ARRT Radiography Study Guide — 2026 Edition

Radiation Physics and Radiobiology (21 scored items)^[1] + Radiation Protection (29 scored items) — 50 of 200 scored items^[1], the second-largest domain after Procedures (66)^[1].

Safety is the only domain that sits under every exposure you will ever make. The examination gives it 50 scored items^[1] — the second-largest share after Procedures^[1] — because every other domain depends on a technologist who understands how radiation is produced, what it does to living tissue, and how to keep everyone in the room below the legal limits.

2.1 Radiation Physics

X-ray Production

An x-ray tube converts electrical energy into a beam of x-ray photons. In a process known as thermionic emission, thermal energy (or heat) is used to expel the electrons from the cathode, whose filament is heated by passing a current through it^[2]. Those electrons are accelerated across the tube toward the anode by the high voltage between them, then decelerated abruptly when they strike the anode target — most x-ray tubes use tungsten, atomic number 74, as the anode material^[2].

Two distinct interactions at the anode produce the x-ray photons:

• Bremsstrahlung ("braking radiation"). Electrons that penetrate the anode material and pass close to a nucleus are deflected and slowed by the nucleus's attractive force; the energy the electron loses appears as an x-ray photon. The kVp establishes the maximum photon energy in the beam and has a major role in determining the quantity of radiation produced for a given mAs^[3].
• Characteristic radiation. Characteristic radiation is so named because the photon's energy is characteristic of the chemical element serving as the anode material^[3].

The X-ray Beam

A useful mental model is to separate the beam into three parts: the primary beam that leaves the tube, the remnant (exit) beam that reaches the image receptor after passing through the patient, and everything else. Several properties matter for the examination:

• Frequency and wavelength. X-rays are electromagnetic radiation; kVp determines the maximum photon energy present in the beam^[3].
• Beam quality vs. beam quantity. Quality is the beam's penetrating ability; quantity is the number of photons. The kVp establishes the maximum photon energy and has a major role in determining the quantity of radiation produced for a given mAs^[3].
• Filtration and HVL. Filtration removes the beam's low-energy photons, raising its average energy. Half-value layer (HVL) is the standard measure of beam quality: the thickness of material penetrated by one half of the radiation, expressed in mm or cm^[4].
• Inverse square law. Because the beam diverges from a point source, intensity falls with the square of the distance. As a rule: doubling the distance from the source reduces the exposure by a factor of four^[5]. This is why distance is one of the three cardinal protection principles^[6].
• Absorption and scatter. As photons pass through matter they are absorbed or scattered; the fraction removed from the beam is described as attenuation.

Photon Interactions with Matter

Four interactions appear on the examination, but two dominate diagnostic imaging:

• Photoelectric interaction. The incident photon is completely absorbed by an atom and ejects an inner-shell electron; all of the photon's energy is deposited locally^[7].
• Compton interaction. The photon gives up only part of its energy to an electron and continues as a lower-energy scattered photon; the remainder continues as scattered radiation^[7].
• Coherent (classical/Thomson) scattering. The photon changes direction without losing energy — no ionization, essentially no significance in diagnostic imaging.
• Pair production / photodisintegration. Require photon energies far above the diagnostic range; they do not occur in radiography and appear on the examination mainly as "which of these does NOT occur at diagnostic energies."

Attenuation factors — the patient factors that determine how much beam gets through: atomic number, density, and thickness of the tissue, plus the beam's energy spectrum.

2.2 Radiobiology

SI Units — Learn These Cold

The examination uses SI units as its primary radiation measurement system^[8]. The units that recur:

Quantity	SI unit	Legacy unit
Exposure	coulomb/kilogram (C/kg)	roentgen (R)
Absorbed dose	gray (Gy)	rad
Dose equivalent / effective dose	sievert (Sv)	rem
Radioactivity	becquerel (Bq)	curie (Ci)	[9]
Air kerma	gray (Gy)	—

Each row is defined in federal text: exposure is the charge of one sign produced per unit mass of air, X = dQ/dm, in C/kg^[10]; absorbed dose is energy imparted per unit mass, in rad and gray^[9]; dose equivalent is in rem and sievert^[9], as is effective dose^[11]. Air kerma is kerma in air, and the special name for the unit of kerma is the gray^[10] — it is the quantity behind the fluoroscopic air-kerma rate limits in Section 2.3. The outline names the dose area product (DAP) meter among the dosimetry instruments^[8].

Radiosensitivity and Cell Response

• Dose-response relationships. Stochastic effects show no threshold: the probability of occurrence increases with dose, but the severity of the effect does not depend on dose^[12].
• Relative radiosensitivity of tissue. Rapidly dividing, undifferentiated cells are the most sensitive — the Bergonié–Tribondeau principle, which states that radiosensitivity is directly proportional to reproductive rate and inversely proportional to differentiation^[13].
• LET and RBE. Linear energy transfer (LET) is the amount of energy deposited by ionizing radiation per unit length of tissue traversed^[14]. Low-LET radiation (x-rays, gamma rays, beta rays) has a lower relative biological effectiveness (RBE) of about 1, while high-LET radiation (alpha particles, neutrons, heavy ions) has a higher RBE^[14].
• Oxygen effect. Named in the examination outline as a factor in radiosensitivity^[8]; tested as a recognition item.

Somatic Effects

• Tissue radiosensitivity ranking and the special case of the embryo/fetus: the lower dose limit for the embryo/fetus of a declared pregnant worker is based on its greater sensitivity to radiation and the involuntary nature of the exposure^[15].
• Carcinogenesis is the principal stochastic somatic effect: cancer, leukemia, and genetic mutations are examples of stochastic effects, whose probability rises with dose while their severity does not depend on dose^[12].
• Early vs. late effects. Late (stochastic) effects — cancer, genetic effects — are random: their probability rises with dose while their severity does not^[12].
• Deterministic effects at high whole-body doses — the acute radiation syndromes. In humans the hematopoietic (bone marrow) syndrome occurs at about 2 to 8 Gy^[16] and is caused by killing of precursor cells in the bone marrow^[16]; the gastrointestinal syndrome follows doses greater than about 5 up to 15 Gy^[16]; the cerebrovascular (CNS) syndrome follows even higher doses^[16]. LD50 is the dose that kills 50% of those exposed within a set period, most commonly 30 days^[16]; for humans it has been estimated at 4 to 7 Gy, depending on supportive care^[16]. None of these doses occurs in diagnostic radiography — they appear on the exam because they anchor the deterministic end of the dose scale.
• The oxygen effect. Cells irradiated in air are about three times more sensitive than cells under severe hypoxia^[16]. The oxygen enhancement ratio (OER) is the ratio of doses needed for the same effect without and with oxygen^[16], and it falls to 1 for high-LET radiation above about 200 keV/µm^[16] — oxygen matters most for x-rays.

2.3 Radiation Protection

Minimizing Patient Exposure

Every exposure factor is a dose decision. The examination's list, with the dose logic behind each:

• kVp: sets beam penetrability (quality) — kVp establishes the maximum photon energy and strongly influences output^[3].
• mAs: the primary control of beam quantity — more mAs means more photons reaching the receptor.
• AEC: automatic exposure control terminates the exposure when the image receptor has received the required radiation intensity^[17], preventing repeats from mis-set manual techniques.
• Beam restriction (collimation): limits the irradiated field, reducing the volume of tissue exposed.
• Patient positioning and communication: accurate positioning and clear breathing/motion instructions prevent repeats — every repeat is an avoidable dose.
• Pediatric and bariatric considerations: children have longer post-exposure life expectancy (more time for a stochastic effect to manifest^[12]), so pediatric techniques are minimized and size-specific; techniques are adjusted for body size.
• Filtration: removes low-energy photons from the beam, raising its average energy.
• Dose documentation: the outline names the dose area product (DAP) meter among the dosimetry instruments^[8].
• Grids: absorb scatter before it reaches the receptor, improving contrast^[18]; the Grid Conversion (Bucky) factor sets the mAs adjustment when changing between grid and nongrid techniques^[19], so grid selection is a dose decision too.

Minimizing Occupational Exposure

The governing philosophy is ALARA — keeping every exposure as low as reasonably achievable. The ARRT Code of Ethics frames the duty as demonstrating expertise in minimizing radiation exposure to the patient, self, and other members of the healthcare team^[20]. In daily work it reduces to the three cardinal principles^[6]: time (limiting or minimizing the exposure time reduces the dose^[6]), distance (doubling the distance quarters the exposure^[5]), and shielding (barriers of lead, concrete, or water between person and source^[6]).

• Sources of exposure: the primary beam (never place any body part in it), scatter from the patient, and leakage radiation from the tube housing.
• Basic methods of protection: time, distance, shielding — applied jointly, every case^[6].
• Protective devices: lead aprons, thyroid shields, leaded gloves, and mobile or fixed barriers stand between the worker and the source^[6].
• Special considerations: mobile radiography demands maximum distance and awareness of everyone in the room; fluoroscopy demands distance, shielding, and minimal beam-on time^[6].
• Units, guidelines, and limits. Federal law sets the hard numbers (10 CFR Part 20):

Limit	Value
Occupational annual TEDE	5 rem (0.05 Sv)	[21]
Lens of the eye (annual)	15 rem (0.15 Sv)	[21]
Skin of whole body / any extremity (annual shallow-dose)	50 rem (0.5 Sv)	[21]
Individual organ/tissue (annual)	50 rem (0.5 Sv)	[21]
Embryo/fetus of declared pregnant worker (entire gestation)	0.5 rem (5 mSv)	[22]
Individual member of the public (annual)	0.1 rem (1 mSv)	[23]

• Which rulebook the numbers come from. The 10 CFR 20 figures above are written for NRC licensees whose workers are exposed to radiation from licensed radioactive materials^[24]; the Conference of Radiation Control Program Directors' Suggested State Regulations recommend the same 5 mSv whole-pregnancy figure for a declared pregnant worker^[24]. The ARRT outline, however, cites NCRP Report No. 116 for personnel monitoring, and NCRP states the fetal limit differently: an equivalent dose limit for the fetus of an occupationally exposed individual of 0.5 mSv (50 mrem) per month during the pregnancy, alongside a public limit of 1 mSv per year^[24]. Learn both forms — "5 mSv for the whole pregnancy" and "0.5 mSv per month" — and read the stem to see which one it is asking for.

• Fluoroscopy equipment standards (21 CFR 1020.32): with automatic exposure-rate control, the air-kerma rate may not exceed 88 mGy/min^[25] (44 mGy/min without AERC^[25]); with the high-level (boost) control activated, the cap is 176 mGy/min^[25]. Minimum source-to-skin distance: 38 cm for stationary units, 30 cm for mobile/portable units^[25].
• Personnel exposure monitoring: adults likely to receive more than 10 percent of the occupational limits in a year are supplied individual monitoring devices, and individual monitoring records are maintained^[26].

Fluoroscopy features that save dose

Federal performance standards build dose control into the fluoroscope. Equipment made on or after June 10, 2006 must display a last-image-hold image after the exposure ends^[27], so the physician can study an image with the beam off, and must show the air kerma rate and cumulative air kerma at the fluoroscopist's working position^[27]. Older equipment carries a cumulative timer that cannot exceed 5 minutes without resetting^[27], with an audible signal when it runs out^[27]. Pulsed fluoroscopy lowers dose at pulse rates below 30 per second^[28] and freezes motion, sharpening each frame^[28]; its cost is poorer temporal resolution at low frame rates for fast-moving structures^[28].

For the people in the room, a lead apron of typically 0.3–0.5 mm lead equivalence attenuates 90% or more of incident scattered radiation^[28], and a front-only apron protects only while the wearer faces the scatter source^[28].

Sources cited in this excerpt

1. ARRT Examination Content Specifications for Radiography.
2. Sprawls, Physical Principles of Medical Imaging — X-ray production.
3. Sprawls, The Physical Principles of Medical Imaging (XRAYPRO).
4. Sprawls, The Physical Principles of Medical Imaging (RADPEN).
5. US EPA RadTown Radiation Protection: Teacher Information. http://www.epa.gov/radtown/radtown-radiation-protection-teacher-information
6. US EPA Protecting Yourself from Radiation. https://www.epa.gov/radiation/protecting-yourself-radiation
7. Sprawls, The Physical Principles of Medical Imaging (INTERACT).
8. ARRT Radiography Content Specifications.
9. 10 CFR 20.1003 definitions. https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-A/section-20.1003
10. 21 CFR 1020.30 Diagnostic x-ray systems and their major components — definitions (govinfo, 2025-04-01 edition).
11. US EPA, Radiation Terms and Units. https://www.epa.gov/radiation/radiation-terms-and-units
12. CE4RT, Stochastic Effects of Radiation for X-ray Techs. https://ce4rt.com/rad-tech-talk/stochastic-effects-of-radiation/
13. University of Mosul, Dept. of Radiological Technique, Radiobiology lecture.
14. UoM medical physics radiobiology lecture.
15. NRC Regulatory Guide 8.13, Instruction Concerning Prenatal Radiation Exposure.
16. IAEA, Radiation Biology: A Handbook for Teachers and Students, Training Course Series 42 (2010). https://www-pub.iaea.org/MTCD/Publications/PDF/TCS-42_web.pdf
17. UoM radiologic technology X-ray console and AEC.
18. SAHPRA radiography anti-scatter grid guideline.
19. UoM radiologic technology anti-scatter grids.
20. ARRT Standards of Ethics (March 2026).
21. 10 CFR 20.1201 Occupational dose limits for adults. https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1201
22. 10 CFR 20.1208 Dose equivalent to an embryo/fetus. https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1208
23. 10 CFR 20.1301 Dose limits for individual members of the public. https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-D/section-20.1301
24. OSHA, Ionizing Radiation — Pregnant Workers. http://www.osha.gov/ionizing-radiation/pregnant-workers
25. 21 CFR 1020.32 Fluoroscopic equipment. https://www.ecfr.gov/current/title-21/chapter-I/subchapter-J/part-1020/section-1020.32
26. 10 CFR 20.1502 conditions requiring individual monitoring. https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-F/section-20.1502
27. 21 CFR 1020.32 — Fluoroscopic equipment (eCFR). https://www.ecfr.gov/current/title-21/chapter-I/subchapter-J/part-1020/section-1020.32
28. IAEA, Diagnostic Radiology Physics: A Handbook for Teachers and Students (2014). https://www-pub.iaea.org/MTCD/Publications/PDF/Pub1564webNew-74666420.pdf