This summary of the 53rd Annual Meeting of the National Council on Radiation Protection and Measurements (NCRP) captures the highlights of the presentations including the Warren K. Sinclair Keynote Address and the five scientific sessions and wrap-up summary and panel discussion of "Assessment of National Efforts in Emergency Preparedness for Nuclear Terrorism: Is There a Need for Realignment to Close Remaining Gaps?" The issue of radiological emergency preparedness has evolved in the last 20 y from a primarily nuclear power plant focus to a wider, more comprehensive approach that includes response to all types of radiological and nuclear emergencies, including terrorism. The meeting took an introspective look at the advances in radiological emergency preparedness in the last 15 y and focused on four major topic areas: plans and guidance, training and exercising for both the first responder and the first receiver communities, recovery and return, and communication. In each area, the speakers reflected on the current state of that specific area and provided three to five practicable priority actions/initiatives for future work. As a result of the meeting, NCRP has made a commitment to create a committee to write a commentary that will go into more detail in each of the proposed priority areas discussed in the meeting and provide a roadmap for future work.