Cementing Radiological Knowledge

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No one understands the demand of time management like radiologists. Not only are there ever-increasing caseloads to complete, reports to draft and physicians and patients to consult with (among many other things), radiologists must keep current with their knowledge and obtain CME credits for their licensing. Radiology trainees face a similar battle while they study for the ABR’s certification exams. “The volumes of clinical work have gone up dramatically over the past several years making it harder for faculty to teach and trainees to learn,” says Priscilla J. Slanetz, MD, MPH, FACR, chair of the ACR Commission on Publications and Lifelong Learning, and Continuous Professional Improvement (CPI) Breast Imaging Module author. “The reality is that we’re so busy at work that it’s hard for most physicians to travel to meetings to get those CME credits.”

Fortunately, ACR’s CPI program has been here for over 20 years to help — whether you’re a pro brushing up on your knowledge or a trainee just starting out.

Wealth of Information

Developed by expert editors and authors, CPI self-assessment modules consist of relevant, image-rich, multiple-choice test questions based on a variety of topics. Although modules focus on ABR core topics for all subspecialties, special-edition topics have also been created to focus on less-emphasized imaging areas, such as oncologic imaging, emergency imaging or fetal imaging. CPI modules are designed without a lengthy introduction of topics or preliminary learning to give learners a “mini lesson” within each test question and its answer explanations. Learners begin each multiple-choice question testing their existing knowledge and/or image analysis and then review detailed rationales with annotated images for both correct and incorrect answer choices.

Modules are created by a team of volunteers consisting of a subspecialty editor and six to ten experienced writers. With 50–70 multiple-choice questions in each module, radiologists can earn a total of 8–10 CME. Most questions cover key aspects of radiology that radiologists will see in their day-to-day practice, but modules will also include some of the more unusual ones. “Our goal is to make certain the educational information is relevant to people’s working lives,” says Harris L. Cohen, MD, FACR, FSRU, FAIUM, editor in chief emeritus of CPI.

Slanetz recalls one particularly interesting case she included in a past module: a patient had presented with palpable lumps in her breast, which turned out to be polyacrylamide gel (from a prior cosmetic procedure) that had infiltrated the patient’s pectoral muscles. “It had been injected over 10 years ago, and, at the time, the patient was told it would disappear within months,” she remembers. “It was an unusual case, but I thought it was important to include because so many of my colleagues had been confused by it, and I thought it was good for radiologists to see what polyacrylamide gel looked like on an image.”

Detailed Explanations

CPI has come a long way since Cohen became editor in chief. Cohen led the way for nearly 15 years before passing the torch to CPI’s new editor in chief, Jennifer Pierce, MD, in 2025. Prior to CPI, Cohen had worked on creating ACR syllabi for radiologists that were often used to help prepare for the ABR exams. “I really wanted to make sure CPI used a lot of the methodologies I learned with the syllabi to help learners understand and retain content,” he says. “I knew radiologists preferred learning with images and that learning needed to be in small doses, each distilled into several key educational points.” Under Cohen’s leadership, CPI began including annotated images as well as additional imaging examples in the answers to the test questions. “Each answer ideally includes an explanation in several paragraphs accompanied by images that explain what you’re seeing,” he says. Cohen also wanted to ensure the integrity of the individuals writing the modules. “I wanted people who had real writing experience — people who knew their subject matter well,” he adds. As a result, each multiple-choice answer contains detailed reasoning explaining why the answer is correct. Even incorrect answers include images and an explanation as to why the answer is wrong.

These explanations are one of the reasons that Slanetz prefers using CPI. “I’ve seen a lot of educational products that only tell you why an answer is correct, if it says anything at all,” she says. “But it’s often just as important to understand why an answer is wrong — you can learn a lot from the thought process and rationale,” adds Cohen. “As a result, sometimes users get exposed to multiple diagnoses, presentations of a disease or even multiple diseases.”

Educational Value

One of CPI’s biggest strengths is its digestibility. Each module can be completed as the user has time, rather than all at once. “Whether I have time for one question or twenty — it doesn’t matter. I can just come back to it when I’m ready,” says Cohen. CPI modules are also created so that users are exposed to credits in areas that aren’t as easy to access, says Slanetz. “For example, breast imagers are required to maintain CME in a variety of modalities, and it’s often hard for people to find enough credits in risk management or certain modalities. These modules are good at giving practicing radiologists the sort of breadth of CME they need to remain certified,” she notes.

Another strength of CPI is the program’s reliance on feedback, says Cohen. “We spend a lot of time getting feedback and adjusting to what users have identified as educational needs,” he notes. From image-quality improvement to topic suggestions, each is informed in some way by past users. Cohen will even seek feedback while content is still in production. To create the recently published CPI Editor’s Choice 2025: Pediatric Imaging module, a compilation and update of best pediatric-related questions of the last decade, he formed test groups of radiologists in the pediatric fellowship at his institution and asked them to evaluate which questions appeared most educationally outstanding and used those when they coincided with his list of “best of the best” questions.

Trainee Value

Trainee feedback is important to CPI because these modules are not only for the seasoned radiologist completing CME — they’re also valuable tools for studying. Slanetz herself used CPI as a resident to study for the boards. “After going through textbooks, it was really helpful to do a self-assessment on my knowledge. CPI is set up very well to help people prepare for the exam because the format is similar to the test,” notes Slanetz. Both parts of the exam, the Qualifying (core) exam and the Certifying exam, are currently multiple choice. In 2028, the Certifying portion of the exam will change to an oral exam (core remains unchanged). Although the format will be different from CPI, Slanetz argues that it’s still important. “On the oral exam, a lot of what will be tested is discussing findings; you will need to lay out your thought process of why you come to a particular diagnosis and management plan. In CPI, each answer models that thought process really well, discussing why it’s a specific answer versus the other possibilities. Trainees can use that to model how to walk through a case,” she says. These modules are made more accessible to residents as well: they can be accessed online or downloaded as an e-book so that users can have an easy, on-the-go reference.

No matter where you are in your career, CPI has the tools to keep radiologists well-informed and prepared for whatever lies ahead. “CPI gives you fast information, good images, and spans a large breadth of knowledge and experience,” says Cohen. “Our goal has always been to be a helpful, informative tool, and I think we’re achieving that.”

By Meghan Edwards, freelance writer, ACR Press

DID YOU KNOW?

Continuous Professional Improvement modules are created by a team of volunteers consisting of a subspecialty editor and six to ten experienced writers. With 50–70 multiple-choice questions in each module, radiologists can earn a total of 8–10 CME.