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How to Pass ARDMS SPI Exam the First Time: 7 Tips from Real Sonographers

Updated: Feb 22

You did it! You've graduated sonography school and now you're one step closer to becoming a registered sonographer. Now, there’s just one small hurdle to overcome before you can officially become a registered sonographer with ARDMS credentials (RDMS, RDCS, RVT and RMSKS) passing the ARDMS SPI Exam. You've studied hard in sonography school and you know your stuff, but that doesn't mean you can't learn some tips and tricks to help pass the ARDMS SPI exam on your first try. We've put together our top seven tips for passing the ARDMS SPI exam the first time.

1. Understand the ARDMS SPI Exam Format

The ARDMS SPI examination consists of 110 questions, which must be answered within a time limit of 2 hours. You will be given a score that falls somewhere between 300 and 700. To pass, you must score 555 or greater.

The ARDMS (American Registry for Diagnostic Medical Sonography) uses a scaled scoring system to ensure fairness in comparing test scores across different versions of the exam. This means that a person's score is based not only on the number of questions they answer correctly, but also on the relative difficulty of the specific version of the exam they take. The ARDMS recognizes that different versions of the exam may vary slightly in difficulty level. To ensure fairness in comparing test scores across these different versions, the ARDMS uses a scaled scoring system that takes into account the relative difficulty of each version of the exam.

For example, if person A took a version of the exam that was more difficult than the version person B took, then person A's score will be adjusted upward accordingly. This means that if person A scored 63% on a more difficult version of the exam in 2017, and person B scored 93% on an easier version of the exam in 2016, person B's scaled score would be higher than person A's. By using a scaled scoring system, the ARDMS ensures that all test takers are judged fairly and equitably, regardless of which version of the exam they take. This system provides a more accurate representation of a test taker's knowledge and skills, and helps to maintain the integrity of the certification process.

2. Don't Self-Evaluate During the ARDMS SPI Exam

You shouldn't self-evaluate during tests; instead, concentrate on the questions at hand. You should answer every question. With 110 questions in 2 hours, this exam is all about endurance. Don't Focus on "What If" Questions. Many students who don't pass the SPI exam focus on "what if" questions, such as "if I don't pass, what am I going to do?" Concentrate on studying, and stop worrying about what you will do if you fail. You will pass the exam if you put in the time. You will feel confident that you are prepared and that you have grasped crucial ideas with the help of Prepry. Don't Give Up. If you don't pass the exam on your first try, don't give up. This exam is about endurance and confidence, and if you don't pass the first time, you can always pass the second time. Just study a little harder the second time, and don't give up.

3. Find Ways to Manage Your Test Stress

Although it's perfectly normal to feel nervous before a test, some students suffer from debilitating test anxiety. Symptoms such as a fast heartbeat, headache, or nausea may accompany racing thoughts, inability to concentrate, or feelings of dread. No matter if it's the ARDMS SPI Exam or abdomen exam, test anxiety can derail weeks and months of hard work. Test anxiety is a real thing, but you made it through ultrasound school, Prepry can help you feel confident that you are prepared, and have mastered key concepts. Even if you don’t typically have test anxiety, there is a chance that you will be nervous just from the pressure of such an important test.

There are a couple key ways to keep stress at a minimum.

  • Be prepared. If you feel confident that you’ve prepped thoroughly, you’ll feel more confident walking into the test. Need help reviewing tough concepts or question types? Prepry can provide that extra boost you need to feel cool and collected.

  • First, prepare for the exam seriously but don’t make studying your life. It’s important to still keep a balance in the weeks and months leading up to the exam.

  • Allot time in your days for exercise, proper sleep, and whatever you do for fun! By keeping a balance, your mind won’t build up the test moment to anything bigger than it actually is.

  • Get a good night’s sleep. It's never a good idea to cram. Pulling an all-nighter can only make your nerves worse. A good night's sleep (8 hours) is more useful than cramming until dawn.

  • Focus on calm breathing and positive thoughts. This method can slow down your heart and racing mind, so it's a good idea to practice it at home. By concentrating on breathing and thinking, one can biometrically alter their anxious feelings.

4. Know Your SPI Study Style

We all have slightly different learning styles, and you probably know yours by now. Make sure you tailor your studying to what works for you!

  • If you understand concepts well with visuals, draw out rough sketches of probe components or sound waves

  • If you are an auditory learner, there are plenty of YouTube lectures online and podcasts that cover SPI.

  • If you learn best through discussion, be sure to create a study group to talk through concepts together.

As a general rule, using mnemonic devices help most students with harder to learn concepts. Don’t just reread, rewrite, and copy old notes. Utilize Prepry apps to zero in on the topics that you are struggling to learn, and make an effort to link related ideas. Think about what you are learning from a holistic approach and relate it to clinical experiences you had in school.

5. Use Prepry ARDMS SPI Exam Study Plans

Commit to the preparation that the test deserves. Go into studying with a plan, here is an example:

  • Plan days to study. Set a schedule including which days of the week you will study, which days you will take off, and which you will use to take practice exams.

  • Make a goal before each study session. Maybe it’s to do x amount of practice questions, or master x specific content topic, but be intentional.

Studying without a plan is a waste of your time and won’t ultimately help you pass the ARDMS SPI Exam. It’s not about the hours you put in, it’s about how you use them.

This is one exam you can absolutely not cram for – the ARDMS SPI Exam is a holistic test model that aims to test knowledge gained over the course of years, not days.

6. Prepare for Exam Day

  • Be sure to sleep well the week before the exam.

  • Arrive early to the testing center, prepared with necessary documents for testing.

  • Put gas in your car the night before.

  • Don't study or cram the day before you take the SPI.

  • Take the morning before the test to calm your mind. Focus on something that helps you stay grounded – cooking a nice breakfast, listening to music, going on a run, whatever works for you.

  • Set multiple reliable alarms.

  • If you tend to get cold, bring layers of clothing. In order to feel comfortable and prepared for the exam, you should control your environment as much as possible.

  • Consider your usual preference for testing time when scheduling your exam. Those who prefer the morning should take the test early in the day. Schedule your exam for the afternoon if you like lazy mornings and sleeping in.

7. Believe in Yourself

Most importantly, believe in yourself. You deserve to pass and you have already proven your potential as a sonographer by graduating sonography school. You are on your exciting and new journey to being a Registered Sonographer – so congratulations!


Exam Outline Review

Exam Outline Review

The Sonography Principles and Instrumentation exam contains 110 multiple-choice questions, and you will be given a time limit of 2 hours.

The exam is split into five domains, each of which assesses your knowledge, skills, and abilities.

1. Clinical Safety, Patient Care, and Quality Assurance (10%)

The questions in this domain cover clinical safety, patient care, quality assurance, and new technologies. These are some of the specific skills and knowledge you will be asked to demonstrate:


  • Analyze clinical history and previous imaging studies

  • Apply ergonomic techniques

  • Identify potential bioeffects

  • Evaluate statistical parameters

  • Identify ultrasound hybrid imaging

  • Identify tissue Doppler


  • Sterile techniques

  • How and when to communicate via a patient representative

  • Parameters for transducer element integrity tests

  • How to acquire information from various imaging findings

  • Mechanical index

  • Thermal index

  • Damages that can contribute to the degradation of an image

2. Physical Principles (15%)

The questions in this domain cover various aspects of physical principles. These are some of the specific skills and knowledge you will be asked to demonstrate:


  • Differentiate the interactions of sound and matter

  • Integrate axial resolution optimization concepts

  • Integrate temporal resolution optimization concepts

  • Integrate lateral resolution optimization concepts

  • Apply duty factor concepts


  • Grayscale artifacts and reflectors

  • Frame rate

  • Elevational resolution

  • Temporal resolution

  • Lateral resolution

  • Axial resolution

3. Ultrasound Transducers (16%)

The questions in this domain cover various kinds of ultrasound transducers. These are some of the specific skills and knowledge you will be asked to demonstrate:


  • Evaluate and adjust transducer frequency

  • Use sector transducers

  • Distinguish transducer components

  • Use nonimaging transducers

  • Select a specific type of transducer as it pertains to the area being scanned

  • Evaluate transducer integrity


  • Transducer use and limitation

  • 1.5-dimensional array transducers

  • 2-dimensional array transducers

  • Endocavity transducers

  • Curvilinear transducers

  • Endocavity transducers

  • Linear transducers

4. Imaging Principles and Instrumentation (28%)

The questions in this domain cover various kinds of instrumentation. These are some of the specific skills and knowledge you will be asked to demonstrate:


  • Perform accurate measurements

  • Apply concepts related to the following:

  • Gray scale

  • Overall gain

  • Harmonic imaging

  • Spatial compounding

  • Dynamic range

  • Persistence

  • Edge enhancement

  • Imaging systems and storage

  • Time gain compensation


  • Instrumentation and controls

  • Zoom

  • 3-dimensional imaging

  • 4-dimensional imaging

  • 2-dimensional real-time, grayscale imaging

  • Coded excitation

  • Appropriate documentation of findings

5. Doppler Imaging Concepts (31%)

The questions in this domain cover Doppler imaging concepts, specifically in regards to hemodynamics. These are some of the specific skills and knowledge you will be asked to demonstrate:


  • Obtain blood flow velocity measurements

  • Evaluate spectral Doppler waveforms

  • Make modifications based on spectral Doppler artifacts

  • Make modifications based on color artifacts

  • Apply pulse repetition frequency concepts

  • Adjust the volume of a sample size


  • Proper blood flow velocity measurement-taking

  • Wall filter applications

  • Color flow imaging

  • Color packet size

  • Proper volume of sample sizes



How many questions are on the SPI exam?

There are 110 multiple-choice questions on the exam.

How long is the SPI exam?

The exam is timed at 2 hours.

What is a passing score on the SPI exam?

To pass the SPI exam, you must achieve a scaled score of 555.

What is the SPI exam pass rate?

The pass rate for the SPI exam is 60%, according to ARDMS data from a 2021 report.

How much does the SPI exam cost?

The cost of the exam is $225.

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