ARRT Sonography Exam: The Complete Guide (2026)
Last Updated: September 2026 | Reading Time: 22 minutes
Quick Summary: The ARRT Sonography exam is a 400-item, two-session test at Pearson VUE required to earn the Registered Technologist in Sonography, R.T.(S), credential. Passing means an overall scaled score of 75 or higher and a section score of at least 7.5 in both Abdomen and OB/GYN Procedures; the fee is $225. This guide covers everything you need: exam format, every content category, 10 free practice questions, registration steps, and proven study strategies to help you earn your credential.
Table of Contents
- What is the Sonography Exam?
- Sonography Exam Format & Structure
- Understanding the 3 Content Domains
- Free Sonography Practice Test Questions
- Sonography Exam Scoring & Pass Rate
- How to Register for the Sonography Exam
- What to Expect on Exam Day
- How Long Should You Study?
- Free Video Lessons
- Tips to Pass the Sonography Exam
- FAQs
What is the Sonography Exam?
Why the Sonography is Challenging
The Sonography is often considered one of the more challenging exams because:
- The section-score requirement is the single biggest hurdle: even with a passing overall scaled score of 75 or higher, you also need a section scaled score of 7.5 or higher in both the Abdominal Procedures section and the Obstetrical and Gynecological Procedures section — a candidate can pass overall and still fail the exam on a section score
- Procedures carries the most weight: at 216 of 360 scored questions (60%), Procedures — Abdomen, First Trimester Obstetrics, Second/Third Trimester and High Risk Obstetrics, Gynecology, and Superficial Structures — is by far the largest content category
- Breadth of content: the exam spans patient interactions and management, ultrasound physics and image optimization, and clinical sonography across the abdomen, obstetrics, gynecology, and superficial structures
- It's the hardest ARRT primary exam by pass rate: Sonography's 2025 first-time pass rate of 55% is well below Radiography's 86%, and its mean scaled score of 76.7 sits close to the passing score of 75
- Two-session format: 390 minutes of test time split across a 240-minute Procedures session and a 150-minute Patient Care and Image Production session, separated by a scheduled 30-minute break — Sonography is the only ARRT primary exam with a scheduled break built into the appointment
Sonography Exam Format & Structure
Understanding the exam format helps you prepare strategically:
| Aspect | Details |
|---|---|
| Total Questions | Approximately 400 multiple-choice |
| Time Limit | 6 hours 30 minutes (390 minutes) |
| Passing Score | 75 (on a 1-99 scale) |
| Format | Multiple choice questions with ultrasound images |
| Testing Centers | Pearson VUE (in-person test centers only) |
| Exam Fee | $225 (as of 2026) |
Understanding the 3 Content Domains
The Sonography exam is divided into 3 content domains, each weighted differently. Knowing these weights helps you prioritize your study time.
Content Domain Weights
Question estimates based on total question count. Focus study time proportionally.
Study tip: Spend the most time on the largest domain—it makes up the biggest portion of your exam.
Domain 1: Patient Care (7.2%)
Approximately 26 questions
26 questions - Patient preparation, safety, communication
Domain 2: Image Production (32.8%)
Approximately 118 questions
118 questions - Technical factors, image optimization
Domain 3: Procedures (60%)
Approximately 216 questions
216 questions - Abdomen, OB/GYN, superficial structures
Total items: 400 (360 scored + 40 unscored pilot questions)
Session 1 (Procedures): 240 minutes; scheduled 30-minute break; Session 2 (Patient Care and Image Production): 150 minutes
Plus an 8-minute tutorial, 2-minute nondisclosure agreement, and 10-minute survey (total appointment: 440 minutes, or 7 hours 20 minutes)
Passing score: an overall scaled score of 75 or higher (scores range from 1 to 99) and a section scaled score of 7.5 or higher in both Abdominal Procedures and Obstetrical and Gynecological Procedures (section scores range from 0.1 to 9.9)
Patient Care: 26 questions (7.2%) — Patient Interactions and Management
Image Production: 118 questions (32.8%) — Basic Principles of Ultrasound (45), Image Formation (47), Evaluation and Selection of Representative Images (26)
Procedures: 216 questions (60%) — Abdomen (75), First Trimester Obstetrics (20), Second/Third Trimester and High Risk Obstetrics (57), Gynecology (32), Superficial Structures and Other Sonographic Procedures (32)
Free Sonography Practice Test Questions
Test your knowledge with these sample Sonography exam questions. Answers and explanations are provided below.
Question 1
A patient is scheduled for a transvaginal pelvic ultrasound. Which bladder preparation is correct for this exam?
Question 2
Which ultrasound control compensates for sound attenuation by selectively amplifying the returning echoes from deeper structures more than those from shallower structures?
Question 3
On pulsed wave Doppler, aliasing appears on the spectral display when the Doppler shift frequency exceeds which value?
Question 4
An ultrasound system's on-screen Thermal Index (TI) value estimates the relative likelihood of which potential bioeffect?
Question 5
On a properly fasting patient, what is generally accepted as the upper limit of normal gallbladder wall thickness measured on ultrasound?
Question 6
During a renal transplant ultrasound, Doppler interrogation of the intrarenal arteries shows an elevated resistive index. This finding is most suggestive of which of the following?
Question 7
Which sonographic finding provides the most specific evidence of an ectopic pregnancy?
Question 8
The fetal biophysical profile (BPP) combines four sonographic observations with which additional component to assess fetal well-being?
Question 9
In a postmenopausal patient with vaginal bleeding who is not on hormone therapy, an endometrial thickness above what measurement on transvaginal ultrasound is generally used as the threshold for recommending further evaluation, such as biopsy?
Question 10
Which sonographic feature of a thyroid nodule is most concerning for malignancy?
Answer Key with Explanations
A transvaginal exam is typically performed with an empty bladder, since the transducer is placed close to the pelvic organs and doesn't need a distended bladder as an acoustic window. A full bladder is required for transabdominal pelvic imaging instead, where it displaces bowel gas and improves visualization of the uterus and ovaries.
Time gain compensation lets the sonographer amplify echoes differently by depth, boosting weaker signals returning from deeper tissue to offset attenuation along the beam path. Overall gain amplifies the entire image uniformly regardless of depth, dynamic range controls the range of echo amplitudes displayed as shades of gray, and persistence averages frames over time to reduce noise.
The Nyquist limit equals half the pulse repetition frequency; when the true Doppler shift exceeds this value, the system can't sample it accurately and the spectral waveform wraps around, displaying as aliasing. Raising the PRF (within machine limits) raises the Nyquist limit and can resolve aliasing on a pulsed system; aliasing does not occur with continuous wave Doppler.
The Thermal Index estimates the relative likelihood of tissue heating from absorbed acoustic energy, while the Mechanical Index (MI) estimates the relative likelihood of cavitation. Both are displayed under the ALARA principle so the sonographer can keep patient exposure as low as reasonably achievable while still obtaining a diagnostic image.
A gallbladder wall up to 3 mm is generally considered normal when measured on the anterior wall, away from the liver or bowel. Walls thicker than 3 mm are considered thickened, which can be caused by cholecystitis but also by a non-fasting state, hepatitis, or ascites, so wall thickening alone isn't specific for cholecystitis.
Resistive index (RI) equals peak systolic velocity minus end-diastolic velocity, divided by peak systolic velocity. An elevated RI reflects increased downstream resistance to flow and can be seen with acute rejection, acute tubular necrosis, or obstruction, though the finding is nonspecific and must be correlated with clinical history and other imaging findings.
Visualizing a yolk sac or embryo within a gestational sac outside the endometrial cavity is the most specific and definitive sonographic sign of ectopic pregnancy. An empty uterus, free pelvic fluid, and a thickened endometrium can all raise suspicion for ectopic pregnancy, but none of them confirm it on their own since each has other possible causes.
The BPP score combines the non-stress test with four ultrasound observations — fetal breathing movements, gross body movements, fetal tone, and amniotic fluid volume — each scored 0 or 2 points for a maximum total of 10. Umbilical artery Doppler is a separate, complementary tool used in fetal surveillance but is not one of the five BPP components.
An endometrial thickness of 4 mm or less in a postmenopausal patient with bleeding has a high negative predictive value for endometrial cancer. When the endometrium measures thicker than 4 mm in this clinical setting, further evaluation such as endometrial biopsy or sonohysterography is generally recommended.
Hypoechogenicity, irregular or infiltrative margins, microcalcifications, marked internal vascularity, and a taller-than-wide shape are sonographic features associated with a higher risk of thyroid malignancy. Purely cystic, spongiform, and well-circumscribed isoechoic nodules with a smooth halo are features more typical of benign nodules.
Want More Practice Questions?
Try Prepry's 2,925+ Sonography practice questions with detailed explanations and a pass guarantee.
Get Started FreeAlso available on mobile:
25 free questions per exam plus the Question of the Day. No credit card required.
Sonography Exam Scoring & Pass Rate
Current Pass Rates
According to official data, the Sonography first-time pass rate is approximately 55%.
Why Pass Rates May Be Lower
- The section-score requirement is the single biggest hurdle: even with a passing overall scaled score of 75 or higher, you also need a section scaled score of 7.5 or higher in both the Abdominal Procedures section and the Obstetrical and Gynecological Procedures section — a candidate can pass overall and still fail the exam on a section score
- Procedures carries the most weight: at 216 of 360 scored questions (60%), Procedures — Abdomen, First Trimester Obstetrics, Second/Third Trimester and High Risk Obstetrics, Gynecology, and Superficial Structures — is by far the largest content category
- Breadth of content: the exam spans patient interactions and management, ultrasound physics and image optimization, and clinical sonography across the abdomen, obstetrics, gynecology, and superficial structures
- It's the hardest ARRT primary exam by pass rate: Sonography's 2025 first-time pass rate of 55% is well below Radiography's 86%, and its mean scaled score of 76.7 sits close to the passing score of 75
- Two-session format: 390 minutes of test time split across a 240-minute Procedures session and a 150-minute Patient Care and Image Production session, separated by a scheduled 30-minute break — Sonography is the only ARRT primary exam with a scheduled break built into the appointment
Understanding Your Score Report
Your score report includes:
- Overall scaled score (a 1 to 99 scale; 75 or higher is passing)
- Separate section scaled scores (a 0.1 to 9.9 scale) for Abdominal Procedures and for Obstetrical and Gynecological Procedures — both must be 7.5 or higher to pass, regardless of your overall score
- A secure link you can use to share your score report with employers or schools
What If You Don't Pass?
First, know that you're not alone—many examinees don't pass on their first attempt.
- Waiting period: None (3 attempts total within 3 years of your first exam window) before you can retake
- Re-application: You must submit a new application and fee for each attempt
How to Register for the Sonography Exam
Step 1: Create an ARRT Account
Visit arrt.org and create an account. Your educational program director will typically help set this up and will approve your account once you're ready to apply.
Step 2: Meet the Education Requirement
Complete an ARRT-recognized, accredited sonography educational program through the Primary Eligibility Pathway before you can apply for the Sonography credential.
Step 3: Address Ethics Requirements
Comply with the ARRT Standards of Ethics. Your application will ask ethics questions covering criminal charges and convictions. If you're concerned about a past issue, ARRT offers an optional Ethics Review Preapplication you can submit before you apply.
Step 4: Submit Your Application and Pay the Fee
Log in to your ARRT account, apply for the Sonography credential, and pay the $225 primary-pathway application fee. Once your application is approved, you'll receive a Candidate Status Report and an exam window.
Step 5: Schedule with Pearson VUE
Schedule your exam at a Pearson VUE test center, either online at home.pearsonvue.com/arrt or by phone. ARRT offers no online or at-home proctoring option for Sonography, so your exam must be taken in person.
What to Expect on Exam Day
For In-Person Testing
Before arrival:
- Get a full night's sleep and eat a balanced meal beforehand
- Arrive at least 30 minutes before your scheduled appointment
- Bring two forms of valid, unexpired ID: a government-issued primary ID with your printed name, photo, and signature (such as a driver's license, state ID, passport, or military ID), plus a secondary ID with your printed name and signature
At the testing center:
- Store all personal items — including your phone, watch, and any notes — in a secure locker before entering the test room
- Sign a digital signature pad at check-in
- Don't bring your own calculator — Pearson provides an onscreen basic and scientific calculator you can use during the exam
During the exam:
- You'll get an 8-minute tutorial and 2 minutes to accept the nondisclosure agreement before your test time starts
- Session 1 (Procedures) runs 240 minutes, followed by a scheduled 30-minute break, then Session 2 (Patient Care and Image Production) runs 150 minutes — Sonography is the only ARRT primary exam with a scheduled break built into the appointment
- During the break you may retrieve snacks or lunch from your locker, but electronic devices, books, and papers stay prohibited
- You must answer each question before the computer lets you move on — flag questions you're unsure of and return to them if you have time left
- Raise your hand if you need help; staff can bring you a handheld calculator, earplugs, or noise-reducing headphones, but don't leave the test center building before you finish your exam
How Long Should You Study?
The ideal study timeline depends on your background:
| Situation | Recommended Study Time |
|---|---|
| Recent graduate, currently finishing clinicals | 6-8 weeks |
| Recent graduate (< 6 months out) | 8-10 weeks |
| Working limited-scope or student sonographer | 10-12 weeks |
| Returning after a break (6+ months) | 12-14 weeks |
Sample Study Schedule
Week 1-2: Patient Care & Image Production Foundations
- Review Patient Care: patient interactions, communication, and exam preparation
- Review Image Production: basic principles of ultrasound (acoustics, transducers, Doppler physics) and image formation
- Complete 100-150 practice questions
Complete 100-150 practice questions
Week 3-4: Procedures — Abdomen
- Study normal sonographic anatomy and pathology for the liver, gallbladder and biliary tree, pancreas, spleen, kidneys, and retroperitoneum
- Abdomen is the single largest Procedures subcategory at 75 of 360 scored questions
- Practice Doppler assessment of abdominal vessels, including resistive index calculations
Complete 150-200 practice questions
Week 5-6: Procedures — Obstetrics
- Study First Trimester Obstetrics: dating, viability, and ectopic pregnancy
- Study Second/Third Trimester and High Risk Obstetrics: fetal biometry, anatomy survey, biophysical profile, and Doppler
- Together these two OB subcategories make up 77 of 360 scored questions and, along with Gynecology, drive your OB/GYN section score
Complete 200+ practice questions
Week 7: Procedures — Gynecology & Superficial Structures
- Study normal and abnormal uterine and ovarian anatomy, including endometrial thickness thresholds by clinical scenario
- Study superficial structures: thyroid, breast, scrotum, and musculoskeletal sonography
- Review evaluation and selection of representative images
Complete 250+ practice questions
Week 8: Comprehensive Review
- Take a full-length, timed mock exam that mirrors the real structure: a 240-minute Procedures session, a 30-minute break, and a 150-minute Patient Care and Image Production session
- Review every missed question, and track your accuracy within Abdominal Procedures and within OB/GYN Procedures separately, since those drive your section scores
- Light review of your weakest areas; rest the day before your exam
Free Video Lessons
Free Video Lessons
Watch these free video lessons to help you prepare for the Sonography.
Abdominal Sonography
Abdominal Transplants and Postoperative Assessment - Part 1
1581
Abdominal Transplants and Postoperative Assessment - Part 2
1071
Abdominal Imaging Optimization
2508
Tips to Pass the Sonography Exam
1. Treat the Section Scores as Their Own Pass/Fail
A 75 overall isn't enough on its own — you also need a 7.5 or higher in both the Abdominal Procedures section and the Obstetrical and Gynecological Procedures section. Track your practice-test accuracy separately for each section, not just your overall score.
2. Prioritize Procedures
Procedures makes up 60% of the exam (216 of 360 scored questions) — more than Patient Care and Image Production combined. Within Procedures, Abdomen (75 questions) and the two OB subcategories combined (77 questions) carry the most weight.
3. Build a Strong OB/GYN Foundation
The Obstetrical and Gynecological Procedures section score is based on the 109 questions across First Trimester Obstetrics, Second/Third Trimester and High Risk Obstetrics, and Gynecology. Because it's scored independently, weakness here can fail you even with a strong overall score.
4. Don't Neglect Image Production
Image Production is 32.8% of the exam and covers basic ultrasound principles, image formation, and evaluating representative images. Understand the reasoning behind controls like TGC, gain, and the ALARA principle instead of just memorizing definitions.
5. Practice Under Real Conditions
Complete a full 400-item mock exam split into a 240-minute session, a 30-minute break, and a 150-minute session, matching the real test-day structure. Get comfortable with the length of the appointment — 7 hours and 20 minutes total.
6. Know Your Exam-Day Logistics Ahead of Time
Confirm your two forms of ID, plan to arrive 30 minutes early, and remember that Sonography is the only ARRT exam with a scheduled break — you can retrieve snacks or lunch from your locker during it, but devices, books, and notes stay off-limits.
FAQs
How many questions are on the ARRT Sonography exam?
The ARRT Sonography exam includes 400 total items — 360 scored questions plus 40 unscored pilot questions that ARRT uses to evaluate future exam content and don't count toward your score. The 360 scored questions are split across Patient Care, Image Production, and Procedures.
How long is the Sonography exam?
You get 390 minutes of test time, split into a 240-minute Procedures session and a 150-minute Patient Care and Image Production session, separated by a scheduled 30-minute break. Including the 8-minute tutorial, 2-minute nondisclosure agreement, and 10-minute survey, the total appointment runs about 7 hours and 20 minutes.
What score do I need to pass the Sonography exam?
You need an overall scaled score of 75 or higher, on a scale that runs from 1 to 99, and a section scaled score of 7.5 or higher in both the Abdominal Procedures section and the Obstetrical and Gynecological Procedures section. A scaled score of 75 corresponds to roughly 67% correct on the scored questions, but both section-score requirements must also be met.
Can I pass the overall exam and still fail?
Yes. Because Sonography requires a section scaled score of 7.5 or higher in both the Abdominal Procedures and Obstetrical and Gynecological Procedures sections, a candidate can score 75 or higher overall and still fail the exam if either section score falls below 7.5. This dual requirement is the single most important thing to understand about how this exam is scored.
Can I take the ARRT Sonography exam online?
No. Unlike some other registry exams, ARRT's Sonography certification exam is administered only in person at Pearson VUE test centers; ARRT offers no online or at-home proctoring option for this exam. You'll need to schedule an in-person appointment through Pearson VUE.
How many times can I take the Sonography exam?
You have three attempts within three years of the date your first exam window opens. There's no ARRT-mandated waiting period between attempts, so you can schedule a new attempt as soon as a new exam window opens after reapplying, though each attempt requires a new application and fee.
What is the ARRT Sonography exam pass rate?
In 2025, first-time candidates passed the Sonography exam at a rate of 55%, with a mean scaled score of 76.7, according to ARRT's Annual Exam Report. That makes Sonography the hardest ARRT primary exam by pass rate — well below Radiography's 86% first-time pass rate the same year.
What topics are covered on the exam?
The exam covers three content categories: Patient Care (7.2%), Image Production (32.8%, covering basic ultrasound principles, image formation, and evaluating representative images), and Procedures (60%, spanning Abdomen, First Trimester Obstetrics, Second/Third Trimester and High Risk Obstetrics, Gynecology, and Superficial Structures).
How long should I study for the Sonography exam?
Most candidates study for 6 to 14 weeks, depending on how recently they finished their program: recent graduates still in clinicals typically need less time, while sonographers returning after a break of six months or more should plan for the longer end of that range.
What happens during the scheduled break?
Sonography is the only ARRT primary exam with a scheduled break — a 30-minute pause between the 240-minute Procedures session and the 150-minute Patient Care and Image Production session. You may retrieve snacks or lunch from your locker during the break, but electronic devices, books, and papers stay prohibited.
Sources
- ARRT Sonography Credential
- 2026 ARRT Primary Eligibility Pathway Handbook
- Sonography Examination Content Specifications (2024)
- ARRT Annual Exam Report 2025
- ARRT Application Fees
- ARRT Exam Scoring
Related ARRT Exam Guides
Explore other ARRT certification exam guides to continue your journey.
View all exam guidesReady to Pass Your Sonography Exam?
Join 130,000+ students who've used Prepry to prepare for their registry exams.
Why Prepry?
- ✓ 2,925+ practice questions with detailed explanations
- ✓ Video lessons covering all domains
- ✓ Timed mock exams that simulate the real test
- ✓ Spaced repetition technology for efficient studying
- ✓ 99.0% reported pass rate among students who complete the program
- ✓ Pass guarantee — pass or extend free until you do
Also available on mobile:
25 free questions per exam plus the Question of the Day. No credit card required.
This guide is updated regularly to reflect the latest ARRT Sonography exam information. Last reviewed: September 2026.