What you need to know about the recent ABR decision related to authorized user eligibility

This past Wednesday March 30, 2022, the ABR announced via webinar that they are removing the “Authorized User (AU) Eligible” designation from certificates issued to board-certified radiologists after December 31, 2023. In the wake of the webinar, there has been some confusion among program directors about whether this change impacts residency program requirements. We dug into the details to clarify this issue.

ABR change is more cosmetic than substantive

The removal of the AU Eligible designation is more cosmetic than substantive. In recent communication regarding the matter, the ABR itself emphasized that "ABR certification has never been a prerequisite to becoming an NRC Authorized User." Meaning that the AU Eligible designation was essentially an ornamental designation. Removing the AU Eligible designation results in no change to (1) the residency curriculum requirements for all radiology residents (DR and IR), and (2) the process to become an authorized user.

Residents will still need 80 NRC-related hours

Following the decision from the ABR to discontinue the "AU eligible" designation, communication from the ACGME confirmed that radiology residents (DR and IR) will still be required to complete 80 hours of documented instruction in radiopharmacy and radiation safety. This ACGME requirement applies to DR and IR residents whether they are pursuing authorized user status or not.

This requirement can be achieved through a combination of hands-on experience and lectures, however the requirement involves specific curriculum coverage that is distinct from usual work on service. The required curriculum elements are outlined by the NRC Training Requirement (10CFR 35.290), including specific topics like "chemistry of byproduct material for medical use" and "radiation biology".

Process to earn AU status remains unchanged

The process to become an authorized user remains unchanged, and is independent of the "AU Eligible" designation being phased out by the ABR. The detailed process (outlined here) involves demonstrating compliance by submitting documentation of completion of the 80-hour training requirement, and completing NRC Form 313A. None of this process is affected by the removal of the "AU Eligible" designation.

Core Exam content will remain unchanged

The RISE exam questions that previously focused on content related to NRC 80-hour training will still remain part of the Core Exam. As a minor change, these questions will contribute to the aggregate score, but will not be scored separately. Previously, a scattering of residents may have passed the Core Exam and selectively failed the RISE exam questions, for which they would return for a RISE-only exam. This RISE-only exam will be phased out.

"You have to be as compulsive as you've always been. I don't think there's any relaxation of documentation."
— M. Elizabeth Oates  MD,  American Board of Radiology, March 30, 2022

Changes to documentation to the ABR

The ABR emphasized that while they will no longer be collecting Program Director Attestation forms A and B related to the 80-hour curriculum, programs will still need to diligently record this documentation for each resident because ACGME requirements are unchanged.

Form A is a detailed checklist related to the NRC 80-hour curriculum, and Form B documents I-131 administration. Documentation of both of these curriculum elements are required by the ACGME, for every radiology resident (DR and IR) regardless of whether they plan to pursue authorized user status. While the ABR will not be accepting forms A and B, completing and filing them for each resident may be useful in answering ACGME audits related to this program requirement.

For residents pursuing the 16-month Pathway Subspecialty Certification in Nuclear Radiology, the ABR will still be collecting Forms A and B per usual.

Bottom line

The ABR announcement that they are removing the "AU Eligible" designation ultimately results in no change to residency program requirements related to the 80-hour NRC-specified curriculum. Programs should remain ready to present their curriculum for audit by either the ACGME or the NRC.

References

1. "AU-E Designation Process Changing at End of 2023," American Board of Radiology, March 2022, here
2. "Program Requirements in Radiology", ACGME, here
3. "Training for imaging and localization studies," NRC, here
4. "Webinar on AU Eligibility", American Board of Radiology, March 30 2022, here