What's Changing on the ARRT® Registry Exam in 2027: A Complete Breakdown for Students and Instructors

by Lazar Lazarovski B.S.,R.T.(R)
Host of the Rad Tech Life Podcast

Download new ARRT Specs by clicking HERE. 

Board Approved: January 2026 | Implementation Date: March 1, 2027

If you're a radiography student planning to sit for the ARRT registry exam, or an instructor preparing your cohort for success, this update is one you need to read carefully. The ARRT has released new Board-Approved Examination Content Specifications, and they go into effect March 1, 2027. While the overall structure of the exam remains intact, several meaningful shifts have been made — some subtle, some significant — that will affect how you study and how you teach.

Let's break it all down.

The Big Picture: How the Point Values Changed

The most immediately noticeable change is in how the 200 scored questions are distributed across the four main content categories. Here's a side-by-side comparison:

The takeaway: Procedures now carry the heaviest weight on the exam at 72 questions — an increase of 6 points across all three subcategories. Safety, particularly Radiation Protection, has been trimmed by 4 questions. Patient Care drops by 2. This signals a clear shift toward prioritizing hands-on procedural knowledge.

Category-by-Category Breakdown of Changes

1. Patient Care (33 → 31 Questions)

The core content within Patient Care remains largely the same, but there are a few noteworthy refinements in how topics are framed.

What's new or reworded:

• Section C is now called "Physical Assistance and Monitoring" instead of "Ergonomics and Monitoring." The term "body mechanics" has been updated to "body ergonomics" — a subtle but more precise shift in clinical language.
• Under patient scheduling (Section B.3), the 2027 specs now explicitly include "length of procedure, patient's condition, age, and preparation for the procedure" as part of what students should understand — making the scope of patient education slightly more defined.
• "Emotional status" is now framed as "mental health state" in the communication challenges section, reflecting more current clinical language.
• In Legal Issues, the 2027 version adds "exam coding" as an example under verification — acknowledging the growing role of billing accuracy in radiography practice.
• Under Pharmacology contraindications, the 2027 version adds the word "allergies" explicitly as an example, whereas the 2022 version listed contraindications without that specific callout.
• "Disinfectants" has been added as a type of toxic/hazardous material under Section F, alongside chemicals and chemotherapy.
• The "communication of critical findings to the health care team" has been added as a standalone item under Medical Emergencies (D.5) — this was not listed explicitly in the 2022 version.
• Patient comfort and modesty is now listed under patient monitoring and documentation (C.3.d), which was not present in the prior version.

What's gone:

• The "fall prevention" topic remains, but "patient comfort and modesty" moved into this section from elsewhere, reorganizing the flow slightly.

2. Safety (50 → 46 Questions)

Safety loses 4 points overall — all of which come from the Radiation Protection subcategory. Radiation Physics and Radiobiology stays at 21 questions and is essentially unchanged in content.

Radiation Physics & Radiobiology — Notable Change:

• The NCRP reference for SI units has been updated from NCRP #160 (2022) to NCRP #184 (2027). This is a significant update for instructors — it means the current NCRP report on radiation exposure of the U.S. population is now the reference standard on the exam. Review your course materials accordingly.

Radiation Protection — Notable Changes:

• The 2022 spec listed "image receptors" and "morbid obesity" as separate line items under minimizing patient exposure. In the 2027 version:
  • "Image receptors" is replaced with "digital detector (e.g., DQE, exposure latitude)" — a more specific and contemporary framing.
  • "Morbid obesity" under patient considerations is replaced with "body habitus" — a broader and more clinically appropriate term.
• Under fluoroscopy, the 2027 spec replaces "air kerma display" and "dose or time documentation" with more specific entries: "cumulative air kerma," "dose rate display," and "time documentation" — breaking one item into three distinct testable concepts.
• Under dosimeter types, the 2027 version adds "DIS" (direct ion storage) as an example alongside TLD and OSL.
• The NCRP reference for personnel monitoring has been updated from NCRP #116 to NCRP #180 — another important update for instructors to incorporate into lectures and study materials.
• The personnel protection section now references "recommendations and regulations" rather than just "NCRP recommendations," suggesting a broader acknowledgment of regulatory frameworks (21 CFR alongside NCRP).

3. Image Production (51 Questions — No Change)

Image Production holds steady at 51 questions and is the most stable category overall. However, there are a few content refinements worth knowing:

Factors Affecting Radiographic Quality Table: The 2022 version listed only three quality columns: Receptor Exposure, Spatial Resolution, and Distortion. The 2027 version expands this to five columns: Receptor Exposure, Image Contrast, Subject Contrast, Spatial Resolution, and Distortion.

This is a meaningful change. Students now need to understand how factors like kVp, OID, SID, tube filtration, beam restriction, and patient factors specifically affect image contrast and subject contrast — concepts that were previously implied but not explicitly tested in this tabular format.

Equipment Operation — Notable Change:

• The 2022 specs listed computed radiography (CR) and digital radiography (DR) as separate image receptor subcategories with detailed breakdowns (PSP plates, plate readers, a-Si, CCD, CMOS). The 2027 version consolidates this under a single "digital detector" entry with direct and indirect conversion listed simply. CR-specific details (plate readers, PSP) appear to be de-emphasized.
• Virtual grids are now listed alongside stationary grids and the Bucky assembly as accessories — CR's compensating filters have been removed.
• Under QC tests, the 2027 version replaces "erasure thoroughness, plate uniformity" with just "plate uniformity" — again reflecting the diminished role of CR in modern practice.
• Informatics now includes "security and confidentiality" and "teleradiology (e.g., third party coverage)" as explicit subtopics under networking — not present in 2022.
• "MIMPS" is added alongside PACS under networking terminology.

4. Procedures (66 → 72 Questions)

This is where the biggest shift happens. Procedures gains 6 questions — 2 in each subcategory — signaling that the ARRT wants future entry-level technologists to demonstrate stronger procedural competency across the board.

Content-level changes within Procedures:

• The positioning definition has been expanded in the 2027 specs to include "planes, anatomical alignment" — a more detailed framing than the 2022 version, which listed only "topographic landmarks, body positions, path of central ray, positioning aids, respiration."
• Clavicle has been moved from Upper Extremities (where it was in 2022) to the Thorax section in the 2027 specs — a reorganization that better reflects anatomical grouping in clinical practice.
• Bone age has been moved from the "Other" category of Extremities to Upper Extremities (listed under the wrist section in Attachment A), which makes more sense clinically since bone age studies are performed on the hand/wrist.
• Intravenous urography (IVU/IVP) has been removed from the GU Studies list in the 2027 specs. This reflects real-world practice, as IVU has been largely replaced by CT urography in most clinical settings.
• Foreign body studies (airway/ingested) have been moved into the Thorax section explicitly, and nasogastric/enteric and orogastric/enteric tube placement has been added as a new procedure under Abdomen and GI Studies — reflecting the radiographer's expanded role in tube placement verification.
• Line placement with C-arm (e.g., PICC) has been added to the Thorax section — another contemporary addition reflecting current practice.
• Under Spine and Pelvis, myelography now includes "lumbar puncture" and "epidural injections" as examples, broadening the scope of what students should know about spinal procedures.
• In Attachment A (Radiographic Positions and Projections), the 2022 version listed several trauma skull projections (AP axial Towne, AP axial reverse Caldwell, AP, and submentovertex) that have been streamlined in 2027 to fewer specific trauma views.
• The Norgaard (ball catchers view) for the hand has been added to the 2027 Attachment A.
• Rosenburg view for the knee has been added in the 2027 specs.
• The 2022 version listed sesamoids, tangential as a toe view — this has been removed from the 2027 specs.
• Several GU positioning views for IVU (RPO, LPO, post-void) have been removed, consistent with the removal of IVU from the procedure list.
• The "mortise weight bearing" ankle view has been added to the 2027 Attachment A.
• Oblique weight bearing for the foot is a new addition in 2027.

What This Means for Students

1. Prioritize Procedures. With 72 questions now dedicated to positioning and anatomy, this is your highest-yield area. Every view, every projection, every procedure adaptation matters. Know your positioning, know your anatomy, and know how to evaluate what you're seeing on the image.

2. Update your NCRP references. If you've been studying with older materials, make sure your radiation biology and personnel protection content reflects NCRP #184 and NCRP #180 respectively. These are the reference documents the 2027 exam is based on.

3. De-prioritize CR-specific content. If your study materials spend significant time on computed radiography plate readers, erasure thoroughness, or PSP plates, that content has been reduced in the 2027 specs. Focus your energy on digital detector concepts and image quality.

4. Expand your contrast knowledge. The updated Factors Affecting Radiographic Quality table now explicitly tests image contrast and subject contrast as separate columns. Make sure you understand how each technical factor affects both.

5. Know the new procedures. PICC line placement verification, NG tube placement, and epidural injections are now on the table. IVU is not. Study accordingly.

What This Means for Instructors

1. Revise your lecture materials for NCRP updates. NCRP #116 → #180 for personnel monitoring and NCRP #160 → #184 for radiation measurement. If your slides or textbooks still reference the older reports, update them before your next cohort takes the 2027 exam.

2. Reorganize your procedure labs. Clavicle now belongs with thorax. Bone age belongs with upper extremities. Update your competency checklists and clinical objectives to reflect the new organizational structure.

3. Increase procedural emphasis. Six more questions on procedures is not trivial. Consider adding more simulation time, positioning labs, or case-based image evaluation exercises — especially for thorax and abdomen procedures, which have historically been underemphasized compared to extremities.

4. Drop IVU from board prep content. Intravenous urography is no longer included in the 2027 specifications. While it remains clinically relevant in some settings, it should not be a focus of registry preparation under the new specs.

5. Update your image quality content. The expanded five-column quality factors table means students need a more nuanced understanding of contrast. Build exercises or case studies that challenge students to identify how changing a specific factor affects image contrast versus subject contrast versus spatial resolution.

Bottom Line

The 2027 ARRT Radiography Content Specifications represent a thoughtful evolution of the exam — one that reflects contemporary clinical practice more accurately than ever. CR is fading. Digital imaging is front and center. Procedural competency is the highest priority. And entry-level technologists are expected to know more about tube placement, spinal procedures, and image quality than in years past.

Whether you're a student building your study plan or an instructor updating your curriculum, the time to adapt is now. The March 1, 2027 implementation date will be here before you know it — and being prepared with the right blueprint makes all the difference.

For the official documents, visit arrt.org to access both the 2022 and 2027 Content Specifications for Radiography.