This paper reviews a test procedure and some empirical and theoretical insights related to V-ribbed belt accessory drive system belt alignment. The paper focuses on the effects of backside pulleys, or the smooth pulleys, which can generate significant belt misalignment. The test procedure has been recently introduced to determine the belt alignment sensitivities of accessory drive belt system variables such as belt tension, belt wrap, belt span length, belt backside surface, and backside pulley crown. The test procedure is described in detail, and some examples of results are provided. The advantages of generating real-time data are also discussed.