As the ABR rolls out updates to its certifying process, trainees should know what to expect as they navigate these changes.
The RFS is a nationwide network of professionally committed radiology, radiation oncology, medical physics and nuclear medicine trainees. The mission of the RFS is to develop trainee-specific resources, and to engage with and support the future leaders of the radiology profession by way of advocacy efforts, educational opportunities, policy implementation and more. This is the first article in a new Bulletin series proposed and authored by RFS members — sharing their perspectives on challenges, opportunities and outcomes within an ever-evolving specialty.
The ABR is entering a period of meaningful change in how diagnostic radiology certification is assessed. For residents, this transition brings both uncertainty and opportunity. It’s clear that the future of board certification will focus not only on what we know, but on how we think, communicate and practice.
Based on recent ABR communications and publicly available resources, several key updates are emerging. Most notably, the certifying process will transition to an oral examination beginning in 2028. Understanding these changes and how to prepare will be essential for trainees.
Beginning in 2028, diagnostic radiology (DR) residents will have their first opportunity to take the Qualifying (Core) Exam in the fall of PGY-5 (R4), followed by the Oral Certifying Exam in June of the same year. This effectively brings both major certification milestones into the final year of residency.
The transition will occur gradually for both DR and IR/DR trainees, as outlined in the ABR exam timing update.
This creates a more compressed preparation timeline for trainees. As a result, board preparation will need to be more longitudinal and integrated into daily training.
Topics related to professionalism and patient safety, such as contrast reactions or communication of errors, may also arise naturally within case discussions.
The new DR Oral Certifying Exam is designed to better reflect real-world radiology practice.
Candidates will participate in 25-minute, one-on-one sessions across seven domains: abdominal, breast, cardiothoracic, musculoskeletal, neuroradiology, nuclear medicine and pediatric imaging, with 10-minute transitions between sessions. The exam takes approximately three hours and 55 minutes and is administered over approximately ten days of testing. Each candidate completes the exam on a single assigned day.
Within these discussions, candidates are expected to address practical, clinically relevant physics and safety considerations as part of routine clinical decision-making. The exam is conducted remotely using a dedicated ABR platform that allows real-time interaction with imaging.
The exam focuses on three core skills:
Cases are centered on common and clinically relevant scenarios. In addition to image interpretation, candidates may be asked to discuss routine diagnostic procedures, including when they are indicated, how they are performed and potential complications. Topics related to professionalism and patient safety, such as contrast reactions or communication of errors, may also arise naturally within case discussions. MRI sequences will be labeled, allowing candidates to focus on interpretation and clinical reasoning.
To support preparation, the ABR has released a set of sample cases and a mock oral exam video demonstrating exam expectations. The exam is offered twice per year. Candidates who do not pass one or two categories may receive a conditioned result and retake only those sections. Candidates who do not pass more than two categories must repeat the entire exam.
ABR has implemented multiple safeguards to support fairness and consistency. After exam sessions, a brief recovery period allows candidates to address technical issues and repeat affected portions if needed. This is followed by category-level meetings to review performance within each subspecialty, and a final panel discussion to determine overall results.
Standardized case sets, structured examiner training and defined scoring approaches further help ensure consistency across candidates.
Although oral case presentation is a critical skill most radiologists will deploy throughout their career — it remains a skill that many struggle to master. To assist residents in developing this skill, the ACR launched an Oral Case Presentation video series which covers how to structure case presentations, describe imaging findings, defend your differential diagnosis and remain calm under pressure. The initiative is part of a broader three-phase preparation effort that includes online teaching sessions, advanced case-review courses and eventually full mock “hot-seat” case presentation simulations.
Change in certification can feel uncertain, particularly when details are still evolving. However, the direction is clear. The new oral boards are designed to better reflect the realities of radiology practice. This is not just a new exam format for trainees; it’s an opportunity to align preparation with the skills that matter most in practice and in patient care.
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