ARRT Vascular-Interventional Radiography Certification Exam –
American Registry of Radiologic Technologists – Complete Exam with
answers and explainers
SECTION I: PATIENT CARE (25 Questions)
Question 1: [Patient Care - Contrast Reaction Management] A 62-year-old patient with a history of mild
asthma is scheduled for a renal angioplasty. During the procedure, they develop urticaria and mild facial
flushing after non-ionic contrast injection. The FIRST appropriate action by the technologist is to: A.
Increase the IV fluid rate. B. Notify the radiologist and prepare 50 mg of diphenhydramine (Benadryl) IM.
C. Assess patient's airway, vital signs, and administer O2 via nasal cannula. D. Immediately inject a
1:1000 epinephrine solution subcutaneously.
Rationale: C. The initial response to any suspected adverse reaction follows the ABCs (Airway,
Breathing, Circulation). Assessment and stabilization of the patient's condition must precede medication
administration. This mild reaction requires monitoring and supportive care first.
Question 2: [Patient Care - Moderate Sedation] During a TIPS procedure under moderate sedation, the
patient's respiratory rate decreases from 16 to 8 breaths per minute, and the SpO2 drops to 88%. The
patient is responsive to verbal stimulation. The technologist's immediate priority is to: A. Administer the
reversal agent naloxone per protocol. B. Increase O2 delivery to 10 L/min via non-rebreather mask and
stimulate patient. C. Document the event and continue monitoring. D. Request the radiologist to pause
the procedure and prepare for intubation.
Rationale: B. Per ASA guidelines for moderate sedation, respiratory depression is first addressed with
supplemental oxygen, airway positioning, and physical stimulation. Reversal agents are reserved for
deeper sedation or failure of initial measures. The patient remains responsive, indicating moderate—not
deep—sedation.
Question 3: [Patient Care - Informed Consent] A patient scheduled for uterine artery embolization
(UAE) expresses confusion about the procedure after the radiologist explains it. The technologist
observes this interaction. According to ACR and SIR guidelines, which action demonstrates appropriate
Patient-Centered Interaction (PCI)? A. Assume the patient understood and proceed with the scheduled
case. B. Notify the radiologist that the patient requires further explanation before consent can be
obtained. C. Explain the procedure to the patient independently to save time. D. Ask the patient to sign
the consent form and address questions later.
Rationale: B. Valid informed consent requires the patient to demonstrate comprehension. The
technologist serves as a patient advocate by alerting the physician to communication barriers. Consent
must be informed, voluntary, and comprehended—rushing or delegating explanation to non-physicians
violates this standard.
,Question 4: [Patient Care - ALARA Principle] To minimize occupational radiation exposure during a
prolonged EVAR procedure, the technologist should: A. Position themselves at the patient's head, 90
degrees to the X-ray beam. B. Wear a lead apron with 0.25 mm Pb equivalence and maintain maximum
distance from the scatter source. C. Use ceiling-suspended lead acrylic shields and position on the image
detector side of the patient. D. Increase the frame rate to reduce fluoroscopy time.
Rationale: C. Scatter radiation intensity follows an inverse square law and is highest on the X-ray tube
side. Standing on the detector side, behind shielding, minimizes exposure. Lead aprons require 0.5 mm
Pb equivalence for adequacy in high-dose procedures; 0.25 mm is insufficient.
Question 5: [Patient Care - Pre-medication Protocol] A 58-year-old patient with a documented severe
anaphylactoid reaction to iodinated contrast requires emergent mesenteric angiography. Which pre-
medication regimen aligns with current ACR Manual on Contrast Media guidelines for high-risk patients?
A. Prednisone 50 mg PO at 13 hours, 7 hours, and 1 hour pre-procedure only. B. Methylprednisolone 32
mg PO/IV at 12 hours and 2 hours pre-procedure plus diphenhydramine 50 mg PO/IV 1 hour pre-
procedure. C. Diphenhydramine 50 mg IV immediately before contrast injection. D. Ephedrine 25 mg PO
1 hour pre-procedure.
Rationale: B. The ACR recommends a corticosteroid-based pre-medication protocol for high-risk
patients requiring emergent or non-emergent contrast studies. The 12-hour and 2-hour
methylprednisolone dosing with adjunctive diphenhydramine is the evidence-based standard for
reducing breakthrough reaction risk.
Question 6: [Patient Care - Hemodynamic Monitoring] During a cardiac catheterization via radial
access, the patient complains of chest discomfort and the arterial pressure waveform shows damping.
The technologist notes the pressure transducer is properly leveled and zeroed. The most likely cause is:
A. Air in the transducer tubing. B. Catheter tip against the vessel wall or clot formation. C. Systemic
hypotension. D. Over-dampening from excessive tubing length.
Rationale: B. Damping of an arterial waveform during catheterization typically indicates mechanical
obstruction at the catheter tip—either vessel wall contact or thrombus formation. This requires
immediate catheter repositioning or flushing to restore accurate hemodynamic monitoring and prevent
vessel occlusion.
Question 7: [Patient Care - Emergency Preparedness] A patient undergoing venous ablation develops
sudden severe chest pain, dyspnea, and tachycardia. The technologist suspects pulmonary embolism.
The immediate intervention is to: A. Administer 325 mg aspirin orally. B. Activate emergency response,
administer high-flow O2, and prepare for potential thrombolytic administration per protocol. C.
Continue the procedure with increased monitoring. D. Place the patient in Trendelenburg position.
, Rationale: B. Suspected pulmonary embolism during an interventional procedure constitutes a medical
emergency. High-flow oxygen supports oxygenation, and rapid activation of emergency protocols
facilitates definitive diagnosis (CT angiography) and treatment (systemic thrombolysis or embolectomy).
Trendelenburg position is contraindicated in PE.
Question 8: [Patient Care - Vascular Access Site] Post-procedure following femoral artery access, the
patient reports increasing groin pain and a pulsatile mass is palpated at the puncture site. The
technologist recognizes these findings as consistent with: A. Retroperitoneal hemorrhage. B.
Pseudoaneurysm formation. C. Arteriovenous fistula. D. Femoral nerve compression.
Rationale: B. A pulsatile, painful groin mass following arterial puncture is pathognomonic for
pseudoaneurysm. This results from inadequate hemostasis allowing blood to leak into surrounding
tissues, contained by the adventitia or soft tissues. Ultrasound-guided compression or thrombin
injection is the standard treatment.
Question 9: [Patient Care - Pediatric Considerations] For a pediatric patient undergoing interventional
radiography, which dose reduction strategy is most effective while maintaining diagnostic image
quality? A. Increasing kVp and reducing mAs. B. Using pulsed fluoroscopy at 7.5 pulses per second with
last-image-hold. C. Eliminating anti-scatter grids for all procedures. D. Using the largest available field of
size regardless of anatomy size.
Rationale: B. Pulsed fluoroscopy at reduced frame rates (7.5 pps vs. 15 or 30 pps) significantly reduces
dose while maintaining adequate temporal resolution for most interventional procedures. Last-image-
hold eliminates the need for additional exposure for final documentation. Pediatric ALARA principles
emphasize frame rate reduction as primary dose optimization.
Question 10: [Patient Care - Contrast-Induced Nephropathy Prevention] A diabetic patient with eGFR
45 mL/min/1.73m² is scheduled for peripheral angiography. Which intervention has the strongest
evidence for preventing contrast-induced acute kidney injury (CI-AKI)? A. N-acetylcysteine 600 mg PO
twice daily. B. Sodium bicarbonate infusion protocol. C. IV isotonic saline hydration pre- and post-
procedure. D. Prophylactic dialysis post-procedure.
Rationale: C. Isotonic intravenous hydration (1.0–1.5 mL/kg/hour) beginning 4–12 hours pre-procedure
and continuing 4–24 hours post-procedure is the only intervention with consistent, high-quality
evidence for CI-AKI prevention. N-acetylcysteine and bicarbonate protocols show conflicting data and
are not primary recommendations.
Question 11: [Patient Care - Patient Positioning] During a prolonged hepatic angiography procedure,
the patient develops a pressure ulcer on the occiput. Which positioning intervention would have best
prevented this injury? A. Placing a gel pad under the occiput and implementing a scheduled
repositioning protocol every 30 minutes when clinically feasible. B. Using a standard pillow without
American Registry of Radiologic Technologists – Complete Exam with
answers and explainers
SECTION I: PATIENT CARE (25 Questions)
Question 1: [Patient Care - Contrast Reaction Management] A 62-year-old patient with a history of mild
asthma is scheduled for a renal angioplasty. During the procedure, they develop urticaria and mild facial
flushing after non-ionic contrast injection. The FIRST appropriate action by the technologist is to: A.
Increase the IV fluid rate. B. Notify the radiologist and prepare 50 mg of diphenhydramine (Benadryl) IM.
C. Assess patient's airway, vital signs, and administer O2 via nasal cannula. D. Immediately inject a
1:1000 epinephrine solution subcutaneously.
Rationale: C. The initial response to any suspected adverse reaction follows the ABCs (Airway,
Breathing, Circulation). Assessment and stabilization of the patient's condition must precede medication
administration. This mild reaction requires monitoring and supportive care first.
Question 2: [Patient Care - Moderate Sedation] During a TIPS procedure under moderate sedation, the
patient's respiratory rate decreases from 16 to 8 breaths per minute, and the SpO2 drops to 88%. The
patient is responsive to verbal stimulation. The technologist's immediate priority is to: A. Administer the
reversal agent naloxone per protocol. B. Increase O2 delivery to 10 L/min via non-rebreather mask and
stimulate patient. C. Document the event and continue monitoring. D. Request the radiologist to pause
the procedure and prepare for intubation.
Rationale: B. Per ASA guidelines for moderate sedation, respiratory depression is first addressed with
supplemental oxygen, airway positioning, and physical stimulation. Reversal agents are reserved for
deeper sedation or failure of initial measures. The patient remains responsive, indicating moderate—not
deep—sedation.
Question 3: [Patient Care - Informed Consent] A patient scheduled for uterine artery embolization
(UAE) expresses confusion about the procedure after the radiologist explains it. The technologist
observes this interaction. According to ACR and SIR guidelines, which action demonstrates appropriate
Patient-Centered Interaction (PCI)? A. Assume the patient understood and proceed with the scheduled
case. B. Notify the radiologist that the patient requires further explanation before consent can be
obtained. C. Explain the procedure to the patient independently to save time. D. Ask the patient to sign
the consent form and address questions later.
Rationale: B. Valid informed consent requires the patient to demonstrate comprehension. The
technologist serves as a patient advocate by alerting the physician to communication barriers. Consent
must be informed, voluntary, and comprehended—rushing or delegating explanation to non-physicians
violates this standard.
,Question 4: [Patient Care - ALARA Principle] To minimize occupational radiation exposure during a
prolonged EVAR procedure, the technologist should: A. Position themselves at the patient's head, 90
degrees to the X-ray beam. B. Wear a lead apron with 0.25 mm Pb equivalence and maintain maximum
distance from the scatter source. C. Use ceiling-suspended lead acrylic shields and position on the image
detector side of the patient. D. Increase the frame rate to reduce fluoroscopy time.
Rationale: C. Scatter radiation intensity follows an inverse square law and is highest on the X-ray tube
side. Standing on the detector side, behind shielding, minimizes exposure. Lead aprons require 0.5 mm
Pb equivalence for adequacy in high-dose procedures; 0.25 mm is insufficient.
Question 5: [Patient Care - Pre-medication Protocol] A 58-year-old patient with a documented severe
anaphylactoid reaction to iodinated contrast requires emergent mesenteric angiography. Which pre-
medication regimen aligns with current ACR Manual on Contrast Media guidelines for high-risk patients?
A. Prednisone 50 mg PO at 13 hours, 7 hours, and 1 hour pre-procedure only. B. Methylprednisolone 32
mg PO/IV at 12 hours and 2 hours pre-procedure plus diphenhydramine 50 mg PO/IV 1 hour pre-
procedure. C. Diphenhydramine 50 mg IV immediately before contrast injection. D. Ephedrine 25 mg PO
1 hour pre-procedure.
Rationale: B. The ACR recommends a corticosteroid-based pre-medication protocol for high-risk
patients requiring emergent or non-emergent contrast studies. The 12-hour and 2-hour
methylprednisolone dosing with adjunctive diphenhydramine is the evidence-based standard for
reducing breakthrough reaction risk.
Question 6: [Patient Care - Hemodynamic Monitoring] During a cardiac catheterization via radial
access, the patient complains of chest discomfort and the arterial pressure waveform shows damping.
The technologist notes the pressure transducer is properly leveled and zeroed. The most likely cause is:
A. Air in the transducer tubing. B. Catheter tip against the vessel wall or clot formation. C. Systemic
hypotension. D. Over-dampening from excessive tubing length.
Rationale: B. Damping of an arterial waveform during catheterization typically indicates mechanical
obstruction at the catheter tip—either vessel wall contact or thrombus formation. This requires
immediate catheter repositioning or flushing to restore accurate hemodynamic monitoring and prevent
vessel occlusion.
Question 7: [Patient Care - Emergency Preparedness] A patient undergoing venous ablation develops
sudden severe chest pain, dyspnea, and tachycardia. The technologist suspects pulmonary embolism.
The immediate intervention is to: A. Administer 325 mg aspirin orally. B. Activate emergency response,
administer high-flow O2, and prepare for potential thrombolytic administration per protocol. C.
Continue the procedure with increased monitoring. D. Place the patient in Trendelenburg position.
, Rationale: B. Suspected pulmonary embolism during an interventional procedure constitutes a medical
emergency. High-flow oxygen supports oxygenation, and rapid activation of emergency protocols
facilitates definitive diagnosis (CT angiography) and treatment (systemic thrombolysis or embolectomy).
Trendelenburg position is contraindicated in PE.
Question 8: [Patient Care - Vascular Access Site] Post-procedure following femoral artery access, the
patient reports increasing groin pain and a pulsatile mass is palpated at the puncture site. The
technologist recognizes these findings as consistent with: A. Retroperitoneal hemorrhage. B.
Pseudoaneurysm formation. C. Arteriovenous fistula. D. Femoral nerve compression.
Rationale: B. A pulsatile, painful groin mass following arterial puncture is pathognomonic for
pseudoaneurysm. This results from inadequate hemostasis allowing blood to leak into surrounding
tissues, contained by the adventitia or soft tissues. Ultrasound-guided compression or thrombin
injection is the standard treatment.
Question 9: [Patient Care - Pediatric Considerations] For a pediatric patient undergoing interventional
radiography, which dose reduction strategy is most effective while maintaining diagnostic image
quality? A. Increasing kVp and reducing mAs. B. Using pulsed fluoroscopy at 7.5 pulses per second with
last-image-hold. C. Eliminating anti-scatter grids for all procedures. D. Using the largest available field of
size regardless of anatomy size.
Rationale: B. Pulsed fluoroscopy at reduced frame rates (7.5 pps vs. 15 or 30 pps) significantly reduces
dose while maintaining adequate temporal resolution for most interventional procedures. Last-image-
hold eliminates the need for additional exposure for final documentation. Pediatric ALARA principles
emphasize frame rate reduction as primary dose optimization.
Question 10: [Patient Care - Contrast-Induced Nephropathy Prevention] A diabetic patient with eGFR
45 mL/min/1.73m² is scheduled for peripheral angiography. Which intervention has the strongest
evidence for preventing contrast-induced acute kidney injury (CI-AKI)? A. N-acetylcysteine 600 mg PO
twice daily. B. Sodium bicarbonate infusion protocol. C. IV isotonic saline hydration pre- and post-
procedure. D. Prophylactic dialysis post-procedure.
Rationale: C. Isotonic intravenous hydration (1.0–1.5 mL/kg/hour) beginning 4–12 hours pre-procedure
and continuing 4–24 hours post-procedure is the only intervention with consistent, high-quality
evidence for CI-AKI prevention. N-acetylcysteine and bicarbonate protocols show conflicting data and
are not primary recommendations.
Question 11: [Patient Care - Patient Positioning] During a prolonged hepatic angiography procedure,
the patient develops a pressure ulcer on the occiput. Which positioning intervention would have best
prevented this injury? A. Placing a gel pad under the occiput and implementing a scheduled
repositioning protocol every 30 minutes when clinically feasible. B. Using a standard pillow without
