ARDMS – Abdomen Specialty Examination
To become a Registered Diagnostic Medical Sonographer (RDMS) with certification in the abdominal specialty, candidates must have appropriate medical education and clinical experience, and pass both the Sonography Principles & Instrumentation (SPI) exam and the Abdomen (AB) specialty exam administered by the American Registry for Diagnostic Medical Sonography (ARDMS). The two exams can be taken in any order, but both must be successfully completed within five years of one another.
Candidates must prove their eligibility to take the Abdomen specialty exam by completing the ARDMS application forms and submitting qualifying documentation. This includes proof of formal education, verification of clinical experience, transcripts, licenses, and letters from a supervising physician, technologist, or program director. Applicants who are renewing or recertifying, or who are not first-time applicants, are subject to different requirements. The ARDMS provides comprehensive guidelines for the application process, including step-by-step outlines and checklists for how to apply for, register for, schedule, and take both the AB specialty and SPI exams.
Once an application has been approved by the ARDMS, candidates must register for the Abdomen specialty exam at a local test center, and pay any exam or renewal fees. Exam results are available online immediately following the test. Candidates who do not pass the exam must wait a minimum of 72 hours before reapplying and 60 days before retaking the test.
The Abdomen specialty exam tests knowledge of specific organs and systems, with a higher percentage emphasis placed on some topics over others. The topics and overall test percentages are:
- liver (16-24%)
- kidneys and urinary tract (16-24%)
- gallbladder and biliary tree (10-18%)
- abdominal vascular (7-15%)
- pancreas (6-14%)
- scrotum (3-7%)
- retroperitoneum (3-7%)
- spleen (1-5%)
- gastrointestinal tract (1-5%)
- abdominal wall, superficial and muscular structures (1-5%)
- neck (1-3%)
- prostate (1-2%)
- and 1-2% each for instrumentation and invasive procedures
Test questions focus on applied knowledge of anatomy, ultrasound techniques, laboratory values, indications and symptoms, diseases and processes, masses and cysts, infections, abnormalities, and transplants.
There are numerous online resources and printed materials available for preparing to take the Abdomen specialty examination for the RDMS credential, including practice tests, content outlines, study guides, sample questions, and tips on test-taking strategies.
ARDMS Practice Questions
1. Which transducer will provide superior imaging of a pediatric abdominal ultrasound?
- 8 MHz curved array
- 1 MHz linear array
- 5 MHz curved array
- 5 MHz sector
2. A renal sonogram is performed on a 67-year-old male. The sonographic findings are consistent with what appears to be a large, anechoic cyst in the upper pole of the left kidney. Increased brightness is visualized posterior to the anechoic area. Which type of sonographic artifact, when demonstrated, may best illustrate the diagnosis?
- Ring down
3. Evaluation of which structure is best visualized with a high-frequency transducer?
- Proximal abdominal aorta
- A palpable lump on the dorsal wrist
- Mid-common carotid artery
- Distal superficial femoral vein
4. A 68-year-old male presents to the ultrasound department for evaluation of the liver. The patient complains of having anorexia, fatigue, and weakness for the past several months. His abdomen is enlarged. His labs indicate an increase in serum alpha-fetoprotein. Which is the most likely diagnosis?
- Focal nodular hyperplasia
- Cavernous hemangioma
- Liver cell adenoma
5. When acute pancreatitis is present, serum amylase and lipase levels both:
- increase at the same rate, but lipase concentration stays elevated longer.
- increase at the same rate, but amylase concentration stays elevated longer.
- decrease at the same rate, but lipase concentration stays decreased longer.
- decrease at the same rate, but amylase concentration stays decreased longer.
Answers & Explanations
1. A: 8 MHz curved array: An 8 MHz curved array transducer will provide the superior imaging of a pediatric abdomen compared to the other choices. The higher-frequency transducer provides a better resolution of the images. A pediatric abdomen will benefit from a higher-frequency probe because less penetration is needed due to smaller body size. Linear probes tend not to be used for abdominal ultrasounds; even though the frequency is higher, the probe type is not adequate. Sector transducers tend to be used for scanning through the rib spaces on difficult abdomens.
2. C: Enhancement: Enhancement artifact occurs when sound waves pass through a weakly attenuating structure, producing increased brightness posterior to the area. This artifact is beneficial when trying to determine if a renal mass is cystic or solid. Aliasing is a Doppler artifact that occurs when the Doppler shift exceeds the Nyquist limit. Shadowing is the opposite of enhancement. Ring down artifact occurs posterior to a reflector as parallel bands.
3. B: A palpable lump on the dorsal wrist: A high-frequency transducer will provide the best sonographic images of a palpable lump on the dorsal wrist. Higher-frequency transducers provide an image with a higher resolution, but lack penetration. Superficial tissues will be best evaluated with a higher-frequency probe. The other choices may be best evaluated with a lower-frequency probe due to their anatomic locations. They are located deeper in the body than a palpable lump.
4. B: Hepatoma: Hepatoma (hepatocellular carcinoma) is the most common primary liver malignancy. Patients may present with hepatomegaly; and elevated levels of AST, ALT, and serum AFP. Focal nodular hyperplasia, cavernous hemangioma, and liver cell adenoma are all benign neoplasms of the liver. They may show similar signs and symptoms, or they may be asymptomatic.
5. A: Increase at the same rate, but lipase concentration stays elevated longer: In the presence of acute pancreatitis, serum amylase and lipase increase at the same rate but lipase will stay elevated longer than amylase.