Radiology training in the United States of America

Last revised by Aaron R Tims on 19 Apr 2023

Radiology training in the United States of America is a five-year residency after obtaining a medical degree (MD or DO). The majority of residency graduates pursue a subspecialty fellowship after graduating from a residency program.

The educational pathway leading to diagnostic radiology consists of the following:

  • BA or BS degree: four years of undergraduate education

    • includes a set of premedical course requirements (e.g. biology, chemistry, physics, mathematics, and English) regardless of actual academic major

  • MD or DO degree: four years of medical school

    • known as a professional graduate/postgraduate degree because a bachelor's degree is a prerequisite

    • sometimes referred to as undergraduate medical education to distinguish it from graduate medical education that follows medical school

  • PGY-1 (postgraduate year 1): clinical internship

    • training in a non-radiology field

    • known as "preliminary year" if concentrated in a single specialty, most commonly in internal medicine or general surgery

    • known as "transitional year" if rotating in multiple specialties (e.g., internal medicine, surgery, pediatrics)

  • PGY-2: radiology residency year 1 (R1)

  • PGY-3: radiology residency year 2 (R2)

  • PGY-4: radiology residency year 3 (R3)

  • PGY-5: radiology residency year 4 (R4)

  • PGY-6: subspecialty fellowship

    • abdominal radiology

    • body imaging/cross-sectional imaging (CT, MR, US)

      • MR imaging (mostly body MRI)

    • breast imaging

    • cardiothoracic radiology (chest/cardiac and pulmonary imaging)

    • cardiovascular radiology (noninvasive cardiac and vascular imaging)

    • emergency radiology

    • musculoskeletal radiology

    • neuroradiology

    • nuclear radiology

    • pediatric radiology

    • vascular and interventional radiology ("independent residency" track)

    • women's imaging (breast, obstetric, and gynecologic imaging)

  • PGY-7: fellowships in some subspecialties

    • neuroradiology (additional year in some programs)

    • neurointerventional radiology

    • pediatric neuroradiology

    • vascular and interventional radiology (additional required year in the "independent residency" track)

  • PGY-8: fellowships in some subspecialties

    • neurointerventional radiology (additional year in some programs)

Interventional radiology training was changed in 2016 from a mostly one-year fellowship undertaken as PGY-6 trainees to two different residency tracks requiring two years of interventional training:

  • integrated residency (IR/DR), in which programs select medical students prior to starting diagnostic radiology training

    • PGY 1: clinical internship, mostly surgical training

    • PGY 2-4: mostly diagnostic radiology

    • PGY 5-6: interventional radiology

  • independent residency, in which programs select residents during diagnostic radiology training

    • PGY 1-5: diagnostic radiology residency

    • PGY 6-7: interventional radiology

For placement into residency and many of the subspecialty fellowships, programs and applicants participate in a computerized ranking and matching system organized by the National Resident Matching Program.

Radiology residencies, like other residency programs in the United States, are accredited by the ACGME (Accreditation Council for Graduate Medical Education). Skill in practical radiology at the workstation as well as basic interventional competence (covering areas similar to those in DOPS, IPX, and CAT in the Australian pathway) is subsumed into the ACGME accreditation of the residency. The ACGME offers accreditation of some but not all fellowship subspecialties.

The American Board of Radiology (ABR) requires two computer-based exams to become a board-certified radiologist:

In an announcement4 on April 13th, 2023, the ABR announced that the oral board exam will be returning in a remotely-administered format, starting with the class beginning their R1 year in 2023. This exam (taken after the final year of residency) will assess one's readiness for general practice within seven clinical categories: breast, chest, abdominal, MSK, nuclear radiology, pediatrics, and neuroradiology. Procedures, professionalism, and safety will be assessed in tandem with one or more of the aforementioned.

Written exams were once a part of the training pathway but were discontinued after 2013. No exam similar to the RANZCR viva examinations or Final FRCR Part B viva is currently part of the training pathway in the United States.

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