ACR-SNM Task Force on Nuclear Medicine Training: Report of the Task Force

doi:10.1016/j.jacr.2011.03.009

Journal of the American College of Radiology

Volume 8, Issue 6, June 2011, Pages 388-392

https://doi.org/10.1016/j.jacr.2011.03.009 Get rights and content

The expansion of knowledge and technological advances in nuclear medicine and radiology require physicians to have more expertise in functional and anatomic imaging. The convergence of these two specialties into the new discipline of molecular imaging has also begun to place demands on residency training programs for additional instruction in physiology and molecular biology. These changes have unmasked weaknesses in current nuclear medicine and radiology training programs. Adding to the impetus for change are the attendant realities of the job market and uncertain employment prospects for physicians trained in nuclear medicine but not also trained in diagnostic radiology. With this background, the ACR and the Society of Nuclear Medicine convened the Task Force on Nuclear Medicine Training to define the issues and develop recommendations for resident training.

Section snippets

Background

Since its inception, nuclear medicine (NM) has been noteworthy for its innovation and unique expertise in using radioisotopes for assessing organ function. More recently, this expertise has progressed to characterizing these processes at the cellular and subcellular levels with the emergence of molecular imaging. Within the past decade, assessment of function has become enhanced by the emergence of hybrid imaging techniques, notably PET/CT and SPECT/CT, which combine anatomic and functional

The Role of History

To understand the current issues in NM and radiology training, a brief overview of their origins and influence on the present is instructive [2]. With the discovery of x-rays and naturally occurring radioactivity in the late 19th century, the therapeutic uses of radiation were paramount. However, primarily because of the ready availability of the x-ray tube, imaging the human body using x-rays quickly evolved, while modern physiologic imaging with radioisotopes awaited the advent of the

Training in the Era of Hybrid and Molecular Imaging

CT images that are acquired as part of PET/CT and single photon-emission SPECT/CT need to be interpreted by a physician with appropriate training and experience, which has resulted in recognition that NM physicians must obtain additional training in CT, although there is no consensus on the appropriate amount of training. In addition, molecular imaging requires a broad understanding of metabolism, receptors, cell signaling pathways, and molecular biology. The recent reduction in the number of

Training Pathways for the Future: Recommendations

There was general agreement among the members of the task force that future radiologists and NM physicians will need more training in anatomic and functional imaging to be fully competent in the emerging field of molecular imaging. It is envisioned that most molecular imaging will be practiced by physicians who are dual certified by the ABR and the ABNM. It was also recognized that at present, there is still a need for general radiologists with basic NM training and for NM physicians with basic

Conclusion: A Task Force Facilitating Change

Although changes in training pathways may be seen as necessary by this task force, and recommendations for change have been advanced, the task force is cognizant that hurdles must be leaped and barriers taken down. Given the well-developed cultures that have evolved around the current training pathways, RRCs, and certifying boards and the substantial territorial investments in ownership by both radiology and NM, community-wide acceptance of a new paradigm of compromise and cooperation will be a

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Citation Excerpt :
Four work groups with members of both NM and radiology organizations were established to execute the objectives of the task force, the RRC work group, the board certification work group, the training pathway work group, and the economics work group. These groups reached a strong consensus and finally reported their conclusions and recommendations in a summary document.13 There was general agreement that in the future it was likely that MI would be practiced by physicians who are dually certified by the ABR and the ABNM, and that more training in anatomical and functional imaging would be necessary to reach full proficiency for future radiologists and NM physicians.
Nuclear Medicine (NM) has evolved from a medical subspecialty using quite basic tests to one using elaborate methods to image organ physiology and has truly become “Molecular Imaging.” Concurrently, there has also been a timely debate about who has to be responsible for keeping pace with all of the components of the developmental cycle—imaging, radiopharmaceuticals, and instrumentation. Since the foundation of the American Board of NM, the practice of NM and the process toward certification have undergone major revisions. At present, the debate is focused on the inevitable future convergence of Radiology and NM. The potential for further cooperation or fusion of the American Board of Radiology and the American Board of NM is likely to bring about a new path for NM and Molecular Imaging training. If the merger is done carefully, respecting the strengths of both partners equally, there is an excellent potential to create a hybrid NM-Radiology specialty that combines Physiology and Molecular Biology with detailed anatomical imaging that sustains the innovation that has been central to NM residency and practice. We introduce a few basic trends in imaging use in the United States. These trends do not predict future use, but highlight the need for an appropriately credentialed practitioner to interpret these examination results and provide value to the health care system.
CT training of nuclear medicine residents in the united states, 2013-2014
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Having 2 practitioners interpret and report the same diagnostic imaging examination is neither practical nor efficient. Thus, lack of expertise in independent diagnostic CT interpretation can be an impediment for NM physicians in regard to future and even current employment opportunities [1,2,5-8]. As of July 1, 2011, the ACGME published a revision of the NM program requirements that increased the CT training for NM residents from 4 to 6 months, of which 4 months are required on a dedicated diagnostic CT service, and 2 additional months on either a dedicated diagnostic CT service or a CT hybrid rotation [9].
In 2011, the ACGME Nuclear Medicine (NM) Residency Review Committee revised the NM program requirements, which increased CT training for NM residents. This article examines the effect of this revision.
Requests were e-mailed to all NM program directors asking that their residents be given the opportunity to complete an online survey regarding their CT training. Subsequently, an identical online survey regarding CT training was e-mailed directly to all members of the NM Residents Organization of the American College of NM asking that they complete the survey regarding their CT training if they had not already done so.
Resident responses, compared with those from a similar 2011 survey, indicate a perception that CT training and CT expertise gained in ACGME-accredited NM programs have improved. However, some NM residents are not provided with the opportunity to develop critical skills in interpreting and dictating CT scans during their time on dedicated CT services. The survey indicates that experience gained during NM residency in head and neck/neuroradiology, emergency, and musculoskeletal CT is marginal at best. A slight majority felt that CT training should be further increased.
Compared with a 2011 survey of NM residents and the 2011 implementation of expanded CT training requirements, a follow-up survey seems to indicate improvement in CT training for most NM residents. Nevertheless, an opportunity clearly remains to further improve the breadth and depth of CT skills during NM residency. However, whether such an improvement will result in a reversal of multiyear downward trends in the number of NM residents and training programs in the United States is not clear.
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In 2010, the American Board of Radiology (ABR) approved a new 16-month nuclear subspecialty training pathway within a standard 48-month Accreditation Council for Graduate Medical Education (ACGME)–accredited diagnostic radiology (DR) residency available to institutions sponsoring ACGME-accredited nuclear radiology (NR) and/or nuclear medicine (NM) program(s). This accelerated pathway leads to eligibility for dual ABR certifications in DR and NR or in NM by the American Board of Nuclear Medicine (ABNM). The American College of Radiology, in conjunction with the ABR, aimed to understand adoption of this new pathway, barriers to implementation, preferences for subspecialty certification, and competing alternative combined DR/NR/NM training pathways.
During 2013–2014, there were 20 ACGME-accredited NR fellowship and 43 ACGME-accredited NM residency programs eligible to adopt this new 16-month pathway. They were surveyed by e-mail correspondence regarding implementation and barriers to implementation, board certification (ABR-NR and ABNM) preferences, and local alternative training pathways.
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Original articleACR-SNM Task Force on Nuclear Medicine Training: Report of the Task Force