Study guide
1.2 Scoring, Section Minimums & the August 2026 Cut-Score Change
ARRT Sonography Primary
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1 Introduction & Exam Overview
1.1 Current Exam Facts & Logistics 1.2 Scoring, Section Minimums & the August 2026 Cut-Score Change 1.3 Official Blueprint & Study Strategy
2 Patient Care: Ethics, Legal Practice & Communication
2.1 Ethical & Legal Aspects of Patient Care 2.2 Interpersonal Communication & Patient Education 2.3 Physical Assistance, Monitoring & Sonographer Ergonomics
3 Patient Care: Safety, Emergencies & Infection Control
3.1 Medical Emergencies & Critical Findings 3.2 Infection Control & Hazardous Materials 3.3 Ultrasound Safety & Interventional Procedure Care
4 Image Production: Transducers & the Ultrasound Beam
4.1 Piezoelectric Effect & Transducer Construction 4.2 Beam Configuration: Near Field, Far Field & Focus 4.3 Transducer Types, Selection, Care & Malfunctions
5 Image Production: Pulse Characteristics & Resolution
5.1 Pulse Characteristics: PRF, PRP, SPL & Duty Factor 5.2 Resolution: Axial, Lateral, Temporal, Elevational & Contrast 5.3 Frequency, Bandwidth, Q Factor, Power, Pressure, Intensity & Amplitude
6 Image Production: Imaging Modes & Doppler Principles
6.1 B-Mode & M-Mode Imaging 6.2 Spectral Doppler: Pulsed Wave vs Continuous Wave 6.3 Color Doppler & Power Doppler
7 Image Production: Optimization Controls
7.1 Power, Gain, TGC, Depth & Focal Zone 7.2 Frame Rate, Line Density, Dynamic Range, Harmonics & Compounding 7.3 Doppler Optimization Controls
8 Image Production: Sound–Tissue Interactions
8.1 Speed of Sound & the Range Equation 8.2 Acoustic Impedance, Reflection, Refraction & Scattering 8.3 Attenuation, Absorption & Intensity
9 Image Production: Signal Processing, Display & Bioeffects
9.1 Receiver, Signal Processing & Analog-Digital Conversion 9.2 Postprocessing, Magnification, Panoramic & 3D/4D Imaging 9.3 Bioeffects & Output Display Measures
10 Image Production: Image Evaluation & Artifacts
10.1 Criteria for Diagnostic Quality & Annotation 10.2 Grayscale Artifacts 10.3 Doppler Artifacts
11 Image Production: Real-Time Interpretation & Informatics
11.1 Real-Time Imaging, Echogenicity & Echotexture 11.2 Color & Spectral Analysis: Measurements and Waveforms 11.3 Imaging Informatics: HIS, RIS, EMR, PACS & DICOM
12 Procedures: Abdominal & Transplant Vasculature
12.1 Aorta, Its Branches & the IVC 12.2 Portal Venous System & Hepatic Vasculature 12.3 Liver & Renal Transplant Sonography
13 Procedures: Liver
13.1 Liver Anatomy, Variants & Examination Technique 13.2 Diffuse Liver Disease 13.3 Focal Liver Lesions
14 Procedures: Biliary System, Pancreas & Spleen
14.1 Gallbladder & Bile Ducts 14.2 Pancreas 14.3 Spleen
15 Procedures: Urinary Tract, GI Tract & Other Abdominal Structures
15.1 Kidneys & Ureters 15.2 Bladder & Prostate 15.3 GI Tract, Adrenals, Lymph Nodes, Hernias & Peritoneal Cavity
16 Procedures: First-Trimester Obstetrics
16.1 Early Gestation: Normal Development & Structures 16.2 First-Trimester Measurements, Dating & Maternal Anatomy 16.3 First-Trimester Abnormalities
17 Procedures: Second/Third-Trimester Biometry & Fetal Survey
17.1 Standard Biometry: BPD, HC, AC, FL & Growth Assessment 17.2 Fetal Anatomic Survey: Head, CNS, Face & Spine 17.3 Fetal Anatomic Survey: Heart, Chest, GI, GU, Skeleton & Fetal Position
18 Procedures: Chromosomal, Genetic & Structural Abnormalities
18.1 Chromosomal & Genetic Abnormalities 18.2 Major Structural Anomalies by System 18.3 Fetal Infection, Neoplasms & Hydrops
19 Procedures: Placenta, Amniotic Fluid, Cord & Cervix
19.1 Placenta: Normal, Previa, Abruption & Accreta 19.2 Amniotic Fluid Assessment & Growth Disorders 19.3 Umbilical Cord & Cervical Assessment
20 Procedures: Fetal Assessment, Doppler & Multiple Gestation
20.1 Biophysical Profile & Fetal Surveillance 20.2 Fetal & Uteroplacental Doppler 20.3 Multiple Gestations, Assisted Reproduction & Maternal Disease
21 Procedures: Gynecology — Uterus
21.1 Uterine Anatomy, Myometrium & Fibroids 21.2 Endometrium: Cyclic Changes, Hyperplasia & Cancer 21.3 Cervix & Congenital Uterine Anomalies
22 Procedures: Gynecology — Adnexa & Pelvis
22.1 Ovaries: Normal, Functional Cysts & Benign Masses 22.2 Ovarian Malignancy, Torsion & Fallopian Tubes 22.3 Cul-de-Sac, Vagina & Pelvic Floor
23 Procedures: Neck & Scrotum
23.1 Thyroid & Parathyroid 23.2 Salivary Glands & Neck Lymph Nodes 23.3 Scrotum & Testes
24 Procedures: Breast & Peripheral Vascular
24.1 Breast & Axilla 24.2 Venous Extremity Doppler 24.3 Carotid Doppler & Post-Catheterization Complications
25 Procedures: Pediatric, Interventional & Miscellaneous
25.1 Neonatal Head, Spine & Hip Sonography 25.2 Pediatric GI & Noncardiac Chest 25.3 Ultrasound-Guided Interventions, MSK & Superficial Masses
1.2 Scoring, Section Minimums & the August 2026 Cut-Score Change
Key Takeaways Explain This Topic AI
ARRT reports total performance on a scaled score range of 1 to 99, and a scaled score of 75 is required to pass — 75 is not a raw percentage correct
Sonography uniquely adds section minimums: candidates must also earn scaled section scores of at least 7.5 in both the Abdomen section and the OB/GYN section, a requirement ARRT has applied since 2013
The OB/GYN section score is a composite of First Trimester Obstetrics (20 items), Second/Third Trimester and High Risk Obstetrics (57), and Gynecology (32) — 109 scored items against the Abdomen section's 75
On August 1, 2026 ARRT begins using a revised cut score: the reported standard stays at a scaled 75, but roughly four more correct items are needed overall and about one more in each of the Abdomen and OB/GYN sections
ARRT's 2025 Annual Exam Report lists a Sonography pass rate of 54.9% with a mean scaled score of 76.7, among the lowest of any ARRT discipline
Last updated: July 2026
How Scaled Scoring Works
ARRT does not grade the Sonography exam as a simple percentage. Your raw performance is converted to a scaled score ranging from 1 to 99 , and the passing standard is a scaled score of 75 . Scaling (equating) adjusts for small differences in difficulty between exam forms, so a 75 represents the same level of competence whether your form was slightly easier or slightly harder than another candidate's. The practical implication: 75 is not 75 percent correct . Depending on the form, the raw percentage needed to reach a scaled 75 can sit above or below three out of four questions, so do not try to reverse-engineer a raw target from the scaled cut.
The Sonography-Specific Section Minimums
Sonography differs from most other ARRT disciplines in one critical way: a total scaled score of 75 is necessary but not sufficient . Candidates must also earn a scaled section score of at least 7.5 in each of two designated procedure sections:
the Abdomen section (75 scored items), and
the OB/GYN section — a composite of First Trimester Obstetrics (20), Second/Third Trimester and High Risk Obstetrics (57), and Gynecology (32), or 109 scored items .
Section scores are reported on a 0.1 to 9.9 scale, and ARRT has required 7.5 in both of these sections since 2013 — this is the current rule, not a future one. A candidate can therefore score, say, 78 overall — above the total cut — and still fail the exam because one of these two sections came in below 7.5. This rule exists because ARRT's practice analysis treats abdominal and obstetric/gynecologic scanning as the non-negotiable core of entry-level sonography practice; a strong physics score cannot compensate for unsafe procedure knowledge.
The August 2026 Cut-Score Change
Beginning August 1, 2026 , ARRT applies a revised cut score to the Sonography exam, replacing the standard set in 2023. The change is easy to misread, so be precise about what does and does not move:
- Element Before Aug 1, 2026 On/after Aug 1, 2026
- Reported total passing score Scaled 75 Scaled 75 (unchanged)
- Section minimum, Abdomen and OB/GYN 7.5 7.5 (unchanged)
- Correct items needed, whole exam Baseline ≈ 4 more
- Correct items needed, Abdomen and OB/GYN sections Baseline ≈ 1 more each
In other words, the numbers you see on the score report do not change — 75 and 7.5 stay exactly where they are. What changes is the raw performance behind them: ARRT's standard-setting committee re-rated a representative exam form and concluded that a minimally qualified sonographer should answer about four more items correctly across the exam, and about one more in each gated section. ARRT itself anticipates that this may slightly lower the percentage of candidates who pass .
The practical implication is a margin, not a new target. If you are testing on or after August 1, 2026, treat borderline readiness as insufficient: build a cushion of several extra correct answers over your pre-2026 practice benchmarks, and do not let Abdomen or OB/GYN preparation lag, because those two sections carry both the largest question counts and the only section-level veto over your result.
Pilot Questions and Guessing Strategy
Of the 400 items, 40 are unscored pilot questions being statistically evaluated for future use. Two facts about them drive test-day tactics:
Pilot items are indistinguishable from scored items. They are not labeled, not clustered, and not identifiable by style. You cannot skip the ones that look experimental.
There is no penalty for guessing. Scoring counts correct responses only; a wrong answer and a blank answer cost exactly the same — zero.
Together these mean you should answer every single question in both sessions. An unanswered item is a guaranteed loss of a possible point; a reasoned guess on a four-option question carries a baseline 25 percent chance of a point. When time runs short, mark remaining items with your best elimination-based guess rather than leaving blanks.
Pass Rates: Why This Exam Deserves Respect
ARRT publishes discipline-level results every year in its Annual Exam Report . The 2025 edition puts the Sonography pass rate at 54.9 percent , with a mean scaled score of 76.7 and an approximate raw requirement of 67 percent correct to reach a scaled 75; the 2024 edition reported 51.0 percent . That is one of the lowest pass rates of any ARRT discipline — for comparison, Radiography sat at 86 percent and Mammography at 91 percent in the same 2025 report. Several structural features explain the gap:
Breadth: five procedure subcategories spanning abdomen, OB at all trimesters, gynecology, and superficial structures.
Physics weight: 118 of 360 scored questions (nearly one third) test ultrasound physics, instrumentation, and image evaluation, an area many clinically trained candidates under-prepare.
Section minimums: candidates strong in one procedure area can still fail on the other designated section.
Endurance: 400 items across two sessions punishes candidates who trained only on 50-question quizzes.
None of this is meant to discourage. It means the exam rewards systematic, blueprint-proportional preparation — exactly the approach the next section lays out — and punishes casual review. Treat the roughly 45 percent failure rate as a planning input, not a prediction about you.
A Worked Scoring Example
Consider two candidates on the same exam form. Candidate A earns a total scaled score of 78, with an abdominal section score of 8.1 and an OB/GYN section score of 7.7. Candidate B earns a total scaled score of 81 — three points higher — but posts an OB/GYN section score below the applicable standard. Under the section-minimum rule, Candidate A passes and Candidate B fails , despite the lower total. This is the single most counterintuitive feature of Sonography scoring, and it is why review plans built only around total practice-test percentages miss the point.
Why the Pilot System Exists
The 40 unscored pilot items are not filler; they are how ARRT pre-tests future questions statistically before allowing them to count. Embedding pilots inside operational forms lets ARRT gather response data under real testing conditions and keep equating stable across testing windows. For you, the consequence is purely tactical: since you cannot identify pilots, you cannot ration effort around them. Every item deserves the same careful read — which is another way of saying the only rational strategy is to treat all 400 questions as scored.
Finally, remember that a failed attempt is not invisible: it consumes one of your three attempts in the three-year window and requires paying the exam fee again. Preparation quality is therefore a financial decision as well as an academic one.