Physicians who practice nuclear medicine in the United States come from many different backgrounds. In the U.S., most physicians who perform general nuclear medicine imaging procedures are diagnostic radiologists. To be certified as a diagnostic radiologist by the American Board of Radiology (ABR), a doctor must have at least four months of nuclear medicine training during the four years of diagnostic radiology residency training. The diagnostic radiology training is preceded by a one-year clinical internship (also known as the first postgraduate year or PGY-1), for a total of five years of training after medical school. Before the PGY-1 year, a physician must have graduated from an accredited medical school, either in the U.S. or outside the U.S. By completing an additional (sixth) year of training, a fellowship devoted to nuclear medicine, the diagnostic radiologist may subspecialize and become a nuclear radiologist.
Some diagnostic radiologists learn therapeutic as well as diagnostic nuclear medicine during their residency, but many do not. Nuclear radiologists practice both diagnostic and therapeutic nuclear medicine, along with their practice of the other diagnostic radiology modalities, such as x-rays, ultrasound, CT, MRI, mammography, and interventional radiology. Both allopathic physicians (M.D.'s) and osteopathic physicians (D.O.'s) may apply for certification by the American Board of Radiology. Residency and fellowship programs must be approved by the Accreditation Council for Graduate Medical Education.
The American Osteopathic Board of Radiology (AOBR) also administers a board certification program for graduates of osteopathic medical schools (D.O.'s) who then train in diagnostic radiology. The AOBR requires 700 hours of nuclear medicine training as part of the four years of diagnostic radiology training.
In comparison, to be certified by the American Board of Nuclear Medicine, a physician, after completing the PGY-1 clinical year, must complete three years of nuclear medicine residency training (for a total of four years). This residency will provide training and experience in diagnostic and therapeutic nuclear medicine as well as CT scan interpretation and basic sciences (meeting the requirements of 10 C.F.R. §§ 35.190, 35.290, and 35.390 so that the physician may be an authorized user of radioactive materials and radiation safety officer). For those physicians who choose to train in nuclear medicine after completing training in another specialty, only 24 months of nuclear medicine training is required.
Other specialists sometimes practice selected areas within nuclear medicine. Nuclear Cardiologists are cardiologists (heart disease experts) who have taken a special interest in diagnostic nuclear medicine procedures for the heart. Cardiology fellowships currently require two months of nuclear cardiology including a minimum of 80 hours of interpretation of nuclear cardiology studies. The Certification Board for Nuclear Cardiology (CBNC) certifies nuclear cardiology physicians. Because this certification board is not recognized by the American Board of Medical Specialties (ABMS), those who pass the CBNC examination are not considered "board-certified" in nuclear cardiology. The term "board-certified" is reserved for ABMS approved boards. Regardless, this is a well respected certification. [The CBNC home page has a very nice example of multiple cross-sections through the heart from a myocardial perfusion (heart muscle blood flow) scan. The dynamic images show the movement of the heart muscle for a few seconds after the page loads.]
Occasionally, endocrinologists will obtain additional training in diagnostic as well as therapeutic nuclear medicine so that they can perform nuclear medicine procedures related to the thyroid gland. Some psychiatrists and neurologists have learned to interpret nuclear medicine images of the brain.
All physicians must be licensed by the state or territory in which they are practicing. To prescribe the administration of radiopharmaceuticals, a physician must also be an authorized user under a facility's radioactive material license (see the "U.S. Regulations" tab of this guide). If a physician interprets imaging studies from a remote location (telemedicine), the physician must be licensed in the state or territory in which the images were obtained. That is, where the patient was seen.
In Oklahoma, the Oklahoma Board of Medical Licensure and Supervision handles licensing and discipline of physicians. The Oklahoma medical practice statutes are Okla. Stat. tit. 59 §§ 480–518.1. The Oklahoma Administrative Code also contains relevant material including the Rules of the Board: 435 Okla. Admin. Code §§ 435:1-1-1 to 435:10-21-1.
In many other countries, diagnostic radiologists do not practice nuclear medicine. Nuclear Medicine is considered a separate specialty in those countries.
Nuclear Medicine Technologists prepare radiopharmaceuticals for use, administer radiopharmaceuticals to patients, and perform diagnostic nuclear medicine procedures under the general supervision of the physician. Once the images or other data are acquired using the special radiation detection equipment, the technologists process the acquired data in preparation for review and interpretation by the physician.
Nuclear Medicine Technologists are specially trained to safely handle the radioactive liquids and gases used in nuclear medicine procedures. Technologists also learn about patient care, radiopharmaceuticals, and image acquisition and processing. Nuclear Medicine Technology training generally requires a science and mathematics background. There are associate degree and bachelor's degree programs devoted to Nuclear Medicine Technology. A one-year program is available for those with a bachelor's degree in another area of study. The Joint Review Committee on Educational Programs in Nuclear Medicine Technology accredits nuclear medicine technology programs in the U.S.
Once a technologist has completed an accredited training program, the technologist may apply for certification by one of two organizations. The Nuclear Medicine Technology Certification Board (NMTCB) and the American Registry of Radiologic Technologists (ARRT). These boards also administer specialty examinations in related subspecialties including nuclear cardiology and PET.
A technologist's scope of practice defines the limits of the technologist's duties and responsibilities. Working within the defined scope of practice is important for all personnel. The Society of Nuclear Medicine Technologist Section has current guidelines for the Nuclear Medicine Technologist Scope of Practice.
Most states license technologists, but not all require the technologist to be specially trained. Currently, only about two-thirds of states have licensing requirements. Legislation is pending that would require more stringent state standards [the Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy (CARE) Bill].
Because of the complexity of Nuclear Medicine equipment, radiation safety, and radiopharmaceuticals, Nuclear Medicine also depends on a wide range of scientists for basic science and clinical support. These scientists include chemists, physicists, pharmacists, computer scientists, and engineers. Some universities offer special scientist programs related to nuclear medicine, such as health physics and radiopharmacy.
These scientists are a critical part of the development and implementation of new equipment, radiopharmaceuticals, data processing methods, and radiation safety procedures.
Radiopharmacists, pharmacists who special in nuclear pharmacy, may become certified by the Board of Pharmaceutical Specialties. To practice clinically, a radiopharmacists must also be licensed as a pharmacist within the state or territory.
The American Board of Science in Nuclear Medicine (ABSNM) certifies scientists practicing in nuclear medicine. General and specialty examinations include nuclear medicine physics and instrumentation, radiopharmaceutical sciences, molecular imaging science, and radiation protection.
The American Board of Radiology (ABR) offers certification examinations in three areas of radiologic physics: Therapeutic Radiologic Physics, Diagnostic Radiologic Physics, and Medical Nuclear Physics.
The American Board of Health Physics (ABHP) certifies Health Physicists.
The International Atomic Energy Agency has downloadable recommendations for the Clinical Training of Medical Physicists Specializing in Diagnostic Radiology.