- The Headline Number: 78.1% on 146 First-Time Candidates
- How to Read That Cohort Honestly
- Why the 2026 Blueprint Changes the Picture
- A Passing Score of 75 Is Not 75% Correct
- Where the Scored Questions Actually Sit
- Who Sits This Exam and Why That Lifts Pass Rates
- Attempt Limits, Fees, and the Cost of a Miss
- Turning the Data Into a Preparation Plan
- Frequently Asked Questions
- The most recent published first-time pass rate is 78.1% among 146 candidates, from the ARRT Annual Exam Report for 2025.
- That 2025 cohort predates the September 1, 2026 blueprint and passing-standard revision, so treat it as context, not a forecast.
- A passing score is 75 on a 1-99 scaled system, not 75% of questions answered correctly.
- Image Production carries 105 of 185 scored questions, making it the largest single lever on your result.
The Headline Number: 78.1% on 146 First-Time Candidates
If you are searching for the Registered Technologist - Breast Sonography pass rate, the number to anchor on comes from the American Registry of Radiologic Technologists (ARRT). In its Annual Exam Report for 2025, ARRT reports a first-time pass rate of 78.1% for the Breast Sonography postprimary examination, drawn from 146 first-time candidates. The figure appears on pages 3 and 29 of that report.
That is the only observed cohort figure we can responsibly cite. You will see other numbers floating around forums and vendor pages, and many are recycled from unrelated credentials that happen to share the RTBS abbreviation. For this credential, the ARRT report is the source of record. If you want the broader difficulty picture beyond one percentage, our guide on how hard the RTBS exam is puts the number in context.
How to Read That Cohort Honestly
A pass rate is a summary of a specific group of people on a specific form of a specific exam. Three features of the 78.1% figure deserve attention before you draw conclusions.
The sample is small
One hundred forty-six candidates is a small population. A cohort that size can swing noticeably from year to year without any change in exam difficulty, simply because of who happened to test. Do not read a one-year figure as a stable property of the exam.
It counts first-time candidates only
The figure describes people sitting the exam for the first time. Candidates who retest are tracked separately, so the 78.1% should not be mixed with repeat-attempt outcomes. If you are a first-time candidate, though, it is the most relevant comparison group.
It is a backward-looking number
The report covers 2025 testing. The examination you will sit under the current content specifications is not identical to the one those 146 candidates faced, which is the subject of the next section.
Why the 2026 Blueprint Changes the Picture
The Breast Sonography Examination Content Specifications were board approved in July 2025 and take effect September 1, 2026 (document version v2025.10.16). The passing standard was revised alongside them, and ARRT publishes a Standard Setting Report for Breast Sonography effective September 2026.
Here is the part many candidates miss: that report provides a form-specific raw-score equivalent and a projected pass rate. It does not publish a universal raw cutoff that applies to every exam form, and it is not an observed 2026 cohort rate. A projection is a modeled expectation, not a result. Until ARRT publishes a report covering candidates who tested under the new blueprint, no one can honestly state a 2026 pass rate.
A Passing Score of 75 Is Not 75% Correct
The most common misunderstanding about this exam is the passing score. ARRT reports results on a 1-99 scaled-score system, and a score of 75 is passing. That number is a scaled score, not a percent-correct threshold.
Scaling exists so that a given score represents the same level of competence across different exam forms, even if one form is slightly harder or easier than another. The raw number of questions you need to answer correctly can therefore differ from one form to the next, which is exactly why the Standard Setting Report gives a form-specific raw-score equivalent rather than a single universal cutoff.
Two practical consequences follow:
- Do not set a study goal of "get 75% on practice tests" and assume it maps to passing. Treat practice percentages as directional only.
- Do not trust anyone who tells you the exact number of questions you can miss. That number is not fixed across forms.
For a deeper walkthrough of how scores are reported, read our explainer on the RTBS passing score.
Where the Scored Questions Actually Sit
The exam contains 225 total questions: 185 scored and 40 unscored pilot questions. You are given 225 minutes of testing time within a 245-minute appointment, delivered through a Pearson VUE testing center. Pilot questions are indistinguishable from scored ones, so you must treat every question seriously.
The scored questions are allocated across the three official major categories by count. We retain the counts rather than converting them into percentages, since the counts are what ARRT publishes.
| Domain | Scored Questions | What It Covers |
|---|---|---|
| Patient Care | 16 | Patient interaction, safety, and care considerations |
| Image Production | 105 | Ultrasound principles, image formation, and selecting representative images |
| Procedures | 64 | Breast sonographic examinations and related procedures |
Those three counts sum to 185 scored questions. If you saw older figures of 18, 102, and 65, those belong to a previous allocation and should not be used for the current blueprint.
Image Production: The Dominant Domain
With 105 scored questions, Image Production is the largest category and is itself divided into three subcategories:
- Basic Principles of Ultrasound: 32 questions
- Image Formation: 37 questions
- Evaluation and Selection of Representative Images: 36 questions
Notice how evenly those three subcategories are split. Candidates sometimes invest heavily in physics fundamentals and underweight the image-evaluation material, but the blueprint gives Evaluation and Selection of Representative Images nearly as many questions as Basic Principles. A full domain-by-domain breakdown lives in our RTBS exam domains guide.
Procedures: The Second Largest Block
Sixty-four scored questions test your command of the examinations themselves. Expect scenario-driven items where you must decide how to proceed, what to document, or which view best answers a clinical question.
Patient Care: Small but Not Free Points
Sixteen scored questions is the smallest allocation, but these items tend to be answerable with solid clinical judgment. Skipping this domain throws away points that are comparatively cheap to earn.
Question formats
Most items are one-best-answer multiple choice, but the handbook also permits multiple-response, sorting, and image or video items. The exam is closed-book. You may not bring a personal calculator, though a test-center-supplied calculator and an on-screen calculator are available. Image and video items reward candidates who have practiced reading real sonographic frames rather than only memorizing definitions.
Who Sits This Exam and Why That Lifts Pass Rates
This is a postprimary credential, which means candidates are not arriving as beginners. To apply, you must already hold a supporting-category credential. The accepted routes are current Radiography plus Mammography, or Sonography, or Vascular Sonography. The Sonography and Vascular Sonography supporting credentials may be held through ARRT or ARDMS.
Beyond the supporting credential, you need ARRT ethics compliance, 16 structured-education hours completed within 24 months before applying (with at least one credit in each major category), and documented clinical experience within that same 24-month window. The clinical requirement is 200 independently performed, nonsimulated breast examinations plus participation in at least 20 approved elective procedures. Bilateral examinations count as two, no more than nine procedures may be logged per day, scanning must be physically onsite, and each mandatory examination must be presented to the radiologist for final interpretation. The full pathway is detailed in our RTBS requirements guide.
Why does this matter for pass rates? Because the eligibility gate filters the candidate pool. People who reach the testing center have already scanned breasts under supervision, completed focused education, and held a related credential. A pass rate in the high 70s for that self-selected group should be read very differently from the same number on an entry-level licensing exam. It tells you the exam is demanding enough that roughly one in five well-qualified first-timers does not pass, so being eligible is not the same as being ready.
Attempt Limits, Fees, and the Cost of a Miss
Because the data shows a meaningful minority of first-time candidates do not pass, it is worth understanding what a miss costs and how many chances you have.
| Item | Detail |
|---|---|
| Application and 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 |
Pay close attention to the attempt rule: it is three attempts within three years, not three attempts per year. Exhausting your attempts triggers requalification, which is far more disruptive than a retake. The fee structure and what else to budget for are covered in our RTBS certification cost breakdown.
After you earn the credential, maintenance continues. Ordinarily 24 approved CE credits are required per two-year biennium, and credentials earned on or after January 1, 2011 require Continuing Qualifications Requirements (CQR) every ten years. Whether that ongoing commitment pays off is the question we examine in is the RTBS certification worth it, alongside the earnings picture in the RTBS salary guide.
Key Takeaway
A first-attempt failure is expensive in time as well as money, because your clinical documentation and education hours sit inside a 24-month window. Preparing to pass once is cheaper than planning around a retake.
Turning the Data Into a Preparation Plan
The pass-rate data and the blueprint counts point to one sensible allocation rule: spend your hours roughly where the scored questions are. Here is one way to sequence a 6-week plan around the three domains, using the counts above rather than guesswork.
Image Production: Principles and Formation
- Work through Basic Principles of Ultrasound (32 questions) and Image Formation (37 questions) first, since later domains assume this vocabulary.
- Practice explaining how an adjustment changes the resulting image, not just defining the control.
Image Production: Evaluation and Selection
- Drill Evaluation and Selection of Representative Images (36 questions) with real frames and video clips.
- Practice judging what makes an image representative and what makes it inadequate.
Procedures
- Cover the 64-question Procedures domain through case-style scenarios tied to your own logged clinical examinations.
- Rehearse the sequence of decisions, documentation, and presentation to the radiologist.
Patient Care and Full Review
- Close out the 16-question Patient Care domain.
- Take timed mixed sets under the 225-minute limit to build pacing for 225 questions.
For a fuller methodology, our RTBS study guide expands on resources and pacing, and the RTBS cheat sheet is useful for a final-days skim. When you are ready to test yourself against exam-style items, the RTBS practice test gives you timed question sets that mirror the multiple-choice and image-based formats you will see. You can also review how our question bank maps to the three domains before deciding where to focus.
Frequently Asked Questions
The ARRT Annual Exam Report for 2025 lists a first-time pass rate of 78.1% among 146 candidates for the Breast Sonography examination. That cohort took the exam before the September 1, 2026 blueprint and passing-standard revision.
No observed 2026 cohort rate is available from the sources we rely on. The Standard Setting Report effective September 2026 offers a form-specific raw-score equivalent and a projected pass rate, which is a modeled expectation rather than a measured outcome.
No. The exam uses a 1-99 scaled-score system, and 75 is the passing scaled score. The number of raw questions needed varies by exam form, so a fixed percent-correct target is not reliable.
You may attempt the exam three times within three years before requalification is required. This is a three-year window, not three attempts per year. A reapplication costs $200.
Image Production, which holds 105 of the 185 scored questions, deserves the most study time. Within it, the three subcategories are close in size, so do not neglect Evaluation and Selection of Representative Images while focusing on physics.
The pass-rate data tells a straightforward story: this is a credential that most prepared, eligible candidates earn on the first try, but not all of them. Because the blueprint and passing standard changed in September 2026, the best use of the 78.1% figure is as reassurance rather than prediction, and the best response is disciplined preparation aimed at the domains where the scored questions actually live.