Nuclear Medicine: Tips for the ABR Core Exam, ABR Certifying Exam, and ABR Nuclear Radiology Subspecialty Exam
Consistently among the most popular podcast episodes on The Radiology Review Podcast are nuclear medicine reviews. I also receive the most messages from listeners about nuclear medicine topics, particularly requests to cover a certain area of nuclear medicine, or gratitude for the nuclear medicine topics that I have discussed. I also have fielded questions about the ABR Nuclear Radiology Subspecialty Exam on multiple occasions despite the number of test-takers for this exam being quite small. To me, this interest in nuclear medicine for ABR board preparation makes sense.
Nuclear medicine is challenging to prepare for and, while only one of many subspecialties encountered during radiology residency training, this subspecialty area rises to relative prominence when ABR board exams come around. I do not mean to give the false impression that nuclear medicine is the dominant subject area for ABR board exams—it is not. However, nuclear medicine has some unique aspects relative to other subspecialty areas when it comes to ABR board exams.
One example is the Radioisotope Safety Exam (RISE) that largely tests nuclear medicine regulatory concepts and is a mandatory portion of both the ABR Core and ABR Certifying exams. Furthermore, nuclear medicine comprises an entire medical specialty. Indeed, nuclear medicine is a stand-alone residency outside of radiology. Nuclear medicine also has its own separate but related board exam administered by the American Board of Nuclear Medicine.
Nuclear medicine touches all other radiology subspecialty areas in some way—and this is important for board exam preparation. For example, an MSK question could throw in a three-phase bone scan, a neuroradiology question could show you an FDG-PET/CT of the brain, a cardiac imaging question could show you a myocardial perfusion scan, and an interventional radiology question could show you Y-90 planning or post-therapy images. This means that there are many potential avenues beyond the dedicated nuclear medicine section for nuclear medicine images or topics to show up on your ABR Core or Certifying exams.
Let us not forget physics. There is a lot of important physics in nuclear medicine—and much of it is extremely testable. Don’t forget about quality control in nuclear medicine either which is traditionally ripe for multiple choice style questions. Oh yeah—nuclear medicine also has therapies and you need to know how these therapies are administered, what indications they are used for, contraindications, potential toxicities, radiation-protection measures, duration and mechanism of action, and so forth.
And lest I forget, nuclear medicine test-writers may ask questions beyond what is currently in common clinical use to also cover what could be considered historical and emerging radiotracers and therapies.
There is no shortage of material that can be tested on nuclear medicine. It is easy for test-writers to write questions about things you may have never seen in your training program on the clinical services. You must be ready to answer general nuclear medicine questions, PET imaging questions, therapeutic questions, physics questions, quality control questions, instrumentation questions, radiation safety questions, regulatory questions, historical use questions, emerging use questions, name-that-radiotracer-by-imaging-appearance-alone questions, and so on.
What can you do to maximize your board preparation for nuclear medicine? Here are some of my tips:
1. Know the fundamentals.
Many nuclear medicine questions test fundamental concepts that are not tricky if you have put in the work. These will end up being your easiest questions to get right and generally require that you memorize facts in advance. For example, if you memorize the half-lives, energy peaks, critical organs, mode of production, normal biodistribution, and collimators used for various nuclear medicine agents you will be able to correctly answer many of the potential questions that may come your way on a board exam.
Additionally, I suggest reading a complete comprehensive nuclear medicine textbook such as the current editions of Mettler or Requisites at some point in residency prior to the ABR core exam. This will ensure that you have encountered fundamental concepts for the most common imaging studies and nuclear medicine procedures at least once prior to starting your more intensive board preparation study.
2. Do not underestimate the importance of nuclear medicine physics.
Physics is an important part of the ABR core exam and the physics of nuclear medicine is no exception. Along with understanding how things like gamma cameras and PET cameras work, also study the causes of imaging artifacts. Know quality control procedures (such as intrinsic and extrinsic flood tests) that exist to identify and correct imaging artifacts before they become clinically significant. I do not believe you can overprepare for the physics portion of the ABR Core exam and the same sentiment applies for nuclear medicine physics. Prepare diligently to succeed.
3. Rise up to succeed on RISE.
I find the chapter in Mettler’s classic nuclear medicine textbook that discusses radioisotope safety and regulations to provide excellent preparation for RISE questions. If you don’t have access to this textbook, purchase it, borrow it from a friend or your training program, and prepare for this portion of the exam. Qbanks also can help here.
4. Pay attention to nuclear medicine therapies.
For nuclear medicine therapies don’t underestimate the importance of knowing absolute and relative contradictions to receive therapy, as well as any tests necessary following therapy to ensure patient safety, such as blood count values. Understand also what precautions are necessary for various therapies to protect friends, family, and the general public from individuals having received nuclear medicine therapies.
5. Rely on your training program’s nuclear medicine physicians to learn new and emerging radiotracers and nuclear medicine therapies.
Ask your nuclear medicine faculty from your current or past training programs about the newest and emerging radiotracers and therapeutics as these can show up on your board exams. Given the rapidly changing state of this topic area, your current faculty will likely have more up-to-date information than textbooks or qbanks. Other helpful resources can include the most recent articles on nuclear medicine agents in RadioGraphics or other radiology and nuclear medicine journals.
6. Use qbanks to teach you classic topics for nuclear medicine board exams.
Qbank question writers for nuclear medicine often focus on classic and high-yield concepts for nuclear medicine board exams. When they encounter these classic cases in their own clinical practices, they often flag them and include these images in the questions they prepare.
7. Excellence, but not perfection, is required to succeed on board exams.
You will likely be asked about nuclear medicine topics on board exams that you don’t know about. When this happens, keep your mental composure, make your best educated guess, and carry on. There is no textbook, qbank, online resource, or nuclear medicine attending physician that will teach you every nuclear medicine concept that can potentially show up on your board exams.
This especially applies to the ABR Nuclear Medicine subspecialty exam. There are likely to be questions, many of historical importance and others in the research-relm, that you may have never encountered in clinical practice or board study. If so, make your best educated guess and move on to those questions that you do know and understand. Remember that others will also encounter topics beyond their own nuclear medicine understanding.
Nobody knows everything in nuclear medicine—including your fellow test-takers. However, diligent hard work and study is necessary to pass the nuclear medicine section on ABR core exams. Prepare to succeed.
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