- The Four Content Categories at a Glance
- Which Content Specifications Govern a 2026 Exam
- Domain 1: Patient Care
- Domain 2: Safety
- Domain 3: Image Production
- Domain 4: Procedures
- Inside the Procedures Domain: Five Subareas
- How the Questions Are Delivered
- Scoring, Eligibility and Fees That Frame the Domains
- Sequencing Your Review Around the Domain Weights
- Frequently Asked Questions
- The ARRT Nuclear Medicine Technology exam has four categories: Patient Care, Safety, Image Production and Procedures.
- Of 200 scored questions, Procedures holds 118, while Patient Care has 24, Safety 25 and Image Production 33.
- Procedures splits into five subareas, led by Radionuclides and Radiopharmaceuticals with 28 scored questions.
- Exams through January 31, 2027 follow the 2022 content specifications; the 2027 revision starts February 1, 2027.
The Four Content Categories at a Glance
The Registered Technologist - Nuclear Medicine Technology exam, administered by the American Registry of Radiologic Technologists (ARRT) under its Nuclear Medicine Technology (N) discipline, is organized into four official major content categories. Those categories are examination blueprints, not chapter titles from a textbook or a prep course. Every scored question is assigned to one of them, and the way the questions are distributed tells you where your hours should go.
The exam contains 230 questions in total: 200 scored items and 30 unscored pilot questions that ARRT uses to evaluate future content. You cannot tell which items are pilots, so every question deserves full effort. The scored allocation breaks down like this:
| Domain | Scored Questions (of 200) | What It Tests |
|---|---|---|
| Domain 1: Patient Care | 24 | Communication, assessment, infection control, emergency response |
| Domain 2: Safety | 25 | Radiation protection, units, regulations, handling and waste |
| Domain 3: Image Production | 33 | Instrumentation, acquisition, quality control, image processing |
| Domain 4: Procedures | 118 | Radiopharmaceuticals and clinical studies across body systems |
These are question counts, and it is best to keep thinking of them that way. Dividing them into percentages and treating the result as an official ARRT figure adds nothing, because the counts already communicate the weighting precisely. If you want the broader picture of how the credential works before drilling into domains, start with What Is RTN Certification? and then return here.
Which Content Specifications Govern a 2026 Exam
Candidates often study from the wrong document, so this deserves its own section. The controlling source for examinations through January 31, 2027 is the ARRT Nuclear Medicine Technology Examination Content Specifications, board approved January 2021 and effective January 1, 2022. That document defines the four categories and the question counts above.
A separate set of Nuclear Medicine Technology Content Specifications takes effect February 1, 2027. If you test in 2026, that newer document is not your scope, and mixing its topic lists with the current ones is a reliable way to misdirect your study time. Check your own testing date against the effective dates before you build a plan, and confirm window details in RTN Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
Domain 1: Patient Care
Patient Care carries 24 scored questions, the smallest allocation, yet it is where many technologists feel most comfortable because it mirrors daily clinical work. Do not let comfort turn into neglect. These items reward precise knowledge of the correct action in a specific situation, and nuclear medicine adds wrinkles that general radiography candidates never see.
Patient Care: What Candidates Must Understand
Expect scenario-style questions about how a technologist interacts with and protects patients before, during and after a study.
- Verifying patient identity and the order before administering a radiopharmaceutical
- Obtaining and documenting history relevant to the study, including pregnancy and breastfeeding considerations
- Explaining the procedure, including how long the patient will be radioactive and what precautions apply afterward
- Infection control and standard precautions around injections and intravenous access
- Recognizing and responding to adverse reactions and medical emergencies
- Patient preparation specific to the study, such as fasting, hydration or medication holds
The clinical competency requirements behind the credential reinforce this domain. Candidates complete eight general patient-care activities, including CPR certification, and the program director or designee verifies them through in-person direct observation. Remote or virtual observation is not accepted. Because that training is hands-on, the exam tends to test whether you can apply it, not merely recite it.
Domain 2: Safety
Safety accounts for 25 scored questions and is the domain where precise numbers matter most. Nuclear medicine technologists work with unsealed radioactive material every day, so radiation protection is both a legal and a practical core competency.
Safety: High-Value Topics
Questions here blend physics, regulation and workplace practice.
- Both SI and conventional radiation units appear on the exam, so you must convert comfortably between becquerels and curies, and between sieverts and rem
- Time, distance and shielding as the foundation of exposure reduction
- Dosimetry and monitoring practices for personnel
- Safe receipt, storage, handling and disposal of radioactive material and waste
- Decay-in-storage logic, half-life reasoning and practical decay calculations
- Responding to spills and contamination events, including survey and decontamination steps
- Radiation dose considerations for patients, visitors and caregivers
One practical advantage: on-screen basic and scientific calculators are available during the exam, and Pearson can provide a basic four-function calculator on request. Personal calculators are prohibited. Practice your decay and unit conversions on a scientific calculator interface so the tools feel familiar on test day.
Domain 3: Image Production
Image Production has 33 scored questions and covers the equipment and technical side of the work: how gamma cameras, SPECT and PET systems create images, and how technologists keep that process reliable. The five quality-control activities in the clinical competency requirements map directly onto this domain, so program graduates have practical exposure to the material.
Image Production: What to Master
Think instrumentation, acquisition parameters and image quality.
- Gamma camera components, including collimator types and their tradeoffs between sensitivity and resolution
- Daily, weekly and periodic quality-control tests, such as uniformity and center-of-rotation checks, and what failures look like
- Acquisition parameters: energy windows, matrix size, zoom, counts and time per view
- SPECT and PET acquisition, reconstruction and artifact recognition
- Dose calibrator and survey instrument quality control
- Image display, processing and recognizing artifacts from patient motion, equipment faults or technique errors
CT content on this exam is limited. It is tested only in the context of attenuation correction and anatomic localization on hybrid systems, not as diagnostic CT. You should understand why a CT scan is used to correct PET or SPECT data and to localize uptake, but you do not need to study diagnostic CT protocols for this credential.
Domain 4: Procedures
Procedures is the center of gravity: 118 of the 200 scored questions, or well over half the exam. This is also where the clinical competency requirements concentrate. Candidates must document 25 different diagnostic and therapeutic procedures, and no more than five may be simulated. That heavy emphasis in training is mirrored by the heavy weighting on the exam.
A sensible interpretation of the blueprint is that if you are strong in Procedures and merely adequate elsewhere, you are in good shape, while the reverse leaves you exposed. How difficult that proves in practice depends on your preparation; How Hard Is the RTN Exam? Complete Difficulty Guide 2026 examines the question in more depth.
Key Takeaway
Procedures alone is worth 118 scored questions. Allocate review time in proportion to that weight, then fold Safety, Image Production and Patient Care into it rather than treating them as separate silos.
Inside the Procedures Domain: Five Subareas
The Procedures category is itself divided into five subareas, each with its own scored-question count. Knowing this breakdown lets you aim at the highest-yield material first.
| Procedures Subarea | Scored Questions |
|---|---|
| Radionuclides and Radiopharmaceuticals | 28 |
| Cardiac Procedures | 25 |
| Endocrine and Oncology Procedures | 25 |
| Gastrointestinal and Genitourinary Procedures | 18 |
| Other Imaging Procedures | 22 |
Radionuclides and Radiopharmaceuticals (28)
The largest subarea, and the foundation for everything else in the domain.
- Properties of commonly used radionuclides, including half-life, emission type and production method
- Generator systems, elution, and parent-daughter equilibrium concepts
- Radiopharmaceutical preparation, quality control and radiochemical purity testing
- Mechanisms of localization: why a given agent goes where it goes
- Dosage ranges, routes of administration, adverse reactions and drug interactions
Cardiac Procedures (25)
Cardiac imaging blends physiology, pharmacology and acquisition technique.
- Myocardial perfusion imaging protocols, including rest and stress components
- Exercise versus pharmacologic stress, agents used, and patient monitoring and contraindications
- Gated studies and ventricular function assessment
- Interpreting the technologist's role in recognizing artifacts such as attenuation or motion
Endocrine and Oncology Procedures (25)
This subarea joins thyroid and related endocrine work with the expanding world of tumor imaging and therapy.
- Thyroid uptake and imaging, patient preparation and interfering substances
- Parathyroid, adrenal and other endocrine studies
- PET and PET/CT oncology imaging, including patient preparation for FDG studies
- Therapeutic procedures, associated safety instructions and patient release considerations
Gastrointestinal and Genitourinary Procedures (18)
The smallest subarea, but one that rewards clean protocol knowledge.
- Hepatobiliary, gastric emptying and GI bleeding studies, with their preparation and pharmacologic interventions
- Renal imaging and renography, hydration and intervention protocols
- Recognizing normal versus abnormal study patterns well enough to know when to alert the physician
Other Imaging Procedures (22)
This catch-all subarea covers studies that do not fit neatly into the other four.
- Skeletal imaging and its common variants
- Pulmonary perfusion and ventilation studies
- Neurologic, infection and inflammation imaging
- Lymphatic mapping and other specialized studies
How the Questions Are Delivered
The exam is computer-based and delivered at Pearson VUE test centers. It is closed book. Most items are single-best-answer multiple-choice, but ARRT may also use alternative item formats, and the primary-pathway handbook describes multiple-response and ordered-response items. Image-based questions are possible, which fits a discipline where interpreting what you are looking at is part of the job.
- Total items: 230, of which 200 are scored and 30 are unscored pilot questions.
- Answering time: 230 minutes, with a 250-minute appointment that includes the tutorial, nondisclosure agreement and survey.
- Navigation: You must answer each item before advancing, but you may flag questions and return to them.
That navigation rule shapes strategy. You cannot skip silently, so make a best-guess answer, flag the item, and use any remaining time to revisit. Because ordered-response and multiple-response formats exist, read each stem carefully for instructions like "select all that apply" or "place in sequence." Procedure-sequencing questions, such as the order of steps in a stress study or a generator elution, are natural candidates for ordered formats.
Scoring, Eligibility and Fees That Frame the Domains
Understanding the scoring and eligibility rules helps you plan realistically around the domain content.
Scoring
The passing score is 75 on ARRT's 1-99 scaled-score range. That is not 75 percent correct; scaling accounts for differences in difficulty between exam forms. In 2025, the first-time candidate pass rate reported in the ARRT Annual Exam Report was 64.7 percent (n=439). For context on what that figure does and does not tell you, see RTN Pass Rate 2026: What the Data Shows.
Eligibility
Primary eligibility requires an associate degree or higher from an ARRT-recognized accredited institution, in any major, conferred before the examination. You must also complete an ARRT-verified nuclear medicine technology educational program with its didactic and clinical competencies, and comply with ethics requirements. The degree must be earned and the application submitted no more than three years after program completion. That deadline is separate from the examination-attempt period: you get three attempts within three years of the opening of your initial examination window. Full details are in RTN Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Fees and Maintenance
The initial application fee is $225 and an examination reapplication costs $200. After you are certified, annual renewal is $65 regardless of how many ARRT credentials you hold, and you need 24 approved CE credits per two-year biennium, not per credential. Credentials earned on or after January 1, 2011 also require Continuing Qualifications Requirements every 10 years, consisting of a professional profile, a structured self-assessment and any prescribed CE. See RTN Certification Cost 2026: Complete Pricing Breakdown for the full picture.
Sequencing Your Review Around the Domain Weights
You do not need an elaborate method here, just a plan that respects the blueprint. The one scheduling principle that matters: study the foundations first, because they feed the largest domain. Radiopharmaceutical properties and radiation safety underpin nearly every Procedures question, so they belong at the front of your timeline, not the end.
Safety and Radionuclides
- Master SI and conventional unit conversions and decay calculations
- Cover radiation protection principles, monitoring and waste handling
- Learn radionuclide properties, generators and radiopharmaceutical quality control
Cardiac, Endocrine and Oncology
- Work through perfusion, stress and gated study protocols
- Review thyroid, parathyroid and PET oncology preparation and therapy safety
GI/GU, Other Imaging and Image Production
- Cover hepatobiliary, gastric, renal, skeletal, pulmonary and neurologic studies
- Review instrumentation, quality control and artifact recognition
Patient Care and Integration
- Revisit patient assessment, emergencies and infection control
- Take timed mixed-domain practice sets and review every miss against the blueprint
Track your misses by domain and subarea, not just by overall score. If you keep missing Cardiac items, that is 25 scored questions worth targeted attention. A broader week-by-week framework is in the RTN Study Guide 2026: How to Pass on Your First Attempt, and the RTN Cheat Sheet 2026: One-Page Review of Must-Know Facts works well as a final-week refresher. When you are ready to test yourself across all four domains, the RTN practice test lets you simulate the mix of topics and item styles you will face.
Key Takeaway
Let the 24 / 25 / 33 / 118 question counts drive your calendar, but never study Procedures in isolation. Radiation safety, instrumentation and patient preparation all show up inside procedure questions.
Frequently Asked Questions
Four: Patient Care, Safety, Image Production and Procedures. These are the official major examination content categories in the ARRT Nuclear Medicine Technology content specifications that apply to exams through January 31, 2027.
Procedures, with 118 of the 200 scored questions. Image Production has 33, Safety has 25 and Patient Care has 24. Within Procedures, Radionuclides and Radiopharmaceuticals is the largest subarea at 28 questions.
No. The exam has 230 questions, but only 200 are scored. The 30 unscored pilot items are mixed in and not identified, so you should treat every question as if it counts.
No. The 2027 Nuclear Medicine Technology Content Specifications become effective February 1, 2027. Exams through January 31, 2027 follow the 2022 specifications, so study from the document that matches your testing date.
Not for this exam. CT content is limited to attenuation correction and anatomic localization on hybrid systems, rather than diagnostic CT interpretation or protocols.
For a deeper look at career outcomes after you pass, explore RTN Jobs and the RTN Salary Guide 2026: Complete Earnings Analysis, then use the practice test site to turn the domain map above into measurable progress.