100+ Free ABR Core Exam Practice Questions

Pass your ABR Diagnostic Radiology Core Exam (Qualifying Exam) exam on the first try — instant access, no signup required.

✓ No registration✓ No credit card✓ No hidden fees✓ Start practicing immediately

~85-90% first-attempt (ABR publishes annual pass-rate summaries) Pass Rate

100+ Questions

100% Free

1 / 100

Question 1

Score: 0/0

On a CT scan, what is the Hounsfield unit (HU) value of water by definition?

-1000 HU

0 HU

+100 HU

+1000 HU

to track

Same family resources

More ABR Radiology and Medical Physics Certifications Prep

Continue through related practice pages, study guides, comparisons, and articles from the same exam family.

Practice Pages

ABR Practice200 questions ABR Diagnostic Medical Physics Practice100 questions ABR Diagnostic Radiology Primary Certification Practice100 questions ABR IR and Diagnostic Radiology Primary Certification Practice100 questions ABR Neuroradiology Practice100 questions ABR Nuclear Medical Physics Practice100 questions

2026 Statistics

Key Facts: ABR Core Exam Exam

~600

Total MCQ Items

ABR Diagnostic Radiology Core (Qualifying) Exam

2 days

Exam Duration

Computer-based testing across 2 consecutive days

~15%

Physics/NIS Weight

Largest single domain on ABR Core Exam

$1,950

2026 Core Exam Fee

ABR initial certification

36 mo

Required DR Residency

Core Exam taken after 36 months ACGME DR residency

Pearson VUE

Test Delivery

Computer-based testing at authorized centers

The ABR Core (Qualifying) Exam is a 2-day computer-based test administered at Pearson VUE test centers containing ~600 single-best-answer image-rich MCQs over ~16 hours across 2 days. Content emphasizes physics/NIS (~15%), cardiothoracic (~12%), GI (~10%), GU (~8%), neuroradiology (~10%), MSK (~10%), nuclear/PET-CT (~7%), pediatric (~7%), ultrasound (~5%), breast (~5%), vascular/IR basics (~5%), and informatics (~3%). Core Exam fee is ~$1,950; taken after 36 months of DR residency and is prerequisite to the Certifying Exam.

Sample ABR Core Exam Practice Questions

Try these sample questions to test your ABR Core Exam exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1On a CT scan, what is the Hounsfield unit (HU) value of water by definition?

A.-1000 HU

B.0 HU

C.+100 HU

D.+1000 HU

Explanation: By definition, water = 0 HU. Air = -1000 HU, fat is approximately -50 to -100 HU, muscle is approximately +40 HU, acute hemorrhage is +50 to +70 HU, and dense cortical bone is >+1000 HU. The HU scale is calibrated so that water is exactly zero and air is -1000.

2Increasing kVp on a CT scanner has which primary effect on image quality and dose?

A.Decreases patient dose and increases tissue contrast

B.Increases patient dose and decreases tissue contrast

C.Decreases patient dose and decreases noise without affecting contrast

D.Has no effect on dose and increases noise

Explanation: Increasing kVp raises the average photon energy, which increases patient dose (dose ~ kVp^2 to kVp^2.5) and reduces tissue contrast because higher-energy photons see less differential attenuation between tissues. mAs primarily affects noise (linearly) and dose (linearly) but not contrast.

3Which MRI sequence is best for suppressing CSF signal to highlight periventricular lesions?

A.T1-weighted

B.T2-weighted

C.FLAIR

D.STIR

Explanation: FLAIR (Fluid Attenuated Inversion Recovery) uses a long inversion time to null CSF signal, making it dark while preserving T2 weighting in tissues. This is ideal for detecting periventricular lesions such as MS plaques. STIR nulls fat. T1 and T2 do not specifically suppress CSF.

4On DWI/ADC mapping, restricted diffusion (e.g., acute infarct) appears how?

A.Bright on DWI, bright on ADC

B.Bright on DWI, dark on ADC

C.Dark on DWI, dark on ADC

D.Dark on DWI, bright on ADC

Explanation: True restricted diffusion is bright (hyperintense) on DWI and dark (hypointense) on the ADC map. T2 shine-through can also be DWI-bright but is also bright on ADC, distinguishing it from true restriction. Acute ischemic infarct shows DWI restriction within minutes.

5Which CT dose metric represents the dose delivered per unit length, integrated over the scanned anatomy?

A.CTDIvol

B.DLP (Dose-Length Product)

C.SSDE

D.Effective dose (Sv)

Explanation: DLP = CTDIvol × scan length (mGy·cm) and represents total integrated dose for an exam. CTDIvol represents the average dose per slice within the scanned volume. SSDE corrects for patient size. Effective dose (Sv) accounts for tissue radiosensitivity and is derived from DLP using k-factors.

6According to the ACR Manual on Contrast Media, what is the standard 13-hour elective premedication regimen for prior moderate iodinated contrast reaction?

A.Diphenhydramine 50 mg IV 1 h before contrast only

B.Methylprednisolone 32 mg PO at 13 h, 7 h, and 1 h before contrast plus diphenhydramine 50 mg 1 h before

C.Hydrocortisone 200 mg IV q4h × 3 doses only

D.Epinephrine 0.3 mg IM 30 min before contrast

Explanation: The Greenberger 13-hour ACR elective premedication regimen is methylprednisolone 32 mg PO at 13, 7, and 1 hours prior to contrast, plus diphenhydramine 50 mg IV/PO/IM 1 hour prior. The accelerated short regimen uses hydrocortisone 200 mg IV q4h.

7Nephrogenic systemic fibrosis (NSF) risk is highest with which scenario?

A.Group II GBCA in a patient with eGFR 90

B.Group I GBCA in a patient with eGFR <30 (CKD stage 4-5)

C.Group III GBCA in pregnancy with normal renal function

D.Any GBCA in a hemodialysis patient if dialyzed within 30 minutes

Explanation: NSF is a rare but serious fibrosing disorder linked to gadolinium exposure in patients with severe renal impairment (eGFR <30, CKD stage 4-5, or AKI). Risk is highest with Group I GBCAs (e.g., gadodiamide). Group II macrocyclic agents have negligible NSF risk and are preferred when GBCAs are needed in CKD.

8Which of the following is a deterministic (tissue-reaction) radiation effect with a threshold dose?

A.Radiation-induced leukemia

B.Solid tumor induction

C.Cataract formation

D.Heritable genetic mutation

Explanation: Cataracts are a deterministic effect with a threshold (~0.5 Gy per ICRP 2011). Severity increases with dose above threshold. Cancer induction (leukemia, solid tumors) and heritable effects are stochastic — probability increases with dose without a threshold, but severity does not depend on dose. Skin erythema and epilation are also deterministic.

9What is the primary purpose of the ABR Non-Interpretive Skills (NIS) domain?

A.Test image interpretation accuracy across modalities

B.Assess practice-management knowledge: safety, quality, communication, ethics, and informatics

C.Replace the physics section of the Core Exam

D.Evaluate procedural competency in IR

Explanation: NIS covers practice-of-radiology competencies: patient safety, quality improvement, professionalism/ethics, communication of findings, contrast and radiation safety, informatics/PACS, and management. NIS is integrated throughout the Core Exam rather than tested as a separate isolated domain.

10Compared with color Doppler, power Doppler is more sensitive to slow flow but lacks which feature?

A.Ability to display flow at all

B.Information about flow direction

C.Real-time imaging capability

D.Compatibility with B-mode overlay

Explanation: Power Doppler displays the integrated power (amplitude) of the Doppler signal — angle-independent and more sensitive to slow flow — but it does not encode direction. Color Doppler encodes both direction (toward/away) and mean velocity but is angle-dependent and less sensitive to slow flow.

About the ABR Core Exam Exam

The ABR Diagnostic Radiology Core Exam (Qualifying Exam) is the first of two certifying exams from the American Board of Radiology, taken after 36 months of ACGME-accredited DR residency (typically PGY-4) before the Certifying Exam. The 2-day computer-based test contains approximately 600 single-best-answer image-rich MCQs assessing physics and imaging safety (NIS), cardiothoracic, gastrointestinal, genitourinary, neuroradiology, musculoskeletal, breast, vascular and interventional basics, pediatric, nuclear medicine/PET-CT, ultrasound, and informatics. Questions use image-rich vignettes drawn from CT, MRI, US, radiography, fluoroscopy, mammography, and nuclear medicine.

Questions

600 scored questions

Time Limit

2-day CBT (~16 hours across 2 days)

Passing Score

Criterion-referenced scaled score set by ABR subject-matter experts

Exam Fee

~$1,950 Core Exam fee (ABR 2026) (American Board of Radiology (ABR) / Pearson VUE)

ABR Core Exam Exam Content Outline

~15%

Physics & Safety (NIS)

X-ray production (tube kVp 60-120, mAs, Al 2.5 mm equivalent filtration, bremsstrahlung + characteristic), digital detectors (CR/DR), kVp vs mAs effects on contrast/noise, HVL; CT (helical, MDCT, dual-energy, iterative reconstruction ASIR/SAFIRE/DLR, HU scale water 0/air -1000/bone >+1000); MRI (1.5T/3T, T1 vs T2, TR/TE, STIR fat-sat, FLAIR CSF suppression, TOF MRA, DWI/ADC restriction, MR spectroscopy — NAA, Cho, Cr, lactate); US (B-mode, color/power/spectral Doppler, elastography, CEUS); mammography (25-30 kVp Mo/Rh); ALARA, dose metrics (CTDIvol, DLP), iodinated and gadolinium contrast safety, ACR premedication.

~12%

Cardiothoracic Imaging

Pneumonia patterns (lobar, bronchopneumonia, interstitial; Klebsiella bulging fissure), ILD (UIP — basal subpleural honeycombing with traction bronchiectasis, ATS/ERS; NSIP; OP/COP reverse halo; sarcoidosis perilymphatic), SPN Fleischner 2017, lung cancer screening LDCT 50-80 with ≥20 pack-years (USPSTF 2021), Lung-RADS, mediastinal masses (anterior 4Ts, middle LAD, posterior neurogenic), PE on CTPA (Hampton hump, Westermark), aortic dissection (Stanford A/B, DeBakey I/II/III); coronary CTA, calcium scoring Agatston, cardiac MRI delayed-enhancement patterns (subendocardial ischemic; mid-wall DCM; patchy mid-wall HCM; global subendo amyloid).

~10%

Gastrointestinal Imaging

Appendicitis (US first pediatric; CT adult; target, >6 mm non-compressible), bowel obstruction, free air on upright CXR or cross-table lateral, diverticulitis, IBD, GI bleeding workup (CTA vs tagged RBC), liver masses (hemangioma discontinuous nodular peripheral fill-in; FNH central scar T2 bright; HCC — LI-RADS arterial enhancement + washout ± capsule), pancreatitis (CTSI, IPMN main/side-branch), gallbladder (cholecystitis WES sign, porcelain), esophageal disease.

~8%

Genitourinary Imaging

Renal mass Bosniak 2019 cystic (I/II/IIF/III/IV), adrenal adenoma (<10 HU; washout >60% absolute / >40% relative), PI-RADS prostate, O-RADS ovarian and adnexal, urolithiasis (NCCT), renal cell carcinoma staging, transitional cell carcinoma, testicular tumors and torsion (US), gynecologic imaging (endometrial thickness postmenopausal, uterine fibroids), pregnancy-related findings.

~10%

Neuroradiology

Acute stroke (hyperdense MCA, loss of gray-white, insular ribbon, ASPECTS; CTP core/penumbra; DWI restricts acute, FLAIR mismatch 4.5 h), ICH (hypertensive basal ganglia/thalamus/pons/cerebellum; CAA lobar; SWI microbleeds), tumors (GBM ring-enhancing with central necrosis; meningioma dural-based with dural tail; CP angle vestibular schwannoma ice-cream cone; 4th ventricle ependymoma peds; cerebellar midline medulloblastoma), MS McDonald 2017 (Dawson fingers, periventricular, juxtacortical, infratentorial, cord), aneurysm/AVM/cavernoma (popcorn + hemosiderin rim).

~10%

Musculoskeletal Imaging

Trauma (Salter-Harris I-V pediatric, named fractures), arthritis (OA — osteophytes, subchondral sclerosis, joint-space narrowing; RA — marginal erosions, symmetric, carpal; psoriatic — pencil-in-cup, DIP, dactylitis; AS — sacroiliitis, bamboo spine; gout — tophi, rat-bite; CPPD — chondrocalcinosis), tumors (benign — osteoid osteoma <1.5 cm nidus, osteochondroma, NOF, enchondroma, FD ground glass; malignant — osteosarcoma sunburst/Codman, Ewing onion-skin; mets), osteomyelitis (MRI, sequestrum, involucrum), pediatric (DDH, LCP, SCFE).

~7%

Nuclear Medicine & PET-CT

Radiopharmaceuticals (Tc-99m MDP bone scan, sestamibi cardiac/parathyroid, I-123/I-131 thyroid), FDG PET-CT oncology staging, Ga-68 DOTATATE for neuroendocrine, PSMA PET for prostate, F-18 FES for ER+ breast, Zr-89 immunoPET, F-18 amyloid brain (florbetapir, flutemetamol), theranostics (Lu-177 DOTATATE, Lu-177 PSMA-617), V/Q scan for PE, MAG3/DMSA renal, octreotide imaging.

~7%

Pediatric Radiology

Pyloric stenosis (muscle >4 mm thickness, length >14 mm), malrotation (ligament of Treitz position on upper GI), intussusception (target/donut on US, air enema reduction), trauma FAST, C-spine clearance (PECARN <2 yr), pediatric phakomatoses (TSC tubers, NF1 UBOs, Sturge-Weber pial enhancement), congenital heart disease, NEC, neonatal lung disease (RDS, TTN, MAS), pediatric posterior fossa tumors (medulloblastoma, ependymoma, pilocytic astrocytoma, ATRT).

~5%

Ultrasound

B-mode gray-scale, color and power Doppler (power more sensitive to slow flow but no direction), spectral Doppler (RI/PI), CEUS microbubbles, elastography (strain vs shear-wave), artifacts (shadowing, posterior enhancement, mirror image, twinkle in calculi), obstetric and gynecologic US (ectopic, discriminatory β-hCG/TVUS), abdominal US, thyroid US (TI-RADS), carotid duplex.

~5%

Breast Imaging

BI-RADS 0-6 (0 incomplete, 1 negative, 2 benign, 3 probably benign <2% malignancy short-interval f/u, 4A/B/C suspicious, 5 highly suggestive >95%, 6 biopsy-proven), screening (USPSTF 2024 biennial 40-74; ACS annual 45-54 then biennial 55+; ACR annual 40+), DBT tomosynthesis, MRI for high-risk >20% lifetime (BRCA1/2, Li-Fraumeni, Cowden, chest RT), microcalcifications (pleomorphic, heterogeneous, amorphous), architectural distortion, DCIS.

~8%

Vascular & IR Basics

AAA screening USPSTF (65-75 ever-smoked men one-time US), PAD (ABI), carotid US (>70% stenosis per NASCET), venous imaging (DVT compression US, Phlegmasia cerulea/alba dolens), endovascular (thrombolysis, mechanical thrombectomy for acute limb ischemia), IR-guided biopsy, percutaneous abscess drainage, central line placement, gastrostomy, TIPS, embolization (UAE, GI bleed).

~3%

Informatics & Quality

PACS and RIS workflows, structured reporting, peer learning/peer review, ACR Appropriateness Criteria, Imaging 3.0, communication of actionable findings (critical and urgent results), radiomics, AI in radiology (triage, worklist prioritization, computer-aided detection), quality improvement and patient safety (NIS-related).

How to Pass the ABR Core Exam Exam

What You Need to Know

Passing score: Criterion-referenced scaled score set by ABR subject-matter experts
Exam length: 600 questions
Time limit: 2-day CBT (~16 hours across 2 days)
Exam fee: ~$1,950 Core Exam fee (ABR 2026)

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABR Core Exam Study Tips from Top Performers

1Fleischner Society 2017 pulmonary nodule guidelines stratify recommendations by nodule size, number, and density. For SOLID nodules in a low-risk patient: <6 mm — no routine follow-up; 6-8 mm — CT at 6-12 months, consider 18-24 months; >8 mm — CT at 3 months or PET/tissue sampling. For SUBSOLID nodules: GGN <6 mm — no follow-up; GGN ≥6 mm — CT at 6-12 months then every 2 years for 5 years; part-solid <6 mm — no follow-up; part-solid ≥6 mm — CT at 3-6 months; if persistent with solid component ≥6 mm — biopsy/resection.

2LI-RADS (Liver Imaging Reporting and Data System) for HCC in high-risk patients. Major features: nonrim arterial phase hyperenhancement, nonperipheral washout, enhancing capsule, and threshold growth (≥50% size increase within 6 months). LR-5 (definitely HCC) = ≥10 mm with nonrim APHE + 1 or more additional major features (washout, capsule, or threshold growth). LR-4 probable, LR-3 intermediate, LR-M probable/definite non-HCC malignancy. LR-TR for treatment response.

3Bosniak 2019 renal cystic mass classification. I — simple cyst, no follow-up. II — minimally complex benign. IIF — needs follow-up. III — indeterminate, ~50% malignancy, surgery/biopsy. IV — clearly malignant, surgery. Key 2019 updates: allow for MRI grading, allow thin septa (≤3 mm), objective measurements for enhancement, and move some lesions previously classified III to IIF.

4Adrenal incidentaloma workup. Non-contrast HU ≤10 = lipid-rich adenoma — no further workup. HU >10 = proceed to washout CT. Absolute washout = (enhanced HU − delayed HU) / (enhanced HU − unenhanced HU) × 100. Absolute washout >60% or relative washout >40% = adenoma. Low washout + high HU = consider metastasis, pheochromocytoma, or adrenocortical carcinoma. Always check for biochemical evidence of functioning adenoma (pheo: metanephrines; Cushing: dex suppression).

5Acute ischemic stroke imaging pearls. Non-contrast CT — hyperdense MCA sign, loss of gray-white differentiation, insular ribbon sign, basal ganglia obscuration; ASPECTS score (10 = normal, deduct 1 per affected region). CT perfusion — core (low CBV and low CBF) vs penumbra (preserved CBV, decreased CBF, prolonged MTT) — reperfusion target is the penumbra. MRI DWI shows restricted diffusion (bright DWI, dark ADC) within minutes. DWI/FLAIR mismatch (DWI+ but FLAIR−) suggests onset <4.5 hours and informs thrombolysis eligibility in unknown-onset stroke (WAKE-UP trial).

Frequently Asked Questions

What is the ABR Diagnostic Radiology Core (Qualifying) Exam?

The ABR Core Exam is the qualifying exam — the first of two certifying exams from the American Board of Radiology for diagnostic radiology board certification. It is a 2-day computer-based image-rich examination taken at Pearson VUE test centers after 36 months of ACGME-accredited DR residency (typically PGY-4). The Core Exam assesses foundational knowledge across all diagnostic imaging — physics and Non-Interpretive Skills (NIS) safety, cardiothoracic, GI, GU, neuroradiology, musculoskeletal, breast, vascular/interventional basics, pediatric, nuclear medicine/PET-CT, ultrasound, and informatics. After passing the Core Exam and completing residency, candidates must pass the ABR Certifying Exam to achieve full certification.

Who is eligible to take the ABR Core Exam and when?

The Core Exam is taken after 36 months of ACGME-accredited Diagnostic Radiology residency, typically during PGY-4. The full training pathway is 5 postgraduate years — 1 transitional or preliminary year plus 4 years of dedicated Diagnostic Radiology residency. Candidates must hold a valid unrestricted medical license, have program director attestation of satisfactory progress, and submit the application through the ABR within the eligibility window. Successful completion of the Core Exam is a prerequisite to sitting for the Certifying Exam after residency completion.

What is the format of the ABR Core Exam?

The Core Exam is a 2-day computer-based image-rich examination administered at Pearson VUE test centers, consisting of approximately 600 single-best-answer multiple-choice questions delivered over about 16 hours across the 2 days. Questions extensively use clinical vignettes with imaging (CT, MRI, US, radiographs, fluoroscopy, mammography, nuclear medicine) and are organized by organ-system categories plus physics and Non-Interpretive Skills (NIS). Content is distributed across the ABR Core Exam study guide with physics/NIS as the largest single domain (~15%).

How much does the 2026 ABR Core Exam cost?

The 2026 ABR Core Exam fee is approximately $1,950. The subsequent Certifying Exam (taken 15 months after residency completion) has a separate fee (approximately $1,640). Continuing Certification (MOC) is maintained through the ABR Online Longitudinal Assessment (OLA) with annual fees. Retakes within the eligibility window require full re-registration and fee payment. Cancellation and refund policies follow the ABR schedule with decreasing refunds as the exam date approaches.

When is the 2026 Core Exam administered?

The ABR Core Exam is typically offered twice per year in testing windows (historically spring and fall). Applications open several months in advance with submission deadlines prior to each testing window. Candidates schedule specific Pearson VUE appointments after application approval. Exact 2026 dates should be confirmed on the ABR Diagnostic Radiology Core Exam page.

How is the Core Exam scored and what is the pass rate?

The ABR uses a criterion-referenced scaled scoring system with a passing standard set by subject-matter experts. A candidate's pass/fail result depends on performance relative to the fixed cut-score rather than on other test-takers (not graded on a curve). The first-attempt pass rate is historically ~85-90%. Score reports include subdomain performance by organ system and by physics to guide future study and potential retake preparation. Results are typically released several weeks after each testing window closes.

What are the highest-yield topics for the Core Exam?

Highest-yield topics: physics/NIS (CT, MRI T1/T2/TR/TE/STIR/FLAIR, US Doppler, dose metrics CTDIvol/DLP — physics is the largest single domain ~15%), Fleischner 2017 lung nodules and Lung-RADS, ILD UIP pattern (basal subpleural honeycombing with traction bronchiectasis), LI-RADS for HCC (arterial enhancement + washout ± capsule), Bosniak 2019 renal cystic, adrenal adenoma (<10 HU; washout >60%/>40%), BI-RADS and screening guidelines, acute stroke (DWI/FLAIR, ASPECTS), MS McDonald 2017, arthritis imaging patterns, Salter-Harris, pediatric abdomen (pyloric stenosis, malrotation, intussusception), and PET-CT tracers (FDG, PSMA, DOTATATE, FES, amyloid).

How should I study for the ABR Core Exam?

Use a structured 18-24 month longitudinal plan beginning in PGY-3 and intensifying in PGY-4. Map to the ABR Core Exam study guide: lead with physics/NIS (Hendee, Huda, RSNA/AAPM physics modules), then body imaging (Brant and Helms, Webb/Brant/Major chest, Federle abdomen), neuroradiology (Osborn), MSK (Manaster), pediatric (Donnelly Fundamentals), nuclear medicine (Mettler, RADPrimer/STATdx), and breast (ACR BI-RADS). Drill image-rich MCQs (RSNA Diagnostic Radiology In-Training Exam (DXIT), ACR In-Training, Radprimer, Crack the Core, Core Review series) and complete 2-3 full-length timed mock exams.