ARDMS Pediatric Sonography Exam: The Complete Guide (2026)
Last Updated: January 2026 | Reading Time: 20 minutes
Quick Summary: The ARDMS Pediatric Sonography (PS) exam is a 170-question, 3-hour specialty exam that evaluates your knowledge of sonographic imaging in neonatal and pediatric patients. This guide covers everything you need: exam format, all 5 content domains, 10 free practice questions, registration steps, and proven study strategies to help you pass.
Table of Contents
- What is the Pediatric Sonography Exam?
- Pediatric Sonography Exam Format & Structure
- Understanding the 5 Content Domains
- Free Pediatric Sonography Practice Test Questions
- Pediatric Sonography Exam Scoring & Pass Rate
- How to Register for the Pediatric Sonography Exam
- What to Expect on Exam Day
- How Long Should You Study?
- Tips to Pass the Pediatric Sonography Exam
- FAQs
What is the Pediatric Sonography Exam?
Why the Pediatric Sonography is Challenging
The Pediatric Sonography is often considered one of the more challenging exams because:
- Specialized anatomy: Neonatal and pediatric anatomy differs significantly from adult anatomy, requiring knowledge of developmental changes
- Congenital anomalies: Heavy emphasis on recognizing and understanding congenital variants and malformations
- Age-specific considerations: Normal values and appearances change with patient age, from premature infants to adolescents
- Multiple organ systems: Covers brain, spine, hips, abdomen, pelvis, and more in pediatric patients
Pediatric Sonography 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 pediatric ultrasound images |
| Testing Centers | Pearson VUE (in-person or online proctoring) |
| Exam Fee | $300 (as of 2026) |
Understanding the 5 Content Domains
The Pediatric Sonography exam is divided into 5 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 (26%)
Approximately 43 questions
Domain 2: Congenital Variants, Pathology & Pathophysiology (45%)
Approximately 74 questions
Domain 3: Data and Protocols (19%)
Approximately 31 questions
Domain 4: Physics and Instrumentation (5%)
Approximately 8 questions
Domain 5: Treatment and Emerging Technology (5%)
Approximately 8 questions
Pyloric muscle thickness: >3 mm is abnormal
Pyloric channel length: >15-17 mm is abnormal
Alpha angle (hip): >60 degrees is normal
Beta angle (hip): <55 degrees is normal
Resistive Index (RI) = (PSV - EDV) / PSV
Neonatal lateral ventricle width: >10 mm suggests ventriculomegaly
Appendix diameter: >6 mm suggests appendicitis
Intussusception target sign: >3 cm diameter
Renal pelvis AP diameter: >10 mm (hydronephrosis grading)
Free Pediatric Sonography Practice Test Questions
Test your knowledge with these sample Pediatric Sonography exam questions. Answers and explanations are provided below.
Question 1
What is the most common location for germinal matrix hemorrhage in premature infants?
Question 2
In developmental dysplasia of the hip (DDH), what alpha angle measurement indicates a mature hip?
Question 3
What are the sonographic criteria for hypertrophic pyloric stenosis?
Question 4
Which fontanelle provides the primary acoustic window for neonatal cranial ultrasound?
Question 5
What is the classic sonographic appearance of intussusception on transverse view?
Question 6
In neonatal spine ultrasound, at what level does the conus medullaris normally terminate?
Question 7
What appendix diameter is considered the threshold for diagnosing acute appendicitis in children?
Question 8
Which grade of germinal matrix hemorrhage involves intraventricular hemorrhage with ventricular dilation?
Question 9
What is the most common cause of neonatal hydronephrosis?
Question 10
In pediatric testicular torsion, what is the typical sonographic finding regarding blood flow?
Answer Key with Explanations
The caudothalamic groove (at the junction of the caudate nucleus and thalamus) is the most common site of germinal matrix hemorrhage in premature infants. The germinal matrix is a highly vascular area that involutes by 34 weeks gestation, making preterm infants particularly vulnerable to hemorrhage in this location.
An alpha angle of 60 degrees or greater indicates a mature, well-developed acetabulum. An alpha angle less than 60 degrees suggests hip dysplasia, with lower angles indicating more severe dysplasia. The Graf classification uses alpha and beta angles to categorize hip development.
Hypertrophic pyloric stenosis is diagnosed when the pyloric muscle thickness exceeds 3 mm and the channel length exceeds 15-17 mm. Additional findings include the 'target sign' on transverse view and failure of the pyloric channel to open during real-time observation.
The anterior fontanelle is the primary acoustic window for neonatal cranial ultrasound because it is the largest fontanelle and remains open until approximately 12-18 months of age. The posterior and mastoid fontanelles can provide supplementary views but are smaller and close earlier.
Intussusception appears as a 'target' or 'doughnut' sign on transverse view, representing the layers of bowel within bowel. On longitudinal view, it may show a 'pseudokidney' or 'sandwich' sign. The target sign typically measures greater than 3 cm in diameter.
The conus medullaris normally terminates at the L1-L2 level in term infants. A conus that terminates below L2-L3 is considered low-lying and may indicate tethered cord syndrome. In premature infants, the conus may appear slightly lower but should ascend to normal position.
An appendix diameter greater than 6 mm (measured outer wall to outer wall) is considered abnormal and suggestive of appendicitis. Additional findings include non-compressibility, hyperemia on color Doppler, periappendiceal fat stranding, and the presence of an appendicolith.
Grade III germinal matrix hemorrhage involves intraventricular hemorrhage (IVH) with acute ventricular dilation. Grade I is confined to the germinal matrix, Grade II extends into the ventricles without dilation, and Grade IV includes parenchymal involvement (periventricular hemorrhagic infarction).
Ureteropelvic junction (UPJ) obstruction is the most common cause of significant hydronephrosis in neonates. It results from intrinsic narrowing at the junction of the renal pelvis and ureter. Posterior urethral valves are the most common cause in males when bilateral hydronephrosis is present.
Testicular torsion typically shows decreased or absent intratesticular blood flow on color Doppler compared to the contralateral normal testis. The affected testis may also appear enlarged and hypoechoic. Early torsion may show only decreased diastolic flow, making comparison to the normal side essential.
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Pediatric Sonography Exam Scoring & Pass Rate
Current Pass Rates
According to official data, the Pediatric Sonography first-time pass rate is approximately 70%. This makes it one of the more challenging exams.
Why Pass Rates May Be Lower
- Specialized content: Pediatric sonography is a niche specialty with unique pathologies not encountered in general sonography
- Congenital emphasis: 45% of the exam focuses on congenital variants and pathology, requiring extensive memorization
- Age-related variations: Normal findings vary significantly by patient age, from premature neonates to adolescents
- Limited exposure: Many sonographers have limited pediatric clinical experience before taking the exam
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 Pediatric Sonography Exam
Step 1: Ensure You Meet Prerequisites
Before applying for the PS exam, you must meet ARDMS eligibility requirements:
- Prerequisite 1: Pass the SPI exam (or have a current ARDMS credential)
- Prerequisite 2: Complete an approved educational pathway
- Prerequisite 3: Document required clinical experience in pediatric sonography
Step 2: Create or Access Your ARDMS Account
Visit myARDMS.org to create a new account or log in to your existing account. Complete all profile information accurately.
Step 3: Submit Your Application
Select 'Pediatric Sonography' from available specialty exams, verify your eligibility pathway, upload required documentation (transcripts, clinical verification), and pay the examination fee ($275 as of 2026).
Step 4: Receive Your Authorization to Test (ATT)
ARDMS typically reviews applications within 2-4 weeks. Upon approval, you'll receive an ATT via email. Your ATT is valid for 90 days from the date of issue.
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. Select your preferred date and time within your ATT window.
What to Expect on Exam Day
For In-Person Testing
Before arrival:
- Get 7-8 hours of sleep the night before
- Eat a balanced meal before your exam
- Arrive at the testing center 30 minutes early
- Bring two forms of valid ID (one with photo and signature)
At the testing center:
- Check in with the test administrator
- Store personal belongings in a provided locker (no phones, watches, or notes allowed)
- Palm vein scan or photo may be taken for security verification
During the exam:
- You'll have access to scratch paper and a basic calculator
- Breaks are permitted but count against your 3-hour time limit
- Raise your hand if you need administrator assistance
- Pace yourself: approximately 63 seconds per question
For Online Proctoring
System requirements:
- Reliable high-speed internet connection
- Working webcam and microphone
- Windows or Mac computer (tablets not permitted)
- Download and test Pearson VUE software before exam day
Environment requirements:
- Quiet, private room with closed door
- Clear desk (remove all items except computer)
- No dual monitors permitted
- Well-lit room where your face is clearly visible
How Long Should You Study?
The ideal study timeline depends on your background:
| Situation | Recommended Study Time |
|---|---|
| Working in pediatric sonography (daily exposure) | 6-8 weeks |
| General sonographer with some pediatric experience | 8-10 weeks |
| Recent graduate with pediatric clinical rotations | 10-12 weeks |
| Limited pediatric experience | 12-16 weeks |
Sample Study Schedule
Week 1-2: Anatomy & Physiology Foundation
- Study Domain 1: Pediatric anatomy and physiology (26%)
- Focus on neonatal brain anatomy and fontanelle imaging
- Review normal developmental anatomy by age
- Complete 100-150 practice questions
Complete 100-150 practice questions
Week 3-5: Congenital Variants & Pathology (Critical)
- Dedicate extended time to Domain 2 (45% of exam)
- Study germinal matrix hemorrhage grading
- Master hip dysplasia classification (Graf)
- Review GI pathology: pyloric stenosis, intussusception, appendicitis
- Study renal anomalies and hydronephrosis
Complete 200-250 practice questions
Week 6-7: Protocols & Data Acquisition
- Study Domain 3: Data and protocols (19%)
- Review standard imaging planes and measurements
- Practice age-specific measurement criteria
- Take first full-length mock exam
Complete 150-200 practice questions
Week 8: Physics, Treatment & Final Review
- Review Domain 4: Physics and instrumentation (5%)
- Study Domain 5: Treatment and emerging technology (5%)
- Review all weak areas identified in practice tests
- Take 2-3 additional mock exams under timed conditions
Complete 200+ practice questions
Week 9: Final Preparation
- Light review of key measurements and thresholds
- Focus on congenital pathology recognition
- Review missed questions from practice exams
- Rest the day before your exam
Tips to Pass the Pediatric Sonography Exam
1. Prioritize Congenital Pathology
Domain 2 (Congenital Variants, Pathology & Pathophysiology) accounts for 45% of the exam. Dedicate the majority of your study time to understanding congenital anomalies, their sonographic appearances, and associated conditions.
2. Master Key Measurements
Memorize critical thresholds: pyloric muscle >3 mm, alpha angle >60 degrees for normal hip, appendix >6 mm for appendicitis, and lateral ventricle >10 mm for ventriculomegaly. These measurements are frequently tested.
3. Know the Grading Systems
Be thoroughly familiar with germinal matrix hemorrhage grades (I-IV), Graf hip classification (Types I-IV), and hydronephrosis grading. Understand what distinguishes each grade and the clinical implications.
4. Study Age-Specific Variations
Normal findings change dramatically with age in pediatric patients. Know how the conus medullaris position, fontanelle size, and organ appearances change from premature infants through adolescence.
5. Use Visual Learning
Pediatric pathology recognition requires pattern recognition. Study ultrasound images extensively. Know classic appearances: target sign (intussusception), doughnut sign (pyloric stenosis), and candle-drip calcifications (CMV).
6. Practice Time Management
With 170 questions in 180 minutes, you have about 63 seconds per question. Take full-length practice exams under timed conditions. Don't spend too long on difficult questions - flag them and return later.
FAQs
How many questions are on the Pediatric Sonography exam?
The exam contains approximately 165 multiple-choice questions.
What is the passing score for the PS exam?
You need a scaled score of 555 or higher (on a 300-700 scale) to pass the Pediatric Sonography exam.
How long is the Pediatric Sonography exam?
You have 3 hours (180 minutes) to complete the exam, which allows approximately 63 seconds per question.
How much does the PS 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 (or hold a current ARDMS credential) before or in conjunction with the Pediatric Sonography specialty exam to earn the RDMS-PS credential.
What is the largest content domain on the PS exam?
Domain 2: Congenital Variants, Pathology & Pathophysiology is the largest at 45% of the exam. Focus significant study time on this domain.
How long must I wait to retake the exam if I fail?
You must wait 60 days between exam attempts. You can take the exam up to 3 times within a 12-month period.
Can I take the Pediatric Sonography exam online?
Yes, ARDMS offers online proctoring through Pearson VUE. You must meet specific technical and environmental requirements for online testing.
What clinical experience is required for the PS exam?
Clinical experience requirements vary by eligibility pathway. Most candidates need documented pediatric sonography experience, which may include clinical rotations during an accredited program or work experience. Check ARDMS.org for specific requirements.
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This guide is updated regularly to reflect the latest ARDMS Pediatric Sonography exam information. Last reviewed: January 2026.