Milton J. Guiberteau

SNM Practice Guideline for Breast Scintigraphy with Breast-Specific γ-Cameras 1.0

VOICE Credit: This activity has been approved for 1.0 VOICE (Category A) credit. For CE credit, participants can access this activity on page 17A or on the SNM Web site (http://www.snm.org/ce_online) through December 31, 2012. You must answer 80% of the questions correctly to receive 1.0 CEH (Continuing Education Hour) credit.

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

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.

Are Nuclear Medicine Residents Prepared for Employment? A Survey-Informed Perspective

INTRODUCTION Nuclear medicine (NM) residency is a 3-year specialty program. However, previous accredited graduate medical education can satisfy up to 2 years of the 3-year requirement. There are 3NMresidency pathways available: (1) 3 years (after 1 year of graduate medical education), (2) 2 years (after 2 years of graduate medical education), and (3) 1 year (after completion of an accredited diagnostic radiology [DR] residency) [1]. The majority of NM residents are nonradiologists enrolled in 2-year or 3-year pathways; the 1-year pathway is populated by those already trained in DR. Thus, NM residents constitute a heterogeneous group. NM graduates from 2-year and 3-year programs are eligible for NM certification through the American Board of Nuclear Medicine (ABNM) only. Graduates from the 1-year program can pursue dual certification in DR and in NM through the ABR and the ABNM, respectively; these graduates are also eligible for ABR subspecialty certification in nuclear radiology. Radiology practices are experiencing an explosion in hybrid imaging (PET/CT, SPECT/CT). Coupled with manpower efficiencies forced by current economic constraints, there has been a clear demand for physicians with dual competency in radiology-based body imaging (especially CT) and NM. In recent years, many NM and DR educators have expressed their concerns regarding the employability of NM-only trainees who lack independent expertise in anatomic imaging. Relevant discussions have occurred within and among the

Adoption of the 16-Month American Board of Radiology Pathway to Dual Board Certifications in Nuclear Radiology and/or Nuclear Medicine for Diagnostic Radiology Residents

RATIONALE AND OBJECTIVES 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. MATERIALS AND METHODS 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. RESULTS With 100% of the surveys completed, a small cadre of qualifying DR programs (14, 22%) has adopted (9, 14%) or is seriously considering adopting (5, 8%) the 16-month ABR pathway. For most, implementation is problematic with numerous barriers in common. Five (8%) institutions are developing 60-month nontraditional models as alternative routes to ABR-DR/ABR-NR certifications and/or dual ABR/ABNM board certifications. CONCLUSIONS In spite of strategies to promote a shortened training pathway in NR/NM, traditional subspecialty fellowships outside the DR residency remain the dominant pathway leading to ABR subspecialty certification in NR and/or ABNM certification for diagnostic radiologists.

Counterpoint: Maintenance of Certification: Focus on Physician Concerns

the implementation of a new process viewed as an added burden by physicians already coping with increased workloads, growing administrative tasks, and mounting regulatory requirements. In an article in this issue of JACR � , “Twin Dogmas of Maintenance of Certification,” the author’s stated intent is to “show how MOC is of value” while exposing “fallacies” in familiar arguments both supporting and questioning the effectiveness of MOC. In doing so, he has dutifully assembled a list of miscellaneous criticisms directed toward MOC in the frequently quoted and very public discussions between the American Board of Internal Medicine and a vocal minority of its diplomates. As such, these concerns are not necessarily pertinent to or reflective of the discussions between diplomates and the remaining 23 specialty boards that constitute the ABMS. Although comprehensive, such a lengthy recounting detracts from the fewer critical issues more widely perceived as barriers to the universal acceptance of MOC. For this reason, we wish to add to this discussion by focusing on selected issues most in need of clarification and with the greatest potential for improving physicians’ and, more specifically, radiologists’ experiences with MOC.

Career prospects for graduating nuclear medicine residents: survey of nuclear medicine program directors.

There has been much consternation in the nuclear medicine (NM) community in recent years regarding the difficulty many NM graduates experience in securing initial employment. A survey designed to determine the extent and root causes behind the paucity of career opportunities was sent to all 2010-2011 NM residency program directors. The results of that survey and its implications for NM trainees and the profession are presented and discussed in this article.

CT training of nuclear medicine residents in the united states, 2013-2014

PURPOSE 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.

Recruitment Into a Combined Radiology/Nuclear Medicine Subspecialty

Between the 2009-2010 and 20152016 academic years the number of nuclear medicine (NM) residency programs accredited by the ACGME has dropped 23%, from 56 to 43, and NM residents 48%, from 166 to 86. During the 20152016 year only 86 of 158 (54%) NM residency slots and 13 of 37 (35%) nuclear radiology (NR) fellowship slots were filled [1-3]. Unfilled slots place residency and fellowship programs at risk for closure. At a time when combined skills in diagnostic radiology (DR) and NM or NR are highly soughtafter by private and academic practices, these unfilled positions are lost opportunities for diagnostic radiologists to receive marketable advanced training. Therefore, it is timely to establish a robust recruitment program to encourage more DR residents to pursue advanced training in NM or NR and to attract medical students into combined DR and NM or NR residency programs. Marketability of NM graduates is far better for diagnostic radiologists than for those without certification in DR for many reasons, including that NM physicians cannot cross-cover other radiological disciplines; some even have difficulty providing independent interpretations of hybrid imaging

American board of radiology maintenance of certification program: Evolution to better serve stakeholders

*21st Century Oncology, Inc, Fort Myers, Florida; yAmerican Board of Radiology, Tucson, Arizona; zHuntsman Cancer Institute, University of Utah, Salt Lake City, Utah; xVanderbilt University Medical Center, Nashville, Tennessee; jjYale School of Medicine, New Haven, Connecticut; {University of Texas M. D. Anderson Cancer Center, Houston, Texas; Memorial Sloan-Kettering Cancer Center, New York, New York; and **Baylor College of Medicine, Houston, Texas