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I don’t think I have any magic bullets to offer here, but here are my impressions just from my own experiences applying.
A big hurdle with a low step 1 is to get your foot in the door.
Things that might help you here: if you have a home radiology program where the program director knows you and might consider looking past the score, or otherwise you are able to be strongly recommended to a program preferably by someone they have a working relationship with.
You will need to bolster your application with other stuff, strong research would be a big plus. I don’t just mean publishing a case study or two, though certainly anything would help. But if you can get involved with research on new ideas in the field, like for example new imaging techniques in MRI or burgeoning methods of imaging certain pathologies, that would be impressive.
If you can find attendings who are doing interesting work and you can take over or spearhead some projects with them, that could open doors.
In short, you will need to do something to get noticed by the programs you are applying to and give them cause to look past the exam. Building relationships directly with staff or departments you might be applying to could make a difference.
