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  1. 1. RESIDENCY REVIEW COMMITTEE FOR DIAGNOSTIC RADIOLOGY 515 N State, Ste 2000, Chicago, IL 60610 • SUBSPECIALTY PROGRAMS IN NUCLEAR RADIOLOGY PROGRAM INFORMATION FORM FOR CONTINUED ACCREDITATION GENERAL INSTRUCTIONS Use this Continued Accreditation PIF in conjunction with the Accreditation Data System (ADS). Follow the provided instructions to create the correct PIF. Go to the Accreditation Data System (ADS) found on the ACGME home page (, using your previously assigned username and password, complete the shaded items (as appropriate), print all sections of Part 1 of the PIF and sign the form. If you find items displayed incorrectly change your data using ADS update sections; in some instances you may need to contact your DIO for the entry of updated information. Next, proceed to the section under the RRC for Diagnostic Radiology to retrieve Part 2 of the PIF for continued accreditation in Microsoft Word. Complete Part 2 of the PIF using your preferred word processor (only after Part 1 has been completed). Combine Part 1 and Part 2, number the pages consecutively on the lower center of each page, beginning with Part 1 Section 1 and completing the Table of Contents (found with the Part 2 instructions). After completing the PIF documents, make four (4) copies. They must be identical and final. Draft copies are not acceptable. Mail one (1) set of the completed forms to the site visitor at least 14 working days before the site visit. The remaining three (3) sets should be provided to the site visitor on the day of the visit. The Program Requirements, the Institutional Requirements, and Program Information Form (PIF) may be downloaded from the ACGME Website ( and should be reviewed carefully. For questions regarding the completion of the form (content), contact the Accreditation Administrator (Phone: 312-755-5042) For Accreditation Data System questions, contact or email For a glossary of terms, use the following link – The program director is responsible for the accuracy of the information supplied in this form and must sign it. It must also be signed by the DIO of the sponsoring institution. SPECIFIC INSTRUCTIONS Program Letters of Agreement (PLA): For new applications, attach at the end of the PIF a program letter of agreement (PLA) for each participating site providing an assignment. Those seeking continued accreditation must have all PLA’s available onsite during the site visit (do not attach to PIF). Sponsoring Institutions: Please review carefully the following statement from the Program Requirements for the Subspecialties of Diagnostic Radiology: “Residency education programs in the subspecialties of diagnostic radiology maybe accredited only in institutions that either sponsor a residency education program in diagnostic radiology accredited by the ACGME or are integrated by formal agreement into such programs. Close cooperation between the subspecialty and residency program directors is required.” For purposes of completing the application, this means that: a) If the program is conducted in the institution in which there is an ACGME-accredited diagnostic radiology residency program, the signature of the Director of the core Diagnostic Radiology program will suffice to document sponsorship by the core program. residency-review-committee-for-diagnostic-radiology1467.doc i
  2. 2. b) If the program is conducted in an institution other than that of the core residency program, a formal signed integration agreement between the Diagnostic Radiology program and the Nuclear Radiology program must also be provided. Participating Sites: For accredited programs the entry on the PROGRAM TITLE line should correspond to the title of the program in the current Graduate Medical Education Directory. If a change in title is being requested, this should be included in a cover letter accompanying the forms. For new applications the requested title should be the title of the core Diagnostic Radiology residency program. All program titles are subject to editing to conform to ACGME policies. All sites offering required rotations or experiences should be listed. One site should be designated as the primary clinical site and identified as Site #1”. If multiple sites are used, append letters of agreement which describe the trainees’ activities including the content of the experience, duration, supervision, and patient numbers. residency-review-committee-for-diagnostic-radiology1467.doc ii
  3. 3. RESIDENCY REVIEW COMMITTEE FOR DIAGNOSTIC RADIOLOGY 515 N State, Ste 2000, Chicago, IL 60610 • SUBSPECIALTY PROGRAMS IN NUCLEAR RADIOLOGY PROGRAM INFORMATION FORM Program Name: TABLE OF CONTENTS When you have the completed forms, sequentially number the bottom center of each page. Start on Part 1, Section 1 of the PIF. Report this pagination in the Table of Contents and submit this cover page with the completed PIF. 1Part 1 Section Page(s) General Program Information 1 Participating Institutions 2 Fellow Complement 3 Faculty / Teaching Staff 4 Part 2 Section Page(s) Background Information 5 Institutional Data 6 Medical Data 7 Space 8 Formal Teaching Exercises 9 Equipment 10 Library Facilities 11 Educational Program 12 Narrative Description 13 residency-review-committee-for-diagnostic-radiology1467.doc 1
  4. 4. 11 RESIDENCY REVIEW COMMITTEE FOR DIAGNOSTIC RADIOLOGY 515 N State, Ste 2000, Chicago, IL 60610 • PROGRAM INFORMATION FORM (Part 2) FOR CONTINUED ACCREDITATION– NUCLEAR RADIOLOGY SECTION 5. BACKGROUND INFORMATION A. Previous Citations or Concerns (if applicable) List the citations from last RRC accreditation if applicable and describe briefly the steps that have been taken to address the citations or suggestions made by the RRC. If documentation is required, provide a specific reference to the information provided in the PIF or append additional support materials. If no citations were listed, indicate this in the response. B. Changes (if applicable) Briefly describe major changes, other than those included in the response to previous citations and/or concerns (above) that have been implemented since the last survey and review. Include changes in sponsoring organization, participating hospitals, required rotations, fellow complement, and facility or facilities. C. Sponsoring Institution/Single or Limited Residency Institution (see ACGME Institutional Requirements) For those institutions which are either a single-program institution (e.g. Diagnostic Radiology), or an institution with multiple residencies accredited by the same Residency Review Committee, the institutional review will be conducted in conjunction with the review of the program. Only programs in these two categories are to complete the following institutional questions. Complete only if "single/limited site sponsor" field in Part 1, Section 2 is yes. 1. Provide an institutional statement that commits the necessary financial, educational and human resources to support the GME program(s) and provide documentation that the statement has been approved by the governing body, the administration and the teaching staff (Insert 1). 2. Describe the formal method by which a periodic evaluation of the program’s educational quality and compliance with the program requirements occurs. Explain how fellows and faculty in the program are involved in the evaluation process. 3. Describe how the institution complies with the Institutional Requirements regarding “Fellow Eligibility and Selection” and the development of appropriate criteria for the selection, evaluation, promotion and dismissal of fellows in accordance with the Program and Institutional Requirements. 4. Summarize how the institution complies with the ACGME Institutional Requirements regarding fellow support, benefits and conditions of employment to include the details of the fellow contract or agreement as outlined in the ACGME Institutional Requirements. (Do not append the fellow contract/agreement to the PIF but state when it is given to the fellows and applicants. Have a copy available for verification by the site visitor on the day of the survey with the various items required by the ACGME numbered according to the Institutional Requirements.) residency-review-committee-for-diagnostic-radiology1467.doc 2
  5. 5. 5. Describe in detail the grievance (due process) procedure(s) that is available to fellows, including the composition of the grievance committee, and mechanisms for handling complaints and grievances related to actions which could result in dismissal, non-renewal of a fellow’s contract, or other actions that could significantly threaten a fellow’s intended career development. residency-review-committee-for-diagnostic-radiology1467.doc 3
  6. 6. SECTION 6: INSTITUTIONAL DATA All information requested must be included for each site listed in Section 1. Period covered by statistics: (Latest 12- month period available) FROM: TO: Site #1 Site #2 Site #3 Total beds in facility Adult Admissions Pediatric Admissions # cutoff age for pediatrics Newborn nursery admissions Neonatal intensive care unit admissions Total Admissions (enter on this line) Adult Outpatient visits Pediatric Outpatient (include neonates) Total Outpatients Visits *Note: The cutoff age used by each participating s for pediatric patients should be indicated. residency-review-committee-for-diagnostic-radiology1467.doc 4
  7. 7. SECTION 7: MEDICAL DATA Site # 1 Site #2 Site #3 Thyroid Brain Lung: perfusion Ventilation Cardiac: Myocardial perfusion Infarct avid study Wall motion study Total number of imaging studies(continued) Liver: morphology Biliary tract study Bone Kidney: morphology Excretion Tumor/abscess localization Other* Total number of non-imaging in vivo studies Thyroid uptake Renogram Blood volume (including PV, RSM) Ferrokinetics RBC survival and sequestration Schilling text Fibrogen uptake study Other* Total number of in vitro studies: Check those performed in Radiology Dept. T³ and T4 Radioimmunoassay (specify type) Other* Total number of therapeutic procedures (by radionuclide): *Please list “Other” studies for 5% of the category workload: residency-review-committee-for-diagnostic-radiology1467.doc 5
  8. 8. SECTION 8: SPACE (Complete only for sites to which rotations total a minimum of 3 months) Site #1 Site #2 Site #3 Nuclear Radiology Physics Radiological Research Other (specify) ALLOCATION OF SPACE: Number of examining rooms controlled by Nuclear Radiology (including any rooms used to perform patient examinations) Number of nuclear examining rooms not controlled by Radiology, by located in Nuclear Radiology space Number of Nuclear Radiology staff offices Number of conference rooms available to Nuclear Radiology for regular use Number of Nuclear Radiology resident offices/lounges residency-review-committee-for-diagnostic-radiology1467.doc 6
  9. 9. SECTION 9: FORMAL TEACHING EXERCISES Enter the schedule of formal exercises for the most recent one year period. The specific title of lectures/sessions is requested. Topic Title residency-review-committee-for-diagnostic-radiology1467.doc 7
  10. 10. SECTION 10: EQUIPMENT List number of units available to residents in each site. Include units in other departments, e.g., cardiology, GI and GU. Append copy of current equipment list. Site #1 Site #2 Site #3 A. NUCLEAR RADIOLOGY EQUIPMENT 1. In Vivo Imaging/Counting a) Single or Multi Probe Counting Systems b) Tomographic Imaging Systems (specify) c) Cameras 1) Stationary, standard or large field 2) Mobile 2. In Vitro Laboratory 3. Other Nuclear Imaging Equipment (specify) 1. Are residents required to learn to operate, utilize or program any phase of computer utilization specifically part of nuclear units?...........................................................................................................................( ) YES ( ) NO If yes, describe briefly: residency-review-committee-for-diagnostic-radiology1467.doc 8
  11. 11. SECTION 11: LIBRARY FACILITIES Site #1 Site #2 Site #3 A. INSTITUTIONAL LIBRARY Distance from Radiology Department Hours of operation Total volumes Total journal titles B. DEPARTMENTAL LIBRARY Hours of operation Total volumes Total journal titles C. TEACHING FILE 1. Total number of cases in institutionally accumulated nuclear radiology file: 2. Does the department have a teaching file gathered from outside the site?...........................( ) YES ( ) NO 3. ACR file (list sections available and date of acquisition) SECTIONS AVAILABLE DATE OF ACQUISITION residency-review-committee-for-diagnostic-radiology1467.doc 9
  12. 12. SECTION 12: EDUCATIONAL PROGRAM 1. Please submit an outline of typical assignments and the time spent in each assignment during the 12 months of the training program. Assignment: Time Spent Location Months Weeks Site #1,2,3 2. List regular conferences, lectures, and seminars in nuclear medicine, physics, radiobiology, nuclear radiology, etc. (Conferences must include those in which there is resident participation.) Also list clinicopathological conferences, journal club, etc. Extradepartmental conferences in which the department and nuclear radiology residents participate or attend may be listed separately. Attach the lecture/conference schedule for the past year, to include topics, dates and presenters. Conferences, lectures, etc. (Intradepartmental) Frequency Individual (s) (and specialty) responsible for organization of sessions residency-review-committee-for-diagnostic-radiology1467.doc 10
  13. 13. SECTION 13: NARRATIVE DESCRIPTION OF TRAINING The Review Committee for Radiology must determine whether a truly educational experience is offered by your program as it is presented. The Committee recognizes that many variations exist among excellent programs and it does not intend to design or dictate curricula. In addition to the material already provided, information of significance relative to the following questions will be helpful in evaluating your program: 1. What are the principal objectives of the program? 2. Describe the organization of the teaching. 3. Explain the provision for graduated resident responsibility. 4. Explain the availability of attending coverage and provision for resident supervision. 5. a. How does each of the affiliated institutions contribute to the educational program? b. Describe the nature of resident participation on rotations at the affiliated institutions. 6. How does the program provide for graduated study, experience and responsibility in the following areas: a. nuclear radiologic diagnosis b. medical nuclear and diagnostic radiological physics c. radiobiology d. health physics and protection e. nuclear medicine instrumentation f. radiopharmaceutical chemistry and instrumentation residency-review-committee-for-diagnostic-radiology1467.doc 11
  14. 14. g. clinical applications of nuclear radiology h. pathology 7. Describe how the residents participate in the teaching conferences. a. How much responsibility do they have for their preparation and presentation? b. Is attendance/participation of residents and faculty documented?.........................................( ) YES ( ) NO 8. Describe briefly the research space and important special research facilities. a. List intramural research programs (not more than 5) being conducted by members of the Department, indicating those in which (if any) residents participate. DO NOT SUBMIT COPIES OF PROTOCOLS, PAPERS OR GRANT APPLICATIONS. 9. Describe method of resident evaluation, cite intervals of regular evaluation, and provide copies of the evaluation forms used. a. Please include responses to the following questions: 1) Are residents informed of their evaluations?.................................................................( ) YES ( ) NO 2) Are faculty members periodically evaluated by the residents?......................................( ) YES ( ) NO If yes, describe methods and indicate how frequently. 10. Describe the mechanism for periodic internal (institutional) review and evaluation of the residency program. residency-review-committee-for-diagnostic-radiology1467.doc 12