SNMMI/ABNM joint position statement on optimizing training in nuclear medicine in the era of hybrid imaging.

The American Board of Nuclear Medicine (ABNM) was recognized as an independent medical specialty board in 1971 and was the first conjoint board of the American Board of Medical Specialties (ABMS). The conjoint board was sponsored by the American Board of Internal Medicine (therapies), the American Board of Pathology (radioimmunoassay), the American Board of Radiology (ABR) (diagnostic imaging), and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) based on the recommendation of the Liaison Committee for Specialty Boards, the ABMS, and the Council on Medical Education of the American Medical Association. It became a primary medical specialty board whose only sponsor was the SNMMI in 1985. Medical specialties are defined by their core knowledge, not by technologies, because technologies are constantly changing. Nuclear medicine is a primary medical specialty because its core knowledge (exploitation of the tracer principle to study biochemical, physiologic, and molecular processes in time and space) is unique. The ABNM defines nuclear medicine as “the medical specialty that uses the tracer principle, most often with radiopharmaceuticals, to evaluate molecular, metabolic, physiologic and pathologic conditions of the body for the purposes of diagnosis, therapy and research” (1). The ABNM has recently published a statement on nuclear medicine professional competency and scope of practice (2). Nuclear medicine training programs embrace the complete spectrum of the practice of nuclear medicine, including general diagnostic procedures, radionuclide therapies, and cardiac imaging with exercise or pharmacologic agents. Residency programs in nuclear medicine are robust and for the past 40 y have trained most of the nuclear medicine physicians in practice. In 2012–2013, there are 54 Accreditation Council for Graduate Medical Education (ACGME)–accredited nuclear medicine resident training programs, and there are currently 144 on-duty trainees (3,4). ABNM has issued 789 certificates from 2000 to 2012, and the number has remained stable since the early 1980s (Fig. 1). The ABR began offering its own certificate of competence in nuclear radiology in 1973. Nuclear radiology was established as a subset of nuclear medicine limited to nuclear diagnostic imaging. Fellowship programs in nuclear radiology have been created that lead to eligibility for subspecialty certification in nuclear radiology by the ABR. Physicians must have ABR certification in diagnostic radiology and have an additional year of fellowship training in nuclear radiology in one of the 19 ACGME-accredited nuclear radiology training programs. In 2012–2013, there are 18 onduty trainees (3,4). This training pathway includes a total of 16 mo in nuclear radiology: 4 mo during diagnostic radiology residency and 12 mo during a nuclear radiology fellowship. In 2011, the ABR created a second pathway for subspecialty certification in nuclear radiology consisting of 16 mo of training in nuclear radiology or nuclear medicine during 4 y of diagnostic radiology residency, of which 10 mo must be consecutive. A significant difference between nuclear medicine and nuclear radiology is the amount of training required for therapy with radiopharmaceuticals as described in a conjoint statement on credentialing and delineation of privileges for therapeutic procedures using radiopharmaceuticals (5).