Revision History
The physician shall have the responsibility for all aspects of the study including, but not limited to, reviewing all indications for the examination, specifying the pulse sequences to be performed, specifying the use and dosage of contrast agents, interpreting images, generating official interpretations (final reports), and assuring the quality of both the images and interpretations. The physician interpreting breast MRIs must have knowledge and expertise in breast disease and breast imaging diagnosis.
All physicians who supervise and/or interpret MRI examinations must be licensed medical practitioners who meet the following minimum criteria:
Requirements for Physicians Supervising and Interpreting MRI Examinations | ||
Initial Qualifications | ||
Radiologist(Board-Certified)
| Radiologist(Not Board-Certified)
AND
| Other Physician(MR imaging limited to a specific anatomic area)All of these:
|
Continuing Experience | ||
On renewal, all MR interpreting physicians must meet one of the following:
Additional information regarding continuing experience requirements | ||
Continuing Education | ||
On renewal, meets one of the following:
Additional information regarding continuing education requirements |
Occasional readers who are providing imaging services to and for the practice are not required to meet the interpreting physician initial qualifications or continuing experience requirements; however, the reads of all occasional readers combined should not exceed 5% of the total volume of reads per practice and per modality. There must be an active written review process in place at the institution for occasional readers based on each institution’s credentialing requirements. Validation of this process will take place during any site visit by the ACR.
Requirements for Physicians Supervising and Interpreting Cardiac MRI Examinations | ||
Initial Qualifications | ||
Radiologist(Board Certified) | Radiologist(Not Board-Certified) | Cardiologist*(Cardiac ONLY) |
| All of these:
| American Board of Internal Medicine (ABIM) certification in cardiology with completion of Level 2 training or higherLevel 2 Requirements (All of these):
Level 3 Requirements (All of these):
Nuclear Medicine Physicians-(Cardiac Only)All of these:
*ACCF/AHA Clinical Competence Statement on Cardiac CT and MRI |
Continuing Experience | ||
Upon renewal, radiologists reading Cardiac MRI exams must have read 50 exams over the prior 24-month period. The cardiac examinations interpreted will count toward the overall continuing experience for other MR modules. | Upon renewal, cardiologists reading Cardiac MRI examinations must have continuing experience in accordance with level 2 requirements or higher – 50 examinations each year. | |
Additional information regarding continuing experience requirements | ||
Continuing Education | ||
Upon renewal, physicians must have earned at least 15 CME hours in MRI (half of which must be category 1) in the prior 36 months. These should include CME in Cardiac MRI as is appropriate to the physician’s practice needs. | Upon renewal, cardiologists must have earned at least 30 hours of coursework in the prior 36 months, in accordance with level 2 requirements. | |
Additional information regarding continuing education requirements |
The following are required for all physicians supervising and/or interpreting breast MRI examinations (interpretation of exams for documentation must be within the past 36 months):
Requirements for Physicians Supervising and Interpreting Breast MR Examinations | ||
Initial Qualifications | ||
Radiologist: Board-Certified | Radiologist: Not Board-Certified | Other Physician |
Certified since 2008 by the American Board of Radiology (ABR), American Osteopathic Board of Radiology (AOBR), Royal College of Physicians and Surgeons of Canada (RCPSC), or College des Medecins du Quebec (CMQ). Radiologists graduating from residency after 6/30/14 must be board-eligible as defined by the ABRIf certified before 2008:
| All of these:
| All of these:
|
Please note that a fellowship in Breast MRI is not required to meet the initial qualifications. Conversely, a fellowship in Breast MRI does not automatically mean the physician meets the initial requirements; however, if the fellowship provided for one of the required experience levels, the physician would meet the requirements. | ||
Continuing Experience | ||
On renewal, documents one of the following:
Additional information regarding continuing experience requirements | ||
Continuing Education | ||
On renewal, documents one of the following:
Additional information regarding continuing education requirements | ||
Biopsies performed under MRI guidance may be counted toward initial and continuing experience. A bilateral breast exam of one patient is considered one examination.The requirements specify that physicians must complete 15 hours of continuing education(half in category 1) in the prior 36 months specific to the imaging modality or organ system. These CE credits may be in MRI, breast, or a combination of MRI and breast. As examples, the following would meet the continuing education requirements for the Breast MRI Accreditation Program:
|
Regarding intravascular contrast media:
The following providers may be considered capable of providing direct supervision1 of intravenous contrast material administration*, subject to applicable state and federal law:
A radiologist (MD/DO)
Or – one of the following under the general supervision2 of a radiologist
Non-radiologist physicians (MD/DO)
Advanced practice provider (NP, PA)
Registered nurses following a symptom- and sign-driven treatment algorithm
*Note: supervision in this context only applies to administration of intravenous contrast media, not to the supervision of the radiologic examination or procedures.
This change would align radiology with the recognized skills of the aforementioned providers who are capable of managing acute hypersensitivity reactions to other drugs.
Responsible providers should be trained in, and periodically demonstrate competence in:
Managing acute hypersensitivity and physiologic drug reactions. This may be done using diagnostic decision-making, or by use of a symptom- and sign-driven treatment algorithm as commonly is used by nursing.
Appropriately administering reassurance, oxygen, antihistamine, intravenous fluids, beta2-agonist inhaler, epinephrine, position changes.
Understanding when to call for assistance and how to activate emergency response system(s).
Basic Life Support (BLS)
The provider of direct supervision must be immediately available to furnish assistance and direction throughout the performance of the procedure. This does not mean that the supervising provider or radiologist must be present in the room where and when the procedure is performed. However, there should be at least one person who can recognize adverse events related to contrast media administration in attendance (in the room or in an adjacent control room) to observe the patient during and immediately after the injection and summon medical assistance as needed. All local and state regulations regarding supervision of contrast media administration must be followed.
Regarding oversight and supervision: The supervising interpreting physician reviews, discusses, and confirms the diagnosis of the physician being supervised. The supervising interpreting physician does not have to be present at the time of initial interpretation; however, the supervising physician must review and, if necessary, correct the final interpretation. Supervision may also be accomplished through a formal course that includes a lecture format in addition to all of the following:
A database of previously-performed and interpreted cases
An assessment system traceable to the individual participant
Direct feedback regarding the responses
Examples of suitable assessment systems are an audience response system, a viewbox- or monitor-based program or an individual CD-ROM or web-based instruction system.
1 “Direct supervision” means the definition specified at 42 CFR 410.32(b)(3)(ii), that is, the physician must be immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician or must be present in the room when the procedure is performed.
2 “General supervision” means the definition specified at 42 CFR 410.32(b)(3)(i), that is, the procedure or service is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure.
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