2026 ARRT Mammography Study Guide
Practice Questions & Answer Explanations
Breast Imaging • Patient Positioning •
Radiation Safety Procedures • Clinical
Preparation Review
Domain I: Breast Imaging & Anatomy (Questions 1–30)
1. The primary purpose of mammography is to:
A) Detect fractures in the ribs
B) Evaluate chest pain
C) Detect breast cancer at early stages, often before it is palpable
D) Assess heart function
Rationale: Mammography is specifically designed to detect breast cancer at its
earliest stages, when it is most treatable and often before a lump can be felt. It is
not used for evaluating chest pain, rib fractures, or cardiac function.
2. Which of the following is the standard projection for a screening mammogram?
A) Mediolateral oblique (MLO) and craniocaudal (CC) views of each breast
B) Only CC view
C) Only MLO view
D) Spot compression views only
Rationale: The standard screening mammogram includes two views per breast: the
mediolateral oblique (MLO) and craniocaudal (CC) views. These two views
provide complementary information about breast tissue and are the foundation of
breast cancer screening.
3. Which mammographic view is also called the "top-down" view?
A) Mediolateral oblique (MLO)
B) Craniocaudal (CC)
C) Lateral
D) Axillary
,Rationale: The craniocaudal (CC) view is taken from above the breast, looking
down, which is why it is referred to as the "top-down" view. This view
demonstrates the medial and lateral aspects of the breast.
4. The MLO view is particularly useful for visualizing which structure?
A) Pectoralis muscle and axillary tail
B) Breast tumor only
C) Fibroadenoma only
D) Microcalcification only
Rationale: The mediolateral oblique (MLO) view is positioned at a 30–60 degree
angle (optimally 45 degrees) and demonstrates the pectoralis muscle, axillary tail
of Spence, and the upper outer quadrant of the breast. This view is essential for
evaluating the most common site of breast cancer origin.
5. Breast tissue age is measured in years from:
A) Menarche to menopause
B) Perimenopause to menopause
C) Menarche to lactation
D) Lactation to menopause
Rationale: Breast tissue age is calculated as the number of years from menarche to
menopause. This is a relevant risk factor for breast cancer because longer exposure
to endogenous hormones increases breast cancer risk.
6. The most common breast symptom is:
A) Nipple discharge
B) Breast pain
C) Palpable lump
D) Thickening of the skin
Rationale: Breast pain (mastalgia) is the most common breast symptom reported
by women, though it is rarely associated with malignancy. Other symptoms such as
nipple discharge, palpable lumps, and skin thickening warrant further evaluation.
7. Which genetic mutation confers the highest lifetime risk for breast cancer?
A) BRCA1
B) BRCA2
,C) TP53
D) PALB2
Rationale: BRCA1 carriers have a slightly higher cumulative lifetime risk of
breast cancer (approximately 55–65%) compared to BRCA2 carriers
(approximately 45–55%). Both mutations significantly increase breast and ovarian
cancer risk.
8. A dense breast tissue is classified as which BI-RADS category?
A) BI-RADS 1
B) BI-RADS 2
C) BI-RADS 3
D) BI-RADS 4
Rationale: BI-RADS 3 denotes heterogeneously dense breast tissue, which may
obscure small masses and lower the sensitivity of mammography. BI-RADS 4
indicates extremely dense tissue. This classification informs both risk assessment
and screening recommendations.
9. The primary radiation dose concern in mammography is:
A) Stochastic effects (cancer induction)
B) Deterministic skin burns
C) Cataracts
D) Hair loss
Rationale: The main concern from repeated low-dose radiation exposure in
mammography is the risk of cancer induction, which is a stochastic effect.
Deterministic effects such as skin burns and cataracts require much higher
radiation doses than those used in diagnostic mammography.
10. Increased breast tissue density lowers the sensitivity of mammography and
makes ________ more difficult:
A) MRI
B) Clinical breast examinations
C) Breast ultrasound
D) The early detection of breast cancer
Rationale: Dense breast tissue can mask malignancies on mammography because
both dense tissue and cancer appear radiopaque (white). This reduces the
, sensitivity of mammography and makes early detection of breast cancer more
challenging.
11. The most common cause of a repeat mammogram due to motion artifact is:
A) Patient anxiety
B) Improper compression
C) Inadequate positioning
D) Patient movement during exposure
Rationale: Motion during the brief exposure creates blurring, necessitating a
repeat image. Proper patient education, comfortable positioning, and adequate
compression help minimize motion artifact.
12. The DMIST study found that full-field digital mammography (FFDM) is a
better imaging tool in certain subsets of women. Which of the following are NOT
included in those subsets?
A) Women under the age of 50
B) Women with very dense glandular breast tissue
C) Women with very small breasts
D) Women who are pre-menopausal or peri-menopausal
Rationale: The DMIST (Digital Mammographic Imaging Screening Trial)
demonstrated that FFDM is superior for women under 50, women with dense
breasts, and pre/peri-menopausal women. Women with very small breasts were not
identified as a subset benefiting specifically from digital mammography.
13. The "asymmetry" on a mammogram refers to:
A) Bilateral masses
B) A finding that is present in only one breast and has no corresponding
counterpart in the other breast
C) Calcifications in both breasts
D) Symmetric breast tissue
Rationale: Asymmetry refers to a finding present in only one breast without a
corresponding finding in the contralateral breast. It requires careful evaluation to
distinguish normal variation from potential pathology.
14. Which of the following is the most common cause of false-negative
mammography?
Practice Questions & Answer Explanations
Breast Imaging • Patient Positioning •
Radiation Safety Procedures • Clinical
Preparation Review
Domain I: Breast Imaging & Anatomy (Questions 1–30)
1. The primary purpose of mammography is to:
A) Detect fractures in the ribs
B) Evaluate chest pain
C) Detect breast cancer at early stages, often before it is palpable
D) Assess heart function
Rationale: Mammography is specifically designed to detect breast cancer at its
earliest stages, when it is most treatable and often before a lump can be felt. It is
not used for evaluating chest pain, rib fractures, or cardiac function.
2. Which of the following is the standard projection for a screening mammogram?
A) Mediolateral oblique (MLO) and craniocaudal (CC) views of each breast
B) Only CC view
C) Only MLO view
D) Spot compression views only
Rationale: The standard screening mammogram includes two views per breast: the
mediolateral oblique (MLO) and craniocaudal (CC) views. These two views
provide complementary information about breast tissue and are the foundation of
breast cancer screening.
3. Which mammographic view is also called the "top-down" view?
A) Mediolateral oblique (MLO)
B) Craniocaudal (CC)
C) Lateral
D) Axillary
,Rationale: The craniocaudal (CC) view is taken from above the breast, looking
down, which is why it is referred to as the "top-down" view. This view
demonstrates the medial and lateral aspects of the breast.
4. The MLO view is particularly useful for visualizing which structure?
A) Pectoralis muscle and axillary tail
B) Breast tumor only
C) Fibroadenoma only
D) Microcalcification only
Rationale: The mediolateral oblique (MLO) view is positioned at a 30–60 degree
angle (optimally 45 degrees) and demonstrates the pectoralis muscle, axillary tail
of Spence, and the upper outer quadrant of the breast. This view is essential for
evaluating the most common site of breast cancer origin.
5. Breast tissue age is measured in years from:
A) Menarche to menopause
B) Perimenopause to menopause
C) Menarche to lactation
D) Lactation to menopause
Rationale: Breast tissue age is calculated as the number of years from menarche to
menopause. This is a relevant risk factor for breast cancer because longer exposure
to endogenous hormones increases breast cancer risk.
6. The most common breast symptom is:
A) Nipple discharge
B) Breast pain
C) Palpable lump
D) Thickening of the skin
Rationale: Breast pain (mastalgia) is the most common breast symptom reported
by women, though it is rarely associated with malignancy. Other symptoms such as
nipple discharge, palpable lumps, and skin thickening warrant further evaluation.
7. Which genetic mutation confers the highest lifetime risk for breast cancer?
A) BRCA1
B) BRCA2
,C) TP53
D) PALB2
Rationale: BRCA1 carriers have a slightly higher cumulative lifetime risk of
breast cancer (approximately 55–65%) compared to BRCA2 carriers
(approximately 45–55%). Both mutations significantly increase breast and ovarian
cancer risk.
8. A dense breast tissue is classified as which BI-RADS category?
A) BI-RADS 1
B) BI-RADS 2
C) BI-RADS 3
D) BI-RADS 4
Rationale: BI-RADS 3 denotes heterogeneously dense breast tissue, which may
obscure small masses and lower the sensitivity of mammography. BI-RADS 4
indicates extremely dense tissue. This classification informs both risk assessment
and screening recommendations.
9. The primary radiation dose concern in mammography is:
A) Stochastic effects (cancer induction)
B) Deterministic skin burns
C) Cataracts
D) Hair loss
Rationale: The main concern from repeated low-dose radiation exposure in
mammography is the risk of cancer induction, which is a stochastic effect.
Deterministic effects such as skin burns and cataracts require much higher
radiation doses than those used in diagnostic mammography.
10. Increased breast tissue density lowers the sensitivity of mammography and
makes ________ more difficult:
A) MRI
B) Clinical breast examinations
C) Breast ultrasound
D) The early detection of breast cancer
Rationale: Dense breast tissue can mask malignancies on mammography because
both dense tissue and cancer appear radiopaque (white). This reduces the
, sensitivity of mammography and makes early detection of breast cancer more
challenging.
11. The most common cause of a repeat mammogram due to motion artifact is:
A) Patient anxiety
B) Improper compression
C) Inadequate positioning
D) Patient movement during exposure
Rationale: Motion during the brief exposure creates blurring, necessitating a
repeat image. Proper patient education, comfortable positioning, and adequate
compression help minimize motion artifact.
12. The DMIST study found that full-field digital mammography (FFDM) is a
better imaging tool in certain subsets of women. Which of the following are NOT
included in those subsets?
A) Women under the age of 50
B) Women with very dense glandular breast tissue
C) Women with very small breasts
D) Women who are pre-menopausal or peri-menopausal
Rationale: The DMIST (Digital Mammographic Imaging Screening Trial)
demonstrated that FFDM is superior for women under 50, women with dense
breasts, and pre/peri-menopausal women. Women with very small breasts were not
identified as a subset benefiting specifically from digital mammography.
13. The "asymmetry" on a mammogram refers to:
A) Bilateral masses
B) A finding that is present in only one breast and has no corresponding
counterpart in the other breast
C) Calcifications in both breasts
D) Symmetric breast tissue
Rationale: Asymmetry refers to a finding present in only one breast without a
corresponding finding in the contralateral breast. It requires careful evaluation to
distinguish normal variation from potential pathology.
14. Which of the following is the most common cause of false-negative
mammography?
