As molecular imaging emerges from the cocoon of nuclear medicine, fueled by changes that have made it a vital technique for diagnosing disease and predicting and monitoring treatment response, training for physicians and technologists has made its way to the forefront for many education programs around the United States. Individual programs are modifying their curriculum to incorporate molecular imaging training.
As PET/CT and SPECT/CT take hold and studies prove their clinical strength, the approach to diagnosis and evaluation of the patient also is changing. According to Michael Graham, PhD, MD, director of nuclear medicine, at the University of Iowa and vice-president elect of the Society of Nuclear Medicine (SNM), this change in approach is driving the surge in interest in molecular imaging and the focus on formalizing training and education requirements.
“There seems to be a growing recognition about the importance of molecular imaging principles, particularly in personalizing both diagnosis and treatment,” Graham notes. “But, ultimately, it is the treatment.”
Right now, interest in molecular imaging is focused on the nuclear medicine department, although additional interested groups include oncology, gynecology and gastroenterology, the latter of which use various optical imaging methodologies.
“Nuke med has been doing MI all along except it was not called that,” he says. “A lot of what we train residents in can be called molecular imaging—it includes training on how it localizes, metabolizes and more—we just have never labeled it before.”
Graham says that formalizing molecular imaging training will be the next iteration of nuclear medicine training residency program requirements.
Currently, according to SNM, the average residency program in nuclear medicine takes three years to train qualified physicians in the diagnostic and therapeutic use of radioactive pharmaceuticals. Residents are required to have one or more years of preparatory training and two or more years of nuclear medicine residency training in programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). Diagnostic imaging consultation and nuclear medicine facility management are emphasized in the two-year program. Training also includes research experience, therapy with unsealed sources, and tomographic imaging with SPECT or PET radioisotopes.
“It is quite possible for molecular imaging training for physicians to move to a four-year program due to the increased complexity of molecular imaging,” Graham says. In the next iteration of training requirements, it is difficult to put a number on specific hours for a molecular imaging program because it is not yet a separate clinical entity. “You cannot exactly have a rotation for it,” he adds. “The program would include didactic sessions, the principles, the lab sessions and maybe data analysis, but it is still kind of nebulous—however, we are working our way forward.”
The path to formalized molecular imaging training is not completely free of obstacles. With radiologists more involved in image interpretation and with shifting reimbursement issues—physicians being paid less to do more—what is happening in the academic realm is that radiology faculty are becoming more clinically oriented and less focused on research.
In light of these issues, the field is beginning to see a shortage of full-time nuclear medicine physicians, and needless to say, growth is slow. “Since the early 1970s, we have been averaging about 70 to 80 people a year—an annual average of board certified nuclear medicine physicians that is simply not enough to sustain the field,” according to Graham.
“Radiologists, with more clinical appointments instead of academic appointments, are not expected to do research—just the clinical work of image interpretation,” says Graham. “They are not providing the research that we need to move the nuclear medicine field forward.”
Building technologist skills
Training in molecular imaging is not only being formalized for physicians, but for technologists as well. Many programs are trying to incorporate new courses focused on molecular imaging into the standard two-year nuclear medicine curriculum.
According to Mark Wallenmeyer, CNMT, RT (N), the president-elect of the SNM Tech Section, there are several different approaches that SNM plans to suggest as requirements for nuclear medicine programs. SNM has suggested extensive pre-professional requirements for