Click here for pdf version

ARROgram #37
Unsealed Sources/ABR Letter

September 27, 2005

To: Radiation Oncology Trustees of the American Board of Radiology (ABR)
       Residency Review Committee (RRC) for Radiation Oncology
Re: Policies on unsealed sources training requirements
CC: Association of Program Directors in Radiation Oncology (ADROP)
      Resident physicians in Radiation Oncology training programs in the United States

The Association of Residents in Radiation Oncology (ARRO) was recently informed of a letter
from the ABR to Radiation Oncology Program Directors regarding residency training in unsealed
radionuclide therapy administration (dated August 11, 2005 and available online at
http://www.theabr.org/NRC_Final_Reg_RO.htm ). ARRO writes to the ABR and the RRC to
clarify several questions that have arisen regarding the new unsealed sources policy.

To summarize from the ABR letter, beginning with the oral examination of June 2007, the ABR
will only admit for examination candidates who have had classroom and laboratory instruction
incorporating the new Nuclear Regulatory Commission (NRC) regulations and NRC-mandated
work experience for oral administration of I-131 in quantities >33 mCi and parenteral
administration of unsealed beta- or photon-emitting by-product material with a photon energy of
<150 KeV. The letter states that such instruction may take place as part of the RRC-required
courses in radiation physics, radiation and cancer biology, and clinical radiation oncology or a
rotation in nuclear medicine. Residents will be required to participate with preceptors in three
cases involving oral administration of >33 mCi I-131 and three cases involving parenteral
administration of unsealed beta- or photon-emitting by-product material with a photon energy of
<150 KeV.

The RRC also previously announced the requirement that each resident must participate in at least
six procedures during their residency training involving radioimmunotherapy, other targeted
therapeutic radiopharmaceuticals, or unsealed radioactive sources. However, the RRC stated in
correspondence with Program Directors on June 27, 2005 the following:

“Programs will be provided a period of transition beginning July 1, 2005. Current residents
will be expected to participate in the administration of no fewer than two cases during each
year spent in clinical radiation oncology. By June 30, 2009, all graduating residents must
document that they have participated in a total of 6 procedures.”

On behalf of Radiation Oncology residents, ARRO respectfully asks the following questions of
the ABR and the RRC regarding the unsealed sources policies:

1. Will the new ABR policy be rigidly enforced for all residents as written beginning with the
oral examination in June 2007, or will a phased-in approach be adopted similar to that
suggested in the previous RRC correspondence? We ask both the ABR and the RRC to
consider adopting a common, specific phase-in policy for the unsealed sources requirements.
One such policy is as follows:

Residents graduating 6/2009: ≥6 cases required
Residents graduating 6/2008: 4-6 cases required (2 cases/clinical year after 7/05)
Residents graduating 6/2007: 2-4 cases required (2 cases/clinical year after 7/05)
Residents graduating 6/2006: 0-2 cases required (2 cases/clinical year after 7/05)

ARRO is concerned that senior residents, in particular, may have difficulty in meeting the
new requirements. Several Program Directors have informed ARRO that they were counting
on a phase-in policy in order to have time to establish the appropriate training systems at their institutions. Currently, some training programs have not yet even determined a system for their residents to meet the new unsealed sources requirements. In addition, residents’
schedules are already determined for the 2005-6 academic year at most institutions.
Moreover, many upper-level residents may be on research or other electives in the 2005-6
academic year that are necessary for their graduation. Thus, it may be quite difficult for
senior residents and training programs to establish the required formal training before the end of the academic year so that these residents can sit for the ABR oral examination in June 2007.

2. Will physicians whose Radiation Oncology training ended prior to June 2005 be required to meet the new ABR policy as well in order to sit for the ABR oral examination? For instance, will current Fellows (who completed their training prior to 2005) or physicians who failed or conditioned their oral boards in previous years also be required to meet the new ABR requirements despite the fact that their training ended prior to the announcement of the new policy by the ABR?

3. Will physicians whose Radiation Oncology training is/was outside the United States (e.g.,
Canada) also be required to meet the new ABR requirements?

ARRO is hopeful that the ABR Radiation Oncology Trustees and the RRC for Radiation Oncology will carefully review and consider the questions raised in this letter. On behalf of our constituents and colleagues, we thank you in advance for your attention.

Sincerely,
The ARRO Executive Board