Program Signaling, Geographic Alignment, and Program Reputation in Diagnostic Radiology Interview Invitations: A National Program-level Analysis.

RATIONALE AND OBJECTIVES: As diagnostic radiology (DR) application volumes grow, programs increasingly depend on signaling to differentiate applicant interest, making it important to understand how signaling tiers are associated with applicant selection. Programs also receive geographic preference information meant to support applicant-program fit, yet national patterns in how geography and signaling shape interview selection-and whether program reputation affects their use-remain unclear. MATERIALS AND METHODS: We conducted an updated cross-sectional analysis of the 2025 Residency Explorer program-level interview invitation rates stratified by signaling tier (gold, silver, unsignaled), geographic preference alignment (aligned, unaligned, no preference), and state-level medical school or hometown ties, with program reputation measured using 2025 to 2026 Doximity rankings. Paired Wilcoxon tests assessed within-program differences, and regression models evaluated whether reputation predicted reliance on signaling or geography. RESULTS: Among 199 DR programs, 156 reported signal-tier data, and 103 reported geographic preference data. A strong signal gradient was observed (median interview rates: gold 0.57, silver 0.44, unsignaled 0.06), with 49.4% of programs showing near exclusion of unsignaled applicants. Geographic preference showed even stronger stratification (median interview rates: aligned 0.19, no preference 0.05, unaligned 0.04), with 70.9% of programs showing near exclusion of unaligned applicants. In-state medical school and hometown ties conferred substantial advantages. Gold signals conferred a greater advantage in higher-reputation programs, but geographic screening did not vary by reputation. CONCLUSION: DR programs demonstrated steep gradients in signaling and geography. While higher-reputation programs placed greater weight on gold signals, geographic preference patterns were more consistent across programs.