Training Requirements for the ABNM Certifying Examination

Common Requirements for all Physicians

All physicians must have the following training or supervised experience:

Table of Contents
1. U.S. Nuclear Regulatory Commission Training and Experience Requirements

All physicians must meet the training and experience required by the NRC in basic radionuclide handling techniques and radiation safety applicable to the medical use of unsealed byproduct material, and successfully complete residency training in a radiation therapy or nuclear medicine training program or a program in a related medical specialty approved by the Residency Review Committee of the Accreditation Council for Graduate Medical Education, the Royal College of Physicians and Surgeons of Canada, or the Council on Postdoctoral Training of the American Osteopathic Association. The training must include 700 hours of training and experience as described below.

  • 10 CFR 35.390 Use of unsealed byproduct material for which a written directive is required
    • The training and experience must include a minimum of 700 hours, all of which are applicable to the medical use of unsealed byproduct material requiring a written directive, including:
      • A minimum of 200 hours of classroom and laboratory training* in accordance with 10 CFR 35.390(b) in the following areas:
        • Radiation physics and instrumentation
        • Radiation protection
        • Mathematics pertaining to the use and measurement of radioactivity
        • Chemistry of byproduct material for medical use
        • Radiation biology

*The classroom and laboratory training may be obtained using a variety of instructional methods (including on-line training) as long it meets the specific clock hour requirements, and the subject matter relates to radiation safety and safe handling of byproduct material for the uses for which authorization is being requested.  Reviewing case histories or interpreting scans should not be counted toward the minimum 200 hours of required classroom and laboratory training in radiation safety and safe handling of byproduct material.
AND

  • Supervised work experience**, which must include:
    • Ordering, receiving, and unpacking radioactive materials safely and performing the related radiation surveys.
    • Performing quality control procedures on instruments used to determine the activity of dosages and performing checks for proper operation of survey meters;
    • Calculating, measuring, and safely preparing patient or human research subject dosages;
    • Using administrative controls to prevent a medical event involving the use of unsealed byproduct material;
    • Using procedures to contain spilled byproduct material safely and using proper decontamination procedures;
    • Administering dosages of radioactive drugs to patients or human research subjects involving a minimum of three cases in each of the following categories:
      • Oral administration of less than or equal to 1.22 gigabecquerels (33 millicuries) of sodium iodide I-131, for which a written directive is required
      • Oral administration of greater than 1.22 gigabecquerels (33 millicuries) of sodium iodide I-131
      • Parenteral administration of any radioactive drug that contains a radionuclide that is primarily used for its electron emission, beta radiation characteristics, alpha radiation characteristics, or photon energy less than 150 keV, for which a written directive is required

**Physicians in training may not dedicate all of their supervised work experience time specifically to the subject areas listed in the regulatory requirements (i.e., 10 CFR 35.390(b)(1)(ii)) and will be attending to other clinical matters involving the medical use of the material under the supervision of an AU (e.g., reviewing case histories or interpreting scans). This type of supervised work experience may be counted toward the supervised work experience to obtain the required 700 total hours of training.
Supervised work experience for use of unsealed byproduct material for which a written directive is required must be under the supervision of an authorized user who meets the requirements in 35.57, 35.390, or equivalent Agreement State requirements. A supervising authorized user, who meets the requirements in 35.390(b), must also have experience in administering dosages in the same dosage category or categories (i.e., 35.390(b)(1)(ii)(G)) as the individual requesting authorized user status.

  • 10 CFR 35.290 Imaging and localization studies
    • A 10 CFR 35.390 authorized user must have the following additional work experience applicable to imaging and localization studies.
    •  35.290(c)(1)(ii)(G)
      • Eluting generator systems appropriate for preparation of radioactive drugs for imaging and localization studies, measuring and testing the eluate for radionuclidic purity, and processing the eluate with reagent kits to prepare labeled radioactive drugs.

Supervised work experience for imaging and localization studies, including eluting generators, measuring and testing the eluate for radionuclidic purity, and processing the eluate with reagent kits to prepare labeled radioactive drugs, must be under the supervision of an authorized user who meets the requirements in 35.57, 35.290, or 35.390 AND meets the requirements in 35.290(c)(1)(ii)(G), or equivalent Agreement State requirements. An authorized Nuclear Pharmacist in accordance with 10 CFR 35.55 may also provide the supervised work experience for 35.290(c)(1)(ii)(G).

  • 10 CFR 35.190 Uptake, dilution, and excretion studies
    • A 10 CFR 35.390 authorized user already has experience administering dosages requiring a written directive, which would meet the requirement to be an authorized user for uses under 10 CFR 35.100.
  • Preceptor Attestation
    • Written attestation that the individual has satisfactorily completed the requirements and is able to independently fulfill the radiation safety-related duties as an authorized user must be obtained from either:
      • (i.) A preceptor authorized user who meets the requirements in 35.57, or 35.390 AND 35.290(c)(1)(ii)(G), or equivalent Agreement State requirements and has experience in administering dosages in the same dosage category or categories as the individual requesting authorized user status; or
      • (ii.) A residency program director who affirms in writing that the attestation represents the consensus of the residency program faculty where at least one faculty member is an authorized user who meets the requirements in 35.57, 35.390 AND 35.290(c)(1)(ii)(G), or equivalent Agreement State requirements, has experience in administering dosages in the same dosage category or categories as the individual requesting authorized user status, and concurs with the attestation provided by the residency program director. The residency training program must be approved by the Residency Review Committee of the Accreditation Council for Graduate Medical Education or the Royal College of Physicians and Surgeons of Canada or the Council on Postdoctoral Training of the American Osteopathic Association and must include training and experience specified in 10 CFR 290(c)(1) and 35.390(b)(1).

2. Preparatory Clinical Training

Before starting Nuclear Medicine training, all physicians must satisfactorily complete one year of clinical training that includes at least nine months in any specialty that provides direct patient care. Training must be completed in ACGME-accredited residency programs, AOA-approved residency programs, Royal College of Physicians and Surgeons of Canada (RCPSC)-accredited or College of Family Physicians of Canada (CFPC)-accredited residency programs located in Canada, or in residency programs with ACGME International (ACGME-I) Advanced Specialty Accreditation.

Physicians who receive their preparatory training outside the United States and Canada may be accepted into Nuclear Medicine residency programs if they are an “exceptionally qualified applicant,” as defined in the ACGME Common Program Requirements. The designation of an “exceptionally qualified applicant” is made by the Nuclear Medicine Program Director, Training Program Selection Committee, and Graduate Medical Education Committee. ABMM will accept this designation for physicians beginning their training after June 30, 2016. Alternatively, a training program director may ask the ABNM to accept preparatory clinical training outside the United States and Canada as being equivalent to training in the United States and Canada (ABNM Review of Training Outside the United States).

3. ACGME Nuclear Medicine Program Requirements

All physicians must have training and/or supervised work experience equivalent to the ACGME Nuclear Medicine Program requirements (https://www.acgme.org/globalassets/pfassets/programrequirements/2024-prs/200_nuclear-medicine_2024.pdf), which include the following patient care experience:

  • Cardiovascular stress test (exercise or pharmacologic) supervision – 100 studies (note: the training must include the supervision of stress tests, not just review and interpretation of nuclear cardiac images)
  • Pediatric nuclear medicine – 100 studies
  • Radiotherapy with I-131 – 30 cases (at least 10 benign plus 10 malignant, including 3 ≤ 33 mCi and 3 > 33 mCi)
  • Parenteral therapies requiring a written directive – 5 cases

All physicians must also have certification in basic and advanced life support.

1. Nuclear Medicine training for US medical school graduates

1. Nuclear Medicine training for US medical school graduates

A. Physicians without other specialty training

A. Physicians without other specialty training.

36 months of training at an institution with an ACGME accredited Nuclear Medicine program.

1. Nuclear Medicine training for US medical school graduates

B. Physicians with Diagnostic Radiology training

B. Physicians with Diagnostic Radiology training

a. Combined Nuclear Medicine and Diagnostic Radiology training in separately accredited programs

Combined Nuclear Medicine and Diagnostic Radiology residency training totaling 5 years in separately ACGME accredited Nuclear Medicine and Diagnostic Radiology programs with 16-24 months of Nuclear Medicine training, during which time the physician may be designated as a Nuclear Medicine resident or a Diagnostic Radiology resident. Generally, physicians are designated as a Nuclear Medicine resident for at least 12 months.

1. Nuclear Medicine training for United States medical school graduates

B. Physicians with Diagnostic Radiology training

b. Nuclear Medicine or Nuclear Radiology training during Diagnostic Radiology residency

16 months (equivalent to 64 weeks when one month is defined as one 4-week rotation) of Nuclear Medicine training during 4 years of Diagnostic Radiology residency training at an institution with an ACGME accredited Nuclear Medicine or Nuclear Radiology program, or other ACGME accredited program that provides the education and training equivalent to the ACGME Nuclear Medicine program requirements.

The 16 months (64 weeks) of training may include up to 8 weeks of elective time in any field (clinical or research) or any location approved by the Diagnostic Radiology Program Director.

1. Nuclear Medicine training for US medical school graduates

B. Physicians with Diagnostic Radiology training

c. Nuclear Medicine training before or after Diagnostic Radiology residency

4 months of Nuclear Medicine training at an institution with an ACGME accredited Diagnostic Radiology program, plus 12 months of Nuclear Medicine training at an institution with an ACGME accredited Nuclear Medicine program, or other ACGME accredited program that provides the education and training specified in the ACGME Nuclear Medicine program requirements

1. Nuclear Medicine training for US medical school graduates

B. Physicians with Diagnostic Radiology training

d. Nuclear Radiology fellowship training

4 months of Nuclear Medicine training at an institution with an ACGME accredited Diagnostic Radiology program, plus 12 months of Nuclear Radiology training at an institution with an ACGME accredited Nuclear Radiology fellowship program.

1. Nuclear Medicine training for United States medical school graduates

C. Physicians with specialty training other than Diagnostic Radiology

C. Physicians with specialty training other than Diagnostic Radiology

a. Other specialty training prior to Nuclear Medicine training

Physicians who are certified or eligible to be certified by another member board of the American Board of Medical Specialties, may receive up to one year of credit for prior training. The required amount of Nuclear Medicine training is two years in an institution with an ACGME accredited Nuclear Medicine program, or other ACGME accredited program that provides the education and training specified in the ACGME Nuclear Medicine program requirements.

1. Nuclear Medicine training for United States medical school graduates

C. Physicians with specialty training other than Diagnostic Radiology

b. Combined Nuclear Medicine and Internal Medicine Training

To be eligible for dual certification, a resident must have American Board of Internal Medicine (ABIM) and ABNM approval of the proposed training program before beginning the combined program. The combined program consists of a total of 4 years of training in an accredited internal medicine and an accredited nuclear medicine training program and leads to admissibility to certification in both specialties. To meet eligibility for dual certification, the resident must satisfactorily complete 48 months of combined training that is verified by the Program Directors of both training programs. It is strongly recommended that combined training occur in the same institution. Residents will be eligible for admission to the written certifying examination in Internal Medicine after successfully completing the third resident year of training and for the Nuclear Medicine examination after the fourth resident year. All training must be in ACGME, RCPSP or PCPQ accredited programs and approved by the Program Director of each program. More details about this combined training program can be found at (www.abim.org/certification/policies/combinedim/comnuc.aspx).

2. Nuclear Medicine or Diagnostic Radiology Training outside the United States and Canada

2. Nuclear Medicine or Diagnostic Radiology Training outside the United States and Canada

a. Credit for international training plus additional Nuclear Medicine training in the United States

a. Credit for international training plus additional Nuclear Medicine training in the United States

Physicians who have had Diagnostic Radiology training outside the United States and Canada may receive a maximum of one year of credit for prior training. The minimum required amount of additional Nuclear Medicine training is two years (which may include up to 8 weeks of research or elective time) in an institution with an ACGME accredited Nuclear Medicine program, or other ACGME accredited program that provides the education and training specified in the ACGME Nuclear Medicine program requirements.

Physicians who have had Nuclear Medicine training outside the United States and Canada may receive a maximum of two years of credit for prior training. The minimum required amount of additional Nuclear Medicine training is one year in an institution with an ACGME accredited Nuclear Medicine program, or other ACGME accredited program that provides the education and training specified in the ACGME Nuclear Medicine program requirements.

Physicians who have had Diagnostic Radiology training and Nuclear Medicine training outside the United States may receive a maximum of two years of credit for prior training. The minimum required amount of additional Nuclear Medicine training is one year in an institution with an ACGME accredited Nuclear Medicine program, or other ACGME accredited program that provides the education and training specified in the ACGME Nuclear Medicine program requirements.

Physicians who would like to receive credit for prior training must have a Nuclear Medicine program director in the United States submit a request on their behalf (ABNM Review of Training Outside the United States).

2. Nuclear Medicine or Diagnostic Radiology Training outside the United States and Canada

b. ABR Alternate Pathway

b. ABR Alternate Pathway, which includes Nuclear Medicine training

A physician may be eligible for ABNM certification upon completion of the ABR alternate pathway that includes a minimum of 16 months of Nuclear Medicine training (not including research or elective time) in an institution with an ACGME accredited Nuclear Medicine program, or other ACGME accredited program that provides the education and training specified in the ACGME Nuclear Medicine program requirements.

Physicians in the ABR alternate pathway will not receive any credit for prior training outside the United States and Canada that would reduce the amount of nuclear medicine training to less than 16 months.

Physicians in the ABR alternate pathway should inform the ABNM as soon as possible of their training plan, and no later than their second year in the alternate pathway. They must provide the ABR letter acceptance letter for the alternate pathway, as well as Sponsoring Department Agreement (SDA) that includes their training schedule. The training schedule must show 16 months of Nuclear Medicine training. If the SDA only shows 12 months of Nuclear Medicine training, the physician must provide a letter from the program director documenting how the additional 4 months of nuclear medicine training will be obtained, including the date(s) of this training.

2. Nuclear Medicine or Diagnostic Radiology Training outside the United States and Canada

c. ABNM Alternate Pathway

c. ABNM Alternate Pathway

Physicians certified in Nuclear Medicine in a country other than the United States or Canada may be eligible for certification by ABNM without additional training in an ACGME accredited Nuclear Medicine program, or other ACGME accredited program that provides the education and training specified in the ACGME Nuclear Medicine program requirements, under the following circumstances:

Training and experience required by the NRC in basic radionuclide handling techniques and radiation safety applicable to the medical use of unsealed byproduct material as described in Section 1. (bookmark)

Three years of full-time Nuclear Medicine experience, or equivalent, in a department with an ACGME accredited Nuclear Medicine training program, or other ACGME accredited program that provides the education and training specified in the ACGME Nuclear Medicine program requirements. The 3 years of Nuclear Medicine experience may be any combination of the following categories: resident, fellow, visiting scholar, or faculty. The 3 years may include up to 6 months of research and/or elective time.

3. Nuclear Medicine training in Canada

3. Nuclear Medicine training in Canada
Graduates of Nuclear Medicine training programs in Canada must meet the following requirements:
Graduate from a medical school approved by the Liaison Committee on Medical Education, or the Committee on Accreditation of Canadian Medical Schools.
Pass the Medical College of Canada Qualifying Examination (MCCQE) Part I and Part II
Successfully complete a Nuclear Medicine training program approved by the Royal College of Physicians and Surgeons of Canada (RCPSC).
Be eligible for a medical license issued by one of the twelve provincial or territorial licensing authorities.

Diplomates who received their training in the Canada will have “Canada” printed under their certificate number, whereas diplomates who received their training in the United States will have “United States” printed under their certificate number. These designations allow the United States Nuclear Regulatory Commission to ascertain which diplomates have fulfilled NRC supervised training and work experience requirements to be an Authorized User, which can only be obtained in the United States under the supervision of an Authorized User listed on the facility radioactive materials license.