The entire structure of the Radiology professional board exam, the last but crucial hurtle after eight years of post-graduate training, changed this year. The old exam, that in place for decades, had two discrete elements. First, a written exam that included imaging physics followed by an oral exam that reviewed only diagnostic imaging that was taken at the end of training. One of the regular criticisms of this process was that the level of resident physics training was not sufficiently relevant to the practice of clinical radiology. While residents knew all about “bremsstrahlung” they were often uneasy about adjusting imaging parameters on a CT scanner or explaining the source of a common MR imaging artifact. The change to an entirely new exam format provided an opportunity to alter the focus of the physics questions with the expectation that residencies would therefore incorporate more practical physics in their resident’s education.
The challenge for residents and medical educators will be to make the changes necessary to prepare trainees for this exam. After forty years of preparing residents for the old exam, the physics curriculum is well established at most programs and presumably carefully refined over the years based on resident performance on their written exams. But change does not come easy and providing the necessary lectures and training will require a close collaboration between the clinical radiologists and medical physicists that may not have existed before.

Radiology requires both detection and analytic skills since there are really two elements to making a diagnosis. First, the radiologist must detect the abnormality so the first decision is establish whether the study is normal or abnormal. If the imager decides it is abnormal, the next decision is whether it is clinically relevant, artifact, or normal variant. While detection skill depend on innate visual skills and experience, the analysis is almost entirely based on education. The ability to recognize imaging artifacts is essential so that they are not mistaken for disease, resulting in unnecessary follow up imaging or treatment. These are all examples of imaging artifacts that you will eventually encounter in your practice of radiology.