What to know about the new DR Oral Exam

In 2028 the American Board of Radiology replaces the computer-based Diagnostic Radiology Certifying Exam with an oral exam, the first in fifteen years. This is a reader's guide to what the ABR has published about it, with a link to the ABR's own page beside each point.

Written October 8, 2026 from the ABR's announcement, study guide and Beam articles. It paraphrases; it is not the ABR speaking, and the ABR can change the rules. Check the linked pages before you rely on a detail.

Why the ABR changed the exam

The ABR says stakeholders told it that multiple-choice questions do not measure detection, interpretation or communication well, and that the certifying exam came too long after residency. The oral format is meant to assess higher-order clinical skills, and remote technology after the pandemic made it practical to deliver.ABR source

The study guide puts it this way: the Qualifying (Core) Exam shows knowledge across the whole domain in multiple choice, while the Oral Exam focuses on higher-level skills in observation, synthesis and management, and assesses the clinical and communication skills and professionalism of an independently practicing general radiologist.ABR source

When

The first DR Oral Exam is in 2028, with winter, June and fall administrations that year. From 2029 there are two a year, in June and the fall. Each administration has several one-day exam periods; a candidate needs one day.ABR source
An optional pilot runs on September 24 and 25, 2027 for up to 220 eligible candidates, chosen at random among those who say yes to an April 2027 survey. A pass counts toward certification. A fail is a non-event with no re-exam fee.ABR source
Two computer-based Certifying Exam administrations are still offered in 2027.ABR source
From 2028, every DR candidate must pass the Oral Exam to certify, whenever they finished residency. Candidates have six full calendar years after residency to pass.ABR source
In steady state the Qualifying (Core) Exam moves to the fall of R4 and the Oral Exam to June of R4. Residents graduating in 2029 or later can take the Core in the fall of R4 rather than June of R3.ABR source
Eligibility is unchanged: complete or be on track to complete residency, pass the Core, pay the fees. Fees are not expected to rise.ABR source

The day itself

Remote, online, from a location the candidate chooses. A technical check with the exam software is available beforehand.ABR source
Seven one-on-one sessions by video, one examiner at a time, each about 20 to 25 minutes and each covering one content area.ABR source
The software presents cases in real time. Candidates can adjust images, and scrolling stacks are included.ABR source
Every candidate in a category on a given date sees the same standard case set. Examiners do not bring their own cases; a committee of volunteer subject-matter experts assembles them.ABR source, and 2
Normal cases are not shown as primary questions, though normal variants may be. MRI sequences are labeled.ABR source
Examiners are told not to give positive or negative feedback during the exam. Moving quickly to the next case, or saying little, signals nothing about how you are doing.ABR source

What is on it

Seven categories, each with its own session: abdominal (including GI, GU and ultrasound), breast, cardiothoracic, musculoskeletal, neuroradiology, nuclear and pediatric. Modalities may include radiography, CT, ultrasound, MRI, fluoroscopy, mammography and nuclear techniques including PET, SPECT, planar imaging and therapies. Images may be single images, cine clips or scrollable stacks.ABR source

The content is critical findings and the common, important diagnoses of general practice, chosen to test observation, communication, judgment and reasoning. The ABR says it is not a comprehensive review of clinical content.ABR source, and 2

Procedures are in scope at the level a general radiologist is expected to perform: the APDR’s ten procedures, which the guide lists as image-guided core biopsy, abscess drainage, paracentesis, thoracentesis, lumbar puncture, ultrasound-guided breast biopsy, ultrasound-guided venous access, over-the-wire tube exchange, thyroid fine-needle aspiration and joint procedures. Advanced interventional procedures are excluded, but the imaging findings and complications after them are not.ABR source

Physics is limited to clinically relevant safety principles raised by a case.ABR source, and 2

What the examiner is listening for

The ABR describes three things it has always scored in oral exams and now writes into a rubric for every case.ABR source

Observation: Identifying the abnormality and the pertinent negatives.
Synthesis: The differential diagnosis, including the most likely diagnosis.
Management: The next step, for example additional imaging or an urgent referral.

The ABR’s own example: abdominal radiographs in a young adult with vomiting show dilated small bowel. The pertinent negative is the absence of free air. A second finding is a subtle lucency over the right inguinal region. The additional test is CT with intravenous contrast, which shows a right inguinal hernia containing thickened ileum with diminished enhancement. The management is urgent surgical consultation for presumed ischemic bowel in an incarcerated hernia.ABR source

Exam committees define the performance elements for each case, the essential points a candidate should mention, and examiners score against them on an electronic score sheet.ABR source, and 2

How it is scored

Each case is scored as a whole number from 68 to 72. The labels are the same across all four ABR disciplines.ABR source, and 2

Score	The ABR's label
72	Outstanding. Exceptionally strong performance.
71	Good. A strong performance.
70	Satisfactory. The passing standard.
69	Marginally unsatisfactory. Weak performance.
68	Absolutely unsatisfactory. Poor and potentially unsafe performance. The ABR says this score is uncommon.

A category score is the average of the case scores in that session. An average of 70 or more passes the category; below 70 fails it.ABR source, and 2
Each examiner commits to a score before seeing the scores other examiners gave the same candidate, and each content-area result comes from an examiner with no knowledge of the candidate’s other sessions.ABR source, and 2
Because a category is an average, a poor case can usually be offset by better cases. The ABR says a candidate rarely fails because of a single case.ABR source
Passing does not require perfection. It requires demonstrating competence to practice independently, effectively and safely.ABR source
After each session, examiner panels meet. A low section score can be raised if the candidate performed well elsewhere and the low score looks like an outlier. All examiners must agree on the overall result.ABR source, and 2
Failing one or two of the seven categories is a conditional pass: the candidate repeats only those categories at the next administration. The ABR says a conditioned result is closer to a pass than a fail.ABR source, and 2, and 3
Historically, 86 to 92 percent of first-time DR oral candidates passed outright, 5 to 12 percent conditioned, and under 5 percent failed. The ABR says it has no target pass rate.ABR source

Five myths the ABR has answered

A fast examiner does not mean you did well. Examiners sometimes move on to help a struggling candidate.ABR source
Silence is not a verdict. Examiners are instructed not to give feedback during the exam.ABR source
Results are not down to chemistry with the examiner. The ABR reports very low variability between examiners.ABR source
Taking extra time on each case is not in your interest. Seeing more cases gives strong performance more room to offset weak ones.ABR source
Cases are not built with a twist. Most reflect common or clinically important diagnoses at a generalist level.ABR source

What the ABR gives you to prepare

The ABR has published a study guide covering content and scope, sample cases from each category with a discussion of what examiners may look for, a reenactment video showing simulated case discussions at a range of performance levels, a remote-exam guide for candidates covering registration, computer and location requirements and accommodations, and an expanded FAQ. The study guide suggests case conferences and daily readouts as the place to practice presenting findings, a short differential and a reasonable next step.ABR source, and 2

Where VerbalWars fits. VerbalWars is a practice room for exactly this conversation: an examiner shows prepared studies, asks neutral questions, and scores Observation, Synthesis and Management on a 68 to 72 band modeled on the ABR’s description, then shows what an outstanding candidate would have said. It is independent of the ABR, and its scores are practice feedback, not official scores. How VerbalWars scores a case.

Sources

All seven are ABR publications. Quotations and paraphrases are the author’s reading of them on October 8, 2026.

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