Initial Certification for Diagnostic Radiology

Alternate Pathway (International Medical Graduates)

Last verified on January 24, 2024

Prerequisites and Requirements

An international medical graduate who is not planning to enter the standard residency pathway can apply to the alternate pathway to be considered a candidate for certification by the American Board of Radiology (ABR). The prerequisites and requirements are detailed below for application to the pathway.


  • Satisfy the training requirements of a non-U.S., non-Canadian country
  • Have documentation verifying the applicant’s ability to practice radiology independently in the country of training or board certification in his or her country (if applicable)
  • Complete one year of clinical training
  • Complete diagnostic radiology training in a residency program outside the U.S. or Canada
  • If trained in India, the applicant must have the following degrees to be eligible for the Alternate Pathway: MBBS + DNB and/or MD.


  • Complete four years of radiology training. Training may be completed as a residency (up to three years maximum), fellowship, and/or faculty appointment in one institution with a diagnostic radiology training program approved by the Accreditation Council for Graduate Medical Education (ACGME) or Royal College of Physicians and Surgeons of Canada (RCPSC).
    • Four years of training must be at one institution and completed within eight years from training start date.
    • Part-time appointments working > 0.5 FTE are allowable, as long as the equivalent of four years of training as a 1.0 FTE is completed within eight years from training start date. For example, a candidate could train years one through three as a 1.0 FTE and years four and five as a 0.5 FTE to meet the requirement of four years as a 1.0 FTE. Please contact an ABR certification manager at for details.
    • Up to three years of diagnostic radiology residency may be counted. However, four years of diagnostic radiology residency does not qualify for the ABR Alternate Pathway, as that is the standard training pathway.
    • For candidates seeking board certification prior to January 1, 2024, the training must include four months of clinical nuclear radiology training. These four months of nuclear radiology should be the same as those completed by diagnostic radiology residents at the sponsoring institution.
      • One-week increments of training at 40 hours a week is the minimum acceptable training increment permitted.
      • All nuclear radiology training must be clinical training; research is not applicable.
      • Training at an affiliated institution is acceptable.
      • Nuclear radiology and/or PET/CT studies interpreted or reviewed during a fellowship or multidisciplinary conference as a part of clinical assignments in rotations not dedicated to nuclear radiology (such as chest, abdominal, or cardiac imaging) cannot be used to satisfy this requirement.
      • Candidates must meet the diagnostic radiology residency curriculum requirements for nuclear radiology therapy of 131I administrations. Under preceptor supervision, candidates must perform at least three therapies involving oral administration of 131I in quantities less than or equal to 33 millicuries (mCi), and at least three therapies in quantities greater than 33mCi.
  • Pass the ABR Qualifying (Core) Exam: Click here for more information.
  • Pass the ABR Certifying Exam: Click here for more information.
  • Provide proof of valid state or provincial medical license: For those in training, a valid training license is acceptable.
  • Demonstrate high moral and ethical principles: The American Board of Radiology expects candidates for initial certification to uphold fundamental moral and ethical principles.


The Board will assess an applicant’s status relative to ABR policies and Alternate Pathways toward Board Certification (see policyonly after receiving the following documents:
  • Diagnostic Radiology IMG Application Form
  • Current, detailed curriculum vitae with specific dates of all training
  • Verification of the following:
    • Medical school training
    • Clinical training
    • Radiology residency training
    • Radiology certification (if applicable)
    • NOTE: The Board accepts copies of diplomas or letters from training institutions as verification. If original documents are in a language other than English, an English translation must accompany them.
  • Candidates will be notified when to submit the application fee.
  • Copy of Educational Commission for Foreign Medical Graduates (ECFMG) certificate or Licentiate of the Medical Council of Canada (LMCC) certificate.
  • Sponsoring Department Agreement (SDA), outlining the applicant’s four-year plan.
    • The SDA is intended to be a prospective four-year training plan. Candidates may only use up to two years of retrospective training (prior to submission of the application) as part of their SDA.
    • Credit for research training of up to 12 months will be granted toward diagnostic radiology certification if the research is completed at the same institution as the remaining clinical training.
    • Any changes in the above requirements carried out without the written consent of the ABR will be considered as grounds for termination of the individual’s participation in the Alternate Pathway.
  • Copies of United States Medical Licensing Exam (USMLE)
    • Steps 1 and 2 score reports
    • USMLE Step 3 is required six months before admittance to the Certifying Exam.
    • Current unrestricted medical license is required at the time of application and also when certification is conferred.


Qualifying (Core) Exam

After an applicant’s application has been approved, and they have completed 36 months of approved training, the applicant may take the Qualifying (Core) Exam.

Certifying Exam

IMG alternate pathway candidates will be eligible for the Certifying Exam after they comply with the following:
  • Successfully pass the Qualifying (Core) Exam.
  • Complete the four-year plan in one ACGME- or RCPSC-accredited diagnostic radiology residency program.
  • Alternate pathway candidates do not have to wait 12 months after completion of their plan to be eligible for the Certifying Exam.
  • The ABR office must receive the Final Verification Form (FVF) signed by the department chair, attesting completion of the applicant’s four-year plan.

Board Eligibility

Please see the Board Eligibility page for more details.


A fee schedule for the IMG alternate pathway can be found here.