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Key Facts: NMAA Exam

~200

Total Questions

NMTCB NMAA exam page

$1,000

Exam Fee

NMTCB application form

16

Total Certified

Since 2011 inception

2x/yr

Exam Windows

January and July

10 yrs

Credential Validity

NMTCB recertification

Master's

Education Required

NMTCB-recognized program

The NMTCB NMAA exam uses ~200 multiple-choice questions with a $1,000 fee. Four domains: Patient Care, Clinical Procedures, Pharmaceuticals, and Radiation Safety/Radiobiology (weightings not published). Offered twice per year (January and July) at IQT testing centers. Requires active CNMT/ARRT(N) + master's-level NMAA program. Only 16 certified NMAAs since 2011. Content outline updated November 2025 with expanded theranostics coverage.

Sample NMAA Practice Questions

Try these sample questions to review concepts for the NMAA exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1An NMAA is performing a pre-procedure assessment on a patient scheduled for a PET/CT scan. Which of the following findings would be MOST important to address before administering F-18 FDG?
A.Patient has a known allergy to iodinated contrast media
B.Patient's fasting blood glucose is 245 mg/dL
C.Patient reports mild claustrophobia
D.Patient took aspirin earlier that morning
Explanation: Elevated blood glucose (>200 mg/dL) significantly impairs F-18 FDG uptake because glucose and FDG compete for the same GLUT transporters. Hyperglycemia causes increased FDG uptake in muscles and decreased uptake in tumor cells, severely degrading image quality and diagnostic accuracy. The blood glucose must be managed before FDG administration. Iodinated contrast allergy is relevant only if IV contrast is planned for the CT portion, claustrophobia can be managed with positioning or anxiolytics, and aspirin does not affect FDG biodistribution.
2During a pharmacologic cardiac stress test using regadenoson (Lexiscan), a patient develops severe bronchospasm. What is the MOST appropriate immediate intervention?
A.Administer intravenous diphenhydramine 50 mg
B.Administer aminophylline 100-200 mg IV slowly
C.Administer sublingual nitroglycerin 0.4 mg
D.Administer intravenous metoprolol 5 mg
Explanation: Aminophylline is the specific reversal agent for regadenoson-induced bronchospasm. Regadenoson is an A2A adenosine receptor agonist, and aminophylline (a methylxanthine) competitively antagonizes adenosine receptors, reversing the bronchoconstrictive effects. The recommended dose is 50-250 mg IV administered slowly. Diphenhydramine treats histamine-mediated reactions, nitroglycerin addresses coronary vasospasm, and metoprolol could worsen bronchospasm.
3Which of the following BEST describes the scope of practice for a Nuclear Medicine Advanced Associate (NMAA)?
A.Independent practitioner who may prescribe radiopharmaceuticals without physician oversight
B.Physician extender who performs clinical duties under the supervision of an authorized user physician
C.Technologist with expanded authority to operate imaging equipment
D.Radiologist assistant authorized to interpret nuclear medicine studies independently
Explanation: The NMAA is a physician extender (advanced practice professional) who works under the supervision of an authorized user (AU) physician. NMAAs may perform history and physical examinations, order and interpret laboratory tests, and administer radiopharmaceuticals, but they do not practice independently. Their scope is defined by NRC regulations and institutional credentialing. They are distinct from technologists and do not independently interpret studies.
4A patient presents for a thyroid uptake and scan after discontinuing methimazole. The 24-hour I-123 uptake is 58%. Which condition is MOST consistent with this finding?
A.Subacute thyroiditis
B.Graves' disease
C.Factitious thyrotoxicosis
D.Struma ovarii
Explanation: A markedly elevated 24-hour I-123 uptake of 58% (normal range approximately 10-30%) is characteristic of Graves' disease, an autoimmune condition where thyroid-stimulating immunoglobulins (TSI) drive excessive thyroid hormone production and increased iodine trapping. Subacute thyroiditis, factitious thyrotoxicosis, and struma ovarii all present with suppressed thyroidal uptake because the thyroid gland itself is not actively trapping iodine in these conditions.
5An NMAA is reviewing a Tc-99m MDP bone scan and notes diffusely increased skeletal uptake with faint renal visualization. This pattern is MOST consistent with which finding?
A.Renal failure causing delayed clearance
B.Metabolic superscan from widespread osseous metastases
C.Improper radiopharmaceutical preparation with free pertechnetate
D.Patient dehydration requiring repeat imaging
Explanation: A metabolic superscan demonstrates diffusely increased skeletal uptake with diminished or absent renal and soft tissue activity. This pattern occurs when widespread osteoblastic metastases (commonly from prostate or breast cancer) avidly extract the bone-seeking radiopharmaceutical, leaving insufficient tracer for normal renal excretion. The symmetrically intense skeletal uptake can appear deceptively 'normal' and requires careful recognition. Renal failure causes increased soft tissue activity, free pertechnetate would show thyroid and gastric uptake, and dehydration alone does not produce this pattern.
6According to NRC regulations (10 CFR 35.75), what is the dose-rate criterion for releasing a patient treated with I-131 sodium iodide for thyroid cancer?
A.Less than 2 mR/hr at 1 meter
B.Less than 7 mR/hr at 1 meter
C.Less than 5 mR/hr at 1 meter
D.Less than 33 mR/hr at 1 meter or total effective dose equivalent to any individual is unlikely to exceed 5 mSv
Explanation: Under 10 CFR 35.75, patients may be released when the total effective dose equivalent (TEDE) to any other individual from exposure to the released patient is not likely to exceed 5 mSv (500 mrem). The older default criterion of 33 mR/hr at 1 meter (approximately 30 mCi retained activity) is a conservative surrogate, but the regulation actually allows release based on patient-specific dose calculations that may permit release at higher measured dose rates if living conditions support it. The 7 mR/hr value is commonly cited but is not the regulatory threshold.
7A patient is referred for Lu-177 PSMA-617 (Pluvicto) therapy for metastatic castration-resistant prostate cancer. Which prerequisite study is required before initiating therapy?
A.F-18 FDG PET/CT to confirm metabolically active disease
B.Ga-68 PSMA-11 or F-18 PSMA PET/CT demonstrating PSMA-positive disease
C.Tc-99m MDP bone scan showing at least 3 osseous metastases
D.CT chest/abdomen/pelvis with IV contrast within the past 90 days
Explanation: Lu-177 PSMA-617 (Pluvicto) therapy requires a PSMA-positive PET scan (Ga-68 PSMA-11 or F-18 piflufolastat/flotufolastat) demonstrating PSMA-expressing tumor sites. This theranostic approach uses the diagnostic PSMA PET to confirm target expression before administering the therapeutic radiopharmaceutical. Without PSMA-positive disease on imaging, Lu-177 PSMA-617 would not effectively target tumor cells. FDG PET shows metabolic activity but not PSMA expression, and bone scan or CT alone cannot confirm PSMA receptor status.
8Which of the following radiation effects is classified as a stochastic effect?
A.Radiation-induced cataract formation
B.Acute radiation syndrome
C.Radiation-induced thyroid cancer
D.Erythema following high-dose fluoroscopy
Explanation: Radiation-induced cancer is a stochastic effect, meaning it is probabilistic in nature — the likelihood of occurrence increases with dose, but there is no threshold dose, and the severity is independent of dose (cancer is cancer regardless of the dose that caused it). Cataracts, acute radiation syndrome, and erythema are all deterministic (tissue reaction) effects that have threshold doses and increase in severity with increasing dose above the threshold.
9An NMAA is evaluating a patient with suspected pulmonary embolism. The ventilation-perfusion (V/Q) scan shows multiple segmental perfusion defects with normal ventilation in the corresponding areas. This pattern is classified as:
A.Low probability for pulmonary embolism
B.Intermediate probability for pulmonary embolism
C.High probability for pulmonary embolism
D.Normal study excluding pulmonary embolism
Explanation: Multiple segmental or larger perfusion defects with normal ventilation (V/Q mismatch) in the corresponding regions is classified as high probability for pulmonary embolism according to the modified PIOPED criteria. The mismatch pattern indicates that the lung parenchyma is ventilated but not perfused, consistent with vascular obstruction from thromboemboli. A minimum of two large segmental mismatches is required for high probability classification.
10What is the primary mechanism of action of F-18 FDG in oncologic PET imaging?
A.It binds to tumor-specific surface receptors and is internalized
B.It is trapped intracellularly after phosphorylation by hexokinase because FDG-6-phosphate cannot proceed through glycolysis
C.It undergoes oxidative phosphorylation in mitochondria of metabolically active cells
D.It passively accumulates in areas of increased blood flow surrounding tumors
Explanation: F-18 FDG is a glucose analog that enters cells via GLUT transporters (the same as glucose) and is phosphorylated by hexokinase to FDG-6-phosphate. Unlike glucose-6-phosphate, FDG-6-phosphate cannot be further metabolized through glycolysis because it lacks the 2' hydroxyl group needed for the next enzymatic step (phosphoglucose isomerase). This metabolic trapping results in intracellular accumulation proportional to the glycolytic rate, which is elevated in most malignancies (Warburg effect).

About the NMAA Exam

The NMAA credential certifies physician-extender nuclear medicine advanced associates. The exam covers patient care including history/physical and emergency management, clinical procedures including theranostics (Lu-177 PSMA, Ra-223, Ac-225) and stress testing, diagnostic and therapeutic pharmaceuticals, and radiation safety and radiobiology. This is a master's-level credential requiring completion of an NMTCB-recognized NMAA education program. Content outline updated November 2025 for 2026.

Exam sponsor: NMTCB. The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Questions

200 questions

Time Limit

3.5 hours (estimated)

Passing Score

Criterion-referenced (not publicly disclosed)

Exam / Certification Fees

$1,000

Exam sponsor website

Reported exam pass rate: Not publicly reported. Extremely small candidate pool; only 16 certified since 2011 Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

~25%

Patient Care

History/physical exam, patient assessment, plan of care, sedation, ACLS/BLS, glucose management, contrast reactions, informed consent, HIPAA

~25%

Clinical Procedures

Cross-sectional anatomy, diagnostic procedures, therapy/theranostics (Lu-177, Ra-223, Ac-225), dosimetry, stress testing, ECG interpretation

~25%

Diagnostic & Therapeutic Pharmaceuticals

Drug mechanisms, contrast media, Lu-177 PSMA-617, F-18/Ga-68 PSMA, I-131, medication errors, adverse drug reporting

~25%

Radiation Safety & Radiobiology

Absorbed dose, cell radiosensitivity, deterministic/stochastic effects, dose-response, fetal effects, dosimetry calculations

Preparing for the NMAA Exam

What You Need to Know

  • Passing score: Criterion-referenced (not publicly disclosed)
  • Exam length: 200 questions
  • Time limit: 3.5 hours (estimated)
  • Exam / certification fees: $1,000 Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

NMAA: Suggested Study Strategy

1Master theranostics — the 2026 outline adds Lu-177 PSMA-617 (Pluvicto), Ac-225, Pb-212, Pb-203, and Y90-DOTATOC, reflecting the field's growth
2Know patient care at the advanced practice level: comprehensive vs limited H&P, stethoscopy, sedation protocols, emergency management
3Study radiation safety calculations: half-life decay, inverse square law, shielding calculations, and patient release criteria (7 mR/hr at 1 meter for I-131)
4Understand stress testing: exercise protocols (Bruce), pharmacologic agents (regadenoson, dobutamine), ECG interpretation, and endpoints

Frequently Asked Questions

What is the NMAA credential?

The NMAA (Nuclear Medicine Advanced Associate) is NMTCB's advanced practice credential for physician-extender roles. NMAAs work under physician supervision to perform history/physicals, order/interpret labs, and manage nuclear medicine procedures including theranostics.

How much does the NMAA exam cost?

The initial NMAA exam fee is $1,000 (significantly higher than other NMTCB exams at $225). Recertification exam fee is $250.

What are the prerequisites?

Active CNMT, ARRT(N), or CAMRT nuclear medicine credential plus completion of a master's-level NMTCB-recognized NMAA education program with 2,000 hours clinical experience.

When is the NMAA exam offered?

Twice per year: January and July, at IQT testing centers. Certification is valid for 10 years with 48 CE hours biennially.