Introduction

The field of biomedical imaging in both radiology and nuclear medicine has grown rapidly over the last three decades. Imaging is now a major area of biomedical research and has become a multidisciplinary process, with radiologists and nuclear medicine physicians working not only with physicians from other disciplines but also with biochemists, physicists, physiologists, and bioengineers [1, 2]. Therefore, an appropriate training curriculum in the two disciplines is crucial to ensure optimal patient care [3,4,5,6,7]. The European Society of Radiology (ESR) has revised the European Training Charter for Clinical Radiology. In this revised version, molecular imaging and other nuclear medicine techniques are comprehensively integrated into basic and advanced diagnostic radiology residency training, and an option to subspecialize in molecular imaging is offered during the last 2 years of the 5-year program [8]. In Switzerland, as in most European countries, clinical radiology and nuclear medicine are separate medical specialties. Both disciplines can combine their complementary skills to work toward a common goal of the interdisciplinary development of hybrid imaging, such as positron emission tomography and computed tomography (PET/CT) and PET and magnetic resonance imaging (PET/MRI). In this context, training periods in one of the disciplines can be credited at least proportionally in the other discipline. As an example, 1 year of training in nuclear medicine can be credited to an overall 5-year radiology residency anytime during the radiology training period. Moreover, a fully trained radiologist needs only a further 3 years of training in nuclear medicine to complete the full training in nuclear medicine. Little is known about the interest and willingness of radiologists and nuclear medicine physicians at different stages of their professional life to undergo further training in the complementary field. We therefore conducted a questionnaire survey to obtain an overview of the demand for interdisciplinary further education of residents and consultants in radiology and nuclear medicine and their preferences regarding a possible joint future training curriculum in Switzerland.

Materials and methods

We developed a 58-page questionnaire (two language versions: German and French) with a total of 34 items to conduct an anonymous and comprehensive survey of the demand for interdisciplinary further education of residents and board-certified physicians in radiology and nuclear medicine in Switzerland (see Tables 1, 2, and 3). The questionnaire was sent electronically (SurveyMonkey online survey tool) between August 2016 and January 2017 to 1244 radiologists and nuclear medicine physicians (residents and consultants) in Switzerland. Electronic addresses were provided by the Swiss Society of Radiology.

Table 1 Summary of the common questions for radiologists and nuclear medicine physicians
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Table 2 Summary of the questionnaire for radiologists
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Table 3 Summary of the questionnaire for nuclear medicine physicians
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Results

A total of 370 questionnaires were analyzed, 30% of the total of questionnaires sent. Among them, 76% were from board-certified physicians in either radiology (64%) or nuclear medicine (12%), and 18% were from residents (radiology, 15%; nuclear medicine, 3%; see Tables 4 and 5).

Table 4 Participant structure of the survey: gender, age, and region
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Table 5 Participant structure of the survey: current position, years of training (for residents), and current workplace
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Residents in radiology

Of all residents in radiology who responded (54 residents, 100%), 56% would in general be interested in completing further specialist training in nuclear medicine, 22% were still undecided, and another 22% were not interested in interdisciplinary further training in nuclear medicine. Of great interest were the topics of PET/CT (50%), PET/MRI (40%), and scintigraphy and SPECT/CT (37%). A mixed picture of interests across the entire evaluation range (from very great to no interest) was seen for research activities. The main motivating factors were an expansion of the diagnostic capabilities with 24 entries and the personal need for continuous further training with 20 entries. Of moderate interest in terms of motivation were better employment chances with 16 entries. Twenty-seven responders expressed their preference regarding a training program for obtaining a double medical specialist title in radiology and nuclear medicine. 52.0% of these radiology residents (see Fig. 1) opted for the concept of “4 years in radiology and 2 years in diagnostic nuclear medicine” with their motivation being to also perform diagnostic nuclear medicine besides radiology. Another 41.0% of these radiology residents favored “4 years of radiology, then another 3 years of nuclear medicine”. The concept of “4 years of nuclear medicine, then another 4 years of radiology until both specialist titles are attained” was supported by only 7%. Overall, 98.6% of the radiology residents were in favor of a training period of 6 or 7 years to specialize in both disciplines.

Fig. 1
figure 1

Residents’ preferences concerning the current training curriculum for obtaining a double medical specialist title (n = 27 answers from radiology residents; n = 7 answers from nuclear medicine residents) 

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Residents in nuclear medicine

Of the 11 residents (100%) in nuclear medicine who responded, 63.3% were interested in completing additional specialist training in radiology, 1 resident (9.1%) was still undecided, and 3 residents (27.3%) were not interested in additional radiology training. The areas of oncological imaging, cardiac/thoracic radiology (with 7 entries for each), and abdominal radiology (with 6 entries) were of greatest interest to those who responded. Interest was more divided for neuroradiology, research activities, musculoskeletal radiology, and pediatric radiology (with 4 entries for each). Emergency radiology, breast imaging, and interventional radiology were of minor interest. The motivation pattern was mostly similar to that of radiology residents, expansion of the diagnostic capabilities with 6 entries and personal need for interdisciplinary further training with 5 entries. In the middle of the motivation scale (7 entries each) were the better chances of employment as well as the long-term safeguarding of employment.

According to the current training curriculum for obtaining a double medical specialist title, of the 7 responses received (see Fig. 1), 71.4% of the responders were in favor of the concept of “4 years in radiology and 2 years in diagnostic nuclear medicine”. One resident (14.3%) supported the concept of “4 years in radiology, then another 3 years in nuclear medicine” and another participant voted for “3 years in nuclear medicine and 4 years in radiology” as an option. The concept “4 years of nuclear medicine, then another 4 years of radiology until both specialist titles are attained” was not supported. Of the 7 responses, 6 (86%) fell to a training period of 6 and 7 years, respectively.

Preferences regarding a possible future joint training curriculum for residents in radiology and nuclear medicine

To obtain radiology and nuclear medicine residents’ opinion regarding a joint training program, different variants were presented, also with regard to possible adjustments to the general conditions by the radiological society/nuclear medicine society in Switzerland. The following two options were preferred by residents in radiology and nuclear medicine taken together (53% of all residents; see Fig. 2).

  • Specialist title in radiology after 5 years of training plus another 2 years of specialist training in nuclear medicine (38.2%)

  • Specialist title in radiology and diagnostic neuroradiology in 6 years of training plus another 2 years of training in nuclear medicine (14.7%)

Fig. 2
figure 2

Participants’ preferences concerning possible future joint training curricula. Rad, radiology; IR, interventional radiology; NM, nuclear medicine; NR, neuroradiology; DNR, diagnostic neuroradiology; INR, interventional neuroradiology; PR, pediatric radiology

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Consultants in radiology

The first question referred to the willingness of board-certified radiologists to undergo further training in nuclear medicine according to the current training curriculum. Of the 238 consultants who responded, 7.3% would accept a training period in nuclear medicine of 3 years, 13.4% would invest a maximum of 2 additional years, and 32.8% a maximum of 1 year in subareas of nuclear medicine. Of great interest (multiple answers were possible) were the modalities of PET/CT (93.4%), scintigraphy, and SPECT/CT (50%).

A total of 108 consultant radiologists (45.4%) expressed no interest in further training in nuclear medicine. Presented with the option of obtaining the title of nuclear medicine specialist in 2 years according to a possible future joint training program, 69 respondents (29.0%) would be willing to invest this time. Another 74 respondents (31.1%) would be prepared to invest a maximum of 1 year in subareas of nuclear medicine. The remaining 86 respondents (36.1%) would not be interested in further training in nuclear medicine even according to a possible new curriculum.

Consultants in nuclear medicine

The first question referred to the willingness of board-certified physicians in nuclear medicine to undergo further training in radiology according to the current training curriculum. Of the 40 board-certified nuclear medicine physicians who responded, 30.0% would be willing to invest four years for the specialist title in radiology, 7.5% preferred a maximum radiology training period of three years, 25.0% favored two years, and 12.5% one year. Of great interest (multiple answers were possible) were the areas of MRI (94.4%) and CT (72.2%).

Twenty-five percent of consultants expressed no need for further training in radiology. Regarding the answer to the option of obtaining the title of radiology specialist in two years according to a possible future joint training program, 55.3% will agree to invest this time, 18.4% would agree to invest a maximum of one year in subareas of radiology, and another 26.3% did not show any interest in further education in radiology, even according to a possible new curriculum. This number was the same compared with those who were not interested according to the existing curriculum.

Discussion

Radiology and all specialties related to imaging science, including nuclear medicine, are changing rapidly. Radiologists and nuclear medicine physicians are threatened by both internal and external challenges [9,10,11,12,13,14] that may diminish our role in health care and limit our ability to attract outstanding trainees and to optimize advances in imaging research. One possible solution to strengthen our position is for radiology and nuclear medicine to combine their complementary skills and work toward a common goal in the multidisciplinary development of molecular imaging. The first step is to set up a combined new cross-curricular training curriculum for residents in both specialties, which will improve competence in advanced medical imaging and knowledge of molecular imaging.

Residents in radiology and nuclear medicine

More than half of all residents (52%) in either radiology or nuclear medicine participating in our survey believe that comprehensive expertise in both disciplines can be ensured through adequate cross-curricular training (see Fig. 3). At present, neither radiology nor nuclear medicine training alone in Switzerland prepares residents optimally for future advances in molecular imaging. Radiologists and nuclear medicine physicians should face this problem and realize that we live in an era of transition that requires new approaches to tackle the changes our specialties are facing.

Fig. 3
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Responses of residents and consultants regarding their attitudes toward interdisciplinary cross-curricular training in radiology and nuclear medicine

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Another interesting result of our survey among residents is that the willingness to undergo further training in the other’s specialty is higher among nuclear medicine residents than among radiology residents. Residents who initially start specialist training in nuclear medicine would like to do further specialist training later in radiology with a higher percentage (63.3%) compared to radiology residents (56%). In fact, there is some concern that both the fields of radiology and nuclear medicine may face an uncertain future unless more medical students can be attracted to both specialties [6, 12,13,14].

Preferences regarding a possible joint training curriculum for residents in radiology and nuclear medicine

Only a small percentage of respondents from either radiology or nuclear medicine (5.9%) showed no eagerness for further training in each other’s specialty. More than half of all respondents would be willing to invest 2 more years of training in subareas of nuclear medicine (53%, see Fig. 2). This illustrates how extensive the interest in the other discipline in both radiology and nuclear medicine is.

Consultants in radiology and nuclear medicine

Almost half of the consultants in radiology (46.6%) and a quarter of consultant physicians in nuclear medicine (25.0%) had no interest in further training in a cross-curricular training (43%, see Fig. 3). While, at first sight, this might suggest a lack of interest in each other’s specialty, results by age show that this is in part attributable to higher age, when further training is no longer considered worthwhile (see Fig. 4). Other participants already had a double medical specialist title or had practical experience in the interpretation of hybrid imaging data. Other reasons given were a loss of income during further education, high existing workloads, and an enormous expenditure of time.

Fig. 4
figure 4

Overview on different age groups of the participants and age distribution in the participating residents and board certified physicians in radiology and nuclear medicine

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Interestingly, we found that the willingness of consultants in radiology or nuclear medicine to do further training in each other’s specialty increased significantly with shortening the training period to 2 years. This observation suggests that the duration of specialty training plays a key role in the decision to undergo interdisciplinary further education.

There are some limitations to our study. It is always desirable to have a large number of respondents. However, physicians are less likely to participate in surveys possibly because of their heavy workload. Our return rate of 30% is moderate but corresponds to the return rate of questionnaire surveys that can be expected according to Jepson et al [15]. It even exceeds the return rate in other surveys in radiology [16, 17].

Some bias may have resulted from the fact that mainly radiologists participated in the survey. Relatively fewer nuclear medicine physicians responded (14%). We cannot claim that our data provide a comprehensive overview of the current demand for interdisciplinary further education of residents and board-certified physicians in nuclear medicine in Switzerland, but our study nevertheless provides interesting insights into the demand for interdisciplinary further education from two medical specialties.

Conclusion

Our survey indicates that residents and consultants in radiology and nuclear medicine have a great interest in further training in each other’s specialty. Regarding a possible future joint training curriculum for residents in both specialties, gaining a specialist title in radiology in 5 years plus 2 years of specialist training in nuclear medicine is the most popular concept. This demand should be considered in new cross-curricular training programs which should incorporate the principles and all modalities of both specialties.