What to Expect and How to Study for the American Board of Radiology Exam

Passing the ABR (American Board of Radiology) exam is one of the most significant milestones in a radiologist’s journey. It’s the professional badge of honor that confirms your knowledge, critical thinking, and diagnostic accuracy in one of the most complex and technology-driven fields of modern medicine.

Whether you’re a diagnostic radiology resident gearing up for the Core Exam, a medical physicist aiming for certification, or a radiation oncology candidate preparing for the Qualifying or Certifying Exams—this guide will help you approach the ABR with the mindset, strategy, and resources of a top-scorer.

Table of Contents

1. Understanding the ABR Exam Structure
2. Start with the End in Mind: Know What You're Being Tested On
3. Building a Solid Study Timeline
4. Resources: Books, Question Banks, and Courses
5. High-Yield Topics You Must Master
6. Practice, Practice, Practice: Why Questions Matter More Than Notes
7. Study Groups, Sprints, and Solo Sessions
8. Mental Preparation: Avoiding Burnout
9. What to Expect on Exam Day
10. The Final Weeks: Review Without Overloading
11. If You Don't Pass: What Comes Next
12. Conclusion: You’re Closer Than You Think

1. Understanding the ABR Exam Structure

The ABR exam is not a single test. It’s a sequence of rigorous assessments designed to evaluate whether a candidate is competent in their chosen radiologic specialty.

Diagnostic Radiology Pathway

• Core Exam (Usually taken after 36 months of residency)
• Certifying Exam (15 months after residency)

Radiation Oncology Pathway

• Qualifying Exam (Divided into Physics, Biology, and Clinical sections)
• Certifying Oral Exam

Medical Physics

• Part 1: General and Clinical exams
• Part 2 and 3: Advanced clinical knowledge and oral defense

Each pathway is unique, but they share a common theme: depth over breadth. The ABR is designed to test your clinical reasoning, familiarity with modalities, and application of knowledge—not just rote memorization.

2. Start with the End in Mind: Know What You're Being Tested On

ABR isn’t like the USMLE—it’s not about obscure disease statistics or rare syndromes. The board focuses on:

• Daily practice relevance
• Image interpretation
• Critical diagnosis-making
• Safety principles
• Technical understanding of imaging modalities

For Diagnostic Radiology:

The Core Exam includes sections on:

• Breast Imaging
• Cardiac
• Gastrointestinal
• Genitourinary
• Musculoskeletal
• Neuroradiology
• Nuclear Medicine
• Pediatrics
• Physics
• Safety
• Interventional Radiology

The Certifying Exam includes:

• General Diagnostic Radiology
• Non-interpretive Skills
• Practice Profiles (elective modules in subspecialties)

3. Building a Solid Study Timeline

When Should You Start?

• 12 months before exam: Start content review
• 6 months before: Ramp up question banks and case review
• 3 months before: Simulate full exam sections
• 1 month before: Full-day review simulations

Break your study plan into 3 phases:

• Foundation Phase (months 1–6): Textbook and lecture-based study
• Application Phase (months 7–9): Daily question bank + topic integration
• Mastery Phase (months 10–12): Mixed-topic practice exams and error logging

4. Resources: Books, Question Banks, and Courses

Books

• Core Radiology by Jacob Mandell – Ideal for the Core Exam
• Crack the Core (Vol I & II) – High-yield, digestible, and exam-oriented
• Radiology Review Manual by Dähnert – Dense but detailed

Question Banks

• RadPrimer (by StatDx/Elsevier) – Trusted by most residents
• BoardVitals ABR Qbank – Excellent for timed practice
• Huda Review for Physics – Must-have for physics prep

Online Courses

• The White Coat Companion
• The Physics of Medical Imaging by Huda
• RSNA Core Exam Resources
• CaseStacks for oral prep and image recognition

The secret is not using all resources, but mastering a curated few thoroughly.

5. High-Yield Topics You Must Master

For Diagnostic Radiology Core Exam

• Breast: BI-RADS, Tomosynthesis, Screening protocols
• Neuroradiology: Stroke, Trauma, Mass lesions, CSF disorders
• Chest: ILD, Lung cancer, Pulmonary embolism
• MSK: Bone tumors, Fractures, Soft tissue masses
• Physics: Radiation safety, MR safety, Image artifacts
• Non-interpretive: ACR Appropriateness Criteria, PQI projects

Focus on common pathologies, safety questions, and modality-based differentials.

6. Practice, Practice, Practice: Why Questions Matter More Than Notes

Radiology is visual. You will learn more from interpreting 5000 CTs, X-rays, and MRIs than by reading 500 pages.

Tips:

• Do 50–100 questions per week initially, and 300+ per week closer to exam
• Flag questions that tricked you or were “lucky guesses”
• Make flashcards or “missed question logs” for repeated errors
• Use PACS-like viewers (e.g., CaseStacks, Radiopaedia playlists) to mimic real-exam environment

7. Study Groups, Sprints, and Solo Sessions

• Use study groups to review high-yield areas weekly (e.g., “MSK Mondays”)
• Pair with a peer for mock orals
• Use Pomodoro method: 25-min study / 5-min break to maintain focus
• Use weekends for power sessions (4–6 hours) to consolidate material

8. Mental Preparation: Avoiding Burnout

Studying for the ABR exam is a marathon, not a sprint. Avoid:

• Cramming late into the night
• Comparing yourself to others
• Ignoring exercise, hydration, or rest

Instead:

• Prioritize sleep and mental breaks
• Practice mindfulness and visualization techniques
• Reward yourself weekly for consistency

9. What to Expect on Exam Day

• Core Exam is administered at Prometric centers or remote (due to evolving ABR policies)
• It’s two days long, each with several modules
• Expect:
  • High-resolution images
  • Time pressure
  • Clinical scenarios with multiple-choice and matching formats

Tips:

• Bring blue-light filter glasses
• Simulate exam environment at least twice before the real test
• Do not over-caffeinate on the day

10. The Final Weeks: Review Without Overloading

• Shift to mixed practice sets
• Don’t start new books—review your weak topics instead
• Take 2–3 full-length mock exams
• Review physics and non-interpretive skills daily in bite-sized chunks
• Re-read your error log regularly

11. If You Don't Pass: What Comes Next

Failure is not the end—it’s feedback.

The ABR allows re-attempts, and many excellent radiologists didn’t pass on the first try. Take these steps:

• Request your performance breakdown
• Identify knowledge gaps vs. test strategy issues
• Change your resource strategy
• Consider a tutor or guided course (e.g., Huda Physics Live)

Most importantly—don’t lose momentum.

12. Conclusion: You’re Closer Than You Think

Studying for the ABR is one of the most intellectually demanding challenges in radiology, but it’s also a rite of passage. It pushes you to become not just a better test taker, but a more competent and confident radiologist.

Stay consistent. Stay curious. And remember: the ABR exam doesn’t define you—it certifies what you’ve already become.