Initial Certification for Diagnostic Radiology

International Medical Graduates Alternate Pathway

Last verified on October 7, 2021
An international medical graduate (IMG) is defined as an individual trained in a diagnostic radiology program outside the U.S., its territories, or Canada.


To be considered a candidate for certification by the American Board of Radiology (ABR), an applicant must demonstrate the following:
  • 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 a diagnostic radiology training in a residency program outside the U.S. or Canada
  • If trained in India, he or she must have the following degrees to be eligible for the Alternate Pathway: M.B.B.S. + D.N.B. and/or M.D.
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:
  • 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)
      • Radiology residency training, fellowship, and/or full-time 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).
    (See Sponsoring Department Agreement below.)
    • 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.
    • 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.
  • Copy of Educational Commission for Foreign Medical Graduates (ECFMG) certificate or Licentiate of the Medical Council of Canada (LMCC) certificate
  • Sponsoring department agreement, including the applicant’s four-year plan
    • 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.
    • In addition to the four-year plan, the applicant must also submit a letter of commitment for four years of service signed by the host department chair. This letter of commitment may include a statement of condition for termination for cause, although availability of funds should not fall into this category.
The department chair must complete and submit annual verification forms.
  • 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.
  • The four-year experience 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.
    • All nuclear medicine radiology training must be clinical training; research is not acceptable.
    • 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.
  • Candidates with full applications accepted on or after July 1, 2013, must meet the diagnostic radiology residency curriculum requirements for nuclear radiology therapy of 131I administrations. Candidates must perform under preceptor supervision 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.
  • Copies of United States Medical Licensing Exam (USMLE) Steps 1 – 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.


Core Exam

After an applicant’s application has been approved, and he or she has completed 36 months of approved training, the applicant may take the Core Exam.

Certifying Exam

IMG alternate pathway candidates will be eligible for the Certifying Exam after they comply with the following:
  • Successfully pass the Core Exam
  • Complete the four-year plan in one ACGME-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 consecutive plan, including:
    • four months of nuclear radiology training, and
    • the diagnostic radiology curriculum requirements for radionuclide therapy for high- and low-dose sodium iodide 131I administrations.

More Information

Board Eligibility

Please see the Board Eligibility page for more details.


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


Diagnostic Radiology IMG Application Form
Diagnostic Radiology IMG Sponsoring Department Agreement


Continuation of the IMG Alternate Pathway
Despite any changes implemented by other organizations, the American Board of Radiology has no plans at this time to discontinue its IMG Alternate Pathway to Certification Program. The program will continue to be available to individuals who meet the requirements outlined above.
ACGME Rule Changes
The ACGME rule changes, implemented on July 1, 2016, apply only to criteria for entrance into an ACGME-accredited residency or fellowship, and not to the ABR Alternate Pathway Program. The Alternate Pathway may be completed with four years as a resident; as a fellow (in an ACGME-accredited or a non-accredited fellowship); as a faculty member; or as any combination of residency, fellowship, or faculty service in a single institution with an ACGME- or RCPSC (Canadian)-accredited residency program. Research may be credited for a maximum of 12 months if it is part of a pre-approved four-year plan.