Changes in the certification program of the ABR were first described in some detail in 2008 and have since undergone refinements. Controversies surrounding these changes have included the relevance of test questions, costs, effects of altering the examination scheduling, residency program curriculum changes, and issues related to preparing for the examinations. However, the role of psychometric testing in radiology itself, as the technical foundation for the new ABR Core and Certification Examinations, has undergone less scrutiny. This article examines the validity and consequences of the ABR psychometric testing process, and we conclude that its validity can be challenged and that negative consequences, including adverse effects on allocating human and financial resources and on what is taught and learned in residency programs, should be addressed. The ABR could collaborate with the ACGME, education experts, patients, and public representatives to reform their testing processes, especially by integrating modern evaluation techniques that more authentically simulate radiology practices to better align the examination with its intended purposes.