| Delivery | Computer-based at Pearson VUE test centers |
| Total questions | 145 (115 scored + 30 unscored pilot) |
| Answering time | 150 minutes |
| Total appointment | 170 minutes, including tutorial, nondisclosure agreement and survey |
| Question style | Primarily single-best-answer multiple choice; alternative item formats and image-based questions possible; the ARRT handbook also describes multiple-response and ordered-response formats |
| Book policy | Closed book |
| Calculators | Basic and scientific on-screen calculators; Pearson can supply a basic four-function calculator on request; personal calculators prohibited |
| Navigation | Answer each item before advancing; flag and revisit as needed |
Why the Navigation Rule Matters
You cannot skip a question and leave it blank. Every item needs an answer before you move forward, but you can flag it and return. The practical strategy: enter your best guess, flag it, and keep your pace. With 145 questions in 150 minutes, you have roughly one minute per item, and the 30 unscored pilot questions are indistinguishable from scored ones, so treat every item as if it counts.
Image-based questions are especially relevant in mammography, where recognizing positioning quality, artifacts and anatomy on an image is core to the job. For a deeper read on how this plays out on test day, see How Hard Is the RTM Exam?
The Three Domains and Their Question Counts
The September 2025 content specifications allocate the 115 scored questions across three major content categories. These are the issuer's own counts, so this cheat sheet keeps them as counts rather than converting them into percentages ARRT has not published.
| Domain | Scored Questions (of 115) |
|---|---|
| Domain 1: Patient Care | 20 |
| Domain 2: Image Production | 30 |
| Domain 3: Procedures | 65 |
Procedures is the largest category and breaks into two sub-areas: Anatomy, Physiology, and Pathology (26) and Mammographic Positioning and Procedures (39). Together these two sub-areas account for more than half of everything that is scored.
For a full walk through each area, read RTM Exam Domains: Complete Guide to All 3 Content Areas.
Scoring and Pass-Rate Facts That Get Misread
The 75 Is Not 75 Percent
ARRT reports results on a scaled score range of 1 to 99, and the passing score is 75. Scaling adjusts for small difficulty differences between exam forms, so a scaled 75 does not mean you answered 75% of questions correctly. Do not plan around a raw-percent target. The full explanation is in RTM Passing Score: Exactly What You Need to Pass.
Two Pass-Rate Numbers, Two Different Cohorts
ARRT's Annual Exam Report - 2025 contains two figures that candidates routinely confuse:
- 91% (rounded): the full-year first-attempt summary, covering 1,865 candidates and spanning the September blueprint change.
- 90.3%: the revised-exam first-time cohort for September 1 through December 31, 2025 (n=567).
The 90.3% figure is not the full-calendar-year pass rate, and the two percentages describe different groups of candidates. Quote them accurately and do not swap one for the other. For context on interpreting these numbers, see RTM Pass Rate: What the Data Shows.
Key Takeaway
High first-attempt pass rates reflect a self-selected group: candidates who are already ARRT-certified radiographers with documented mammography experience. Do not read the numbers as permission to under-prepare, especially for the Procedures domain.
Eligibility and Clinical Requirements Checklist
You must qualify before you can sit for the exam. The postprimary pathway requires all of the following:
- Current ARRT certification and registration in Radiography.
- Compliance with ARRT ethics requirements.
- 16 hours of structured education completed within the 24 months before you apply, with at least one credit in each major content category.
- Verified clinical experience completed within the corresponding 24-month eligibility window.
Clinical Experience Requirements
What Your Logbook Must Show
Under the Mammography Clinical Experience Requirements (effective September 1, 2025), you need:
- MQSA compliance established before you perform any procedure that will count.
- Independent mammographic imaging of 75 patients, with no phantom or simulated substitutions.
- All nine prescribed quality-control activities, each at its required repetition count.
- Review of at least 10 mammography cases with an MQSA-qualified interpreting physician.
- At least five elective procedures completed through observation, assistance or participation.
Logging Rules That Trip People Up
- A maximum of 16 mammographic procedures per day may be logged across mammograms, QC, image evaluation and electives combined.
- QC documentation is limited to one submission per day per test.
- You must be physically present for the examinations and procedures you log.
- Your qualified clinical verifier does not need to directly observe the work and may verify remotely.
- For image evaluation, a HIPAA-compliant virtual meeting with a remote interpreting physician is permitted while you review the same images on a local monitor. In-person review is recommended.
The daily caps mean your QC repetitions cannot be rushed into a few marathon days; plan your logbook across weeks. The full eligibility picture lives in RTM Requirements: Eligibility, Prerequisites & How to Qualify, and the education side is covered in RTM Training.
Fees, Attempts and Application Mechanics
| Item | Amount or Rule |
|---|---|
| Initial application | $225 USD |
| Examination reapplication | $200 USD |
| Annual renewal | $65, regardless of how many ARRT credentials you hold |
| Attempt limit | Three attempts within three years of the opening of the initial examination window |
The attempt clock matters more than most candidates realize. It is tied to the opening of your initial examination window, not to the date you happen to test. If you delay your first sitting, you shrink the time available for retakes. A complete cost breakdown is available in RTM Certification Cost: Complete Pricing Breakdown, and timing details are in RTM Exam Dates: Testing Windows, Deadlines & Scheduling.
Concrete Topics to Master by Domain
The blueprint tells you where the points are; this section tells you what to actually know. Content below reflects standard mammography practice consistent with the three official categories.
Domain 1: Patient Care (20 scored questions)
Smaller in weight, but these items are often the most accessible points on the exam.
- Patient communication, including explaining the procedure, addressing anxiety and discussing breast compression expectations.
- Patient history collection: symptoms, prior surgeries, implants, family history and hormonal factors relevant to imaging.
- Ethical and professional conduct, privacy and informed-consent principles.
- Infection control and safe handling of the equipment between patients.
- Recognizing situations that need escalation, such as unusual symptoms reported during history.
Domain 2: Image Production (30 scored questions)
This domain covers the technical chain from equipment to final image.
- Mammography unit components: tube, filtration, compression device, grid and detector.
- Exposure factors, automatic exposure control behavior and how breast thickness and density affect technique selection.
- Image quality attributes: contrast, resolution, noise, artifacts and how to troubleshoot each.
- Quality control testing, including the nine prescribed activities you documented for eligibility.
- Digital image processing, display considerations and radiation dose awareness.
Domain 3: Procedures (65 scored questions)
The deciding domain. Split your attention between its two sub-areas.
- Anatomy, Physiology, and Pathology (26): breast anatomy and tissue types, lymphatic drainage, physiologic changes across life stages, and common benign and malignant findings as they appear on images.
- Mammographic Positioning and Procedures (39): standard craniocaudal and mediolateral oblique views, supplemental and problem-solving views, positioning for implants and special patient populations, criteria for evaluating whether a view is adequate, and the logic behind repeat decisions.
- Image evaluation: judging nipple profile, pectoral muscle visualization, inframammary fold and tissue coverage.
- Interventional and adjunct procedures at the level of the technologist's role.
A topic-by-topic walk through these areas is in RTM Study Guide: How to Pass on Your First Attempt.
Keeping the Credential Active
Passing the exam is not the finish line. To stay certified and registered, you must meet three ongoing obligations:
- Annual renewal at $65, a single fee regardless of how many ARRT credentials you hold.
- Ethics compliance maintained continuously.
- 24 approved continuing education credits per two-year biennium. This total applies to you as a person, not per credential, so extra credentials do not multiply your CE load.
Credentials earned on or after January 1, 2011 also fall under Continuing Qualifications Requirements (CQR), which come due every 10 years. CQR involves a professional profile, a structured self-assessment and any prescribed CE. ARRT also lets you accept the maximum CQR CE prescription instead of taking the self-assessment. Since your mammography credential is earned well after 2011, expect CQR to apply.
A Domain-Weighted Study Sequence
Because Procedures holds 65 of 115 scored questions, front-load it. This is the one place generic scheduling helps, and only because the blueprint dictates the order.
Procedures: Anatomy, Physiology, and Pathology
- Build breast anatomy and pathology recognition (26 questions).
- Pair every finding with how it presents on an image.
Procedures: Positioning and Procedures
- Drill standard and supplemental views plus image-adequacy criteria (39 questions).
- Practice with image-based questions, not text alone.
Image Production
- Review technique, artifacts and the nine QC activities (30 questions).
Patient Care and Full Review
- Cover communication, history and ethics (20 questions).
- Finish with timed practice at one minute per item.
When you are ready to test your pacing against realistic questions, try the RTM practice tests and review any weak domain against the domain guide.
Frequently Asked Questions
The exam contains 145 questions: 115 scored and 30 unscored pilot questions. You have 150 minutes of answering time within a 170-minute appointment that also covers the tutorial, nondisclosure agreement and survey.
The passing score is 75 on ARRT's 1-99 scaled-score range. It is not 75% of questions correct, because scaling accounts for difficulty differences between exam forms. See the passing score guide for details.
Procedures, with 65 of 115 scored questions. It includes Anatomy, Physiology, and Pathology (26) and Mammographic Positioning and Procedures (39), making it the largest single category on the exam.
Yes. The postprimary pathway requires current ARRT certification and registration in Radiography, along with ethics compliance, 16 hours of structured education and verified clinical experience. See RTM Requirements for the complete list.
You get three attempts within three years of the opening of your initial examination window. The initial application costs $225 and each reapplication costs $200.
That depends on your career goals and local demand for mammography technologists. For a structured look at the tradeoffs, read Is the RTM Certification Worth It?, then compare earnings context in the RTM Salary Guide and hiring options in RTM Jobs.