100+ Free ABR DR Core Practice Questions

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In diagnostic CT, which of the following best describes the relationship between kVp and image contrast for soft tissues?

Higher kVp increases soft-tissue contrast because Compton scatter is maximized

Lower kVp increases soft-tissue contrast because photoelectric interactions dominate at lower energies

kVp has no effect on contrast; only mAs changes contrast

Higher kVp decreases patient dose and increases contrast simultaneously

to track

2026 Statistics

Key Facts: ABR DR Core Exam

~600

Total MCQ Items

ABR Diagnostic Radiology Core Exam

2 days

Exam Duration

Computer-based testing across 2 consecutive days

~15%

Physics Weight

Largest single domain on ABR Core Exam

$1,950

2026 Core Exam Fee

ABR initial certification

5 yr

Required Training

1 transitional + 4 DR residency (ACGME)

Pearson VUE

Test Delivery

Computer-based testing at authorized centers

The ABR Core 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. The content outline emphasizes physics (~15%), chest (~12%), abdomen/pelvis (~12%), neuroradiology (~10%), MSK (~10%), nuclear/PET-CT (~7%), pediatric/ER (~7%), ultrasound (~5%), breast (~5%), safety/contrast (~5%), vascular/IR basics (~5%), cardiac (~4%), and informatics (~3%). Core Exam fee is ~$1,950; taken after PGY-4 of ACGME DR residency.

Sample ABR DR Core Practice Questions

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

1In diagnostic CT, which of the following best describes the relationship between kVp and image contrast for soft tissues?

A.Higher kVp increases soft-tissue contrast because Compton scatter is maximized

B.Lower kVp increases soft-tissue contrast because photoelectric interactions dominate at lower energies

C.kVp has no effect on contrast; only mAs changes contrast

D.Higher kVp decreases patient dose and increases contrast simultaneously

Explanation: At lower kVp (closer to the k-edges of calcium and iodine), the photoelectric effect dominates, which is strongly dependent on atomic number (Z^3). This markedly increases contrast between soft tissues, iodinated contrast, and bone. Raising kVp shifts interactions toward Compton scatter (Z-independent) and reduces contrast. mAs primarily controls noise/dose, not contrast.

2Which Hounsfield unit (HU) value is closest to normal non-contrast brain parenchyma?

A.0 HU

B.30-40 HU

C.-100 HU

D.200 HU

Explanation: Normal brain parenchyma measures approximately 20-40 HU on non-contrast CT (gray matter 35-45, white matter 20-30). Water is 0, air is -1000, fat is -80 to -100, and cortical bone is >+1000. Acute hemorrhage is hyperdense at approximately 50-70 HU.

3On MRI, which sequence best suppresses CSF signal to highlight periventricular lesions such as multiple sclerosis plaques?

A.FLAIR (Fluid-Attenuated Inversion Recovery)

B.STIR

C.T1-weighted spin echo

D.Gradient echo

Explanation: FLAIR uses an inversion pulse timed (long TI) to null CSF signal, leaving periventricular white-matter lesions (MS plaques, gliosis) conspicuous. STIR nulls fat (short TI). T1 and gradient echo do not preferentially suppress CSF.

4Which MRI sequence is MOST sensitive for detecting acute ischemic stroke within the first few hours?

A.T1-weighted post-contrast

B.Diffusion-weighted imaging (DWI) with ADC map

C.T2-weighted fast spin echo

D.Time-of-flight MRA

Explanation: Acute ischemic stroke causes cytotoxic edema, restricting water diffusion. DWI shows hyperintensity (bright) with corresponding low ADC (dark) within minutes of ischemia — long before T2/FLAIR changes become visible. T2/FLAIR changes typically appear at 4.5-6 hours.

5On non-contrast CT of acute ischemic stroke, which finding is a well-recognized early sign?

A.Honeycomb destruction of gray matter

B.Ring-enhancing lesion with central necrosis

C.Dawson fingers

D.Hyperdense middle cerebral artery (MCA) sign

Explanation: The hyperdense MCA sign reflects a fresh thrombus within the M1 segment and is a classic early (<6 hours) CT finding of acute ischemic stroke. Other early signs include loss of gray-white differentiation, insular ribbon sign, and basal ganglia obscuration. ASPECTS score quantifies these early ischemic changes.

6According to the 2017 Fleischner Society guidelines, a 4 mm solid pulmonary nodule incidentally detected on CT in a low-risk patient requires which follow-up?

A.CT at 3 months

B.No routine follow-up is required

C.PET-CT immediately

D.Biopsy

Explanation: Per Fleischner 2017 for solid nodules in a low-risk patient: <6 mm — no routine follow-up; 6-8 mm — CT at 6-12 months with optional 18-24 month follow-up; >8 mm — CT at 3 months, PET-CT, or tissue sampling. For high-risk patients, <6 mm nodules can have optional 12-month CT.

7Which HRCT pattern is MOST characteristic of usual interstitial pneumonia (UIP) from idiopathic pulmonary fibrosis?

A.Basal, subpleural, peripheral honeycombing with traction bronchiectasis

B.Upper-lobe perilymphatic nodules

C.Diffuse centrilobular ground-glass opacities

D.Reverse halo sign (atoll sign)

Explanation: UIP on HRCT (ATS/ERS/JRS/ALAT criteria) shows basal and subpleural predominance with reticulation, traction bronchiectasis, and honeycombing. Perilymphatic nodules with upper-lobe predominance suggests sarcoidosis. Reverse halo (atoll) suggests organizing pneumonia (OP/COP).

8Which sign on chest radiograph has long been associated with pulmonary embolism showing a peripheral wedge-shaped opacity of pulmonary infarction?

A.Kerley B lines

B.Hampton hump

C.Silhouette sign

D.Luftsichel sign

Explanation: Hampton hump is a pleura-based, wedge-shaped opacity indicating pulmonary infarction distal to a PE. Westermark sign is regional oligemia distal to a PE. CT pulmonary angiogram is now the diagnostic modality of choice, directly visualizing filling defects in the pulmonary arteries.

9Which USPSTF 2021 recommendation defines eligibility for low-dose CT lung cancer screening?

A.Age 55-74, ≥30 pack-years, current smoker only

B.Age 40+, any smoking history

C.Age 50-80, ≥20 pack-years, current smoker or quit within 15 years

D.Anyone with a family history of lung cancer

Explanation: USPSTF 2021 updated LDCT lung-cancer screening to age 50-80 (previously 55-80) with ≥20 pack-years (previously ≥30), currently smoking or having quit within 15 years. Screening should stop once a person has not smoked for 15 years or develops a condition that limits life expectancy. Results are reported using Lung-RADS categories.

10An anterior mediastinal mass in a 30-year-old is most likely to be which of the following (classic '4 Ts')?

A.Esophageal duplication cyst

B.Thymoma, teratoma, thyroid (substernal goiter), or 'terrible' lymphoma

C.Neurogenic tumor (schwannoma)

D.Bronchogenic cyst

Explanation: The '4 Ts' of the anterior mediastinum are Thymoma/Thymic carcinoma, Teratoma (germ cell tumor), Thyroid (substernal goiter), and 'Terrible' lymphoma. Middle mediastinal masses include adenopathy and bronchogenic/foregut cysts; posterior mediastinal masses are typically neurogenic (schwannoma, neurofibroma, ganglioneuroma).

About the ABR DR Core Exam

The ABR Diagnostic Radiology Core Exam is the first of two certifying exams from the American Board of Radiology. The 2-day computer-based test contains approximately 600 single-best-answer MCQs assessing physics and imaging safety, chest/thoracic, abdominal and pelvic (GI/GU), neuroradiology, musculoskeletal, breast, cardiac, 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. Taken after PGY-4 of an ACGME-accredited Diagnostic Radiology residency (1 transitional/preliminary year + 4 DR years).

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 DR Core Exam Content Outline

~15%

Physics & Imaging Modalities

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); PET-CT radiopharmaceuticals.

~12%

Chest / Thoracic

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).

~12%

Abdomen & Pelvis (GI/GU)

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), Bosniak 2019 renal cystic (I/II/IIF/III/IV), adrenal adenoma (<10 HU; washout >60% absolute / >40% relative), PI-RADS prostate, O-RADS ovarian.

~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), pediatric phakomatoses.

~10%

Musculoskeletal

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 breast/lung/thyroid/renal/prostate), 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).

~7%

Pediatric & Emergency 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 (NEXUS/Canadian; PECARN <2 yr), blunt aortic injury (mediastinal widening, periaortic hematoma), pneumoperitoneum (upright CXR, cross-table lateral decubitus).

~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).

~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.

~5%

Radiation Safety & Contrast

ALARA, dose quantities (absorbed Gy, equivalent/effective Sv), deterministic vs stochastic effects, pregnancy <0.5 mSv gestation limit, CT dose metrics (CTDIvol, DLP), Image Gently pediatric dose reduction, iodinated reactions (anaphylactoid; CA-AKI formerly CIN), gadolinium (NSF in CKD stage 4-5, GBCA groups I/II/III, deposition), ACR premedication (methylprednisolone 13/7/1 h + diphenhydramine; short course).

~5%

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.

~4%

Cardiac Imaging

Coronary CTA (SCCT), calcium scoring Agatston (≤100 low, 101-400 moderate, >400 high, >1000 extensive), cardiac MRI delayed-enhancement patterns (subendocardial ischemic; mid-wall DCM; patchy mid-wall HCM; global subendo amyloid; apex HCM), ARVC task-force imaging criteria.

~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).

How to Pass the ABR DR Core 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 DR Core 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 Exam?

The ABR Core Exam is 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. The Core Exam assesses foundational knowledge across all diagnostic imaging — physics and imaging safety, chest, abdomen/pelvis, neuroradiology, musculoskeletal, breast, cardiac, 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?

Candidates must be enrolled in or have completed an ACGME-accredited Diagnostic Radiology residency. The training pathway is 5 postgraduate years — 1 transitional or preliminary year plus 4 years of dedicated Diagnostic Radiology residency. The Core Exam is taken after the PGY-4 year. Candidates must hold a valid unrestricted medical license, have program director attestation, and submit the application through the ABR within the eligibility window.

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. Content is distributed across the ABR Core Exam study guide.

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?

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. 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?

Highest-yield topics include: physics (CT, MRI T1/T2/TR/TE/STIR/FLAIR, US Doppler, dose metrics CTDIvol/DLP), 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 (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.