FNB Breast Imaging: Admissions, medical colleges, fees, eligibility criteria details

FNB Breast Imaging or Fellow of National Board in Breast Imaging also known as FNB in Breast Imaging is a doctoral fellowship program for doctors in India that is done by them after completion of their postgraduate medical degree course. The duration of the FNB course is for 2 years.

The Fellowship Programme intends to provide a well-balanced clinical, research, and teaching curriculum as it will take place in a high-volume academic environment. This two-year FNB program will provide training in all aspect’s mammography, ultrasound, computed tomography, and magnetic resonance imaging.

The course is a full-time course pursued at various accredited institutes/hospitals including Kovai Medical Centre, Coimbatore, Tamil Nadu, and Medanta the Medicity, Gurgaon, Haryana.

Candidates can get admission to 2 years FNB course after successfully qualifying for the FET (Fellowship Entrance Test) examination which NBEMS conducts. FET is conducted annually as per the prescribed schedule. The merit-based counseling for admissions to the FNB Programme after the conduct of FET is administered by NBEMS.

The fee for pursuing FNB Breast Imaging varies from accredited institute/hospital to hospital and is Rs.1,25,000 per year.

After completion of their respective course, doctors can either join the job market. Candidates can take reputed jobs at positions as research fellows, Senior residents, Consultants, etc. with an approximate salary range of Rs. 12 lakhs to Rs. 48 lakhs per year which varies according to experience.

The Nomenclature of the FNB qualification awarded by the National Board of Examinations in Medical Sciences is “Fellow of National Board”. The FNB qualifications are recognized qualifications in terms of the Gazette notification dated 10th August 2016.

What is FNB in Breast Imaging?

FNB in Breast Imaging is a two-year doctoral fellowship program that candidates can pursue after completing a postgraduate degree.

Breast Imaging is one of the key constituents of triple assessment for effective breast cancer detection and management along with clinical and histopathological evaluation.

Breast Imaging is an emerging area of Radiology that places emphasis on the unique health needs of women and provides an increased focus on public awareness and screening programs. However, breast Imaging is a subspecialty involved in the diagnosis of not just various malignant diseases, but also benign pathologies including breast disorders like nipple discharge, and mastitis, besides benign breast lumps. Apart from imaging various diseases, the radiologist is also involved in diagnostic and therapeutic interventional procedures like image-guided FNACs, biopsies, aspirations, etc.

Upon completion of the course, the candidate should be capable of delivering the highest quality of patient care by making an early and accurate diagnosis and guiding subsequent management and becoming clinically competent, and being able to pursue both clinical and experimental research in this field.

The National Board of Examinations (NBE) has released a curriculum for FNB Breast Imaging.

The curriculum governs the education and training of FNB Breast Imaging.

Course Highlights

Here are some of the course highlights of FNB Breast Imaging

Eligibility Criteria

Note:

Admission Process

The admission process contains a few steps to be followed in order for the candidates for admission to FNB. Candidates can view the complete admission process for FNB Breast Imaging mentioned below:

• FET is a qualifying-cum-ranking examination for admission to Fellow of National Board (FNB)/Fellow of National Board - Post Doctoral (FNB-PD) courses.
• The selection of a student will be through an MCQ-based examination namely Fellowship Entrance Test.
• A student can apply for the fellowship courses for which his/her broad or super specialty qualification/ equivalent qualification is eligible, at the time of online submission of the application form.
• The total duration of the question paper will be 105 minutes (Part A - 45 minutes and Part B - 60 minutes).
• QUALIFYING CRITERIA: Students who obtain a minimum of 50th Percentile in their respective question paper/specialty shall be declared as “Qualified”.
• NBEMS shall declare a specialty-wise merit list i.e., there will be a separate merit list for each fellowship course. There shall not be any equating/scaling and normalization. The merit shall be generated strictly on the basis of marks obtained by the student and application of the prescribed tie-breaking criteria.
• The admission to Fellowship courses in the accredited hospitals shall be undertaken solely on the basis of merit-based counseling conducted by NBEMS.
• Documents required to be produced at the time of counseling: MBBS Degree Certificate and MD/MS/DNB/DM/MCh/DrNB Degree Certificate/Provisional Pass Certificate of eligible Post Graduate Medical Qualification issued.

Fees Structure

The fee structure for FNB Breast Imaging varies from accredited institute/hospital to hospital. The fee is generally less for Government Institutes and more for private institutes. The average fee structure for FNB Breast Imaging is Rs.1,25,000 per year.

Colleges offering FNB Breast Imaging

Syllabus

FNB in Breast Imaging is a two years specialization course that provides training in the stream of Breast Imaging.

The course content for FNB Breast Imaging is given in the NBE Curriculum released by the National Board of Examinations, which can be assessed through the link mentioned below:

SYLLABUS

By means of clinical experience, lectures, conferences, journals and online references, the fellow should become familiar with and understand the following topics in breast disease:

1. Breast Anatomy & Physiology

i. Breast development

ii. Normal breast anatomy and histology; alteration with age, pregnancy, menstrual cycle, and hormonal effects; male breast anatomy, Regional lymph node anatomy & drainage.

2. Histopathology

i. Pathologic appearance and clinical significance of:

a. Benign breast lesions - fibrocystic changes, usual duct hyperplasia, columnar cell lesions without atypia, fibro adenomas, and fat necrosis.

b. High-Risk lesions - Atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), lobular carcinoma in situ (LCIS), flat epithelial atypia, lobular neoplasia (atypical lobular hyperplasia and lobular carcinoma in situ), papillary lesions, radial scar/complex sclerosing lesions.

c. Ductal carcinoma in situ (DCIS), including its histologic subtypes.

d. Invasive ductal carcinoma not otherwise specified (NOS); subtypes of invasive ductal carcinoma (mucinous, medullary, papillary, tubular); invasive lobular carcinoma

e. Other types of breast cancer, such as Paget's disease and inflammatory carcinoma

f. Other malignancies involving the breast, including phyllodes tumor, lymphoma, leukemia, sarcomas, and metastases.

ii. Histologic grading

iii. Pathologic staging

iv. Immunohistochemistry

v. Multifocal and multicentric carcinoma

vi. Margin analysis for specimens containing malignancy

3. Radiologic-pathologic correlations

Considerations to have the sound ability in the recognition of the above in all imaging modalities as stated earlier.

4. Epidemiology

i. Risk factors for breast cancer - Indications for genetic screening

ii. Breast cancer incidence and mortality, including longitudinal trends

iii. Breast cancer staging and survival rates by stage

5. Mammography

Both screen film and full-field digital mammography

i. Equipment features

a. Features of dedicated mammographic units, including target, filtration, automatic exposure control (AEC), and grids

b. Factors affecting optical density, contrast, sharpness, and noise

c. Selection of technique factors, including effects of milliamp-seconds (mAs), kilovolt peak (KVp), target and filter material choice, and density settings on image quality and radiation dose

d. Effect of breast thickness and composition on technique, image quality, and radiation dose

e. AERB guidelines for mammographic equipment and radiation protection issues.

ii. Mammographic positioning

a. For CC and MLO views

b. Mammographic positioning for women with breast implants

c. Rationale for breast compression

d. Clinical image assessment for proper breast positioning, compression, exposure, contrast, sharpness, and noise

iii. Screen-film mammography versus Full-field digital mammography

a. Characteristics of full-field digital mammographic systems, including advantages and limitations

b. Effects of post-processing on the digital mammographic image

c. Effect of signal-to-noise ratio on radiation dose

d. Dedicated high-luminance, high-resolution viewing monitors

iv. Mammography quality assurance

a. Demonstrate proficiency in recognizing the mammographic appearance of artifacts for both screen film and digital mammography

b. Familiarity with content in the Mammography Quality Control

c. Purpose and frequency of performance of quality control tests performed by the technologist and physicist

v. Mammographic interpretation

a. Optimal viewing conditions, including a low ambient light environment

b. Demonstrate proficiency in:

c. Recognizing normal mammographic anatomy

d. Recognizing the mammographic features of characteristically benign and suspicious breast calcifications

e. Recognizing the mammographic features of characteristically benign and suspicious breast masses

f. Recognizing the mammographic appearance of indirect signs of malignancy (architectural distortion, asymmetries, etc)

g. Recognizing the mammographic features of the surgically altered breast, including implants

h. Recognizing the mammographic features of probably benign (BI-RADS category 3) lesions

i. Principles, methods, strengths, and pitfalls of computer-aided detection (CAD) and double reading

vi. Screening mammography

a. Randomized clinical trials, case-control studies, service-screening studies: purpose, methods, results

b. Pitfalls in evaluating screening results: lead-time bias, length-bias sampling, selection bias, prevalence versus incidence screening, interval cancer rate, survival rates

c. Relative screening efficacy of clinical breast examination, breast self-examination, and mammography

d. Benefit-risk assessment, including radiation risk and false positives

e. Controversies regarding screening women aged 40-49 years; younger than age 40

f. Screening guidelines of different countries

g. Logistics and throughput cost-benefit issues in the performance and interpretation of screening mammography examinations

vii. Diagnostic (problem-solving) mammography

a. Techniques and indications for and value of supplementary mammographic views

b. Work-up of lesions seen on only one standard (MLO or CC) screening view

c. Three-dimensional lesion localization

d. Correlation of palpable with imaging findings

e. Evaluation and management of a palpable mass (or other focal symptoms) when there are no associated mammographic findings

f. Assessment of the extent of disease for suspicious and for known- malignant lesions

6. Breast ultrasonography

i. Equipment and physical principles

ii. Techniques

iii. Indications

iv. Recognizing normal sonographic anatomy

v. Recognizing features of simple cysts, complicated cysts, complex masses

vi. Recognizing differential features of benign and malignant solid masses

vii. Correlation with findings at mammography and clinical breast examination

viii. Limitations in the detection and assessment of microcalcifications

ix. Controversies regarding the role of screening whole-breast ultrasound examination

7. Breast MRI

i. Equipment and physical principles

ii. Techniques

iii. Indications

iv. Strengths and limitations of kinetic and morphologic analysis

v. Recognizing normal MRI anatomy

vi. Recognizing differential features of benign and malignant masses

vii. Recognizing differential features of benign and malignant non-mass-like enhancement

viii. Evaluating implant integrity

ix. Correlation with findings at mammography, ultrasound, and clinical breast examination

x. Limitations in the detection and assessment of lesions presenting as micro-calcifications

xi. Controversies regarding the role of screening breast MRI examination

8. Reporting and medico-legal aspects of breast imaging

i. Demonstrate proficiency in producing breast imaging reports, including:

ii. ACR BI-RADS lexicon terms for mammography, ultrasound, and MRI

iii. Lesion location

iv. Categorization of breast composition (BI-RADS breast density descriptors)

v. Final assessment categories (ACR BI-RADS; MQSA regulatory requirements)

vi. Management recommendations

vii. Concordance between lesion descriptors and assessment categories

viii. Concordance between assessment categories and management recommendations

ix. Medico-legal aspects of all breast imaging and interventional procedures

x. Understanding the supervisory responsibility for approving the technical quality of a given examination

xi. Communication issues and follow-up of abnormal findings

xii. Informed consent for invasive procedures

9. Interventional procedures

Principles, indications and contraindications, equipment, preparation, technique, advantages, disadvantages, accuracy, and auditing for:

i. Needle-wire localization guided by mammography and ultrasound

ii. Ultrasound-guided core biopsy

iii. Stereo tactically guided core biopsy

iv. Ultrasound-guided cyst aspiration

v. Targeted ultrasound to substitute ultrasound guidance for MRI guidance

vi. MRI-guided core biopsy and needle-wire localization (Theoretical)

vii. Use and limitations of using markers to indicate the site of percutaneous biopsy

viii. Specimen radiography,

ix. Assessment of imaging-pathologic concordance

x. Post-procedure follow-up imaging

10. Therapeutic and management considerations

i. Basic understanding of breast cancer treatment options

ii. Role of breast imaging in planning and monitoring of breast cancer treatment and post-treatment follow-up

iii. Role of breast imaging in management of Ductal Carcinoma In-Situ of the breast (DCIS)

iv. Role of breast imaging in Breast Conservation Therapy in the Management of Invasive Breast Carcinoma.

v. Strategies to encourage breast screening for detecting early breast cancer

11. Other

i. Active participation in screening and diagnostic mammography interpretation

ii. Active participation in breast MRI interpretation

iii. Formal teaching conferences (lectures, case presentations)

iv. Imaging-pathologic correlation conferences; multidisciplinary breast cancer case conferences

v. Direct observation or videotape of mammographic positioning for routine and supplementary views

vi. Breast imaging textbooks

vii. Demonstrate proficiency in interacting with patients, including how to recommend biopsy, how to explain a cancer diagnosis, and how to develop sensitivity to patients’ emotional needs

viii. Experience interacting with surgeons, pathologists, medical oncologists, and radiation oncologists in providing multidisciplinary patient care

ix. Familiarity with radionuclide breast scanning

x. Familiarity with performing a medical audit

xi. Teaching medical students and residents and general public.

xii. Encourage participation in research projects

xiii. Familiarity with performing breast positioning and setting techniques for mammographic examination

xiv. Knowledge of quality control tests performed by medical physicist

xv. Observation of pathology, breast surgery, and radiation therapy practice

xvi. Educating general public on breast care and breast health, including the value of breast self -examination and breast feeding.

Career Options

After completing FNB Breast Imaging, candidates will get employment opportunities in Government and the Private sector.

In the Government sector, candidates have various options to choose from which include Junior research fellow, Teaching at academic medical centers, and Consultants.

While in the Private sector the options Fellow (Breast Imaging), Junior research fellow, Senior Research fellow (Breast Imaging), and Consultants.

Frequently Asked Questions (FAQs) –FNB Breast Imaging Course/FNB in Breast Imaging Course

• Question: What is the complete full form of FNB?

Answer: The full form of FNB is a Fellow of National board.

• Question: What is FNB Breast Imaging?

Answer: FNB Breast Imaging or Fellow of National Board in Breast Imaging is a doctoral fellowship program for doctors in India that is done by them after completion of their postgraduate medical degree course.

• Question: What is the duration of FNB in Breast Imaging?

Answer: FNB in Breast Imaging is a doctoral fellowship program of two years.

• Question: What is the eligibility of FNB in Breast Imaging?

Answer: The candidate must have an MD/DNB Radiodiagnosis degree obtained from any college/university recognized by the Medical Council of India (Now NMC)/NBE. The feeder qualification is mentioned here as of 2022, for any further changes to the prerequisite requirement please refer to the NBE website.

• Question: What is the scope of FNB Breast Imaging?

Answer: FNB Breast Imaging offers candidates various employment opportunities and career prospects.

• Question: What is the average salary for an FNB Breast Imaging candidate?

Answer: The FNB Breast Imaging candidate’s average salary is between Rs.12 lakhs to Rs.48 lakhs per annum depending on the experience.

• Question: Can you teach after completing FNB Breast Imaging Course?

Answer: Yes, the candidate can teach in a medical college/hospital after completing the fellowship.