ACR ponders molecular imaging training options

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The American College of Radiology (ACR) and Society of Nuclear Medicine (SNM) convened a task force on combined training in diagnostic radiology, nuclear radiology, nuclear medicine and molecular imaging in May 2011, with the goal of developing realistic pathways to integrated residency training, and ACR recommends “expeditiously” moving forward with the design of integrated pathways, according to an article published online in January in the Journal of American College of Radiology.

“Given the considerable spectrum of established and emerging imaging modalities, including multiple hybrid technologies it is clear that patient care will be best served by a versatile imaging physician who has training and expertise in selecting, applying, interpreting, and correlating these various multimodality diagnostic tools in clinical practice,” wrote M. Elizabeth Oates, MD, on behalf of the diagnostic radiology participants of ACR/SNM Task Force II.

Oates emphasized that the two organizations have exchanged ideas on the training proposals, but have not met as an organized task force since the initial task force concluded in January 2011. Thus, intersocietal recommendations have not been developed. The diagnostic radiology members of the task force developed proposed “pathways of the future.”

These pathways should be guided by six principles, according to Oates et al:

  1. Adopt a forward-thinking rationale with visionary planning.
  2. Anticipate future public needs and create opportunities to meet them through innovative medical training-practice paradigms.
  3. Develop a unified, cohesive approach with a common infrastructure to support the pathways and participating programs.
  4. Use, as much as possible, existing training programs to achieve pathways with acceptable Accreditation Council for Graduate Medical Education (ACGME) structure and realistic implementation time frames.
  5. Integrate molecular imaging into current and future training pathways.
  6. Position nuclear radiology, nuclear medicine, and molecular imaging to flourish when goals, resources, and expertise are aligned.

According to ACGME, no new multispecialty training programs can be created or accredited, leaving a single option: combining two or more accredited programs into a single nonaccredited program. In the case of diagnostic radiology and nuclear medicine the independent programs would retain accreditation, but the joint program would be ineligible for accreditation.

Oates noted the goal is certification eligibility for diagnostic radiology through the American Board of Radiology (ABR) and for nuclear radiology and nuclear medicine through the ABR and American Board of Nuclear Medicine and emphasized the desirability of an integrated maintenance of certification program that also encompassed molecular imaging.

The task force proposed short-term and long-term 60-month pathways. Both would be structured as three-two models. In the short-term pathway, the first three years would be directed by a core diagnostic radiology residency program director and the latter two would fall under subspecialty direction.

The near-term proposal incorporates radioisotope molecular imaging during the latter two years, while maintaining exposure to diagnostic radiology throughout the entire length of the program.

The long-term pathway adds nonradioisotope molecular imaging to the program. “[These technologies] are undergoing rapid evolution, with a goal of translation to the clinical arena in the near future. For example, optical techniques, including bioluminescence imaging, fluorescence imaging, and fluorescence mediated tomography … can be used to understand the complexity, diversity, and in vivo behavior of cancers.”

Oates concluded, “These pathways, if adopted, have been designed not only to secure the future of nuclear radiology and nuclear medicine but also to promote the growth and clinical applicability of molecular imaging during its evolution over the next critical decades.”  The proposal also emphasizes the subspecialty training within the context of the foundation of diagnostic radiology, she noted.