Training the Physician Scientist in Radiology

Radiology is a rapidly evolving clinical specialty where basic, translational, and clinical research has become an increasingly important part of the field. In addition to its traditional role in carrying out and interpreting non-invasive medical imaging studies such as X-ray, CT, ultrasound, and MRI, Radiology has expanded to include rapidly evolving practices in image-guided tissue sampling, interventional radiology (IR), and radiopharmaceutical therapy. Research in Radiology encompassed a wide spectrum of topics that include imaging devices and methods for image generation, image informatics and analytics (including AI), and molecular imaging and image guided therapy. In addition to work in advancing radiologic methodology, research in radiology also applies imaging methods to basic, translational, and clinical research in cancer, neurosciences, cardiovascular biology, and other topics where the information provided by imaging is key to the research focus - for example cancer metabolism. The American Board of Radiology governs the certification for Radiology and related subspecialties. The traditional Diagnostic Radiology (DR) Residency includes an internship followed by 4 years in an ACGME-accredited residency program. This is often followed by a subspecialty fellowship training in areas such as abdominal imaging, breast imaging, chest/cardiovascular imaging, interventional radiology, musculoskeletal, nuclear medicine imaging and therapy, or pediatric radiology, especially for academic practices. In addition to the standard DR residency pathways, there are combined pathways that integrate training diagnostic and interventional radiology (Integrated IR (IR/DR) pathway), and nuclear medicine (16-month integrated DR/NR pathway).

With the acceleration of Research in radiology, programs designed to train physician-scientists (Radiology PSPTs) have been developed using one of two approaches:

The ABR Holman Pathway - This is a formal ABR-sanction training pathway is designed for “the exceptional trainee who has both strong clinical abilities and a background in research.” This pathway is individualized to each trainee after the trainees acceptance to the host diagnostic radiology residency program and offers up to 18-20 months dedicated to research. This pathway requires formal approval by the ABR for each individual trainee participating in the Holman Pathway. Applications to the Holman pathway occur after the trainee enters his/her dedicated residency program and are accepted in the 2nd 6 months of the R1 year or anytime in the R2 year. {Note that a similar program exists for Radiation Oncology, which is also governed by the ABR.}
Radiology PSPTs with a Dedicated “Research Track” - In the past 10-15 years, a number of programs have developed dedicated PSPT slots in the residency programs in the form of a research track that typically have their own dedicated applications in the NRMP Match and fulfill all of the training requirements for DR certification. The format of these programs varies somewhat, but almost all include at least one full year dedicated to research, as well as specific training in research methodology. Many Dedicated Radiology PSPTs have benefit from support from the National institute of Biomedical Imaging and Bioengineering (NIBIB) T32 grant support, which typically provides support for a dedicated mentored research year and other research training. Several of the dedicated Radiology PSPTs have formal links to fellowship-level training at the same center to enable additional research to be carried our during subspecialty training.