By Aura Nissa, RDMS, RVT | Founder, Sono Graphics | Last updated: June 2026
The short answer
Failing the ARDMS exam does not end your sonography career. You are eligible to retake it — after a 60-day waiting period for most specialty exams — and the majority of sonographers who fail once go on to pass on their next attempt. It feels devastating. It is not permanent.
What actually happens when you fail
Let's start with the mechanics, because most programs don't walk you through this clearly, and the ARDMS website isn't exactly designed for someone who is reading it at 2am after a hard day.
When you fail an ARDMS specialty examination, you receive a score report showing your performance in each content category. This is not just a pass/fail notification — it's a breakdown of where you were strong and where the exam exposed gaps. That report is useful. Save it. It's your study roadmap for the retake.
You are permitted to retake most ARDMS specialty exams after a 60-day waiting period. There is no limit to the number of times you can attempt an exam, but there is a waiting period between each attempt. For the Sonography Principles and Instrumentation (SPI) exam, the same 60-day rule applies.
There is also a fee for retaking — currently around $225 for most specialty exams — so you'll need to re-register through your ARDMS online account and pay before scheduling a new date.
Your score does not appear on your permanent record. Employers do not receive notification that you failed. The only thing that becomes public or verifiable is when you pass — that's when your credential appears in the ARDMS registry and becomes searchable by employers. Until then, nothing shows.
I've been there — here's what I know
I'm Nissa, RDMS, RVT, and I'm the founder of Sono Graphics. I've been a working sonographer for over six years, I hold dual credentials, and I now train clinical rotation students from two accredited programs. I've watched a lot of students sit with this exact situation.
I'm not going to tell you the exam is easy or that failing means you didn't study hard enough. The ARDMS exams are genuinely difficult. The SPI in particular catches a lot of students off guard because it tests physics and instrumentation concepts in ways that feel disconnected from what you actually do with a transducer. And specialty exams are comprehensive in a way that doesn't always map neatly to how your program prepared you.
What I will tell you is this: failing once — or even twice — does not mean you're in the wrong field. Some of the best sonographers I've worked with failed an exam along the way. What separated them was how they used the time between attempts.
What to do in the 60 days after you fail
The 60-day waiting period feels like punishment. It isn't — it's structure. Here's how to use it.
Get your score report and sit with it. Don't look at it the day you fail. Give yourself 48 hours. Then open it and look at the category breakdown honestly. The categories where you scored lowest are your study priorities. The categories where you scored well don't need the same attention.
Change something about how you're studying. If you used the same resources the first time and failed, adding more of the same won't fix it. The ARDMS publishes content outlines for every exam — download the one for your specialty and build your second-round study plan directly against it. Work outward from your weak categories.
Get specific about physics if you failed the SPI. The SPI trips up more students than any specialty exam, and it almost always comes down to ultrasound physics and Doppler principles. Ultrasound Physics and Instrumentation by Hedrick, Hykes, and Starchman is the textbook most programs use — if yours assigned a different one, Hedrick is worth picking up. Online question banks that target SPI specifically (Pegasus Lectures, SonixRx) help more than general review materials.
Tell someone. Not everyone, but someone. Carrying a failed exam alone for 60 days makes the second attempt harder, not easier. A classmate, a preceptor, someone who has been through it. Isolation between attempts is one of the biggest factors in repeat failures.
Keep scanning if you can. If you're still in clinical or working in any capacity, keep showing up. The disconnect between physical scanning skill and exam performance is real and it works both ways — keeping your hands on a probe helps your brain stay in the clinical mindset that the specialty exam questions are actually testing for.
The part nobody talks about: what this does to your identity
Here's what I want to address directly, because it's the thing that actually matters most and it's almost never in the study guides.
Failing an ARDMS exam when you've poured yourself into becoming a sonographer does something to your sense of self. You start wondering if you're actually meant to do this. You watch classmates post their credentials on social media. You feel like the gap between you and "real sonographer" just got wider.
That feeling is valid. And it's also a story your brain is telling you that isn't accurate.
Credentials are one of the best things about sonography as a profession. The ARDMS system exists to standardize competency across the field, and it's a rigorous standard. Struggling to meet that standard on the first attempt doesn't say anything about whether you belong in the dark room. It says the exam is hard and the content is specific and the testing format is its own skill set.
I've watched students who struggled through the credentialing process become some of the most thoughtful practitioners I've worked alongside. The exam tests a specific kind of knowledge recall under pressure. It does not test your instinct, your patient skills, your ability to recognize something unexpected on a scan, or your commitment to the field — and those are the things that actually make a great sonographer.
You are not a credential. The credential is something you're earning. There's a difference.
A note on timing — especially if you're job hunting
If you're applying for jobs while waiting to retake, you can be transparent about your credential status without disclosing that you failed. "Registry-eligible" or "ARDMS exam in progress" are accurate, professional ways to describe your status. Most hiring managers at hospital systems and imaging centers understand the credentialing timeline and have hired registry-eligible candidates before.
Some positions — particularly in hospital settings — require ARDMS credentials as a condition of continued employment rather than a hiring prerequisite. Check the specific language in job postings carefully. If a posting says "ARDMS required," ask the recruiter or HR contact whether registry-eligible candidates are considered. Often the answer is yes, with an expectation of a set timeframe for credentialing after hire.
FAQ: Failing the ARDMS exam
How long do I have to wait to retake the ARDMS exam after failing?
Most ARDMS specialty exams — including the SPI and specialty exams like Abdomen, OB/GYN, and Vascular — have a 60-day waiting period between attempts. You must re-register and pay the exam fee again before scheduling your retake date. There is no limit on the total number of attempts.
Will employers know I failed the ARDMS exam?
No. Employers cannot access your exam history or score reports. The ARDMS registry only reflects credentials you have earned and currently hold. Nothing appears on the public registry — and nothing is shared with employers — until you pass. A failed attempt leaves no visible record outside your personal ARDMS account.
What is the pass rate for ARDMS specialty exams?
The ARDMS publishes pass rate data in their annual statistics reports, available on ardms.org. Pass rates vary by specialty, but many first-time candidates for specialty exams pass on their first or second attempt. The SPI historically has lower first-time pass rates than most specialty exams, which is why it catches students off guard. Checking the current report gives you realistic expectations going into your retake.
What resources are best for the ARDMS SPI retake?
For the SPI specifically, focus on resources that drill ultrasound physics and Doppler principles rather than anatomy. The Pegasus Lectures SPI review, My Ultrasound Tutor, the Hedrick physics textbook, and SPI-specific question banks (SonixRx, Boards Boot Camp) are widely used by students preparing for retakes. Work directly from the ARDMS SPI Content Outline — download it free from ardms.org — and allocate study time proportionally to your score report weaknesses.
Can I work as a sonographer before passing the ARDMS?
In most states, yes — sonography is not state-licensed the way nursing or radiology are in most jurisdictions. Many employers hire registry-eligible graduates, particularly in outpatient and clinic settings, with an expectation that you'll credential within a set timeframe (often 12–18 months). Hospital systems and trauma centers are more likely to require credentials before or shortly after hiring. Check your state's specific requirements and the language in each job posting carefully.
One more thing
If you're in the middle of this right now — sitting with a failed exam and not sure what to do next — I want you to know that the sonography community is one of the most supportive professional communities I've ever been part of. Reach out to your program's clinical coordinator. Connect with working techs in your area. The people who have been in the field for years remember what this stretch feels like, and most of them will tell you something similar to what I've told you here.
You put in the work to get into a program, survive clinical rotations, and sit for one of the harder professional exams in allied health. That doesn't evaporate because of a score report. Go back in.
Nissa is a Registered Diagnostic Medical Sonographer (RDMS) and Registered Vascular Technologist (RVT) with over six years of clinical experience at Enloe Medical Center in Northern California. She trains clinical rotation students from Gurnick Academy and Sacramento Ultrasound Institute, and is the founder and designer of Sono Graphics — apparel and accessories made exclusively for the sonography community, by someone who works in it.
If you're looking for a way to mark the moment when you finally hold that credential — or to gift something meaningful to a sonographer in your life — explore the Sono Graphics collection. Designed by a working RDMS, for the people who get it.
Author: Aura Nissa, RDMS, RVT — Founder, Sono Graphics
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