- Which Credential This Sheet Covers
- The Blueprint in Numbers
- Exam Format and Test-Day Facts
- Scoring: What 75 Really Means
- Eligibility Checklist
- Fees, Attempts, and Renewal
- Domain 1: Patient Care
- Domain 2: Image Production
- Domain 3: Procedures
- Sequencing Your Review
- Where the Credential Gets Used
- Frequently Asked Questions
- The exam has 225 questions: 185 scored plus 40 unscored pilots, with 225 minutes of testing time.
- Scored allocations are Patient Care 16, Image Production 105, and Procedures 64; Image Production dominates.
- A scaled score of 75 on the 1-99 scale passes. It does not mean 75% correct.
- Clinical requirements: 200 independently performed nonsimulated exams plus 20 approved elective procedures in a 24-month window.
Which Credential This Sheet Covers
Before memorizing anything, confirm you are studying the right credential. On this site, RTBS refers to the ARRT postprimary Breast Sonography (BS) credential, awarded by the American Registry of Radiologic Technologists. It is not the ARDMS Breast (BR) credential, and it is not ARRT's general Sonography (S) credential. Those are separate exams with separate content outlines, so facts from one do not transfer to another.
If you are still orienting yourself, the explainers at What Is RTBS? and What Does RTBS Stand For? cover the naming, and RTBS Certification gives the broader picture. This page is the compressed version: the numbers and rules you should be able to recite without looking.
The Blueprint in Numbers
The content specifications divide the exam into three major categories. The allocations below are counts of scored questions, which are more reliable than percentage conversions floating around the internet.
| Domain | Scored Questions | Relative Weight |
|---|---|---|
| Domain 1: Patient Care | 16 | Smallest |
| Domain 2: Image Production | 105 | Largest |
| Domain 3: Procedures | 64 | Second largest |
Those three add up to the 185 scored questions. Image Production is further divided into three subcategories:
| Image Production Subcategory | Scored Questions |
|---|---|
| Basic Principles of Ultrasound | 32 |
| Image Formation | 37 |
| Evaluation and Selection of Representative Images | 36 |
Notice that the three Image Production subcategories are nearly even. A candidate who is strong on physics but weak on judging which images are diagnostically representative is leaving real points on the table. For a deeper walk through each content area, see RTBS Exam Domains 2026: Complete Guide to All 3 Content Areas.
Exam Format and Test-Day Facts
- Delivery: Computer-based at a Pearson VUE testing center.
- Length: 225 total questions, made up of 185 scored items and 40 unscored pilot items. You will not know which are which.
- Time: 225 minutes of testing. The appointment itself is 245 minutes, which includes the non-testing steps. Do not confuse the two figures, and ignore claims of a three-hour exam.
- Question types: Mostly one-best-answer multiple choice, with other handbook-permitted formats such as multiple-response, sorting, and image or video items.
- Reference rules: Closed book. Personal calculators are not allowed; the test center supplies a calculator or an on-screen one is available.
The image and video items matter more for this credential than for many others, because so much of breast sonography is pattern recognition: lesion margins, orientation, posterior features, and probe technique. Practice with real images, not just text recall. Our RTBS practice tests are built to mirror that mix of recall and image-based judgment.
Scoring: What 75 Really Means
The passing score is 75 on a 1-99 scaled-score system. This is the single most misunderstood number on the cheat sheet. A scaled score is not a percentage of questions answered correctly. ARRT converts raw performance into a scaled score so that different exam forms, which may differ slightly in difficulty, are held to the same standard.
ARRT's Standard Setting Report for Breast Sonography (effective September 2026) gives a form-specific raw-score equivalent and a projected pass rate. That is not a universal raw cutoff you can plan around, and it is not an observed 2026 cohort result. Treat any claim of "you need exactly X correct" with suspicion. The full explanation is in RTBS Passing Score 2026: Exactly What You Need to Pass.
For context on performance, ARRT's 2025 annual exam report shows a first-time pass rate of 78.1% among 146 candidates. That cohort predates the September 2026 blueprint and passing-standard revision, so use it as a rough reference point rather than a prediction. More on interpreting it at RTBS Pass Rate 2026: What the Data Shows and How Hard Is the RTBS Exam?
Eligibility Checklist
You cannot sit for the exam until the prerequisites are met. Work through these in order.
1. Hold a supporting-category credential
You need a current credential in one of these combinations:
- Radiography plus Mammography, or
- Sonography, or
- Vascular Sonography.
The Sonography and Vascular Sonography supporting credentials may be held through ARRT or ARDMS. The Vascular Sonography route is explicitly listed in the 2026 handbook's supporting-category table (printed page 6), and candidates sometimes overlook it. If you hold an ARDMS supporting credential, note the different fee in the next section.
2. Meet ethics requirements
You must be in compliance with ARRT ethics requirements.
3. Complete structured education
You need 16 structured-education hours completed within the 24 months before you apply, with at least one credit in each major category.
4. Document clinical experience
Within the qualifying 24-month window, you must:
- Independently perform 200 nonsimulated breast examinations.
- Participate in at least 20 approved elective procedures.
The counting rules trip people up:
- A bilateral examination counts as two.
- No more than nine procedures may be logged per day.
- Scanning must be physically onsite.
- Each mandatory examination must be presented to the radiologist for final interpretation.
Key Takeaway
Start your clinical log early and verify each entry against the daily cap and the onsite and radiologist-presentation rules. Entries that violate the rules can undercount your total and delay your application. The full pathway is detailed in RTBS Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Fees, Attempts, and Renewal
| Item | Amount or Rule |
|---|---|
| Application/exam fee | $225 USD |
| Fee using an ARDMS supporting credential | $450 USD |
| Reapplication fee | $200 |
| Attempts permitted | Three within three years before requalification |
| Annual ARRT registration renewal | $65, regardless of how many ARRT credentials you hold |
| Continuing education | Ordinarily 24 approved CE credits per two-year biennium |
| Continuing Qualifications Requirements (CQR) | Every ten years for credentials earned on or after January 1, 2011 |
Be careful with the attempt rule: it is three attempts within a three-year window, not three attempts per year. Treat your first attempt as the one that counts. Budget details and what else to plan for are in RTBS Certification Cost 2026: Complete Pricing Breakdown, and scheduling specifics are in RTBS Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
Domain 1: Patient Care
Patient Care (16 scored questions)
The smallest domain, but the questions are often the most approachable. Do not skip it just because it is small; these are points you should be collecting reliably.
- Patient communication and sensitivity during breast examinations, including privacy and comfort
- Gathering relevant history and symptoms before scanning
- Infection control and safe practices around equipment and gel
- Recognizing when a finding or patient situation requires escalation to the radiologist or care team
- Ethical conduct, confidentiality, and professional boundaries
With only 16 scored items, a handful of missed questions here costs proportionally little, but easy points are still points. Aim to get nearly all of them right with minimal study time.
Domain 2: Image Production
This is the heavyweight: 105 of the 185 scored questions. If you only had time to master one domain, this is where the payoff is largest.
Basic Principles of Ultrasound (32)
The physics foundation that supports every other decision you make at the console.
- Sound wave properties: frequency, wavelength, propagation speed, and how they relate
- Interaction with tissue: attenuation, reflection, refraction, and scattering
- Transducer construction and why high-frequency linear arrays suit superficial breast tissue
- Resolution concepts: axial, lateral, and elevational, and what improves each
- Artifacts that arise from physics, and what causes them
Image Formation (37)
The largest Image Production subcategory. It tests whether you can manipulate the system to get a clean, accurate picture.
- Knobology: gain, time-gain compensation, depth, focal zones, dynamic range
- Harmonics, compounding, and other processing options and their trade-offs
- Doppler and color settings as they apply to breast evaluation
- Optimizing images of superficial structures, including standoff and compression considerations
- Recognizing and correcting common technical errors
Evaluation and Selection of Representative Images (36)
This tests judgment: which images belong in the study, and are they diagnostic.
- Identifying normal breast anatomy and tissue layers on sonograms
- Characterizing lesions: shape, margins, orientation, echo pattern, and posterior acoustic features
- Recognizing artifacts that mimic or obscure pathology
- Selecting images that fairly represent a finding for the interpreting radiologist
- Documenting with proper labeling, measurements, and orientation
Domain 3: Procedures
Procedures (64 scored questions)
The second-largest domain, covering what you do clinically and how breast imaging is performed and supported.
- Scanning technique for diagnostic breast examinations, including patient positioning and systematic survey patterns
- Anatomy and its sonographic appearance, plus common benign and malignant presentations
- Correlation with other modalities and clinical findings, such as mammography and physical exam
- Interventional and adjunct procedures where the sonographer assists, which connects to the approved elective procedures you log for eligibility
- Documentation, communication of findings to the radiologist, and workflow expectations
The tie between this domain and your clinical log is useful: the 200 nonsimulated exams and 20 elective procedures you document for eligibility are the same hands-on experience this domain tests. Candidates with a varied, well-documented caseload usually find the Procedures questions more intuitive.
Sequencing Your Review
Because the allocations are so uneven, order your preparation around the blueprint rather than going domain by domain in numerical order. One sensible sequence for a short review window:
Image Production foundations
- Basic Principles of Ultrasound (32) and Image Formation (37): physics, transducers, resolution, knobology
- These concepts underpin everything later, so front-load them
Image evaluation and Procedures
- Evaluation and Selection of Representative Images (36) with real sonograms
- Procedures (64): scanning technique, anatomy, correlation, adjunct procedures
Patient Care and full-length practice
- Patient Care (16): quick review, since the content is concise
- Timed runs at the 225-question length to rehearse pacing and image items
For a fuller plan, including how to adapt the timeline to your own baseline, see RTBS Study Guide 2026: How to Pass on Your First Attempt.
Where the Credential Gets Used
Breast sonography credentials are most relevant in settings that perform diagnostic breast ultrasound and often pair it with mammography and image-guided procedures. Typical employers include hospital imaging departments, outpatient imaging centers, dedicated breast centers, and radiology practices. Because eligibility requires a supporting credential in radiography with mammography, sonography, or vascular sonography, many holders are already working in imaging and add this postprimary credential to broaden their scope or qualify for breast-focused roles.
This site does not publish a salary figure for the credential because we only cite numbers we can source. For a qualitative discussion of compensation drivers, read RTBS Salary Guide 2026: Complete Earnings Analysis, and for job-market context see RTBS Jobs. If you are weighing the investment, Is the RTBS Certification Worth It? lays out the trade-offs.
Frequently Asked Questions
There are 225 questions in total: 185 scored and 40 unscored pilot items. You cannot tell which are pilots, so answer every question carefully.
You have 225 minutes of testing time within a 245-minute appointment. The extra time covers non-testing steps, so plan your pacing around the 225 minutes.
No. The passing score is 75 on a 1-99 scaled-score system. Raw performance is converted to a scaled score, and the raw equivalent is form-specific rather than a fixed universal cutoff.
The application/exam fee is $225, or $450 if you use an ARDMS supporting credential. Reapplication costs $200. You are allowed three attempts within three years before requalification is required.
You need current Radiography plus Mammography, or Sonography, or Vascular Sonography. Sonography and Vascular Sonography may be held through ARRT or ARDMS. Verify the current table on the ARRT site before applying.
Print this cheat sheet, memorize the allocations (16, 105, 64) and the clinical-experience rules, and then pressure-test your recall with the RTBS practice exam. Keep the official ARRT documents as your final authority, since requirements and blueprints are revised periodically.