ARRT Clinical Competency Requirements: Procedures, Records, and Deadlines

To qualify for ARRT Radiography certification, you must complete 61 clinical competencies before you can sit for the national exam. The ARRT clinical competency requirements break into 36 mandatory imaging procedures, 15 elective imaging procedures chosen from a list of 34 options, and 10 mandatory general patient care activities. ¹ The point is to confirm you can produce diagnostic-quality images on real patients, not just answer questions about how it should be done in theory. ²

The 36 Mandatory Imaging Procedures

The mandatory procedures cover the routine work of a radiography department, performed on actual patients under direct observation. ¹ They span the full range of diagnostic imaging:

Chest and thorax: routine chest (PA and lateral), portable chest (AP), and ribs.
Upper extremities: finger or thumb, hand, wrist, forearm, elbow, shoulder, and trauma views of the shoulder, humerus, and non-shoulder upper extremity.
Lower extremities: foot, ankle, knee, lower-extremity trauma, and patella.
Spine and pelvis: cervical spine, lumbar spine, pelvis, hip, and cross-table lateral hip.
Abdomen: supine abdomen (KUB).
Fluoroscopy studies: upper GI and barium enema (or equivalent contrast procedures).
Mobile and surgical studies: portable chest, portable abdomen, portable extremity, and C-arm procedures.

You cannot swap a mandatory procedure for an elective or skip one because your clinical site rarely sees that exam. If your facility doesn’t generate enough of a particular study, your program will need to arrange rotations elsewhere so you can complete every mandatory item on real patients.

The 15 Elective Imaging Procedures

The elective slots give you some flexibility to match your experience to what your facility actually sees. You pick 15 from a list of 34 procedures spanning specialized views of the head, spine, chest, extremities, abdomen, and pediatric and fluoroscopy categories. ¹ Two rules narrow your choices:

At least one elective must come from the head category: skull, facial bones, mandible, nasal bones, orbits, paranasal sinuses, or temporomandibular joints.
At least two electives must come from fluoroscopy studies: small bowel series, esophagus, or cystography/voiding cystourethrography.

How Trauma Procedures Qualify

For an elective to count as a trauma competency, the patient must have an injury that forces you to modify your normal positioning approach while you simultaneously monitor the patient’s condition. ¹ Imaging a patient who happens to have been in an accident doesn’t automatically qualify. The positioning itself must be adapted because of the injury. Trauma categories include shoulder or humerus trauma, non-shoulder upper extremity trauma, and lower extremity trauma.

How Pediatric Procedures Qualify

ARRT defines a pediatric patient as age six or younger for clinical competency purposes. ¹ Pediatric electives include routine chest, upper or lower extremity, abdomen, and mobile studies performed on patients in that age group. Candidates who train at adult-only facilities often struggle to find these cases, so pediatric rotations at children’s hospitals or outpatient pediatric clinics are common workarounds.

The 10 General Patient Care Activities

Beyond imaging, you have to demonstrate competence in 10 patient care activities, the baseline skills that keep patients safe while you’re focused on the image. ¹ They include:

Current, valid CPR/BLS certification
Vital signs: blood pressure, temperature, pulse, respiration, and pulse oximetry
Sterile and medical aseptic technique
Venipuncture
Assisted patient transfer using slider boards, mechanical lifts, gait belts, or similar equipment
Care of patient medical equipment, including oxygen tanks and IV tubing

Venipuncture is the one patient care activity that can be partially simulated. You have to demonstrate aseptic technique on a real person, but the needle stick itself can be performed on an artificial training arm rather than a live patient. Patient care simulations do not count against the imaging simulation cap.

When Simulation Is Allowed

Up to 10 of your imaging procedures may be completed as simulations rather than on live patients. ¹ Not every procedure qualifies. The ARRT’s competency chart marks specific procedures as simulation-eligible, and those markings apply to both mandatory and elective procedures. Many eligible simulations are in categories where live patient access is genuinely difficult, such as head imaging, scoliosis series, and certain mobile and C-arm studies.

Simulations still demand full technical rigor. You set actual exposure factors, position a phantom or volunteer as you would a real patient, and produce images that meet diagnostic quality standards. Your verifying official observes and evaluates the simulation the same way they would a live procedure. If your documentation doesn’t clearly identify a procedure as a simulation, it can be rejected during review.

Who Can Verify Your Competencies

Only certain professionals can sign off on your records. For radiography candidates, verifiers must generally be Registered Technologists (R.T.s) or medical doctors. ³ The verifier has to directly observe the entire procedure, from patient positioning through final image evaluation. They aren’t signing off based on the resulting image alone; they’re confirming they watched you do the work correctly and safely.

Verifiers must also work at the facility where you perform the procedure, or be affiliated through your educational program. ⁴ A technologist from another hospital who wasn’t physically present cannot verify your competency after the fact. For candidates pursuing post-primary credentials like CT or MRI, verifier eligibility rules differ by discipline, so check the specific clinical experience requirements document for your target credential.

The verifier’s own registration must remain current. If a verifier’s credentials lapse, any competencies they signed during that gap could be called into question. Before your verifier signs anything, confirm their ARRT registration is active.

What Each Record Must Contain

Every completed procedure needs a detailed entry. At minimum, the log should include the date performed, the name of the procedure, the verifier’s full name, and whether the procedure was diagnostic or interventional. ⁵ Simulations have to be noted as such. Some disciplines require additional fields like start and end times or scan ID numbers.

Sloppy record-keeping is where a lot of candidates run into trouble. A missing date, an illegible verifier name, or a mismatch between the procedure documented and the competency category claimed can trigger a rejection. Fill out your log the same day you complete the procedure, while every detail is fresh. Review your logs against the official competency requirements every few weeks and confirm you’re accumulating the right mix of mandatory procedures, head and fluoroscopy electives, and patient care activities.

The 24-Month Window and Submission

For post-primary candidates, all clinical procedures have to have been performed within 24 months of the application date. ⁶ Procedures completed outside that window are expired and won’t count. Primary pathway candidates completing an accredited radiography program typically submit their records through their program director, who verifies everything before it reaches ARRT.

ARRT uses an online tool for documenting and submitting clinical experience. As you complete procedures, you enter them into the system and request that your verifiers confirm your work. The registry reserves the right to audit records at any point, and may contact verifiers directly or request original paper documentation. Once everything clears, you’re approved to schedule your certification exam.

What Happens if Records Are Falsified

Falsifying clinical competency records, whether by fabricating procedures, forging verifier signatures, or misrepresenting a simulation as live patient work, triggers an ARRT ethics investigation. ³ Both the candidate and any verifier who participates in submitting false information can face sanctions. The most severe outcome is revocation of certification and registration, which prohibits you from using any ARRT credential for a specified period. ⁷

If the ARRT Ethics Committee issues a decision against you, you have 30 days from the date of notification by U.S. mail to request a hearing. ⁸ The request must be in writing and accompanied by a nonrefundable $100 hearing fee. If you waive the hearing, any sanction takes effect immediately. This process applies to candidates who haven’t yet been certified and to credentialed technologists accused of helping falsify someone else’s records.

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American Registry of Radiologic Technologists. ARRT Radiography Didactic and Clinical Competency Requirements
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American Registry of Radiologic Technologists. Didactic and Clinical Competency Requirements
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ARRT. Clinical Experience Requirements for Verifiers
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ARRT. Clinical Experience Verifiers
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The American Registry of Radiologic Technologists. Postprimary Certification Clinical Experience Daily Worksheet
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ARRT. Clinical Experience Requirements
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ARRT. Types of Sanctions
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ARRT. Ethics Review