Early in October, the American Board of Radiology (ABR) celebrated its 75th anniversary. I wrote a history of the board and had the privilege of participating in the celebration. The specialty and its board have come a long way together in three quarters of a century. And in the next couple of decades, the advances may be more like a quantum jump than plodding progress.
When the ABR was founded in 1934, it had been almost 40 years since the discovery of x-rays and that long a time since doctors had first started using x-ray equipment for diagnosis and therapy. In the first few years, there was a question of whether x-rays would be a slightly simplistic version of stethoscopes and tongue depressors or whether they would be the sophisticated core of a new discipline. The sponsoring societies and their appointees as founding trustees believed that radiology was ready to be a defined specialty. The sponsoring societies were the American College of Radiology, the American Radium Society, the American Roentgen Ray Society, the Radiological Society of North America, and the Radiology Section of the American Medical Association (AMA). The 15 appointed founding trustees were founders and leaders of the radiology societies. The ABR was the fifth specialty board to be recognized by the AMA.
The board’s dilemma, then and now, was how much of radiology it should accept as it was and how much the board should act to set new standards. One of the earliest issues was the matter of training programs to qualify candidates for examination. The training and exams covered both diagnostic imaging and radiation treatment. The ABR and most other boards started with oral examinations. Trustees and invited examiners showed films and asked questions. A section on physics was added in 1936. A decade later, the ABR became the first medical board to certify a nonmedical group, radiation physicists.
From its early years until 1968, when it did so, the board talked about adding written examinations. The written exams did not replace the oral rite of passage—though a computerized version will do so in the next few years. In the 1970s, the ABR recognized the practical separation of diagnostic and therapeutic radiology and responded by ending its examinations in general radiology. Another decade later, it got into the concept of subspecialty credentialing, based mostly on the completion of fellowships beyond basic diagnostic training. Now there are subspecialty exams and certification in pediatric radiology, neuroradiology, vascular and interventional radiology, nuclear radiology, and a new one on palliative care. The palliative credentials are jointly administered by the American Board of Internal Medicine plus nine other specialty boards.
One of the politically tense confrontations for the ABR was the advent of radionuclides in medicine from the 1950s until 1971, when the AMA recognized a conjoint American Board of Nuclear Medicine. The ABR and its sponsoring societies all asserted that the use of any radioactive materials was and should be declared as part of radiology. The boards of pathology and internal medicine disagreed. As did some physicians who contended that radionuclide use should be a separate specialty, not a fragment of any existing one. The result was that the AMA approved a conjoint nuclear board, with the ABR, pathologists, and internists as conjoint sponsors. A decade later, the nuclear board dumped its sponsors, despite the ABR’s objections. For the past half century, there has been a continuing squabble between the medical nuclear boards and the federal Nuclear Regulatory Commission (NRC), which insists upon licensing medical users. Part of the issue is persuading the NRC to recognize medical certification as qualification for NRC licensure.
Most of you remember with a sense of relief that successful passage of the ABR oral exam was a traumatic day that led to a lifetime credential. But that is not the case any longer, in radiology and in virtually all other medical specialties. Certification has a fixed period. During that period, continuing medical education is required, commonly by state medical licensure boards and often hospital staff specifications and some medical societies. And by the end of the defined period, another examination or alternative method of requalification is required. Continuing medical education credentialing is now required in most parts of the world. In the United States, the ABR cooperates with its sponsors. But it has the key role.