3. ABR DX RADIOLOGY CERTIFICATE NRC RECOGNITIONS §35.290 Imaging and Localization Studies Diagnostic Nuclear Medicine Imaging §35.392 “Low-Dose” I-131 Therapy ≤ 33 mCi (1.22 GBq) §35.394 “High Dose” I-131 Therapy > 33 mCi (1.22 GBq)

4. NRC TRAINING REQUIREMENTS ABR DR CERTIFICATES STILL 700 Hours of Supervised Work Experience STILL 80 hours of Classroom and Laboratory Training Part of the 700 Hours

5. WHAT DOES 80 HOURS OF “CLASSROOM AND LABORATORY TRAINING” MEAN?” The 80 hours must contain content applicable To the subject areas described in the regulations To the use of Sodium I-131 Low Dose Therapy High Dose Therapy The "classroom and laboratory training" can be fulfilled in settings other than the traditional classroom setting - Hands-on experience using by-product material Performance of Radiation Safety Tasks Quality Control Procedures

6. Patient Experience – 6 Cases (minimum) “High Dose” Therapy Experience with 3 cases (> 33 mCi) “Low Dose” Therapy Experience with 3 cases (≤ 33 mCi) These cases must be for Therapy NOT for whole body imaging Must be supervised by an AU preceptor under 35.392 &/or 35.394 ABR I-131 THERAPY REQUIREMENTS WHAT DOES WORK EXPERIENCE MEAN?

7. NM EDUCATION REQUIREMENTS I-131 THERAPY NRC: Radiation Safety & Safe Handling Does not address the Practice of Medicine ABR: Medical Aspects of I-131 Therapy Provide Meaningful Experience for Trainees

8. I-131 THERAPY: WHAT CONSTITUTES “MEANINGFUL EXPERIENCE” ? 1. Familiarity with Patient History and Laboratory Findings 2. Determination of any contraindications 3. Review of appropriate Imaging Studies 4. Full Explanation of the Therapeutic Procedure to Patient Radiation Safety Precautions to be followed 5. Determination of the administered dose 6. Supervision of administration of the dose to the patient 7. Arrangement for appropriate follow-up

9. ABR I-131 THERAPY REQUIREMENTS PROGRAM DIRECTOR INFORMATION ABR Form A (PD Attestation) Attestation to NRC T&E (§35. 290, 35.392 & 35.394) ABR Form B (Preceptor Attestations) 3 cases of Low-dose Therapy (AU Supervised) 3 cases of High-dose Therapy (AU Supervised) 2011 Written and Oral ABR DR Exams will include Low-dose Therapy I-131 (≤ 33 mCi) (§35.392 ) High-dose Therapy I-131 (> 33 mCi) (§ 35.394) NRC AU-Eligibility on Certificates (Issued in 2011 and beyond) ALL or NONE Designation

11. DIAGNOSTIC RADIOLOGY/ NUCLEAR RADIOLOGY OPPORTUNITY IN TRAINING CHANGES Nuclear Medicine Training in DR Residency Decreased from 6 months to 4 months ABR Core (comprehensive) exam at 36 months Possibility for More focused 4 th year DR-RRC Allows16 months of in single subspecialty

12. DIAGNOSTIC RADIOLOGY/ NUCLEAR RADIOLOGY 16-MONTH PATHWAY - REQUIREMENTS Diagnostic Radiology Residency Program Institution with either: ACGME-Nuclear Radiology Fellowship, or ACGME-Nuclear Medicine Residency 16-months in Nuclear Medicine 10-months consecutive

13. DIAGNOSTIC RADIOLOGY/ NUCLEAR RADIOLOGY 16-MONTH PATHWAY - CERTIFICATIONS ABR Certified in Diagnostic Radiology 15 months Post-Residency ABR Certified in Nuclear Radiology After obtaining DR Certification Year of Clinical NM Practice Not Required

15. ABR Subspecialty Certification Requirements ACGME-Approved Fellowship (12-months or more) Pass SS Examination within 10-years of Training Completion Cohort of SS -Trained Diagnostic Radiologists Chose NOT to seek SS-Certification 10-year post-training period has lapsed Unlikely to Complete a Second SubSpecialty Training Year

16. Growing Awareness of Value of SS Certification Credentialing and Privileging Career Enhancement Leadership Opportunities Growing Importance of Quality Perception of Accountability Payor Pressures and Incentives Requests from these DR Diplomates to obtain SS-Certification LifeTime DR Certificate Holders Most Not DR MOC Participants

17. Addressing Genuine Needs for these Radiologists Obtain SS Certification Participate in Maintenance of Certification Curing this need is in the Public’s Best Interest ABR Should Develop a Time-Limited Opportunity for Subspecialty Certification for Affected Radiologists

18. Completed an ACGME Fellowship more than 10 years Or, Completed a Fellowship before Accreditation 60% SS Practice in prior 2 years Active unrestricted license

19. Must Apply Applications accepted for a 3-year period Begins July 1, 2011 – Ends June 30, 2014 2-year Program of required CME/SAMs, PQI VIR Participants: Maintain 2-year case log during program SS Examination in November of Year 2 Must Complete Program Requirements by December 31 of year 2 to achieve Certification