The changing landscape of nuclear medicine

Mahmood, S.; Rodríguez Martínez de Llano, S.
doi:10.1016/j.remn.2012.10.001
 array:23 [
  "pii" => "S2253654X12002144"
  "issn" => "2253654X"
  "doi" => "10.1016/j.remn.2012.10.001"
  "estado" => "S300"
  "fechaPublicacion" => "2013-01-01"
  "aid" => "80"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and SEMNIM"
  "copyrightAnyo" => "2012"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "dis"
  "cita" => "Rev Esp Med Nucl Imagen Mol. 2013;32:46-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2143
    "formatos" => array:3 [
      "EPUB" => 10
      "HTML" => 1378
      "PDF" => 755
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2253654X12000510"
    "issn" => "2253654X"
    "doi" => "10.1016/j.remn.2012.01.003"
    "estado" => "S300"
    "fechaPublicacion" => "2013-01-01"
    "aid" => "9"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and SEMNIM"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Rev Esp Med Nucl Imagen Mol. 2013;32:49-51"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2312
      "formatos" => array:3 [
        "EPUB" => 8
        "HTML" => 1757
        "PDF" => 547
      ]
    ]
    "es" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Imagen de inter&#233;s</span>"
      "titulo" => "Detecci&#243;n de trombosis tumoral pulmonar mediante im&#225;genes integradas <span class="elsevierStyleSup">18</span>F-FDG PET&#47;TC con contraste endovenoso"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "49"
          "paginaFinal" => "51"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Detection of pulmonary tumor thrombosis by integrated <span class="elsevierStyleSup">18F</span>FDG PET&#47;CT scans with intravenous contrast"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figura 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1093
              "Ancho" => 1750
              "Tamanyo" => 184811
            ]
          ]
          "descripcion" => array:1 [
            "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Im&#225;genes PET&#47;TCeV&#46; Defecto de repleci&#243;n en el interior de la vena pulmonar superior izquierda con actividad glucol&#237;tica aumentada &#40;SUVmax 5&#44;7&#41; indicativa de invasi&#243;n tumoral por contig&#252;idad&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; Valls, J&#46;R&#46; Garcia, R&#46; Rodriguez, M&#46; Soler, M&#46; Moragas, F&#46; Lome&#241;a"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Valls"
            ]
            1 => array:2 [
              "nombre" => "J&#46;R&#46;"
              "apellidos" => "Garcia"
            ]
            2 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "Rodriguez"
            ]
            3 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Soler"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Moragas"
            ]
            5 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Lome&#241;a"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S225380891200136X"
        "doi" => "10.1016/j.remnie.2012.11.001"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225380891200136X?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X12000510?idApp=UINPBA00004N"
    "url" => "/2253654X/0000003200000001/v1_201305061028/S2253654X12000510/v1_201305061028/es/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S2253654X12001138"
    "issn" => "2253654X"
    "doi" => "10.1016/j.remn.2012.04.004"
    "estado" => "S300"
    "fechaPublicacion" => "2013-01-01"
    "aid" => "41"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46; and SEMNIM"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "Rev Esp Med Nucl Imagen Mol. 2013;32:43-5"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2802
      "formatos" => array:3 [
        "EPUB" => 14
        "HTML" => 2462
        "PDF" => 326
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Clinical note</span>"
      "titulo" => "Chronic myeloid leukemia detected on FDG PET&#47;CT imaging in a patient with renal cell carcinoma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "43"
          "paginaFinal" => "45"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Leucemia mieloide cr&#243;nica detectada con FDG PET&#47;TAC en un paciente con carcinoma de c&#233;lulas renales"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 819
              "Ancho" => 1830
              "Tamanyo" => 146310
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">FDG PET&#47;CT images demonstrating bone marrow infiltration in the patient with chronic myeloid leukemia&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "E&#46; Varoglu, B&#46; Kaya, O&#46; Sari"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "E&#46;"
              "apellidos" => "Varoglu"
            ]
            1 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Kaya"
            ]
            2 => array:2 [
              "nombre" => "O&#46;"
              "apellidos" => "Sari"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X12001138?idApp=UINPBA00004N"
    "url" => "/2253654X/0000003200000001/v1_201305061028/S2253654X12001138/v1_201305061028/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Opinion and debate</span>"
    "titulo" => "The changing landscape of nuclear medicine"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "46"
        "paginaFinal" => "48"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "S&#46; Mahmood, S&#46; Rodr&#237;guez Mart&#237;nez de Llano"
        "autores" => array:2 [
          0 => array:4 [
            "nombre" => "S&#46;"
            "apellidos" => "Mahmood"
            "email" => array:1 [
              0 => "smahmood&#64;yahoo&#46;com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">¿</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "S&#46;"
            "apellidos" => "Rodr&#237;guez Mart&#237;nez de Llano"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Department of Nuclear Medicine&#44; Jacobi Medical Center and North Central Bronx Hospital&#44; Bronx&#44; NY&#44; USA"
            "etiqueta" => "<span class="elsevierStyleSup">a</span>"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Nuclear Medicine Service&#44; Centro Oncol&#243;gico de Galicia&#44; La Coru&#241;a&#44; Galicia&#44; Spain"
            "etiqueta" => "<span class="elsevierStyleSup">b</span>"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "El escenario cambiante en Medicina Nuclear"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2056
            "Ancho" => 2167
            "Tamanyo" => 235383
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Inner circle</span>&#58; captures the different options available to a physician in careers in Industry&#46; These include direct roles in Industry include working with Pharma and Biotech companies&#44; CROs&#44; Regulatory agencies &#40;FDA&#47;EMA&#41;&#44; non-profits&#47;charitires&#44; governmental and private research organizations &#40;CRUK&#44; SNMMI&#44; NIH&#47;NCI&#47;NIAID&#47;NIBIB&#41;&#46; Affiliated roles in Industry include consultant roles anywhere along the drug development spectrum&#58; reading pre-clinical or clinical studies as a local site reader&#44; free-lancing consultants or subject matter experts&#44; advisory board &#40;Ad Board&#41; members&#44; principal investigators &#40;PIs&#41; and key opinion leaders &#40;KOLs&#41; from academia or community hospital practices&#44; and honorary lecturers at symposia&#46; <span class="elsevierStyleItalic">Outer circle</span><span class="elsevierStyleBold">&#58;</span> represents roles &#40;positions&#44; line functions&#41; available within Industry to physician&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Background</span><p id="par0005" class="elsevierStylePara elsevierViewall">When we embarked on our careers a decade ago&#44; there was renewed interest and numerous opportunities for a career in Nuclear Medicine&#46; We were attracted to the variety of procedures in the field of Nuclear Medicine&#58; PET had just come to the clinic&#44; presenting a great deal of promise and a revival of job opportunities&#46; However&#44; recent changes in the medical care paradigm and reimbursement have dictated that while the future of Nuclear Medicine is bright&#44; the future for Nuclear Medicine physicians is uncertain&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Recent analysis from the Society of Nuclear Medicine and Molecular Imaging &#40;SNMMI&#41; 2012 Task Force reported out that while Nuclear Medicine persists as a primary specialty that is evolving into a broader-based discipline of molecular imaging with partnerships and collaboration as necessary&#44; Nuclear Medicine being advanced by dual-certified professionals who practice the broad-based discipline of molecular imaging is imminent&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Challenges with the current job market and its impact on training programs</span><p id="par0010" class="elsevierStylePara elsevierViewall">At the recent SNMMI Annual meeting in Miami Beach&#44; FL in 2012 concerns about currently dismal job market were center-stage and these impressions were essentially unchanged from the annual meetings in Salt Lake City&#44; UT in 2010 and San Antonio&#44; TX in 2011&#46; In various sessions&#44; many speakers emphasized that job availability was cyclical and would likely run its course&#46; Many current United States &#40;US&#41; job opportunities are only open to dual-certified American Board of Radiology &#40;ABR&#41; and American Board of Nuclear Medicine &#40;ABNM&#41; Nuclear Radiologists&#44; and an increasing number of current Nuclear Medicine physicians in clinical practice are being replaced by Nuclear Radiologists&#46; The main reason for this preference for Radiologists is to have a &#8220;one stop&#8221; shop for the radiology and nuclear medicine reads&#44; where one physician could conceivably contribute across many imaging modalities&#44; and potentially have a greater impact on the relative value units &#40;RVUs&#41; per physician in the practice&#46; Whereas previously&#44; interdisciplinary collaboration between Nuclear Medicine and Radiology with its well-recognized advantages and disadvantages was considered indispensable and optimal&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> With the introduction of PET&#47;CT&#44; and recently PET&#47;MRI&#44; and many new tracers in research and development&#44; a new training pathway fusing the physiologic orientation of nuclear medicine and the anatomic orientation of radiology is necessary&#46; At the same time&#44; acknowledging somewhat lower competitiveness of Nuclear Medicine physicians in the job market&#44; many current Nuclear Medicine residency programs are considering closing their doors&#44; while others are decreasing their complement of residents&#46; A few other training programs are only accepting Nuclear Medicine residents that they deem would be competitive in obtaining a radiology residency after their Nuclear Medicine training&#46; Still other remaining programs are now only open to Radiologists for further training in Nuclear Medicine&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Similarly at the 24th Annual European Association of Nuclear Medicine &#40;EANM&#41; Congress meeting in Birmingham&#44; UK&#44; in 2011&#44; sentiments of a decline in perceived marketability of a Nuclear-only physician were cited in the European Nuclear Medicine market&#46; A major feature of the congress was an emphasis on the young generation of Nuclear Medicine physicians&#44; and the popular Highlights Lecture was delivered by three young Nuclear Medicine physicians who have shown great potential in clinical practice as well as a high promise in contributing significantly in research and development&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Due to the ongoing &#8216;Eurozone Crisis&#8217; increasing unemployment is affecting all fields&#44; including healthcare and Nuclear Medicine&#46; Purely clinical positions in both private and public health sectors are being reduced due to the restructuring of facilities&#44; a reduction of overhead spending and slashing of other fixed business costs&#44; which translates into fewer new hires and the existing instability in the job market&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Recently&#44; in the US&#44; the Accreditation Council for Graduate Medical Education &#40;ACGME&#41; Radiology Residency Review Committee&#39;s &#40;RRC&#41; Nuclear Radiology training program curriculum has been rewritten to be virtually indistinguishable from the ACGME Nuclear Medicine program residency requirements&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> The ABNM&#44; SNM and ACGME Nuclear Medicine RRC are in discussions with the ACGME regarding the overlap in training curricula goals&#46; Similarly&#44; the European Society of Radiology &#40;ESR&#41; has also revised and published their &#8220;European Training Charter for Clinical Radiology&#8221; where molecular imaging and other nuclear medicine techniques have been comprehensively integrated into diagnostic radiology residency training&#44; and an option to sub-specialize in Molecular Imaging is offered during the last 2 years of the 5 year curriculum&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Even though ESR and EANM have been working well together on educational initiatives&#44; it is unfortunate that the EANM was not consulted in the development of a curriculum that essentially renders independent Nuclear Medicine training redundant&#46; The European Union of Medical Specialists&#44; Monospecialist Section of Nuclear Medicine and the European Board of Nuclear Medicine &#40;UEMS&#47;EBNM&#41;&#44; who define the basic principles in the field of training of European Nuclear Medicine specialists and guarantee the highest standards in the field of Nuclear Medicine&#44; were also not involved in the development of the ESR curriculum&#46; It is becoming abundantly obvious that open dialog and clear communication between experts is crucial to the future of Nuclear Medicine as a field&#44; and will translate into optimal patient care&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Possible career paths for Nuclear Medicine physicians</span><p id="par0025" class="elsevierStylePara elsevierViewall">Options and practice opportunities for the recent graduate of a Nuclear-only training program are limited&#46; Some graduates pursue additional Molecular Imaging training in clinical nuclear medicine&#44; PET or research fellowships in the EU or US&#46; For EU graduates&#44; US fellowships provide a culturally and academically stimulating experience for overseas trainees who would like to become more fluent in the English language or become more familiar with US Medical Practice&#44; or eventually transition to practicing clinically in the US&#46; For US graduates&#44; pursuing fellowships in the EU is much less common&#46; In the EU&#44; the most popular solution is that recent graduates have sought training in an additional discipline&#44; thus ushering in a new era of double &#8220;hybrid&#8221; specializations&#44; and often with fields other than Radiology&#46; Unlike only a couple of years ago&#44; current European job opportunities are increasingly open to trained specialists in more than one field&#44; and Nuclear Medicine imaging is evolving into a hybrid Radiology and Nuclear Medicine specialty&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a> Hybrid imaging training seems to be the future in the US as well&#44; and opens up a wealth of clinical job opportunities&#46; Another tempting option for recent European Nuclear-only graduates is to pursue Industry job in Europe and abroad&#46; Among the most obvious benefits for European physicians in Industry are the very competitive Industry position salaries when compared to clinical jobs in Europe&#46; Research-oriented US Nuclear physicians have also started to seriously consider and explore Industry careers&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">In Industry&#44; there are a plethora of non-traditional practice opportunities due to an ever increasing need to unlock the promise of personalized medicine&#46; With recent shifts in dynamics of clinical practice&#44; Industry might be a practice setting where Nuclear Medicine physicians are perhaps given greater preference to&#44; and are able to have a higher impact&#44; than Radiologists &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; Another reason why Nuclear Medicine physicians are well-matched for Industry positions is because of the relative parity in Nuclear Medicine physician salaries with Industry standards of compensation of the clinical research physician&#46; Similar to clinical practice&#44; the vast majority of physicians working in Industry are Internists specialized in Oncology&#44; Cardiology&#44; Endocrinology or Nephrology&#44; and physicians in similar Industry roles fall into the same general salary range or bands&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Of note&#44; most companies&#44; and even different business units within a company&#44; have their own unique culture&#46; Oftentimes in the clinical practice setting&#44; physicians view themselves as the leaders of the team&#44; where they place orders and the staff carries out these orders&#46; In Industry&#44; Physicians assume an equally important role&#46; The Imaging Physician&#39;s role in Industry is very similar in that the Imaging Physician often leads one or more project teams&#44; and effectively delegates and monitors the work performed by all project team members&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The corporate world tends to promote long-term professional development and physicians in Industry feel that they gradually may lose touch with clinical practice&#46; Although some employers offer entry-level positions for the uninitiated Nuclear Medicine physician venturing out in a career in Industry&#44; one must usually demonstrate previous exposure to Industry practices during their training or subsequently in practice in order to be successful in obtaining Industry positions&#46; Another reason for an Imaging Physician to get adequate exposure to Industry &#8220;best practices&#8221; is that generally physicians like to be confident in their ability to practice medicine within the bounds of their expertise&#46; Physicians prefer to be poised to deliver and succeed in tasks that they set out to do&#44; and Industry is no exception&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Even within the Pharmaceutical and Biotechnology companies and CRO roles&#44; there are many opportunities in a physician pursuing a career in running trials on a drug product in pre-clinical &#40;Discovery&#47;Research&#47;Translational Medicine&#41;&#44; Clinical Development&#44; Safety&#47;Pharmacovigilance&#44; Medical Affairs&#44; and post-approval or &#8220;Marketing&#8221; teams&#46; Additional roles include working for governmental and large research organizations &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusion</span><p id="par0050" class="elsevierStylePara elsevierViewall">The daily practice of Nuclear Medicine is changing&#44; and Nuclear Medicine physicians are adapting to the current fiscal environment and practice needs&#46; Beyond traditional clinical practice&#44; working in non-traditional positions in Industry&#44; large governmental and private research organizations afford great prospects for the Nuclear Medicine Physician to broaden his&#47;her horizons&#46; Nuclear Medicine physicians are extraordinarily trained to excel in Industry positions because most molecular imaging procedures fall within the realm of nuclear medicine&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical adherence</span><p id="par0055" class="elsevierStylePara elsevierViewall">All institutional ethical standards have been adhered to in association with this publication&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0060" class="elsevierStylePara elsevierViewall">There are no conflicts of interest associated with this publication&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:7 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Background"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Challenges with the current job market and its impact on training programs"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Possible career paths for Nuclear Medicine physicians"
        ]
        3 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Conclusion"
        ]
        4 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Ethical adherence"
        ]
        5 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Conflicts of interest"
        ]
        6 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "multimedia" => array:1 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2056
            "Ancho" => 2167
            "Tamanyo" => 235383
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Inner circle</span>&#58; captures the different options available to a physician in careers in Industry&#46; These include direct roles in Industry include working with Pharma and Biotech companies&#44; CROs&#44; Regulatory agencies &#40;FDA&#47;EMA&#41;&#44; non-profits&#47;charitires&#44; governmental and private research organizations &#40;CRUK&#44; SNMMI&#44; NIH&#47;NCI&#47;NIAID&#47;NIBIB&#41;&#46; Affiliated roles in Industry include consultant roles anywhere along the drug development spectrum&#58; reading pre-clinical or clinical studies as a local site reader&#44; free-lancing consultants or subject matter experts&#44; advisory board &#40;Ad Board&#41; members&#44; principal investigators &#40;PIs&#41; and key opinion leaders &#40;KOLs&#41; from academia or community hospital practices&#44; and honorary lecturers at symposia&#46; <span class="elsevierStyleItalic">Outer circle</span><span class="elsevierStyleBold">&#58;</span> represents roles &#40;positions&#44; line functions&#41; available within Industry to physician&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:9 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The Janus project&#58; the remaking of nuclear medicine and radiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;M&#46; Larson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2967/jnumed.110.085761"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Nucl Med"
                        "fecha" => "2011"
                        "volumen" => "52"
                        "numero" => "Suppl&#46; 2"
                        "paginaInicial" => "3S"
                        "paginaFinal" => "9S"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22144554"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Molding the future of the profession"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "G&#46; Segall"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Nucl Med"
                        "fecha" => "2012"
                        "volumen" => "53"
                        "paginaInicial" => "17N"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22753424"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comments and perspectives&#46; Nuclear Medicine in Europe"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "P&#46;J&#46; Ell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "J Nucl Med"
                        "fecha" => "2005"
                        "volumen" => "46"
                        "paginaInicial" => "903"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Highlights of the EANM Congress 2011&#58; Birmingham&#44; UK"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "L&#46;F&#46; de Geus-Oei"
                            1 => "I&#46; Zerizer"
                            2 => "C&#46; Uebleis"
                            3 => "A&#46; Al-Nahhas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00259-011-2043-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Nucl Med Mol Imaging"
                        "fecha" => "2012"
                        "volumen" => "39"
                        "paginaInicial" => "354"
                        "paginaFinal" => "368"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22237847"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nuclear medicine residency vs nuclear radiology fellowship"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; Ziessman"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Nucl Med"
                        "fecha" => "2012"
                        "volumen" => "53"
                        "paginaInicial" => "13N"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23124869"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Revised European training charter for clinical radiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "European Society of Radiology"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2011"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Editorial on the revised European Training Charter for Clinical Radiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "European Society of Radiology &#40;ESR&#41;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Insights into Imaging &#91;serial online&#93;"
                        "fecha" => "2012"
                        "volumen" => "3"
                        "paginaInicial" => "5"
                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Syllabus for postgraduate specialisation in Nuclear Medicine&#58; 2006&#47;07 update"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Cuocolo"
                            1 => "M&#46; Milcinski"
                            2 => "A&#46; Bischof Delaloye"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00259-009-1339-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Nucl Med Mol Imaging"
                        "fecha" => "2010"
                        "volumen" => "37"
                        "paginaInicial" => "430"
                        "paginaFinal" => "433"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20033151"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Questions about the common core curriculum"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "F&#46; Pons"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.remn.2010.04.003"
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Esp Med Nucl"
                        "fecha" => "2010"
                        "volumen" => "29"
                        "paginaInicial" => "99"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20438981"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/2253654X/0000003200000001/v1_201305061028/S2253654X12002144/v1_201305061028/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7909"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Opini&#243;n y debate"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/2253654X/0000003200000001/v1_201305061028/S2253654X12002144/v1_201305061028/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253654X12002144?idApp=UINPBA00004N"
]
Indexada en:

Síguenos:

Suscribirse:

Artículo

Indexada en:

Síguenos:

Suscribirse:

Artículo

Suscríbase a la newsletter
