Nuclear Medicine Fellowship

[allseasons]

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Out of curiosity, I had question regarding nuclear medicine fellowship. Currently it is a one year fellowship out of radiology, and a two year fellowship out of other fields. Rad Onc is categorized into other. Do you guys think Rad Oncs have enough imaging experience to do it in one year, in theory, if it was permissible?

 

[Bequerel]

Is nuclear medicine still a thing? Why in the world would you want to waste 2 years to do it if it was?

 

[Mandelin Rain]

I don’t think it’s a “terrible” idea tbh. Especially, if you want to specialize in radiopharma. Can always read PETs and Bone Scans and DEXAs, etc… in the down time.

You’d actually be incredibly valuable to any hospital system.

 

[deleted1217978]

I am sure a radiologist will chime in here, but I am friends with a few and my understanding is that nuc med training is literally worthless without general rads training. There used to be "nuclear medicine' residencies that trained people in nuclear med only without ct, mri, etc. and none of these people were employable.

 

[StIGMA]

There's tremendous investment into radiopharm- will be 'hot' soon as long as field doesn't overtrain like some other fields.

 

[medgator]

There's tremendous investment into radiopharm- will be 'hot' soon as long as field doesn't overtrain like some other fields.

The question becomes, do you really need that 2 year fellowship to be in that game? I don't think so

 

[drowsy12]

There's tremendous investment into radiopharm- will be 'hot' soon as long as field doesn't overtrain like some other fields.

generally I agree but there's a TON banking on positive trials reading out. so far it's a lot of 'potential'

 

[StIGMA]

The question becomes, do you really need that 2 year fellowship to be in that game? I don't think so

It could evolve like early medonc. You dont need training to give 10 different chemos, but once theres hundreds of therapies it becomes necessary. Who knows when this will transition/involve governing bodies making tighter rules- probably >10 years

 

[drowsy12]

It could evolve like early medonc. You dont need training to give 10 different chemos, but once theres hundreds of therapies it becomes necessary. Who knows when this will transition/involve governing bodies making tighter rules- probably >10 years

I dont think it's ever going to be nuc med driving prescribing this stuff. it's going to be med onc. and rad onc partly if we can get our foothold in.

 

[medgator]

I dont think it's ever going to be nuc med driving prescribing this stuff. it's going to be med onc. and rad onc partly if we can get our foothold in.

Agreed. Pure nucs is pretty much a dead field outside of some larger academic places

As others have mentioned dx rads with nucs fellowship infinitely more useful in any given practice setting

This isn't going to be some revival for them as the professional reimbursement is just terrible

 

[allseasons]

There's been substantial growth in the nuc med space lately, the future is expected to see more.
But I was asking more so if you guys think a rad onc doctor could do it in one year too, given the imaging experience rad oncs get in residency, not necessarily whether they should do it.
Right now, one year is restricted to just radiologists. Rad Oncs need two, like every other non-imaging or radiation related residency.
I've talked to a number of rad oncs that are interested in this space, especially as it relates to oncology.

 

[Bequerel]

I think it’s the dumbest possible use of 7 years of total post graduate training.

 

[drowsy12]

I think it’s the dumbest possible use of 7 years of total post graduate training.

and this coming from the guy named Bequerel. Listen up.

 

[yesmaster]

Nuclear medicine is a dead specialty. No need to lend them legitimacy in therapeutic radioisotopes by doing their fellowship which I doubt any diagnostic rads resident wants to do with their very strong DR job market. If radiopharm takes off like ADC’s across multiple cancer types, we have to own it. It is not that hard.

 

[madchemist89]

We must be the gatekeepers of radiopharm. No one else has the training regarding the safety of using these medications.

 

[allseasons]

We must be the gatekeepers of radiopharm. No one else has the training regarding the safety of using these medications.

Honestly, my lack of knowledge of this space is definitely going to show here, but I thought nuclear medicine would have the greatest claim to radiopharm procedures.

 

[drowsy12]

We must be the gatekeepers of radiopharm. No one else has the training regarding the safety of using these medications.

NucMed is a service and in many places they will deliver it and med onc will prescribe it.

 

[StIGMA]

Honestly, my lack of knowledge of this space is definitely going to show here, but I thought nuclear medicine would have the greatest claim to radiopharm procedures.

I have a radiopharm conference coming up (pharma conference)- nuc med is running it. It would be nice if radonc took over the space, but I don't see our leadership making the steps to do so.

 

[RadOncDoc21]

I have a radiopharm conference coming up (pharma conference)- nuc med is running it. It would be nice if radonc took over the space, but I don't see our leadership making the steps to do so.

Nope, we'll all die on the proton hill first!

 

[grenz]

I have a radiopharm conference coming up (pharma conference)- nuc med is running it. It would be nice if radonc took over the space, but I don't see our leadership making the steps to do so.

https://www.astro.org/meetings-and-education/micro-sites/2026/rpt-symposium

Astro is putting on its own inaugural symposium. Rad onc has the med onc relationships to own radiopharmaceuticals if we want to. My med onc referrings are much happier with us doing it than nuc med

 

[TheWallnerus]

https://www.astro.org/meetings-and-education/micro-sites/2026/rpt-symposium

Astro is putting on its own inaugural symposium. Rad onc has the med onc relationships to own radiopharmaceuticals if we want to. My med onc referrings are much happier with us doing it than nuc med

An ASTRO rad onc symposium for radiopharm will do as much for rad onc radiopharm as a 5K Race for the Cure does for curing cancer.

 

[Mandelin Rain]

Agreed. Pure nucs is pretty much a dead field outside of some larger academic places

As others have mentioned dx rads with nucs fellowship infinitely more useful in any given practice setting

This isn't going to be some revival for them as the professional reimbursement is just terrible

pure nucs is indeed dead (for now). But a rad onc doing a nuc med fellowship?

It’s a dynamic position for the future imo. Beam patients, radiopharm patients, and reading nuc med scans in between?

You would be the most desirable candidate in any job interview you go on.

Should be a 1 year deal post rad onc. Better yet, it should just be folded in to the existing 4 year structure much better than it currently is. 2 year kills it.

 

[allseasons]

pure nucs is indeed dead (for now). But a rad onc doing a nuc med fellowship?

It’s a dynamic position for the future imo. Beam patients, radiopharm patients, and reading nuc med scans in between?

You would be the most desirable candidate in any job interview you go on.

Should be a 1 year deal post rad onc. Better yet, it should just be folded in to the existing 4 year structure much better than it currently is. 2 year kills it.

is this sarcasm lol

 

[medgator]

is this sarcasm lol

i dont think so. not totally off the wall either. Would be more marketable that way than just doing pure nucs.

 

[maxxor]

Am ABR/ABNM:

I’ve never heard of anyone doing this. Almost all the scans you look at are abnormal. Will you be comfortable calling something normal?

There’s also the weirdness of the rad group at you guys’s places. They probably won’t want a random radonc reading scans off their exclusive contract. Now if you are in a unicorn practice that owns your own pet scanner…maybe some utility…maybe.

Maybe if it’s an old fashioned radonc/rad group this could potentially work. I know of one in Macon GA…

But honestly all pure nucs fellowships should be shut down. The vast majority of the graduates decide to go onto radiology residency afterward.

 

[allseasons]

Am ABR/ABNM:

I’ve never heard of anyone doing this. Almost all the scans you look at are abnormal. Will you be comfortable calling something normal?

There’s also the weirdness of the rad group at you guys’s places. They probably won’t want a random radonc reading scans off their exclusive contract. Now if you are in a unicorn practice that owns your own pet scanner…maybe some utility…maybe.

Maybe if it’s an old fashioned radonc/rad group this could potentially work. I know of one in Macon GA…

But honestly all pure nucs fellowships should be shut down. The vast majority of the graduates decide to go onto radiology residency afterward.

Pure nuc fellowships or pure nuc residencies? There aren’t many pure nuc residencies left. I think there were 3 total last year.

 

[grenz]

Am ABR/ABNM:

I’ve never heard of anyone doing this. Almost all the scans you look at are abnormal. Will you be comfortable calling something normal?

There’s also the weirdness of the rad group at you guys’s places. They probably won’t want a random radonc reading scans off their exclusive contract. Now if you are in a unicorn practice that owns your own pet scanner…maybe some utility…maybe.

Maybe if it’s an old fashioned radonc/rad group this could potentially work. I know of one in Macon GA…

But honestly all pure nucs fellowships should be shut down. The vast majority of the graduates decide to go onto radiology residency afterward.

If this gives you the ability to read the SPECT CT you get for radiopharm Dosimetry, that would significantly increase your professional revenue from a radiopharm program. If you have an entrepreneurial bent, referring physician investors, and enough capital, you could even purchase a SPECT and reap the technical

 

[maxxor]

Pure nuc fellowships or pure nuc residencies? There aren’t many pure nuc residencies left. I think there were 3 total last year.

All training through ABNM is a “residency” like plastic surgery since it’s a separate specialty board. They have 5 different ways to become eligible for the exam depending on base specialties. From experience, the current program directors kind seem to offer everyone 1 year ABNM specific training if ABR or 2 years if not. I haven’t seen anyone do 3 years of ABNM residency in the past 10 years.

If this gives you the ability to read the SPECT CT you get for radiopharm Dosimetry, that would significantly increase your professional revenue from a radiopharm program. If you have an entrepreneurial bent, referring physician investors, and enough capital, you could even purchase a SPECT and reap the technical

Again, this comes down to your local politics. The scan itself is worth 1.5 - 2.0 wrvu (single area vs 2 area). Is 1.5-2 wrvu really going to move the needle? Most of the radiopharm dosimetry codes are actually done by the physicist and are sorta classified as technical rather than professional. It’s been a few years since I deep dived into those codes. They can bring significant technical Revenue but the physician revenue was not that much.

This is why I said “if you are in a unicorn that owns your own scanner(s)”, because hospital contracts being what they are, I’m not sure an employed radonc will be able to force their way into the relationship between the hospital and the existing radiology group. This is a significant problem for independent clinical IRs who are boxed out of hospital based vascular procedures if they aren’t part of the existing group.

 

[PhotonOracle]

University of Toronto offers a two year molecular imaging and therapeutics fellowship. It’s one year if you’re trained in rad onc. I think a one year “Radiotheranostics and Systemic Cancer Therapy” fellowship for rad oncs makes sense.

 

[CurbYourExpectations]

University of Toronto offers a two year molecular imaging and therapeutics fellowship. It’s one year if you’re trained in rad onc. I think a one year “Radiotheranostics and Systemic Cancer Therapy” fellowship for rad oncs makes sense.

I don't think it makes sense if it's just radiopharm, but if it's "cancer based" radiology read focus and/or radiosensitizers/immunotherapy then okay. But radiology is probably not going to want us to do reads, medonc won't want us to do immunotherapy. The lowest hanging fruit is radiopharm.

Current RadOncs are more than educated enough to provide radiopharm. Techs deliver it manually, not the RadOncs, just dose prescribing and symptom management. We already study cell biology and radiation. We manage radiation symptoms. Many radiology trained deliverers of these therapies end up just consenting for the admission of the therapy and then the rest of the care is left up to MedOnc and internal medicine.

The last thing RadOncs need is more unnecessary training.

 

[ramsesthenice]

I don't think it makes sense if it's just radiopharm, but if it's "cancer based" radiology read focus and/or radiosensitizers/immunotherapy then okay. But radiology is probably not going to want us to do reads, medonc won't want us to do immunotherapy. The lowest hanging fruit is radiopharm.

Current RadOncs are more than educated enough to provide radiopharm. Techs deliver it manually, not the RadOncs, just dose prescribing and symptom management. We already study cell biology and radiation. We manage radiation symptoms. Many radiology trained deliverers of these therapies end up just consenting for the admission of the therapy and then the rest of the care is left up to MedOnc and internal medicine.

The last thing RadOncs need is more unnecessary training.

I physically inject Pluvicto and Xofigo. Lutathera uses a pump to administer and I just hit go. Neither require fellowship training. I’ll be the first to say I have not seen anything in rad onc that really needs a fellowship. I trained at place that did point A based intracavitary only brachytherapy, then took a job at a place that did MR based volumetric brachytherapy for Gyn and ended up directing that program and expanding it to include hybrid and traditional interstitial brachytherapy. Along the way, I happened to become a high volume user of adaptive MR-IGRT (mostly for pancreas). Then I ended up getting recruited to a place that had an MRL and needed help with Brachy and was looking for someone with experience getting trials funded by pharma to help expand their radioligand therapies footprint. I could have done a fellowship for any of these things. Instead I got a full salary and on the job training. I’ll be the first to admit there was a lot of luck at play here. But I also took advantage of what was around me to get here.

The only value I see in this kind of fellowship would be if it were a pathway to reading nuclear imaging scans. Even then, I’m skeptical and unsure how marketable you would be. Most PET radiologists still read other modalities as needed and I don’t know how many centers are realistically looking for people who can only read nuclear scans and inject radioligands. It seems much more useful after completing a diagnostic rads residency IMO.

 

[CurbYourExpectations]

I physically inject Pluvicto and Xofigo. Lutathera uses a pump to administer and I just hit go. Neither require fellowship training. I’ll be the first to say I have not seen anything in rad onc that really needs a fellowship. I trained at place that did point A based intracavitary only brachytherapy, then took a job at a place that did MR based volumetric brachytherapy for Gyn and ended up directing that program and expanding it to include hybrid and traditional interstitial brachytherapy. Along the way, I happened to become a high volume user of adaptive MR-IGRT (mostly for pancreas). Then I ended up getting recruited to a place that had an MRL and needed help with Brachy and was looking for someone with experience getting trials funded by pharma to help expand their radioligand therapies footprint. I could have done a fellowship for any of these things. Instead I got a full salary and on the job training. I’ll be the first to admit there was a lot of luck at play here. But I also took advantage of what was around me to get here.

The only value I see in this kind of fellowship would be if it were a pathway to reading nuclear imaging scans. Even then, I’m skeptical and unsure how marketable you would be. Most PET radiologists still read other modalities as needed and I don’t know how many centers are realistically looking for people who can only read nuclear scans and inject radioligands. It seems much more useful after completing a diagnostic rads residency IMO.

Thanks for the input. Here it is pushed by non physicians and the lutathera is pumped. Renal protective protocols, etc.

Yup to the rest of your statement, benefit of a healthy workforce. Fellowships in RadOnc (non accredited) and radiology (some accredited) were popularized based on poor job markets. If a radonc was doing fellowship today, it should be for a good reason, and radiologists are now continuing to do fellowships in some things because it is what was done by their predecessors (somewhat related to the poor job markets in some sense). I could try to give examples, but will leave it for a discussion by someone more intimate with the scenario, as some fellows I talk to swear these fellowships are necessary.

I agree, a RadOnc fellowship should add something unique that other RadOncs couldn't have just done on their own. IR or diagnostic combined. I talked about this a while ago, but why not combine something like nuc med and RadOnc into a fellowship? Or MedOnc/RadOnc? Or IRRadOnc? Or something similar.

We should not be a field that is content with old salaries and lifestyle, we should be attempting to evolve.
The longer RadOncs doggy paddle in the water, the more likely it is we will drown.