All eligibility requirements must be completed prior to submitting a CBNC application. Under no circumstances will an application with incomplete training be accepted. All criteria must be met to receive a U.S. certificate.  

If documentation of other requirements is missing or incomplete, a resubmission fee will be assessed. All documentation must be in English or accompanied by a translation.  

Level 2 Nuclear Cardiology training, a minimum of 700 hours including 80 hours of Classroom and Laboratory Training (CLT) must be completed prior to submission of application.

Be sure your preceptor has the necessary information, verification, and templates to provide your documentation.

Formal Training Pathway

1. Candidates must document Level 2 training in Nuclear Cardiology in accordance with the ACC Core Cardiovascular Training Statement 4 Task Force 6: Training in Nuclear Cardiology, Level 2 (the COCATS Guidelines revised 2015) by providing a 2021 version of the preceptor attestation letter. Training in Nuclear Cardiology must occur at a center that has an ACGME or AOA accredited training program in Cardiovascular Disease, Nuclear Medicine, or Radiology
2. A preceptor attestation letter must verify the candidate’s training pathway and document their training in nuclear cardiology. The preceptor must select the appropriate eligibility pathway based on the applicant’s status:
   1. Authorized User status OR
   2. 80 hours of Classroom and Laboratory Training (CLT) in radiation safety that meets the NRC topic requirements.
      1. Completed either:
         1. Internally within the fellowship program OR
         2. Externally through an NRC-approved courseDocumentation may be a copy of the facility RAM license listing the applicant’s name or a copy of a certificate of completion of an 80-hour CLT course that meets NRC topic requirements.Classroom and Laboratory Training (CLT) Requirements
            1. CLT hours must have been taken no more than seven (7) years prior to the examination date. CLT must be repeated if seven (7) or more years have elapsed since initial training and the applicant is not an Authorized User.
            2. Direct, hands-on laboratory experience must be part of the applicant’s Classroom and Laboratory Training.
3. Recentness of Training: If your Nuclear Cardiology training was completed seven (7) or more years prior to the date of the CBNC examination for which you are applying, you must also provide:
   1. Documentation of at least 300 cases completed within 24 months of application submission.
   2. 30 CME Category I hours completed within 36 months of application submission. Of the total, a minimum of 15 hours must be nuclear cardiology-specific and the remaining 15 hours may be in the applicant’s other area(s) of specialty
   3. Authorized User status or a certificate of completion of an 80 hour CLT course taken no more than 7 years prior to the 2025 exam.

Training and experience requirements for licensure by the Nuclear Regulatory Commission (NRC) or Agreement States vary from state to state; therefore, candidates seeking licensure should check with their regional NRC office or the office responsible for licensure in the Agreement State in which they practice. Information is also available on the NRC website: https://scp.nrc.gov/asdirectory.html

Applicants must, at the time of application, hold a current, unconditional, unrestricted license to practice medicine in the U.S. 

Testamur status 

Applicants with a training medical license may apply to sit for the examination in Testamur status provided that, at the time of application, they are enrolled in a fellowship or residency program in Cardiology, Nuclear Medicine, or Radiology 

Upon successfully passing the CBNC examination, Testamur candidates remain in that status until documentation of a current, unconditional, unrestricted medical license and a diploma or national registration as a specialist in Cardiology, Nuclear Medicine, or Radiology has been provided to the CBNC office. Applicants who pass the CBNC examination under Testamur status have six years from the date of passing the examination to document all requirements. Regardless of when a Testamur becomes a Diplomate, CBNC certification expires 10 years from the date of passing the examination. 

Applicants must be physicians who, at the time of application, hold one or more of the following board certifications. 

• Cardiology, OR any of the ABIM Cardiology subspecialties, 
• Nuclear Medicine, OR 
• Radiology 

By a board which holds membership in the American Board of Medical Specialties or the Bureau of Osteopathic Specialists of the American Osteopathic Association. 

Fellows, residents, and other Testamur applicants may apply under the training-status licensure rules. 

• Applicants must document completion of 15 hours of AMA PRA Category I CME that are CMR specific in the 60 months prior to application submission.
• Applicants are exempt if an ACGME- or AOA-accredited fellowship or residency, an advanced imaging fellowship, or a formal training program from outside the U.S. was completed up to 36 months prior to the date of application.
• Applicants with training outside the U.S. must document 15 education or lecture hours that are CMR specific in the 60 months prior to application.

Unsuccessful candidates
Candidates who are unsuccessful, or who withdrew or were a No-Show, may reapply in future years and must meet the applicable eligibility criteria in the year of application.  

Additional training after three unsuccessful attempts
Candidates unsuccessful after three attempts may not reapply in the immediate administration following the third attempt and must provide an additional 20 AMA PRA Category I CMR-specific CME earned after the third unsuccessful attempt and within the 24 months immediately preceding application submission.  

Special closed-pathway rules also apply to the Clinical CMR Experience Pathway candidates, as stated in the original requirements.  

APCA functions under policies intended to demonstrate impartiality, high ethical standards and validity of its certification assessments. 

APCA does not restrict Applicants, Candidates or becoming a Certificant based on limiting conditions, such as membership of an association or professional society of any organization. APCA will not unfairly impede or inhibit access to its certification to Applicants, Candidates or Certificants who meet our stated policies regarding qualification requirements, renewal requirements and/or passing APCA’s psychometrically sound certification assessments. 

All eligibility requirements must be completed prior to submitting a CBNC application. Under no circumstances will an application with incomplete training be accepted.  

Candidates who meet any criteria from outside the U.S. will receive a non-U.S. certificate when they pass the exam. These certificates are not transferable to U.S. certificates at any time. If an individual relocates to the U.S. and subsequently satisfies all requirements for a U.S. candidate, he/she must retake the examination to obtain a U.S. certificate. 

The equivalent to Level 2 Nuclear Cardiology training, a minimum of 700 hours including 80 hours of Classroom and Laboratory Training (CLT), must be completed prior to submission of application. 

Be sure your preceptor has the necessary information, verification, and templates to provide your documentation. 

• Applicants must submit a preceptor letter to document training in Nuclear Cardiology.  The preceptor letter must be on organizational letterhead, written within the last 36 months, and make one of the following statements:
• The Applicant has completed training in nuclear cardiology equivalent to ACCF/ASNC COCATS Guidelines for Nuclear Cardiology Training, revised 2015, Level 2 between [MM/YYYY] and [MM/YYYY] 
• The Applicant has completed training that meets the national training requirements for the independent sub-specialist practice of nuclear cardiology in [COUNTRY] on [MM/YYYY].

If the nuclear cardiology training was completed seven or more years prior to the exam for which the Applicant is applying, the letter must also verify ongoing experience as evidenced by interpretation of a minimum of 300 cases in the preceding 24 months. 

Applicants must, at the time of application, hold a current, unconditional, unrestricted license to practice medicine. 

Testamur status 

Applicants with a training medical license may apply to sit for the examination in Testamur status provided that, at the time of application, they are enrolled in a fellowship or residency program in Cardiology, Nuclear Medicine, or Radiology 

Upon successfully passing the CBNC examination, Testamur candidates remain in that status until documentation of a current, unconditional, unrestricted medical license and a diploma or national registration as a specialist in Cardiology, Nuclear Medicine, or Radiology has been provided to the CBNC office. Applicants who pass the CBNC examination under Testamur status have six years from the date of passing the examination to document all requirements. Regardless of when a Testamur becomes a Diplomate, CBNC certification expires 10 years from the date of passing the examination.

Applicants must submit at least one of the following to establish training in Cardiology, Nuclear Medicine or Radiology. 

• Submit a copy of your degree certificate in Cardiology, Nuclear Medicine or Radiology 
• Submit a copy of your registration as a specialists in Cardiology, Nuclear Medicine or Radiology. 
• Submit a letter of completion from your Cardiology, Nuclear Medicine or Radiology fellowship/residency program. 

Fellows, residents, and other Testamur applicants may apply under the training-status licensure rules.

APCA functions under policies intended to demonstrate impartiality, high ethical standards and validity of its certification assessments. 

APCA does not restrict Applicants, Candidates or becoming a Certificant based on limiting conditions, such as membership of an association or professional society of any organization. APCA will not unfairly impede or inhibit access to its certification to Applicants, Candidates or Certificants who meet our stated policies regarding qualification requirements, renewal requirements and/or passing APCA’s psychometrically sound certification assessments. 

• Preceptor Attestation Letter – International

• International Specialty Verification Letter

• 300 Case Letter – Practice Based   

• 300 Case Letter – Hospital Based

• Additional Training Preceptor Letter Template: https://cccvi.org/cbnc/resources/additional-training-preceptor-letter-template/ 

For Preceptors/Programs (certification) 

• Program Verification Form

• Radiation Safety Officer Template

Recertification 

• Maintenance of Competency Attestation Template: https://cccvi.org/cbnc/maintenance-of-competency-template/ 

• International Specialty Verification Letter

If documentation of other requirements is missing or incomplete, a resubmission fee will be assessed. All documentation must be in English or accompanied by a translation. 

• Candidates must document Level 2 training in Nuclear Cardiology in accordance with the ACC Core Cardiovascular Training Statement 4 Task Force 6: Training in Nuclear Cardiology , Level 2 (the COCATS Guidelines revised 2015) by providing a 2021 version of the preceptor attestation letter. Training in Nuclear Cardiology must occur at a center that has an ACGME or AOA accredited training program in Cardiovascular Disease, Nuclear Medicine, or Radiology 
• A preceptor attestation letter must verify the candidate’s training pathway and document their training in nuclear cardiology. The preceptor must select the appropriate eligibility pathway based on the applicant’s status: 
  • Authorized User status OR 
  • 80 hours of Classroom and Laboratory Training (CLT) in radiation safety that meets the NRC topic requirements. Completed either: 
    • Internally within the fellowship program OR
    • Externally through an NRC-approved course 

Documentation may be a copy of the facility RAM license listing the applicant’s name or a copy of a certificate of completion of an 80-hour CLT course that meets NRC topic requirements. 

• Applicants must submit a preceptor letter to document training in Nuclear Cardiology.  The preceptor letter must be on organizational letterhead, written within the last 36 months, and make one of the following statements:
  • The Applicant has completed training in nuclear cardiology equivalent to ACCF/ASNC COCATS Guidelines for Nuclear Cardiology Training, revised 2015, Level 2 between [MM/YYYY] and [MM/YYYY] 
  • The Applicant has completed training that meets the national training requirements for the independent sub-specialist practice of nuclear cardiology in [COUNTRY] on [MM/YYYY]. 

Also, if the nuclear cardiology training was completed seven or more years prior to the exam for which the Applicant is applying, the letter must also verify ongoing experience as evidenced by interpretation of a minimum of 300 cases in the preceding 24 months. 

Applicants may document licensure with: 

• A photocopy of a medical license wallet card,  
• A photocopy of a wall-mounted license, or 
• A  printout from a state medical board website to document licensure.  

Testamurs 

• Training medical license, as described above 
• A letter on institutional letterhead from the Program Director stating the duration of training in the program and confirming that the individual is a fellow or resident in good standing 

One of the following documents verifying Board certification must be submitted with the application: 

• A letter from the certifying Board verifying passing of the Board exam including the effective and expiration dates 
• A certificate from the certifying Board showing the effective and expiration dates 
• A print-out from the certifying Board’s website showing the effective and expiration dates 

Non-U.S.-trained physicians 

At least one of the following documents establishing training in Cardiology, Nuclear Medicine, or Radiology: 

• A copy of your degree certificate in Cardiology, Nuclear Medicine or Radiology 
• A copy of your registration as a specialists in Cardiology, Nuclear Medicine or Radiology. 
• A letter of completion from your Cardiology, Nuclear Medicine or Radiology fellowship/residency program 

Applicants who must document CME 

• Certification applicants whose Level 2 nuclear cardiology training was completed seven (7) or more years prior to the exam for which they are applying 
• Recertification applicants 
• Applicants who failed the exam three or more times must provide documentation of additional training, and must submit 25 hours of Nuclear Cardiology Specific CME taken within 18 months of application submission. 

Required CME 

A minimum of 30 hours of CME completed, within the thirty-six (36) months prior to application submission. A minimum of 15 hours must be Nuclear Cardiology-specific. A maximum of 15 hours from the applicant’s other areas of specialty may complete the 30 hour total. Each activity or topic may count one time toward the requirement. 

CME Eligible for Nuclear Cardiology credit (15 minimum) 

• Any program specific to nuclear cardiology which carries AMA PRA category I CME credit, including (but not limited to): 
• Meetings and Conferences 
• Grand Rounds 
• Online Tutorials 
• Educational Products 
• Nuclear Cardiology Working Group meetings, if they carry CME credit 
• Nuclear Cardiology specific sessions at conferences such as ACC, AHA, ASNC, SNM etc, may be counted, particularly the satellite sessions. 
• Basic Radioisotope Handling courses (CLT) that carry CME credit can be counted toward this requirement. 
• Courses that are on mixed topics, such as CT and Nuclear Cardiology or Overviews of Diagnostic Imaging can count only the sessions where nuclear cardiology was a principle part of the session. 
• Dual Modality (e.g., Nuclear AND CT) – may count all hours 
• Multi Modality (more than 2 types – e.g., CT/Echo/MRI/Nuclear) may count ONLY the nuclear cardiology hours 
• Examples: 
• Nuclear Cardiology v Echo – What to use when — YES 
• Getting the most out of your CT data — NO 
• Recent Advances in Clinical Nuclear Cardiology and Cardiac CT Featuring Case Review With the Experts — DEPENDS. 
• Nuclear sessions — YES 
• Nuclear/CT sessions — YES 
• Sessions exclusively on CT — NO 

CME Eligible for Non-Nuclear-Cardiology credit (15 maximum) 

• Courses specific to CT only, or to other cardiovascular imaging modalities 
• Multi Modality courses (more than 2 types – e.g., CT/Echo/MRI/Nuclear) may count the non nuclear cardiology hours 
• Courses on general cardiology, echo, interventional cardiology, cardiovascular electrophysiology, general nuclear medicine, general radiology or anything within these areas, including general cardiology review courses or SAPs. 

Activities that do not carry CME credit may not be used by U.S. applicants to meet any of the CME requirement. Examples: 

• Industry sponsored sessions with no CME credit 
• Case reviews with no CME credit 
• ICNC, unless you have applied to the AMA for conference credit (ICNC sessions per se do not carry CME credit) 

Nota Bene: If the CME certificate does not state specifically that the course was nuclear cardiology related, CBNC staff may require a copy of the syllabus or program to review. CBNC shall have the final word on whether or not the activity meets the requirements. 

CME Requirements for Non-U.S. Applicants 

For those applying from outside the US, educational courses and activities without Cat I CME may be counted.  

Examples: 

• Programs or products offered by the ESC or EANM specific to nuclear cardiology 
• Conferences of national nuclear cardiology organizations 
• Conferences of local working groups 
• Nuclear Cardiology specific sessions from conferences of national Cardiology or Nuclear Medicine associations 

Applicants who have not succeeded in passing the Certification examination after three (3) attempts are required to show proof of additional preceptored training in nuclear cardiology and 25 hours of Nuclear Cardiology specific CME in addition to any training/experience requirements in place at the time of application: 

1. The additional preceptorship in Nuclear Cardiology must be with an individual who is board certified in Nuclear Cardiology (CBNC), Nuclear Medicine (ABNM or osteopathic equivalent) or Radiology (ABR or osteopathic equivalent) and is an Authorized User listed on a Radioactive Materials (RAM) license. The additional preceptorship must be 
   1. A minimum of 4 weeks (160 hours; need not be consecutive weeks) 
   2. A minimum of 100 nuclear cardiology cases read 
2. The additional preceptorship must begin after the date of the third failed examination attempt. The training described above will allow the applicant to sit for three years. 
3. The 25 hours of nuclear cardiology-specific CME must be AMA PRA Category 1 and completed within 18 months of application submission. 

Applicants who have not succeeded in passing the examination after six (6) attempts must re-take Level 2 Nuclear Cardiology training in an ACGME or AOA accredited institution. 

Document Content and Format 

Preceptor letters for the additional training in Nuclear Cardiology must be on organizational letterhead and the author’s relationship to the applicant provided (e.g. Program Director, Colleague, etc.). Preceptors are strongly encouraged to use the  

The preceptor letter must be dated no earlier than June 1, 2020 and must document the applicant’s Nuclear Cardiology training dates. 

The preceptor(s) verifying additional training in Nuclear Cardiology must include in the preceptor letter his or her NRC or Agreement State License Number. 

Preceptors may find templates with acceptable wording on the CBNC website (www.cbnc.org). Preceptors are STRONGLY encouraged to use these. 

Applicants can submit copies of CME certificates or letters from CME activity sponsors. 

CBNC certification is currently valid for 10 years and two months. CBNC is actively evaluating continued competence models.  

The recertification examination is composed of approximately 100 multiple-choice questions, and candidates have two and one-half hours to complete the examination, including a five-minute survey. 

Examination Administration Window: Tuesday, November 3, 2026 – Tuesday, December 29, 2026 

Apply Now

Some questions include interpretation of images. Each question contains four options or choices, only one of which is the correct or best answer. The examination question pool will be updated on a regular basis to reflect current knowledge. Individual questions are modified or deleted based on statistical analysis of the examination. 

Certification Board of Nuclear Cardiology (CBNC) certification and recertification is currently valid for 10 years. Candidates may sit for the recertification exam during years 8, 9, and 10 of their certification period.  

Should a Diplomate not successfully sit or does not take the recertification examination prior to the expiration of his/her certification period, his/her certification will expire and his/her certification will be published as expired. 

Effective since 2014, former Diplomates who have allowed their certification to lapse are allowed to sit for the recertification examination in any given year provided they meet the recertification requirements in the year they are applying. Effective as of 2020, former Diplomates who have allowed their certification to lapse, upon passing the examination, a one-time fee of $250 will be assessed in order to be reinstated. 

There will be no back-dating of one’s certification; there will simply be a gap between certifications. 

Applicants must, at the time of application, hold a current, unconditional, unrestricted license to practice medicine and must provide a copy of the current license with expiration date.

Candidates must submit documented evidence of 30 hours of Category I Continuing Medical Education (CME) credit completed within 36 months of application submission. Of the total, a minimum of 15 hours must be nuclear cardiology-specific and the remaining 15 may be in the applicant’s other areas(s) of specialty (e.g., general cardiology, echo, nuclear medicine, etc).  All 30 hours of CME credit must be completed by the time of application submission. 

Documentation may include certificates of completion or other record provided by the course sponsor. A list of courses alone is not sufficient to qualify as documented evidence.See documentation notes for CME. 

Candidates must submit a signed statement attesting to completion of a minimum of 300 nuclear cardiology cases completed within the 24 months immediately preceding application submission. Case logs should not be submitted with the application, but may be required if the Candidate is audited. The attestation must be on appropriate letterhead.  

Effective in 2020, former Diplomates who have allowed their certification(s) to lapse may apply for recertification by meeting the eligibility requirements. Upon passing the examination a one-time fee $250, per examination, will be assessed in order to be reinstated. 

For preceptor applications, updates, and documentation, log in to your Inteleos online portal. 

Preceptors must not be simultaneously applying for initial CBNC certification or examination and may not be current applicants or candidates for initial CBNC certification. 

Beginning in 2011 and going forward, CBNC requires that preceptors who write letters attesting to Level 2 nuclear cardiology training for CBNC applicants applying through the Formal Training Pathway have on file with the CBNC office  Program Verification documentation that verifies: 

• The training institution’s fulfillment of the current COCATS Guidelines for nuclear cardiology training, Level 2 

AND 

• The appropriateness of the preceptor to serve in that capacity (i.e., is an Authorized User (AU) under 35.200 uses or the Agreement State equivalent and is listed on a RAM license or under a Broad Scope license). 

The preceptor may also be subject to position requirements, depending on the pathway under which the applicant is eligible. See below. If there is more than one individual in the training program or institution serving in the capacity of preceptor they may each fill out a Program Verification document so that all appropriate individuals in the program have a letter on file and can write attestation letters. 

An applicant’s preceptor attestation letter can be accepted only once CBNC has the preceptor’s Program Verification and AU documentation (copy of RAM license or letter from Radiation Safety Committee) on file. 

The program verification document need only be submitted once every three years, OR when there is a change: 

• In NRC 35.290 training or documentation requirements, OR 
• In the Nuclear Cardiology COCATS Guidelines, OR 
• Of the preceptor/training/program director at the institution 

One set of program verification material on file per preceptor is sufficient for all his/her trainees for a period of three years, assuming training of the applicant is/was in accordance with the statement on file. 

• Completion of Level 2 nuclear cardiology training in accordance with the ACC Core Cardiovascular Training Statement 4 Task Force 6: Training in Nuclear Cardiology (the “COCATS Guidelines” revised 2015) which includes Classroom & Laboratory Training (CLT) of 80 (or 200) hours. Individuals who have completed all clinical requirements but not the CLT hours have not completed Level 2 nuclear cardiology training.
• CBNC requires completion of Level 2 nuclear cardiology training prior to applying to sit for the exam. Preceptors must verify that all components of Level 2 training have been completed (which includes the ≥ 80 hours of CLT) prior to signing off on preceptor attestation letters. Letters dated prior to completion of all requirements will not be accepted.
• The US Nuclear Regulatory Commission (NRC) and Agreement States rely on Preceptor Attestations to document appropriate training for those seeking Authorized User status. The NRC and Agreement States conduct audits and penalties can be imposed when misinformation has been found. In authoring a preceptor attestation letter, the preceptor accepts responsibility for the accuracy of the statements made. See NRC report regarding what may occur when incorrect information is provided either deliberately or by lack of verification. When applying to the NRC using CBNC as a pathway for Authorized User status, an applicant must submit the original CBNC certification certificate. NRC currently does not accept the CBNC recertification certificates.
• CBNC randomly audits a number of candidate applications annually and may audit for up to one year following notification of successful certification or recertification.

FORMAL TRAINING PATHWAY – FOR US trained applicants who received Nuclear Cardiology training in an ACGME or AOA-accredited fellowship or residency program in Cardiovascular Disease, Nuclear Medicine, or Radiology. 

The preceptor attestation letter must document that: 

• The applicant completed Level 2 training in Nuclear Cardiology in accordance with ACC Core Cardiovascular Training Statement 4 Task Force 6: Training in Nuclear Cardiology (the “COCATS Guidelines” revised 2015) 
• The applicant’s Nuclear Cardiology training dates (which demonstrate a minimum of 4 months training with full dates inclusive of CLT; mm/dd/yy) 
• The applicant is an Authorized User on a RAM license OR is AU Eligible (i.e., completed formal classroom and laboratory training (CLT), a minimum of 80 hours, and meets the Nuclear Regulatory Commission requirements under 10 CFR 35.290 training, or Agreement State Equivalent, completed no more than seven years from the date of the exam for which the applicants is applying, and 
• The applicant is competent to function independently as an Authorized User under NRC 10 CFR 35.200 uses. 

To author a preceptor attestation letter for an applicant in this pathway, a preceptor must be one of the following: 

• Program Director of an accredited fellowship or residency in Cardiovascular Disease, Nuclear Medicine, or Radiology 
• Director of Nuclear Cardiology laboratory at an institution with an accredited fellowship or residency in Cardiovascular Disease, Nuclear Medicine, or Radiology. 
• If the preceptor is not an Authorized User, an Authorized User at the training institution must co-sign the letter to verify that the candidate has had appropriate training in radiation safety. 

The letter must be on institutional letterhead, dated no earlier than June 1, 2020 and included with the candidate’s application. 

NON US TRAINED APPLICANTS – For applicants who have completed or will complete training in Cardiology, Nuclear  Medicine or Radiology outside the United States. The preceptor letter must be on organizational letterhead, written within 36 months of application submission, and make one of the following statements: 

• The applicant completed training in Nuclear Cardiology equivalent to ACCF/ASNC COCATS Guidelines for Nuclear Cardiology Training, revised 2015, Level 2 between MM/YYYY and MM/YYYY. 

OR 

• The applicant completed training that meets the national training requirements for the independent sub-specialist practice of Nuclear Cardiology in [COUNTRY]. The applicant has completed/will complete national registration as a specialist in [Cardiology or Nuclear Medicine or Radiology] in MM/YYYY. 

If training was completed seven or more years prior to the exam for which the Applicant is applying the letter must also verify ongoing experience as evidenced by interpretation of a minimum of 300 cases in the preceding 2 years. 

Preceptors for these applicants may be: 

• Program Director of a residency or fellowship program in Cardiovascular Disease, Nuclear Medicine, or Radiology. 
• Director of Nuclear Cardiology laboratory at an institution with a residency or fellowship in Cardiovascular Disease, Nuclear Medicine, or Radiology. 

Guidance on the Classroom and Laboratory Training (CLT) component of Level 2 Training in Nuclear Cardiology 

There are many courses available to provide or round out the 80 (or 200) hours of Classroom and Laboratory Training (CLT) experience required for NRC 10 CFR 35.290 Training (Imaging and Localization Studies) or Agreement State equivalent and to complete Level 2 Nuclear Cardiology Training according to the ACC COCATS Guidelines, revised 2015. Program Directors and individuals might note that the NRC recognizes a variety of teaching formats, including internet-based. Laboratory experience is also a requisite part of these hours. Because training programs vary, CBNC does not endorse any specific course to fulfill individual requirements. 

Be aware that it is possible to acquire the obligatory 700 total hours and still not have met the topic requirements mandated by the NRC. Preceptors and individuals have the responsibility to assure that between their programs and CLT, ALL training and experience requirements have been met. The U.S. NRC requires that direct, hands-on laboratory experience be part of the applicant’s Classroom and Laboratory Training. Attesting preceptors must document that their Nuclear Cardiology curriculum includes this experience and the training attestation must affirm that as well. 

The COCATS Guidelines were revised in 2015. Preceptor Attestations referencing this document are required for certification exam applicants.   

SUMMARY of the ACC Core Cardiovascular Training Statement 4 Task Force 6: Training in Nuclear Cardiology, Level 2 (The “COCATS Guidelines” revised 2015) 

Overview of Nuclear Cardiology Training
Training in Nuclear Cardiology at all levels should provide an understanding of the indications for specific Nuclear Cardiology tests, the safe use of radionuclides, basics of instrumentation and image processing, methods of quality control, image interpretation, integration of risk factors, clinical symptoms and stress testing and the appropriate application of the resultant diagnostic information for clinical management. Training in Nuclear Cardiology is best acquired in Accreditation Council for Graduate Medical Education (ACGME) approved training programs in Cardiology, Nuclear Medicine or Radiology. An exception to this ACGME requirement is the didactic and laboratory training in radiation safety and radioisotope handling that may be provided by qualified physicians/scientists in a non-ACGME program when such a program is not available as part of the clinical ACGME training program. For laboratories that provide training to Cardiology Fellows, accreditation by the Intersocietal Commission for the Accreditation of Nuclear Laboratories (ICANL) is also recommended. 

Didactic, clinical case experience and hands-on training hours require documentation in a logbook1 and having the trainee’s name appear on the clinical report or having some other specific record. The hours need to be monitored and verified by the Nuclear Cardiology training preceptor. 

Specialized Training – Level 2 (Minimum of 4 Months)
Fellows who wish to practice the specialty of Nuclear Cardiology are required to have at least 4 months of training. This includes a minimum of 700 hours of radiation safety training in Nuclear Cardiology. There needs to be didactic, clinical study interpretation, and hands-on involvement in clinical cases. In training programs with a high volume of procedures, clinical experience may be acquired in as short a period as 4 months. In programs with a lower volume of procedures, a total of 6 months of clinical experience will be necessary to achieve Level 2 competency. The additional training required of Level 2 trainees is to enhance clinical skills, knowledge, and hands-on experience in radiation safety and to qualify them to become Authorized Users of radioactive materials in accordance with the regulations of the Nuclear Regulatory Commission (NRC) and/or the Agreement States. 

Didactic Program
Lectures and self-study. The didactic training should include in-depth details of all aspects of the procedures listed in Table 1 (see below). This program may be scheduled over a 12- to 36-month period concurrent and integrated with other fellowship assignments. 

Radiation Safety. Classroom and laboratory training needs to include extensive review of radiation physics and instrumentation, radiation protection, mathematics pertaining to the use and measurement of radioactivity, chemistry of byproduct material for medical use, radiation biology, the effects of ionizing radiation and radiopharmaceuticals. There should be a thorough review of regulations dealing with radiation safety for the use of radiopharmaceuticals and ionizing radiation. This experience should total a minimum of 80 hours and be clearly documented. 

Interpretation of Clinical Cases
Fellows should participate in the interpretation of all Nuclear Cardiology imaging data for the 4-6 month training period. It is imperative that the Fellows have experience in correlating catheterization or CT angiographic data with radionuclide-derived data in a minimum of 30 patients. A teaching conference in which the fellow presents the clinical material and Nuclear Cardiology results is an appropriate forum for such an experience. A total of 300 cases should be interpreted under preceptor supervision, from direct patient studies. 

Hands-on Experience
Clinical cases. Fellows acquiring Level 2 training should have hands-on supervised experience in a minimum of 30 patients: 25 patients with myocardial perfusion imaging and 5 patients with radionuclide angiography. Such experience should include pretest patient evaluation, radiopharmaceutical preparation (including experience with relevant radionuclide generators and CT systems), performance of studies with and without attenuation correction, administration of the dosage, calibration and setup of the gamma camera and CT system, setup of the imaging computer, processing the data for display, interpretation of the studies and generating clinical reports. 

Radiation safety work experience. Level 2 trainees must acquire 620 hours of work experience inclusive of radiation safety (in addition to the 80 hours of classroom and laboratory experience)2 during training in the clinical environment where radioactive materials are being used. This training should3 take place under the supervision of an authorized user who meets the NRC requirements of Part 35.290 or Part 35.290(c)(1)(ii)(G) and 35.390 or the equivalent Agreement State requirements, and must include: 

1. Ordering, receiving and unpacking radioactive materials safely and performing the related radiation surveys;
2. Performing quality control procedures on instruments used to determine the activity of dosages and performing checks for proper operation of survey meters;
3. Calculating, measuring and safely preparing patient or human research subject dosages;
4. Using administrative controls to prevent a medical event involving the use of unsealed byproduct material;
5. Using procedures to safely contain spilled radioactive material and using proper decontamination procedures;
6. Administering dosages of radioactive material to patients or human research subjects; and
7. Eluting generator systems appropriate for preparation of radioactive drugs for imaging and localization studies, measuring and testing the eluate for radionuclide purity, and processing the eluate with reagent kits to prepare labeled radioactive drugs.

Additional experience
The training program for Level 2 training must also provide experience in computer methods for analysis. This should include perfusion and functional data derived from thallium or technetium agents and ejection fraction and regional wall motion measurements from radionuclide angiographic studies. 

Table 1 Classification of Nuclear Cardiology Procedures 

1. Procedures in which competency should be achieved during Level 2 training 
   1. Myocardial perfusion imaging 
      1. SPECT, with or without attenuation correction 
      2. ECG gating of perfusion images 
      3. Stress protocols (exercise and pharmacologic) 
      4. Viability assessment using SPECT and/or PET 
   2. Radionuclide angiography 
   3. Use of methods for acquisition, reconstruction, and quantitative analysis of images 
   4. Appropriate radiation safety and quality improvement programs 
   5. Use of radiation monitoring instruments 
2. Procedures in which medical knowledge should be demonstrated and achievement of competency may be accomplished during or after fellowship 
   1. PET Myocardial perfusion imaging 
      1. Myocardial blood flow quantification 
      2. Cardiac planar imaging 
   2. Hybrid PET/CT and SPECT/CT 
      1. Myocardial innervation 
      2. Myocardial metabolism 

(1) Note: These logbooks are not to be submitted with the CBNC application. 

(2) This is a prerequisite for CBNC –  Radiation safety work experience must total 620 hours inclusive of radiation safety (plus the 80 hours of classroom and laboratory) totaling 700 hours. 

(3) This is a prerequisite for CBNC – Radiation safety work experience must take place under an Authorized User who meets the NRC requirements of Part 35.290 or Part 35.290(c)(1)(ii)(G) and 35.390 or the equivalent Agreement State requirements, and must include (a) through (g) as described above. 

After passing CBNC as a Testamur, you must complete the conversion process before you have official certification standing. 

You are ready to convert when you have passed your exam as a Testamur and now have the final documentation required by your program. Each Testamur is responsible for contacting the appropriate program office to request conversion to Diplomate. 

Use the checklist below to get started– be sure to review the program-specific requirements at each step. 

Update your online account: Log in to your Inteleos online account and create or update your contact information before you submit documentation. Your certificate will be mailed to the address listed in your account. 

Gather documentation: Prepare picture or PDF versions of the required documents before submitting your request. The exact documents vary by exam. 

CBNC 

• A picture or PDF version of your current, unconditional, unrestricted medical license. Please make sure the expiration date is showing. 

• U.S. Board Certification documentation: a letter, certificate, or print-out from the certifying Board verifying passing of the Board examination, showing the effective and expiration dates (if applicable) 

• Non-U.S. Board Certification documentation: equivalent documentation verifying training credentials and/or national registration as a specialist in Cardiology, Nuclear Medicine or Radiology 

Submit your documentation: Submit your documentation to the appropriate program office by email. You can also upload it into your Inteleos online account  and notify staff by email.  

CBNC: CBNC@inteleos.org 

Requests are processed in the order received. Requests with all required documentation received by Thursday of each week will be processed by end of business on Friday of the same week. Certificates will be mailed via USPS. 

Watch for confirmation and certificate delivery: Once all required documentation has been received and approved, Diplomate status can be granted by the appropriate program. After conversion, certified physicians may present themselves to the public as Diplomates of the applicable certification board. Certification remains valid for 10 years following the passed examination date.  

Candidates who applied as Testamurs and were successful on the examination have no official certification standing until they complete the conversion process. Only physicians who are granted Diplomate status are certified and may present themselves to the public as Diplomates of the applicable certification board. 

Conversion must occur within six years of passing the examination. Regardless of when a physician converts status, certification expires 10 years from the date of passing the examination.

Starting January 1, 2027, Maintenance of Certification (MOC) replaces the 10-year recertification exam. 

Beginning in 2027, Cardiovascular Imaging (CBCCT, CBCMR and CBNC) certifications will transition to a Maintenance of Certification (MOC) model, replacing the traditional 10-year recertification exam for CBCCT and CBNC Diplomates and formally establishing an ongoing maintenance pathway for CBCMR Diplomates. 

The last 10-year Recertification Examination Administration will be in 2026. 

We are transitioning to an annual Maintenance of Certification (MOC) program. As individual certifications expire, diplomates will be required to complete the Annual MOC components outlined below. 

+ Attesting to Inteleos (ARDMS/APCA) rules and policies 

+ Disclose any credential action, suspension, or censure that affects the physician’s legal ability to practice in the specialty 

+ CME Requirements (to be completed over 3-year period) 

+ Annual, specialty-specific Knowledge Confirmation through the SKILLS platform due by December 31 of each year 

+ Paying renewal fee 

+ Update or confirm contact information in your MyAPCA portal 

+ Attest to having a valid Medical License in good standing 

The transition is designed to be clear, predictable, and respectful of existing certification cycles. With defined timelines and targeted guidance, Inteleos (APCA) is committed to helping Diplomates understand what’s changing, what’s staying the same, and how to move forward with confidence. 

Stay tuned for more information. 

+ CT pilot is currently available 

+ MR and NC pilots will launch in Q3 2026 

The MOC program launches on January 1, 2027. 

Log in to MYAPCA to participate in the SKILLS quizzes and view your current status. 

ACTION MAY BE REQUIRED (Expiring 2026-2028, Lapsed) 

• Year 10 CBCCT/CBNC Diplomates Expiring in 2026/2027 
  • 2026 is your final opportunity to take the 10‑year recertification exam before your certification lapses. Passing the 2026 exam will provide a new 10‑year certification period. 
  • After recertifying in 2026, transition to the annual MOC program will begin the last full year before the expiration of your certification. 
  • We encourage you to participate and meet the current reinstatement requirements before the MOC transition takes effect. 
• Years 8 & 9 CBCCT/CBNC Diplomates (Expiring in 2027/2028 and/or 2028/2029) 
  • You may elect to take the 10-year recertification exam in 2026 to obtain another 10-year certification period, before your scheduled expiration date. 
  • You may instead remain certified through your current expiration date and transition to the annual MOC pathway in year 10 of your certification. 
• Lapsed CBCCT/CBNC Diplomates 
  • 2026 is your final opportunity to regain certification by taking the 10‑year recertification exam under the current reinstatement requirements. 

PLAN AHEAD 

• Years 1-7 Diplomates 
  • Your certification will remain valid through the stated expiration date. APCA will post updates and send emails about the MOC transition before certifications expire. 
• Multi-Credential Holders 
  • You will complete Knowledge Confirmation for each certification annually via the SKILLS platform. 
• Fellowship Program Directors 
  • Your Fellows who take and pass examination in 2026:Receive 10-year certifications. MOC won’t apply until the final full year of certification. 
  • Your Fellows who take and pass examination in 2027+:Upon certification, fellows will complete annual MOC. 10-year recertification exams will no longer be issued. 

MONITOR/REVIEW NEEDED 

• Testamurs 
  • MOC requirements do not apply to you.  
    • Priority: convert to Diplomate status. 
      • Requirements: Full, unrestricted medical licensure; Appropriate board certification; Complete within 6 years of your CBCCT, CBNC and/or CBCMR exam. 
• Initial Candidates 
  • Take and pass examination in 2026 or earlier: earn 10-year certification. 
  • Take and pass examination in 2027 or later:enter MOC directly.
     
• CBCMR Diplomates 
  • No recertification exam exists for CBCMR. MOC transition begins the final year of your certification.