ARRT Mammography Exam 2026: Comprehensive Certification
Practice Examination — Patient Care, Image Production, Breast
Anatomy, Pathology & Positioning — 115 Original Questions with
Answers & Detailed Rationales
PATIENT CARE
1. A 52-year-old patient asks why she needs to wait for her previous mammograms to be
retrieved before her current examination begins. Which of the following best explains the
clinical importance of prior images?
A. Prior images are required by law for all patients over age 50
B. Comparison with prior studies improves detection of subtle interval changes
C. Prior images determine the radiation dose for the current examination
D. Previous mammograms eliminate the need for additional views
Correct Answer: B
Explanation: Comparison with prior images is critical for identifying subtle changes in breast
tissue that may indicate early malignancy. Clinical pearl: Interval change is one of the most
important indicators for recommending biopsy.
2. A patient with a strong family history of breast cancer asks the mammographer whether
she should be screened earlier than the standard age. The mammographer's most
appropriate response is:
A. "You should begin screening at age 30 regardless of family history"
B. "I cannot discuss screening guidelines; you must ask your physician"
C. "Family history may influence screening recommendations, so please discuss this with
your doctor"
,D. "Mammography is not recommended for women with family history until age 50"
Correct Answer: C
Explanation: The mammographer's scope does not include establishing screening protocols
but should encourage physician consultation for risk-based decisions. Best practice:
Recognize when referral is appropriate.
3. During a screening mammogram, a patient discloses that she felt a lump in her left breast
last week. The appropriate action is:
A. Complete the screening examination as ordered and document the finding
B. Convert the examination to a diagnostic study and notify the radiologist
C. Tell the patient the lump is likely benign based on the imaging
D. Reschedule the patient for a diagnostic examination next week
Correct Answer: B
Explanation: A palpable finding converts a screening examination to diagnostic; the
radiologist must be notified. Clinical pearl: Palpable abnormalities require diagnostic
workup, not routine screening.
4. Which of the following patient history items is most relevant for the mammographer to
document before the examination?
A. The patient's occupation
B. Previous breast surgeries and biopsy results
C. The patient's dietary habits
D. The patient's exercise routine
,Correct Answer: B
Explanation: Previous breast surgeries and biopsy results directly affect image interpretation
and positioning. Best practice: Surgical history explains architectural distortion and prevents
unnecessary workup.
5. A 48-year-old patient expresses anxiety about her upcoming mammogram because her
mother died of breast cancer. The most appropriate response is:
A. "Try not to worry; most lumps are benign"
B. "I understand this can be stressful. Let me explain what to expect and answer your
questions"
C. "You should have started screening ten years ago"
D. "The radiologist will tell you immediately if something is wrong"
Correct Answer: B
Explanation: Acknowledging anxiety and providing clear procedural information reduces
patient stress. Clinical pearl: Compassionate communication improves patient cooperation
and image quality.
6. Which of the following patients would most likely be classified as having an inherent risk
factor for breast cancer?
A. A 45-year-old who consumes two alcoholic drinks daily
B. A 50-year-old with a BRCA1 gene mutation
C. A 55-year-old who is 40 pounds overweight
D. A 60-year-old who has never been pregnant
Correct Answer: B
, Explanation: BRCA1/2 mutations are inherent (genetic) risk factors. Clinical pearl: Inherent
factors cannot be modified; social/lifestyle factors may be modifiable.
7. The mammographer observes nipple discharge during positioning for a CC view. The most
appropriate action is:
A. Clean the area and continue the examination
B. Discontinue the examination and reschedule
C. Notify the radiologist and prepare a slide for cytology
D. Apply compression more firmly to stop the discharge
Correct Answer: C
Explanation: Spontaneous nipple discharge requires documentation and may warrant
cytologic evaluation. Best practice: Discharge is a clinical finding that must be communicated
to the interpreting physician.
8. According to ACS guidelines, at what age should women at average risk begin annual
mammography screening?
A. 30
B. 35
C. 40
D. 50
Correct Answer: C
Practice Examination — Patient Care, Image Production, Breast
Anatomy, Pathology & Positioning — 115 Original Questions with
Answers & Detailed Rationales
PATIENT CARE
1. A 52-year-old patient asks why she needs to wait for her previous mammograms to be
retrieved before her current examination begins. Which of the following best explains the
clinical importance of prior images?
A. Prior images are required by law for all patients over age 50
B. Comparison with prior studies improves detection of subtle interval changes
C. Prior images determine the radiation dose for the current examination
D. Previous mammograms eliminate the need for additional views
Correct Answer: B
Explanation: Comparison with prior images is critical for identifying subtle changes in breast
tissue that may indicate early malignancy. Clinical pearl: Interval change is one of the most
important indicators for recommending biopsy.
2. A patient with a strong family history of breast cancer asks the mammographer whether
she should be screened earlier than the standard age. The mammographer's most
appropriate response is:
A. "You should begin screening at age 30 regardless of family history"
B. "I cannot discuss screening guidelines; you must ask your physician"
C. "Family history may influence screening recommendations, so please discuss this with
your doctor"
,D. "Mammography is not recommended for women with family history until age 50"
Correct Answer: C
Explanation: The mammographer's scope does not include establishing screening protocols
but should encourage physician consultation for risk-based decisions. Best practice:
Recognize when referral is appropriate.
3. During a screening mammogram, a patient discloses that she felt a lump in her left breast
last week. The appropriate action is:
A. Complete the screening examination as ordered and document the finding
B. Convert the examination to a diagnostic study and notify the radiologist
C. Tell the patient the lump is likely benign based on the imaging
D. Reschedule the patient for a diagnostic examination next week
Correct Answer: B
Explanation: A palpable finding converts a screening examination to diagnostic; the
radiologist must be notified. Clinical pearl: Palpable abnormalities require diagnostic
workup, not routine screening.
4. Which of the following patient history items is most relevant for the mammographer to
document before the examination?
A. The patient's occupation
B. Previous breast surgeries and biopsy results
C. The patient's dietary habits
D. The patient's exercise routine
,Correct Answer: B
Explanation: Previous breast surgeries and biopsy results directly affect image interpretation
and positioning. Best practice: Surgical history explains architectural distortion and prevents
unnecessary workup.
5. A 48-year-old patient expresses anxiety about her upcoming mammogram because her
mother died of breast cancer. The most appropriate response is:
A. "Try not to worry; most lumps are benign"
B. "I understand this can be stressful. Let me explain what to expect and answer your
questions"
C. "You should have started screening ten years ago"
D. "The radiologist will tell you immediately if something is wrong"
Correct Answer: B
Explanation: Acknowledging anxiety and providing clear procedural information reduces
patient stress. Clinical pearl: Compassionate communication improves patient cooperation
and image quality.
6. Which of the following patients would most likely be classified as having an inherent risk
factor for breast cancer?
A. A 45-year-old who consumes two alcoholic drinks daily
B. A 50-year-old with a BRCA1 gene mutation
C. A 55-year-old who is 40 pounds overweight
D. A 60-year-old who has never been pregnant
Correct Answer: B
, Explanation: BRCA1/2 mutations are inherent (genetic) risk factors. Clinical pearl: Inherent
factors cannot be modified; social/lifestyle factors may be modifiable.
7. The mammographer observes nipple discharge during positioning for a CC view. The most
appropriate action is:
A. Clean the area and continue the examination
B. Discontinue the examination and reschedule
C. Notify the radiologist and prepare a slide for cytology
D. Apply compression more firmly to stop the discharge
Correct Answer: C
Explanation: Spontaneous nipple discharge requires documentation and may warrant
cytologic evaluation. Best practice: Discharge is a clinical finding that must be communicated
to the interpreting physician.
8. According to ACS guidelines, at what age should women at average risk begin annual
mammography screening?
A. 30
B. 35
C. 40
D. 50
Correct Answer: C
