It’s a Success! Update on the ABR 16-Month Pathway in Nuclear Radiology

By M. Elizabeth Oates, MD, ABR Trustee, and David Laszakovits, ABR Communications Director

2024;17(4):5

Graduates of the redesigned ABR 16-month pathway in nuclear radiology (NR) are eligible for primary certification in diagnostic radiology (DR) or interventional radiology/diagnostic radiology (IR/DR) and subspecialty certification in NR (ABR-NR) (or, alternatively, may qualify for the American Board of Nuclear Medicine, ABNM). The pathway was developed to meet the increasing demand for subspecialty trained expertise in NR in academic and community practices, triggered by the explosion of new diagnostic and therapeutic radiopharmaceuticals (“radiotheranostics”) and the burgeoning use of hybrid molecular imaging technologies in clinical care and research. 

Traditional Pathway vs. 16-Month Pathway

The traditional approach for becoming eligible for ABR-NR subspecialty certification involves completing a one-year fellowship in an NR or nuclear medicine (NM) program accredited by the Accreditation Council for Graduate Medical Education (ACGME) after graduating from residency training in DR or IR. The ABR 16-month pathway in NR leverages flexibility within DR and Integrated IR residency programs for the resident to spend up to 16 months in a discipline. Thus, pathway participants can gain eligibility for both primary and subspecialty certification during the standard four (DR) or five (IR) years of residency training.

The original 16-month pathway was introduced in 2010; the redesigned pathway formally went into effect July 1, 2017. Its key components are in keeping with the ACGME NR fellowship program and are summarized in Table 1. 

Table 1. Key Components of ABR 16-Month Pathway in Nuclear Radiology

Enrollment Process

Enrollment is on a rolling basis; there is no annual timeline. However, applications must be received and approved at least six months prior to graduation. To enroll, each resident must complete a short application form. The application must be accompanied by a Sponsoring Department Agreement (SDA) that is signed by the residency program director and the NR/NM preceptor, who both attest to their commitment to the resident’s training in accordance with the pathway requirements. The NR/NM preceptor must be ABR-NR and/or ABNM certified and is typically an appropriately recognized Authorized User. These forms are available here.

As referenced in Table 1, the NR/NM/MI/RPT-related clinical experiences are flexible and specific to each resident/program. In the application, the program describes their detailed plan for providing the participating resident with the requisite training. Popular NR-related rotation choices include but are not limited to abdominal/body, breast, cardiovascular, interventional, musculoskeletal, neuro/head & neck, pediatric, and thoracic. Notably, some residents have instead opted for more months of dedicated NR/NM/MI/RPT.

Status Report

Between July 1, 2017, and June 30, 2024, 76 participating programs enrolled a total of 247 residents who have either completed the pathway or are in progress. Five programs have had 10 or more enrollees, with the University of Pennsylvania well in the lead with 20; 11 programs have enrolled five to nine residents (see Table 2).

Table 2. Participating Programs with Five or More Enrollees (as of June 30, 2024)

Between 2018 and 2024, 206 residents completed the pathway. As of June 30, 2024, 41 were in progress: 30 will graduate in 2025 and 11, in future years (see Figure 1). It is anticipated that residents will continue to be enrolled on a rolling basis, and these numbers will change over time.

Figure 1. Numbers Enrolled (by completed/anticipated graduation year, as of June 30, 2024)

The first opportunity for a graduate of the 16-month pathway to sit for the NR subspecialty exam was in 2021. The number of NR diplomates increased remarkably during 2021-2024 (see Figure 2). Of the 61 diplomates earning ABR-NR during these four years, 37 (61%) qualified by way of the 16-month pathway, while the other 39% were NR/NM fellowship graduates or eligible via the alternate practice pathway.

Figure 2. Number of DR or IR/DR Diplomates Certified in Nuclear Radiology (2013-2024)*

*Note: No subspecialty certification exam was offered in 2020 due to the COVID-19 pandemic.

Current Impact

In March to May 2024, the ABR surveyed the 125 graduates of the 16-month pathway who hold DR or IR/DR certificates. As of June 30, 2024, 75 (60%) have attained advanced certification: 30 (24%) with ABR-NR only, 35 (28%) with ABNM only, and 10 (8%) with both ABR-NR and ABNM.

Of those surveyed, 74 (59%) responded. Of the respondents, approximately 86% completed at least one fellowship after their DR or IR residency (abdominal/body radiology was the most popular fellowship). The vast majority of those who pursued ACGME-accredited neuroradiology or pediatric radiology fellowships either already have, or plan to sit for, those respective ABR subspecialty certificates.

At the time of the survey, approximately 58% of the respondents were in academic practice (with nearly three-quarters university based). Approximately 80% were practicing nuclear radiology at least some of the time or as part of their typical workload; 40% reported that it comprised more than 50% of their time or workload. 

Future Horizons

We anticipate that graduates of the 16-month pathway in nuclear radiology will continue to support clinical practices in this rapidly expanding domain to the benefit of radiology, medicine, patients, and society.

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