1.2 Eligibility, Structured Education & Clinical Experience

Postprimary only — and only Radiography as support

Cardiac-Interventional Radiography is not a primary-pathway exam. You cannot sit CI from a radiography school diploma alone. ARRT's equation for certification is ethics + education + examination. For CI, education has two layers: a supporting discipline plus structured education and clinical experience.

The supporting discipline is a current ARRT R.T.(R) Radiography credential. ARRT's supporting-category chart lists Radiography for CI. Nuclear Medicine Technology Certification Board (NMTCB) and American Registry for Diagnostic Medical Sonography (ARDMS) credentials that can support CT, MRI, or sonography pathways are not listed as CI supporting credentials. A nuclear medicine technologist who wants CI still needs ARRT Radiography first. Do not apply for CI on an NMTCB or ARDMS ticket.

You must remain certified and registered in that supporting Radiography credential while you pursue CI and after you earn it. If Radiography lapses, the postprimary credential is at risk.

Ethics is not a paperwork afterthought. Felony or misdemeanor charges, license sanctions, or exam-security issues can stop an application even when your clinical log is complete. If you have a potential ethics issue, ARRT's ethics review preapplication exists so you learn the answer before you pay $225 and finish 180 cases.

Structured education (CI_SE_2023)

You must document at least 16 hours of structured education earned in the 24 months immediately before you submit the application. Hours older than 24 months do not count, even if they were excellent CI courses.

Those 16 hours must include at least 1 credit in each of:

• Patient Care (Patient Interactions and Management)
• Image Production (Image Acquisition and Equipment)
• Procedures (Diagnostic and Electrophysiology and/or Interventional)

The remaining 13 hours may sit in any of those three categories. ARRT's own examples include 3/6/7, 1/1/14, and 1/10/5 splits. You cannot put all 16 hours in Procedures and skip Patient Care.

Acceptable activities are ARRT-recognized academic courses, CE approved by an ARRT CE Approver, or a mix. Academic conversion: 12 CE credits per quarter credit or 16 CE credits per semester credit. A one-semester-credit college hemodynamics course can cover the entire 16-hour total if the documented content still puts at least one credit into each major category — confirm the syllabus mapping before you assume it does.

Exam trap: structured education is not the same as your biennial 24 Category A CE for renewal. You may use CI-relevant CE for both purposes when the dates and content rules overlap, but you still must report structured education on the postprimary application in the three content bins. Completing 24 CE for renewal does not automatically populate the CI structured-education worksheet.

Clinical experience — the 180-repetition frame

ARRT requires a minimum of 180 repetitions of CI procedures, completed no more than 24 months before application. You may log a maximum of eight procedures per day on the ARRT online worksheet. A 12-hour call shift with 11 cases still yields eight loggable entries that day. Plan the calendar: 180 entries at 8/day is 23 full log days in theory, but mandatory mix, 5-repetition caps, and real case mix stretch that over months.

You must show active, independent participation in a primary role throughout the entire procedure. ARRT's examples of primary roles are scrubbing, circulating, or monitoring. Watching from the control-room doorway, pulling a single cine run, or being the person who only transported the patient does not qualify.

Remote scanning is not acceptable. You must be physically present at the facility where the patient and equipment are located. A verifier, however, is not required to stand at your elbow; clinical verifiers may complete verification remotely after you performed the case in person.

Verification must come from an ARRT certified and registered R.T. (CI credential not required), a cath lab manager (any credentialed healthcare provider), or a licensed physician. Pick verifiers who will actually attest. A traveler who leaves next month is a weak long-term verifier.

You must also document current advanced cardiac life support (ACLS) from an ARRT-recognized organization. Expired ACLS on application day is an avoidable rejection.

Mandatory procedures — left heart, right heart, coronary intervention

Left heart catheterization (LHC): at least 60

Each qualifying LHC must include at least two of:

• coronary angiography
• coronary artery bypass graft (CABG) angiography
• aortography
• hemodynamics (for example aortic pressure, end-diastolic pressure)
• left ventriculography
• ventricular volume measurement / ejection fraction (EF)

Up to 80 additional LHC cases may count as electives.

Right heart catheterization (RHC): at least 10

Each qualifying RHC must include at least two of:

• cardiac output (CO) calculations (Fick, thermodilution)
• hemoximetry
• shunt detection
• pulmonary angiography
• hemodynamics
• valve measurement
• right ventriculography

Up to 80 additional RHC cases may count as electives.

Coronary interventional procedures: at least 10

Choose from angioplasty, stent placement, atherectomy (directional, rotational, laser, or orbital), and thrombectomy (mechanical or pharmacologic). Up to 80 additional coronary interventional procedures may count as electives.

A diagnostic-only LHC with coronary angiography and a left ventriculogram is one LHC. It is not a coronary interventional procedure. PCI credit starts when you participate in angioplasty, stent, atherectomy, or thrombectomy as listed.

Electives: 100 repetitions, with a 5-cap on some

You need at least 100 elective repetitions. Fill them by (a) procedures on the elective list or (b) overflow extra mandatories. Multiple different procedures may be logged on one patient, but each individual procedure type is documented only once per patient.

5-repetition cap examples: peripheral angiography, coronary angiography logged as an elective, aortography, vascular closure devices, pericardiocentesis, endomyocardial biopsy, foreign-body retrieval, inferior vena cava (IVC) filter, temporary pacemaker, leadless pacemaker, cardioversion. Doing 20 radial diagnostic angiograms still counts five elective coronary angiograms.

No-cap electives include intravascular ultrasound (IVUS), optical coherence tomography (OCT), intracardiac echocardiography (ICE), transcatheter aortic valve implantation/replacement (TAVI/TAVR), flow reserve (FFR/iFR/RFR), valvuloplasty, ventricular assist device (VAD), intra-aortic balloon pump (IABP), distal embolic protection, patent foramen ovale (PFO)/atrial septal defect (ASD) closure, ventricular septal defect (VSD) closure, permanent pacemaker, generator exchange, implantable cardioverter-defibrillator (ICD), ablation, EP study, intravascular lithotripsy (IVL), transcatheter mitral valve repair (TMVR), left atrial appendage (LAA) closure, and extracorporeal membrane oxygenation (ECMO).

Cath-lab logging scenario (ARRT's own example). STEMI case: LHC with coronary angiography, left ventriculography, and hemodynamics, then stent, atherectomy, and mechanical thrombectomy. That logs as 1 LHC (the three diagnostic pieces together) plus 3 interventional procedures = 4 total for that patient — not six, and not two LHCs. If the same case also used IVUS, IVUS can be an additional elective on that patient.

ARRT's Candidate C path shows a high-volume diagnostic lab can finish with 130 LHC + 40 RHC + 10 stents and zero named electives because 100 overflow mandatories fill the elective bucket. Candidate A might mix 80 LHC, 40 RHC, 10 angioplasties, plus IVUS, cardioversions, pericardiocenteses, biopsies, and foreign-body cases. Both are legal if the mandatory floors and caps are met.

After three fails or three years

If you exhaust three attempts in three years, you repeat all clinical experience and all structured education. New clinical repetitions must be performed in the two years immediately preceding a new application. Old worksheet rows do not roll forward. Rebuild the entire 180-repetition log, rebuild the 16 structured-education hours inside the 24-month window that applies to the new application, then reapply.