ARDMS Breast Exam: The Complete Guide (2026)
Last Updated: January 2026 | Reading Time: 20 minutes
Quick Summary: The ARDMS Breast (BR) exam is a 170-question, 3-hour specialty examination for sonographers seeking to demonstrate expertise in breast sonography. This comprehensive guide covers the exam format, all six content domains including BI-RADS classification, 10 free practice questions, registration steps, and proven study strategies to help you pass.
Table of Contents
What is the Breast Exam?
Why the Breast is Challenging
The Breast is often considered one of the more challenging exams because:
- BI-RADS classification: You must thoroughly understand the ACR BI-RADS lexicon and know how to categorize findings appropriately
- Pathology diversity: The exam covers a wide range of benign and malignant conditions, from simple cysts to invasive carcinomas
- Clinical integration: Questions require you to correlate sonographic findings with patient history, mammography, and clinical presentation
- Interventional knowledge: Understanding biopsy techniques, needle guidance, and specimen handling is essential
Breast Exam Format & Structure
Understanding the exam format helps you prepare strategically:
| Aspect | Details |
|---|---|
| Total Questions | Approximately 165 multiple-choice |
| Time Limit | 3 hours (180 minutes) |
| Passing Score | 555 (on a 300-700 scale) |
| Format | Multiple choice and hotspot questions with breast ultrasound images |
| Testing Centers | Pearson VUE (in-person or online proctoring) |
| Exam Fee | $300 (as of 2026) |
Understanding the 6 Content Domains
The Breast exam is divided into 6 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: Anatomy and Physiology (15%)
Approximately 25 questions
Domain 2: Pathology (34%)
Approximately 56 questions
Domain 3: Integration of Data (19%)
Approximately 31 questions
Domain 4: Protocols (13%)
Approximately 21 questions
Domain 5: Ultrasound Physics (12%)
Approximately 20 questions
Domain 6: Emerging Technology and Treatment (7%)
Approximately 12 questions
Category 0: Incomplete - Need additional imaging
Category 1: Negative - No findings
Category 2: Benign - Simple cysts, implants, stable findings
Category 3: Probably Benign - <2% malignancy risk, short-term follow-up
Category 4: Suspicious - 2-95% malignancy risk, biopsy recommended
Category 5: Highly Suggestive of Malignancy - >95% risk
Category 6: Known Biopsy-Proven Malignancy
1. Anechoic (completely echo-free interior)
2. Round or oval shape
3. Circumscribed margins
4. Posterior acoustic enhancement
5. Thin, imperceptible wall
6. No internal vascularity on Doppler
Free Breast Practice Test Questions
Test your knowledge with these sample Breast exam questions. Answers and explanations are provided below.
Question 1
Which BI-RADS category is assigned to a lesion with greater than 95% probability of malignancy?
Question 2
A well-circumscribed, oval, anechoic mass with posterior acoustic enhancement and no internal vascularity is most consistent with:
Question 3
Which sonographic feature is most suspicious for malignancy?
Question 4
The most common benign solid mass in women under 30 years of age is:
Question 5
During a breast ultrasound, you identify an intracapsular rupture of a silicone implant. The characteristic finding is:
Question 6
Which lymph node finding is most concerning for metastatic involvement?
Question 7
A breast mass demonstrating a 'taller than wide' orientation (antiparallel) on ultrasound suggests:
Question 8
What is the recommended management for a BI-RADS 3 lesion?
Question 9
Which breast quadrant is the most common location for breast cancer?
Question 10
During an ultrasound-guided core needle biopsy, the needle should approach the lesion:
Answer Key with Explanations
BI-RADS 5 indicates findings highly suggestive of malignancy with >95% probability. BI-RADS 6 is reserved for known biopsy-proven malignancy. BI-RADS 4 indicates suspicious findings (2-95% probability), and BI-RADS 3 indicates probably benign findings (<2% probability).
A simple cyst meets all criteria: anechoic interior, round or oval shape, circumscribed margins, posterior acoustic enhancement, and no internal vascularity. Fibroadenomas are solid masses. Complex cysts have internal echoes, septations, or thick walls.
Posterior acoustic shadowing in a solid mass is associated with desmoplastic reaction seen in many breast cancers. Parallel orientation, circumscribed margins, and oval shape are features more commonly associated with benign lesions.
Fibroadenomas are the most common benign solid breast masses, particularly in young women under 30. They typically appear as well-circumscribed, oval, homogeneous masses with a parallel orientation. Phyllodes tumors are rare and can be benign, borderline, or malignant.
The stepladder sign (also called linguine sign) represents the collapsed elastomer shell floating within the silicone gel and is characteristic of intracapsular implant rupture. The snowstorm appearance is seen with extracapsular rupture where silicone escapes beyond the fibrous capsule.
Eccentric cortical thickening, especially >3mm, is concerning for metastatic involvement. Normal lymph nodes have a preserved fatty hilum, oval shape, and hilar vascularity. Loss of the fatty hilum, round shape, and peripheral or absent vascularity are also suspicious features.
An antiparallel or 'taller than wide' orientation indicates the mass is growing across tissue planes rather than along them, which is a suspicious feature for malignancy. Benign masses typically grow parallel to tissue planes and appear wider than tall.
BI-RADS 3 (probably benign) lesions have less than 2% malignancy risk and are managed with short-term follow-up, typically at 6 months. If stable over 2-3 years of follow-up, the lesion can be downgraded to BI-RADS 2. Biopsy is reserved for BI-RADS 4 and 5 lesions.
The upper outer quadrant (UOQ) contains the greatest amount of breast tissue and is the most common location for breast cancer, accounting for approximately 50% of cases. This area includes the axillary tail of Spence.
The needle should approach parallel to the chest wall to avoid pneumothorax. This technique keeps the needle path visible on ultrasound and away from the chest wall. The nipple-areolar complex should be avoided due to increased risk of complications and potential interference with future surgeries.
Want More Practice Questions?
Try Prepry's 370+ Breast practice questions with detailed explanations and a pass guarantee.
Start Your Free TrialAlso available on mobile:
No credit card required.
Breast Exam Scoring & Pass Rate
Current Pass Rates
According to official data, the Breast first-time pass rate is approximately 75%. This makes it one of the more challenging exams.
Why Pass Rates May Be Lower
- Extensive pathology: Must recognize a wide variety of benign and malignant conditions
- BI-RADS mastery: Proper categorization requires integrating multiple imaging features
- Clinical correlation: Questions often require correlating findings with patient history and other imaging
- Interventional procedures: Must understand biopsy techniques, complications, and specimen handling
Understanding Your Score Report
Your score report includes:
- Overall scaled score (pass/fail)
- Performance breakdown by content domain
- Percentile ranking compared to other examinees
What If You Don't Pass?
First, know that you're not alone—many examinees don't pass on their first attempt.
- Waiting period: 60 days before you can retake
- Maximum attempts: 3 attempts per 12-month period
- Re-application: You must submit a new application and fee for each attempt
How to Register for the Breast Exam
Step 1: Meet Prerequisites
You must first pass the SPI exam and meet clinical requirements:
- Hold current RDMS, RDCS, RVT, or RMSKS credential, OR
- Be enrolled in or graduate from a CAAHEP-accredited program, OR
- Have documented clinical breast sonography experience
Step 2: Create or Access Your ARDMS Account
Visit myARDMS.org, log in to your existing account or create a new one, and verify your profile information is current.
Step 3: Submit Your Application
Select 'Breast Specialty Examination' from available exams, upload required documentation including clinical experience logs if applicable, and pay the examination fee ($275 as of 2026).
Step 4: Receive Your Authorization to Test (ATT)
ARDMS reviews applications within 2-4 weeks. Upon approval, you'll receive an ATT via email valid for 90 days.
Step 5: Schedule with Pearson VUE
Visit Pearson VUE to schedule your exam. Choose between in-person testing at a Pearson VUE center or online proctoring from home.
What to Expect on Exam Day
For In-Person Testing
Before arrival:
- Get adequate sleep the night before
- Eat a nutritious meal - the exam is 3 hours long
- Arrive 30 minutes early to allow time for check-in
- Bring two forms of valid ID (one with photo and signature)
At the testing center:
- Complete check-in with the test administrator
- Store all personal belongings in a provided locker
- No phones, watches, notes, or unauthorized materials allowed
During the exam:
- You'll receive scratch paper for notes and calculations
- Breaks are permitted but count against your 3-hour time limit
- Flag questions for review and manage your time wisely
For Online Proctoring
System requirements:
- Reliable high-speed internet connection
- Working webcam and microphone
- Windows or Mac computer (tablets not permitted)
- Quiet, private room with no interruptions
Environment requirements:
- Clear desk - only computer and approved items
- No dual monitors or additional displays
- Well-lit room where your face is clearly visible
- No one else may enter the room during testing
How Long Should You Study?
The ideal study timeline depends on your background:
| Situation | Recommended Study Time |
|---|---|
| Working breast sonographer (daily scanning) | 6-8 weeks |
| General sonographer (occasional breast exams) | 8-10 weeks |
| Recent graduate with breast rotation | 8-10 weeks |
| Limited breast experience | 12-16 weeks |
Sample Study Schedule
Week 1-2: Anatomy & Physiology Foundation
- Review breast anatomy: quadrants, tissue composition, lymphatics
- Study normal developmental changes and hormonal influences
- Master the radial and anti-radial scanning planes
- Complete 100-150 practice questions
Complete 100-150 practice questions
Week 3-4: Pathology Deep Dive (Most Critical)
- Study benign masses: cysts, fibroadenomas, fat necrosis
- Learn malignant features and types of breast cancer
- Master BI-RADS lexicon and assessment categories
- Focus on differential diagnosis of masses
Complete 200-250 practice questions
Week 5: Integration & Protocols
- Practice correlating ultrasound with mammography findings
- Study screening vs. diagnostic protocols
- Review lymph node evaluation and axillary imaging
- Learn implant imaging techniques
Complete 150-200 practice questions
Week 6: Interventional & Emerging Technology
- Study ultrasound-guided biopsy techniques
- Review pre-operative localization procedures
- Learn about elastography and contrast-enhanced ultrasound
- Study emerging technologies and treatment options
Complete 150 practice questions
Week 7-8: Final Review & Mock Exams
- Take full-length timed mock exams (170 questions, 3 hours)
- Review all missed questions thoroughly
- Focus on weak domains identified in practice tests
- Light review of key concepts before exam day
Tips to Pass the Breast Exam
1. Master BI-RADS Classification
The ACR BI-RADS lexicon is fundamental to breast imaging. Know every descriptor (shape, margin, orientation, echo pattern, posterior features) and understand how findings lead to specific assessment categories. Practice classifying masses until it becomes automatic.
2. Focus on Pathology (34% of Exam)
Pathology is the largest content domain. Create a systematic approach to differentiating benign from malignant masses. Know the classic appearances of fibroadenomas, cysts, invasive ductal carcinoma, and DCIS.
3. Learn the Suspicious Features
Memorize features that increase suspicion for malignancy: irregular shape, angular or spiculated margins, taller-than-wide orientation, posterior shadowing, and associated findings like architectural distortion or calcifications.
4. Understand Lymph Node Assessment
Know the criteria for normal vs. abnormal lymph nodes. Loss of fatty hilum, cortical thickening >3mm, round shape, and peripheral/absent vascularity are concerning features that often appear on exams.
5. Study Implant Complications
Understand the sonographic appearance of implant rupture (intracapsular vs. extracapsular), silicone vs. saline implants, and complications like capsular contracture. Know the characteristic signs like stepladder sign and snowstorm appearance.
6. Practice Time Management
With 170 questions in 180 minutes, you have just over 1 minute per question. Practice under timed conditions and develop a strategy for flagging difficult questions to return to later.
FAQs
How many questions are on the Breast exam?
The Breast exam contains approximately 165 multiple-choice questions.
What is the passing score for the Breast exam?
You need a scaled score of 555 or higher (on a 300-700 scale) to pass.
How long is the Breast exam?
You have 3 hours (180 minutes) to complete the exam, giving you approximately 63 seconds per question.
What are the content domains on the Breast exam?
The six domains are: Anatomy and Physiology (15%), Pathology (34%), Integration of Data (19%), Protocols (13%), Ultrasound Physics (12%), and Emerging Technology and Treatment (7%).
How much does the Breast exam cost?
The examination fee is $275 (as of 2026).
Do I need to pass the SPI exam first?
Yes, you must pass the SPI exam to earn the BR credential. However, you can take the Breast specialty exam before or after the SPI.
How many times can I retake the Breast exam?
You can attempt the exam up to 3 times within a 12-month period with a mandatory 60-day waiting period between attempts.
Can I take the Breast exam online?
Yes, ARDMS offers online proctoring through Pearson VUE if you meet the technical and environmental requirements.
What credential do I earn by passing the Breast exam?
After passing both the SPI and Breast exams, you earn the RDMS (BR) credential - Registered Diagnostic Medical Sonographer with Breast specialty.
Related ARDMS Exam Guides
Explore other ARDMS certification exam guides to continue your journey.
SPI Exam Guide
Required for RDMS/RDCS/RVT | 110 questions
Abdomen Exam Guide
RDMS (AB) | 165 questions
OB/GYN Exam Guide
RDMS (OB/GYN) | 165 questions
Adult Echocardiography Exam Guide
RDCS (AE) | 165 questions
Ready to Pass Your Breast Exam?
Join 95,000+ students who've used Prepry to prepare for their registry exams.
Why Prepry?
- ✓ 370+ practice questions with detailed explanations
- ✓ Video lessons covering all domains
- ✓ Timed mock exams that simulate the real test
- ✓ Spaced repetition technology for efficient studying
- ✓ 95%+ pass rate among students who complete the program
- ✓ Pass guarantee — pass or extend free until you do
Also available on mobile:
No credit card required.
This guide is updated regularly to reflect the latest ARDMS Breast exam information. Last reviewed: January 2026.