Initial Certification for Radiation Oncology

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 radiation oncology training requirements of a non-U.S., non-Canadian country.
  • Have documentation verifying the applicant’s ability to practice radiation oncology independently in the country of training or board certification in his or her country (if applicable).
  • Complete one clinical year of non-radiation oncology training in general medicine, surgery, transitional internship, or its equivalent.
  • Complete at least three years of radiation oncology 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 radiation oncology training. Training may be completed as a residency (up to three years maximum), fellowship, and/or faculty appointment in one institution with a radiation oncology 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 radiation oncology residency may be counted. However, four years of radiation oncology does not qualify for the ABR Alternate Pathway, as that is the standard training pathway.
  • Pass the computer-based Qualifying Exam
  • Pass the oral Certifying Exam
  • 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 the applicant’s status relative to ABR policies and the Alternate Pathways to Board Certification only after receiving the following documents:
  • Radiation Oncology IMG Application Form
  • Current, detailed curriculum vitae with specific dates of all training
  • Verification of the following:
    • Medical school training
    • One year of clinical non-radiation oncology training in general medicine, surgery, transitional internship, or its equivalent. One year of credit for clinical training may be received.
    • Three years of radiation oncology training in a residency program outside the U.S. or Canada
    • Radiation oncology certification (if applicable)
    • Note: The board accepts copies of diplomas or letters from training institutions as verification. If original documents are not in 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 as part of their SDA.
    • Credit for research training of up to 12 months will be granted toward radiation oncology 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 are required
    • 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 when certification is conferred.


Applicants have the option to take the Medical Physics for Radiation Oncology and the Radiation and Cancer Biology parts of the Qualifying Exam at any time after completing 32 months of residency training. With written approval of their program chair, this option may be exercised after completion of 24 months of training. Applicants who wish to take the exam early should have their program reach out to the ABR. Applicants may take the Clinical Radiation Oncology part of the Qualifying Exam at any time after completion of 44 months of training. To be eligible to take the Certifying Exam, applicants must have passed all three qualifying exam parts and completed their four years of approved training.  

More Information

Recognition of Successful Candidates

Successful candidates are awarded a continuous ABR specialty certificate in radiation oncology.

Board Eligibility

See Board Eligibility Policy for details.


A fee schedule for the IMG Alternate Pathway can be found here.