As a radiologic technologist with over two decades of clinical and teaching experience, including directing the radiologic technology program at Tarrant County College, I’ve seen firsthand how much non-routine exams catch students and technologists of all levels off guard. Even if non-routine exams show up on your radar once a year or once every 10 years, they remain critically important.
Let’s talk about why they matter, why they’re tough and what we can do to master them.
What are Non-Routine Exams?
In my career, I’ve taken note of some exams that aren’t performed daily but do come up enough that every tech should feel confident in tackling them. These can include:
Depending on your location, patient population and referrals, these may appear in your workflow more frequently than you think. Knowing your facility’s trends can help you prioritize which procedures to refresh your knowledge of first.
Why are Non-Routine Exams Difficult to Master?
It’s not unpreparedness that leads most radiologic technologists and students to struggle with non-routine exams, but underexposure. In educational programs, the focus is naturally on mandatory competencies: the everyday chest, knee and lumbar spine exams. These are the projections that the American Registry of Radiologic Technologists (ARRT) requires students to demonstrate competency in.
However, that means non-routine exams often get a quick run-through in the classroom. As a result, months go by without most people witnessing or performing a non-routine exam in the clinical setting, leaving technologists and students frantically searching through materials trying to recall best practices, all while a patient waits.
In addition to creating an educational gap, this can also mean hospitals, clinics and patients experience delays while patients may ultimately perceive a lower quality of care.
What to Do When You Freeze in the Moment
Even with preparation, it’s normal to feel stuck when faced with a non-routine exam you haven’t performed in months.
In those cases, pause and double-check by turning to a peer or reviewing your notes. Taking a minute to clarify before bringing in the patient helps to ensure quality, confidence and safety. I remind my students that it’s better to briefly delay than to risk repeat exposure later.
Why Non-Routine Exams Still Matter
Non-routine exams often offer the best diagnostic angle for a highly specific clinical question, which is important to the referring physician to confirm a diagnosis and set up a personalized treatment plan.
They pinpoint areas to assess mobility, instability or post-trauma alignment, all information that may not be identified on standard diagnostic imaging.
Go-To Tips and Tricks
So, how can technologists and students boost their confidence in non-routine exams without additional stress?
1. Semi-Regular Trainings
I encourage radiology department administrators to conduct semi-regular refresher trainings. The first few courses can focus on the upper extremities, and the following can be on the lower extremities. Trickling out training throughout the year can make a big difference while still keeping the content bite-sized and manageable.
2. On-Hand Guides
Whether it’s a digital resource or a tangible binder, having notes on non-routine exams readily available at your facility reduces time and uncertainty, contributing to faster exams and quicker response rates among your team.
Over the years of teaching image production and radiation physics, I’ve seen that small, consistent strategies go a long way. Build habits around them; the more you normalize these practices, the faster those procedures move into your active memory.
Stay Curious
If there’s one message to take away from this article, it's that non-routine exams deserve the same level of care and precision as routine exams. You may only perform a specialized shoulder projection once a year, but when you do, your patient is relying on you for a seamless procedure.
Keeping your skills fresh isn’t just about passing the ARRT exam but about delivering high-quality patient care in every situation. You don't have to tackle everything at once; small, organized refreshers throughout the year can make all the difference.
Learn More
In my upcoming webinar, which is approved by the American Society of Radiologic Technologists for 1 Category A continuing education credit, I take a deep dive into the importance of non-routine exams, including more tips and tricks to implement into your long-term strategies.
Register Today - 7/23/25 | 12PM CDT
Register Today - 7/24/25 | 2PM CDT
Continue to get inspired while earning CE credits through Cassling’s on-demand education library, refreshed monthly. Join the conversation and sign up for future live webinars here.