Examiners’ reports (radiology)

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

SPRING 2016

The Examining Board has prepared the following report on the Spring 2016 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

EXAMINERS' REPORT – SPRING 2016

Rapid Reporting Session

Candidates should be aware that there is considerable variation in the number of normal cases between papers, and that trying to assess whether they have found sufficient abnormal cases to determine
whether the remainder are normal is unlikely to be a successful  strategy.

There has been a growing tendency for candidates to lose marks by incompletely or inaccurately identifying an abnormality such that they can only be awarded a half-mark for their response.

For example:

Identifying a fracture but failing to identify that this is a pathological fracture. If an underlying lesion is visible this should be stated, and if possible, characterised e.g.” fracture through simple bone cyst”

Identifying a fracture but failing to accurately describe its anatomic position e.g. if there is a fracture through the base of the fifth metatarsal on a radiograph of the foot, the following responses would not score any marks, as the Examiners cannot be certain that the candidate has identified the correct area of abnormality:

• Fracture
• Lucent line through metatarsal
• Fracture through metatarsal
• The following responses would gain a half-mark:
• Fracture fifth metatarsal
• Fracture metatarsal base

The following response would gain a full mark:

• Transverse fracture base of fifth metatarsal
• Fracture base fifth metatarsal

Identifying a single fracture in a well-recognised fracture complex, where a second fracture would be expected e.g.:

• Noting only one fracture in paired bones which normally fracture together (radius and ulna, tibia and fibula)
• Noting only one fracture in a ring structure (mandible, pelvis)

Identifying an abnormality but failing to accurately localise it e.g. identifying a posterior mediastinal mass, but calling it anterior, or identifying a renal tract calculus but mistakenly stating this lies in the kidney instead of the ureter or vice-versa.

Candidates at recent sittings have been particularly poor in their interpretation of cervical spine radiographs. Where they have identified an abnormality, they have frequently mis-classified it.

Candidates need to distinguish between unilateral and bilateral facet dislocation, fracture-dislocations and isolated fractures.

Reporting Session

There has been a general improvement in the way in which candidates allocate their time between cases. Some candidates still appear to devote too much time to the first two or three cases, to the detriment of their remaining responses. It is far easier to achieve a passing mark overall by providing adequate answers to all six cases rather than giving a detailed response in one or two cases in the hope that this compensates for poor answers in the remaining questions.

Candidates should use their experience and knowledge of disease patterns to ensure that they look for features to confirm or refute their proposed diagnosis. Although limited, the clinical information provided
with a case should assist the candidate in narrowing down their differential diagnoses. For example, they should ensure that the diagnosis they offer is appropriate for the age of the patient. Whether the patient presents with acute or chronic symptoms should also affect candidates’ analysis of the most likely underlying cause.

Examiners have noted that candidates often omit pertinent negatives: for example, where a diagnosis of malignancy is made, examiners would generally expect candidates to positively mention the absence of evidence of metastatic disease in the areas to which that malignancy frequently spreads.

The Examiners encourage the use of bullet points in preference to long-winded prose, particularly where candidates are listing their observations. Candidates may also find it helpful to consider, having made a primary diagnosis, what other features they should look for that might affect the patient’s subsequent management.

Oral Examinations

It has been noted that candidates’ knowledge of anatomy is frequently limited, and that many candidates struggle with the interpretation of paediatric imaging – even for common paediatric pathologies.
Candidates should be prepared to discuss the management of conditions that they have identified.

With regard to the general approach to the oral cases, candidates should ensure that they complete their analysis of the image that they are shown before requesting to see further investigations. If multiple
modalities are shown to a candidate for a given case, each modality is separately marked, and should be seen as an opportunity to gain marks. The Examiners have noted that candidates often ask for the
clinical history before even looking at the image that they have been shown, and some candidates have a tendency to look at the examiner for the answer or for visual clues rather than looking at the image.

A good general scheme when presenting a case is to describe the findings, provide an interpretation of the observations, offer a short and pertinent differential diagnosis, and suggest a primary or preferred
diagnosis.

Candidates are requested not to start every interpretation with fundamental observations such as: “This is a PA radiograph of a skeletally mature patient…” particularly where the candidate is confident of the diagnosis.

When viewing cross-sectional images, the Examiners advise candidates to be careful not to use the scroll button on the mouse as a stress-reliever! Repeatedly scrolling through the same series of images rarely reveals the answer.

Finally, candidates should be aware that Examiners will be writing   throughout the oral examinations: this does not mean that they are not listening to the candidates’ responses.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

AUTUMN 2016

The Examining Board has prepared the following report on the Autumn 2016 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination
Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as
possible.

EXAMINERS' REPORT – AUTUMN 2016

General Comments

Candidates are advised to read the examiners’ report written following the Spring 2016 sitting as many of the issues raised at that time and advice given remain valid for the Autumn 2016 sitting.

Persisting areas of concern in the Autumn sitting were:

The level of candidates’ anatomy knowledge

Candidates’ ability to extract as much information from the initial  image(s) shown (often, but not always a plain image)

Candidates’ observations and interpretation of plain images

Candidates’ knowledge and performance on paediatric and neuro imaging

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

SPRING 2017

The Examining Board has prepared the following report on the Spring 2017 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

EXAMINERS’S REPORT – SPRING 2017

Rapid Reporting Session

Candidates are reminded that there is considerable variation in the number of normal/abnormal cases between papers.

Marks continue to be lost when an abnormality is incompletely or inaccurately identified or described, resulting in the award of a half-mark or no mark for their response. The report for Spring 2016 gives examples of these responses.

Reporting Session

Candidates are reminded to allocate their time appropriately between cases – a bit less for the straightforward cases and a bit more for the more complex cases – but to ensure an adequate answer is provided for all six cases. It is difficult to compensate sufficiently for poor/brief answers with two or three detailed responses and achieve a passing score.

The candidates’ clinical knowledge and experience should be used to help interpretation of their findings (e.g. age of patient, acute/chronic presentation), guide their search for additional features, and prompt inclusion of relevant negative observations (e.g. absence of metastatic disease in sites common for a particular malignancy).

Bullet points or short sentences are preferable to long sentences or eloquent prose, particularly for the observations made. Features that may affect the patient’s subsequent management should be considered where appropriate and the further management of a patient should go beyond referral to an appropriate MDT. Ideally, the candidate should provide the advice that would be given to that MDT.

Oral Component

Candidates are reminded that the opportunity for scoring marks is the same for all modalities shown; plain images, US scans, CT scans, MRI scans, radionuclide imaging, contrast studies. Each modality shown, even if more than one for the same patient, is a separate opportunity for scoring marks (e.g. a chest plain image followed by a CT scan of the chest for the same patient represents 2 mark scoring  opportunities).

Candidates are advised to extract as much information as possible from the modality first presented (often a plain image) before  requesting another modality, and to build on the information obtained from the first modality when making observations and interpreting any subsequent modality. Even when most appropriate, US is frequently overlooked in favour of CT or MRI as the next modality for further investigation.

Candidates should be aware that talking constantly, barely pausing for breath, does not give the examiner the opportunity to assess the depth of the candidate’s knowledge by additional questions or guide the candidate to summarise or discuss patient management as appropriate.

Candidates should try to determine themselves when they have extracted as much as they can from the images presented to them in order to summarise, discuss further imaging/management as appropriate, end the scoring opportunity and move forward to another (either another modality for the same patient or a different patient and pathology).

The further management of a patient should go beyond referral to an appropriate MDT, and the candidate should provide the advice that would be given to that MDT.

Candidates are requested to speak clearly as mumbling and muttering makes it difficult for the examiners to hear what they are saying and know whether or not what they are saying is correct.

The identified areas of weakness in oral examination performance remain unchanged from recent previous sittings: knowledge of anatomy, observation and interpretation of plain images (particularly chest and abdomen), and clinical aspects relevant to the images being shown (e.g. clinical presentation, further management).

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

AUTUMN 2017

The Examining Board has prepared the following report on the Autumn 2017 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

EXAMINERS’S REPORT – AUTUMN 2017

Rapid Reporting Session

Candidates are reminded that there is considerable variation in the number of normal versus abnormal cases between exam sittings.

Abnormalities should be described accurately and fully to avoid the award of a half-mark or no mark for the candidate’s response. Examples provided in the report for Spring 2016 are reiterated below:

Identifying a fracture but failing to identify that this is a pathological fracture. If an underlying lesion is visible this should be stated, and if possible, characterised e.g.” fracture through simple bone cyst”

Identifying a fracture but failing to accurately describe its anatomic position e.g. if there is a fracture through the base of the fifth metatarsal on a radiograph of the foot, the following responses would not score any marks, as the Examiners cannot be certain that the candidate has identified the correct area of abnormality:

• Fracture
• Lucent line through metatarsal
• Fracture through metatarsal
• The following responses would gain a half-mark:
• Fracture fifth metatarsal
• Fracture metatarsal base

The following response would gain a full mark:

• Transverse fracture base of fifth metatarsal
• Fracture base fifth metatarsal

Identifying a single fracture in a well-recognised fracture complex, where a second fracture would be expected e.g.:

• Noting only one fracture in paired bones which normally fracture together (radius and ulna, tibia and fibula)
• Noting only one fracture in a ring structure (mandible, pelvis)

Identifying an abnormality but failing to accurately localise it e.g. identifying a posterior mediastinal mass, but calling it anterior, or identifying a renal tract calculus but mistakenly stating this lies in the kidney instead of the ureter or vice-versa.

Candidates at recent sittings have been particularly poor in their interpretation of cervical spine radiographs. Where they have identified an abnormality, they have frequently mis-classified it.

Candidates need to distinguish between unilateral and bilateral facet dislocation, fracture-dislocations and isolated fractures.

Reporting Session

Candidates are reminded that an adequate answer should be provided for all six cases as two or three detailed responses are rarely sufficient to compensate for poor or brief answers to the other cases and allow a
passing score to be achieved. Appropriate allocation of their time between cases is essential to achieve this – a bit less for the straightforward cases and a bit more for the more complex cases.

The experience and clinical knowledge of the candidate should be used to guide their search for additional features, help their interpretation of the findings (e.g. the patient’s age, acute/chronic presentation) and prompt the inclusion of relevant negative observations (e.g. absence of metastatic disease in sites common for a particular malignancy). Features that may affect the patient’s subsequent management should be considered where appropriate.

The management of the patient should go beyond referral to an appropriate MDT, and the candidate should provide the advice they would give to that MDT whenever possible.

Short sentences and/or bullet points are preferable to long sentences or eloquent prose, particularly for recording the candidate’s observations.

Oral Components

All modalities of imaging shown provide the same opportunity for scoring marks (plain images, US scans, CT scans, MRI scans, radionuclide imaging, contrast studies). Each modality shown is a separate opportunity for scoring marks, even if more than one is shown for the same patient (i.e. a chest plain image followed by a CT
scan of the chest for the same patient represents 2 mark scoring opportunities).

Candidates are reminded to extract as much information as possible from the modality first presented (often a plain image) before requesting another modality, and to use the information obtained from the first modality when making observations and interpreting any subsequent modality. US is frequently overlooked in favour of CT or MRI as the next modality for further investigation, even when it may be more appropriate.

Candidates should try to determine themselves when they have extracted as much as they can from the images presented to them in order to summarise, discuss further imaging/management as appropriate, end the scoring opportunity and move forward to another (either another modality for the same patient or a different patient and pathology).

Candidates should be aware that barely pausing for breath and talking incessantly does not easily give an examiner the opportunity to guide the candidate to summarise, discuss patient management or assess the depth of the candidate’s knowledge by additional questions as appropriate.

Candidates are requested to speak clearly as mumbling and muttering makes it difficult for the examiners to hear what they are saying and know whether or not what they are saying is correct.

Discussion of patient management should go beyond referral to an appropriate MDT, and the candidate should provide the advice they would give to that MDT.

The identified areas of weakness in oral examination performance remain unchanged from recent previous sittings: knowledge of anatomy, observation and interpretation of plain images (particularly chest and abdomen), and clinical aspects relevant to the images being shown (e.g. clinical presentation, further management).

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

SPRING 2018

The Examining Board has prepared the following report on the Spring 2018 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

Rapid Reporting Session

Candidates are reminded that there is considerable variation in the number of normal versus abnormal cases between exam sittings. Abnormalities should be described accurately and fully to avoid the award of half-marks or no marks for the candidate’s response.

Examples provided in the report for Spring 2016 are
reiterated below:

Identifying a fracture but failing to identify that this is a pathological fracture. If an underlying lesion is visible this should be stated, and if possible, characterised e.g.” fracture through simple bone cyst”

Identifying a fracture but failing to accurately describe its anatomic position e.g. if there is a fracture through the base of the fifth metatarsal on a radiograph of the foot, the following responses would not score any marks, as the Examiners cannot be certain that the candidate has identified the correct area of abnormality:

• Fracture
• Lucent line through metatarsal
• Fracture through metatarsal
• The following responses would gain a half-mark:
• Fracture fifth metatarsal
• Fracture metatarsal base

The following response would gain a full mark:

• Transverse fracture base of fifth metatarsal
• Fracture base fifth metatarsal

Identifying a single fracture in a well-recognised fracture complex, where a second fracture would be expected e.g.:

• Noting only one fracture in paired bones which normally fracture together (radius and ulna, tibia and fibula)
• Noting only one fracture in a ring structure (mandible, pelvis)

Identifying an abnormality but failing to accurately localise it e.g. identifying a posterior mediastinal mass, but calling it anterior, or identifying a renal tract calculus but mistakenly stating this lies in the kidney instead of the ureter or vice-versa.

Candidates at recent sittings have been particularly poor in their interpretation of cervical spine radiographs. Where they have identified an abnormality, they have frequently mis-classified it.

Candidates need to distinguish between unilateral and bilateral facet dislocation, fracture-dislocations and isolated fractures.

Reporting Session

Candidates are reminded that an adequate answer should be provided for all six cases as two or three detailed responses are rarely sufficient to compensate for poor or brief answers to the other cases and allow a
passing score to be achieved. Appropriate allocation of their time between cases is essential to achieve this – a bit less for the straightforward cases and a bit more for the more complex cases.

The experience and clinical knowledge of the candidate should be used to guide their search for additional features, help their interpretation of the findings (e.g. the patient’s age, acute/chronic presentation) and prompt the inclusion of relevant negative observations (e.g. absence of metastatic disease in sites common for a particular malignancy). Features that may affect the patient’s subsequent management should be considered where appropriate.

The management of the patient should go beyond referral to an appropriate MDT, and the candidate should provide the advice they would give to that MDT whenever possible.

Short sentences and/or bullet points are preferable to long sentences or eloquent prose, particularly for recording the candidate’s observations

Oral Components

All modalities of imaging shown provide the same opportunity for scoring marks (plain images, US scans, CT scans, MRI scans, radionuclide imaging, contrast studies). Each modality shown is a separate opportunity for scoring marks, even if more than one is shown for the same patient (i.e. a chest plain image followed by a CT
scan of the chest for the same patient represents 2 mark scoring opportunities).

Candidates are reminded to extract as much information as possible from the modality first presented (often a plain image) before requesting another modality, and to use the information obtained from the first modality when making observations and interpreting any subsequent modality. US is frequently overlooked in favour of CT or MRI as the next modality for further investigation, even when it may be more appropriate.

Candidates should try to determine themselves when they have extracted as much as they can from the images presented to them in order to summarise, discuss further imaging/management as appropriate, end the scoring opportunity and move forward to another (either another modality for the same patient or a different patient and pathology).

Candidates should be aware that barely pausing for breath and talking incessantly does not easily give an examiner the opportunity to guide the candidate to summarise, discuss patient management or assess the depth of the candidate’s knowledge by additional questions as appropriate.

Candidates are requested to speak clearly as mumbling and muttering makes it difficult for the examiners to hear what they are saying and know whether or not what they are saying is correct.

Discussion of patient management should go beyond referral to an appropriate MDT, and the candidate should provide the advice they would give to that MDT.

The identified areas of weakness in oral examination performance remain unchanged from recent previous sittings: knowledge of anatomy, observation and interpretation of plain images (particularly chest and abdomen), and clinical aspects relevant to the images being shown (e.g. clinical presentation, further management).

General comments

(As you will be aware, there were a few “teething” problems and one major issue with the Practique “automation” platform in the written components of the examination. The cause of the major problem has been identified and rectified and the other issues are being addressed with exhaustive testing and re-testing by the Automation Board and College staff to follow, well in advance of the Autumn 2018 sitting.)

Feedback/Advice for Candidates

For candidates eligible for feedback (2 or more unsuccessful  attempts), chest imaging and neuroradiology seem to be the most challenging body systems at this sitting. Candidates may need to make more effort in these areas.

Observation and interpretation of plain images, particularly chest, remain areas of weakness.

No other new advice to candidates from previous reports.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

AUTUMN 2018

The Examining Board has prepared the following report on the Spring 2018 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

Rapid Reporting Session

Candidates are reminded that there is considerable variation in the number of normal versus abnormal cases between exam sittings. Abnormalities should be described accurately and fully to avoid the award of half-marks or no marks for the candidate’s response.

Examples provided in the report for Spring 2016 are
reiterated below:

Identifying a fracture but failing to identify that this is a pathological fracture. If an underlying lesion is visible this should be stated, and if possible, characterised e.g.” fracture through simple bone cyst”

Identifying a fracture but failing to accurately describe its anatomic position e.g. if there is a fracture through the base of the fifth metatarsal on a radiograph of the foot, the following responses would not score any marks, as the Examiners cannot be certain that the candidate has identified the correct area of abnormality:

• Fracture
• Lucent line through metatarsal
• Fracture through metatarsal
• The following responses would gain a half-mark:
• Fracture fifth metatarsal
• Fracture metatarsal base

The following response would gain a full mark:

• Transverse fracture base of fifth metatarsal
• Fracture base fifth metatarsal

Identifying a single fracture in a well-recognised fracture complex, where a second fracture would be expected e.g.:

• Noting only one fracture in paired bones which normally fracture together (radius and ulna, tibia and fibula)
• Noting only one fracture in a ring structure (mandible, pelvis)

Identifying an abnormality but failing to accurately localise it e.g. identifying a posterior mediastinal mass, but calling it anterior, or identifying a renal tract calculus but mistakenly stating this lies in the kidney instead of the ureter or vice-versa.

Candidates at recent sittings have been particularly poor in their interpretation of cervical spine radiographs. Where they have identified an abnormality, they have frequently mis-classified it.

Candidates need to distinguish between unilateral and bilateral facet dislocation, fracture-dislocations and isolated fractures.

Reporting Session

Candidates are reminded that an adequate answer should be provided for all six cases as two or three detailed responses are rarely sufficient to compensate for poor or brief answers to the other cases and allow a
passing score to be achieved. Appropriate allocation of their time between cases is essential to achieve this – a bit less for the straightforward cases and a bit more for the more complex cases.

The experience and clinical knowledge of the candidate should be used to guide their search for additional features, help their interpretation of the findings (e.g. the patient’s age, acute/chronic presentation) and prompt the inclusion of relevant negative observations (e.g. absence of metastatic disease in sites common for a particular malignancy). Features that may affect the patient’s subsequent management should be considered where appropriate.

The management of the patient should go beyond referral to an appropriate MDT, and the candidate should provide the advice they would give to that MDT whenever possible.

Short sentences and/or bullet points are preferable to long sentences or eloquent prose, particularly for recording the candidate’s observations

Oral Components

All modalities of imaging shown provide the same opportunity for scoring marks (plain images, US scans, CT scans, MRI scans, radionuclide imaging, contrast studies). Each modality shown is a separate opportunity for scoring marks, even if more than one is shown for the same patient (i.e. a chest plain image followed by a CT
scan of the chest for the same patient represents 2 mark scoring opportunities).

Candidates are reminded to extract as much information as possible from the modality first presented (often a plain image) before requesting another modality, and to use the information obtained from the first modality when making observations and interpreting any subsequent modality. US is frequently overlooked in favour of CT or MRI as the next modality for further investigation, even when it may be more appropriate.

Candidates should try to determine themselves when they have extracted as much as they can from the images presented to them in order to summarise, discuss further imaging/management as appropriate, end the scoring opportunity and move forward to another (either another modality for the same patient or a different patient and pathology).

Candidates should be aware that barely pausing for breath and talking incessantly does not easily give an examiner the opportunity to guide the candidate to summarise, discuss patient management or assess the depth of the candidate’s knowledge by additional questions as appropriate.

Candidates are requested to speak clearly as mumbling and muttering makes it difficult for the examiners to hear what they are saying and know whether or not what they are saying is correct.

Discussion of patient management should go beyond referral to an appropriate MDT, and the candidate should provide the advice they would give to that MDT.

The identified areas of weakness in oral examination performance remain unchanged from recent previous sittings: knowledge of anatomy, observation and interpretation of plain images (particularly chest and abdomen), and clinical aspects relevant to the images being shown (e.g. clinical presentation, further management).

General comments

I am delighted and relieved that the written components of the exam were successfully delivered to all candidates at this sitting using the automated Practique platform.

Feedback/Advice for Candidates

For candidates eligible for feedback (2 or more unsuccessful attempts), abdominal imaging and neuroradiology seem to be the most challenging body systems at this sitting. MRI seems to be the modality
that gave the candidates the most difficulty. Trainees and examination candidates may need to focus their efforts in these areas.

Observation and interpretation of plain images and anatomical knowledge remain areas of weakness.

The exams team receives several enquiries before each exam sitting regarding normal variants in the rapid reporting component. Normal variants that can cause symptoms will not be included, e.g. accessory navicular, supracondylar spur. Normal variants that do not cause symptoms may be included and the correct response for such an image would be normal.

No other new advice to candidates from previous reports.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

SPRING 2019

The Examining Board has prepared the following report on the Spring 2019 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

General comments

Once again, I am delighted that the written components of the exam were successfully delivered to all candidates at this sitting using the automated Practique platform, and the entire exam sitting was without
major incident.

There are three numbered items of new advice for candidates in this report. Please read carefully.

Comments in previous reports for each component of the exam are still relevant, so please refer to the Autumn 2018 Examiners’ Report for these.

Candidates are reminded that normal variants that can cause symptoms will not be included in the rapid reporting component, e.g. accessory navicular, supracondylar spur. Normal variants that do not cause symptoms may be included and the correct response for such images would be “normal”.

Feedback/Advice for Candidates

At this sitting, knowledge of normal appearances on paediatric plain images and the observation and interpretation of abdominal plain images was particularly poor in the rapid reporting.

The reporting section demonstrated women’s imaging to be a challenge for many candidates, neuroimaging less so.

However, neuroimaging, plain images and vascular findings and interpretation were noticeable areas of difficulty in the oral components.

Written Components - General

1. For the written components delivered on the Practique platform (Rapid Reporting and (Long Case) Reporting), it became apparent during this sitting of the exam that many candidates were not making use of the full resolution capacity of the system. This probably accounts for comments by some candidates about poor image quality following this and previous exam sittings.

For the Rapid Reporting component and Reporting plain images particularly, it is essential to enlarge the image(s) to full screen and sometimes further enlarge (zoom) the image to achieve maximum spatial resolution. This is achieved by double-clicking on the image window in the middle of the question/answer screen.

All image manipulation parameters in the drop-down box (top left of screen) remain functional. Double-clicking on the full screen image will return to the question/answer screen.

This aspect of using the Practique platform is included in the on line demonstration site and pre-exam video but will be emphasised for future examination sittings.

2. Candidates are reminded that continuing keyboard entry after the end of the examination period can lead to disqualification from the exam.

All keyboard entries by all candidates are logged (time and content). Any keyboard entries made after the end of the exam will be discarded and not contribute to the candidate’s examination performance, notwithstanding the risk of disqualification.

Subsequent to the written components, enquiries about answers not submitted/uploaded are easily verified. Upload of all submitted answers from all computers at all venue is confirmed before the examination components are closed and available for marking.

The keyboard entries of candidates who enquire are checked. There have been instances when the claimed “lost” keyboard entry was deleted by the candidate, though could be seen from earlier entries, and worse, the “lost” entry was never made at any time, raising questions about the candidate’s honesty and probity.

Rapid reporting

3. The comments provided by candidates when a case has been considered abnormal have become longer with the use of Practique and an unlimited text box. This has contributed to less concise and less accurate descriptions for an abnormality (if correctly identified) and an increase in the number of half marks awarded for responses.

As a consequence, a greater number of candidates do not achieve the passing mark for this component of the exam.

The FRCR 2B Exam Board has reviewed this and made an appropriate small adjustment to the closed-marks awarded for raw scores, but candidates are strongly advised to keep their comments short and precise to maximize the opportunity to score full marks.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

AUTUMN 2019

The Examining Board has prepared the following report on the Autumn 2019 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the informationcontained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

General comments

This sitting of the Final FRCR 2B examination was the largest ever delivered, for the first time with over 300 candidates and all UK Trainees or NHS contributors. The examiners met the extra demand with their usual professionalism and commitment.

Delivery of the written components of the exam on the Practique platform is now established and occurred without major incident.

Comments in previous reports for each component of the exam are still relevant, so please refer to the Autumn 2018 Examiners’ Report for these, but please pay particular attention to the items below.

Rapid Reporting Session

Candidates are reminded that normal variants that can cause symptoms will not be included in the rapid reporting component, e.g. accessory navicular, supracondylar spur. Normal variants that do not cause symptoms may be included and the correct response for such images would be “normal”.

Candidates are reminded to keep comments regarding the site and nature of the abnormality identified on an image considered abnormal short and precise in order to maximize the opportunity to score full marks (see Spring 2019 report for more detail).

Reporting Session

Candidates should ensure they make use of the full resolution capacity of the system during the written components delivered on the Practique platform (Rapid Reporting and [Long Case] Reporting).

For plain images, particularly in the Rapid Reporting component but also the Reporting component, it is essential to enlarge the image(s) to full screen and sometimes further enlarge (zoom) the image to achieve
maximum spatial resolution. This is achieved by double-clicking on the image window in the middle of the question/answer screen. All image manipulation parameters in the drop-down box (top left of screen) remain functional. Double-clicking on the full screen image will return to the question/answer screen.

This aspect of using the Practique platform is included in the demonstration site and pre-exam video, and is now reiterated in the verbal instructions from the invigilator immediately prior to the start of the exam component. It is important that candidates do this to provide them with the best chance of giving a correct response.

Candidates are reminded that continuing keyboard entry after the end of the examination period can lead to possible disqualification from the exam and that all keyboard entries by all candidates are logged (time and content).

Enquiries subsequent to the written components regarding keyboard entry and upload of responses (or not) are easily checked. Upload of all submitted answers from all computers at all venues is confirmed before the examination components are closed and available for marking.

Candidates are strongly encouraged to visit the Practique  demonstration site to familiarise themselves with the exam delivery platform.

Feedback/Advice for Candidates

In the rapid reporting at this sitting, hands, feet, abnormal spines, mediastinal abnormalities on plain chest images and skull images caused candidates the most difficulties, particularly the hands and feet. Greater experience in reporting these types of images from the Emergency Department should help candidates with this component of the examination.

In the reporting component, neuroimaging continues to be challenging. At this sitting, cardiothoracic CT was also poorly reported. For both areas, it was mainly the failure to make secondary observations that lost candidates marks. In the neuro question it was an important (potentially life-threatening) observation that was commonly missed. In the cardiothoracic question, secondary findings to distinguish acute from chronic pathology were not made.

In the oral components, candidates continue to not get the maximum information from plain images, either compromising their interpretation or leading to inappropriate further investigations. Poor anatomical and
clinical knowledge also remains a feature of poorer candidate performance.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

AUTUMN 2020

The Examining Board has prepared the following report on the Autumn 2020 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

General comments

An extraordinary sitting!

Despite the challenges posed by COVID19 restrictions, the phenomenal efforts of the RCR Examinations, IT and Facilities teams, the Board of Examiners and all Exam Board Chairs, ensured delivery of this sitting of the Final FRCR 2B examination.

Delivery of the written components of the exam on the Practique platform occurred without major incident.

The delivery of the Oral components of the exam was a new experience for us all but the fundamental process was unchanged. Although the experience for the candidates was not always ideal despite extensive testing and piloting prior to the exam sitting, at least all candidates completed the examination, with rescheduling on the same day required for one candidate only. Feedback comments from all aspects of the process have been gratefully received, are being collated and will be considered to improve the delivery of the next exam sitting in January.

Comments in previous reports for each component of the exam are still relevant, so please refer to the Autumn 2018 Examiners’ Report for these. Important and more recent comments are repeated below.

Written Components

Candidates are reminded to view the pre-exam video and visit the Practique demonstration site to familiarise themselves with the exam delivery platform for the written components.

To provide the best chance of giving a correct response, it is essential that plain images, particularly in the Rapid Reporting component but also the Reporting component, are enlarged to full screen and sometimes further enlarged (zoomed) to achieve maximum spatial resolution. This is achieved by double-clicking on the image window in the middle of the question/answer screen. All image manipulation parameters in the drop-down box (top left of screen) remain functional. Double-clicking on the full screen image will return to the question/answer screen.

Rapid reporting session

Candidates are reminded that normal variants that can cause symptoms will not be included in the rapid reporting component, e.g. accessory navicular, supracondylar spur. Normal variants that do not cause symptoms may be included and the correct response for such images would be “normal”.

Candidates are reminded to keep comments short and precise regarding the site and nature of the abnormality identified on an image considered abnormal in order to maximize the opportunity to score full marks (see Spring 2019 report for more detail).

Oral components

Candidates are reminded that plain images are the starting point for several patients shown in the oral components of the exam, so as much information as possible should be extracted from these before
requesting another modality. The information obtained from the plain image or any other initial imaging modality should inform the observations and interpretation of any subsequent modality.

Anatomy and clinical aspects relevant to the images shown are important components of the oral assessment. Discussion of patient management should go beyond referral to an appropriate MDT, and the candidate should provide the advice they would give to that MDT.

Barely pausing for breath and talking incessantly does not easily give an examiner the opportunity to guide candidates to summarise, discuss patient management or assess the depth of their knowledge by additional questions as appropriate.

Finally candidates are encouraged to speak clearly. If examiners cannot hear you clearly, they do not know if what you are saying is correct.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

SPRING 2021

The Examining Board has prepared the following report on the Spring 2021 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

General comments

Unfortunately, the planned exam for January 2021 had to be cancelled owing to the second/third wave of the COVID19 pandemic, so this was the second exam sitting with candidates remote from the College for the oral components, this time during full “lockdown” restrictions. Once again, my sincere thanks to the RCR Examinations, IT and Facilities teams, the Board of Examiners and all Exam Board Chairs for  ensuring successful delivery of the Final FRCR 2B examination.

Delivery of the written components of the exam on the Practique platform occurred without major incident. There seemed to be rather more minor technological clitches during the oral components this time, mostly owing to upgrades to MS Teams and the Mac OS introduced only days before the exam week with resultant incompatibilities/loss of functionality that there was not enough time to resolve before the oral exams commenced.

Regardless, all candidates that were able to attend for the exam completed the oral components during their allotted session, with additional time allowed, when appropriate, to compensate for any technological delays.

Feedback from all participants has been requested again and will be considered, to continue improvement in the delivery of the exam.
I would like to reassure candidates that all the equipment at all the exam venues meets the minimum specifications stipulated by the RCR so no candidate will be disadvantaged by substandard monitors, poor
internet bandwidth and speed.

Comments in previous reports for each component of the exam are still relevant, but given the interim disruptions and time elapsed since fully included in a previous report (Autumn 2018), they are updated and repeated in this report.

I would like to emphasise that minor changes of degenerative arthritis in Rapid Reporting images should be regarded as normal for the purpose of classifying the image as normal or abnormal.

Written Components

Candidates are reminded to view the pre-exam video and visit the Practique demonstration site to familiarise themselves with the exam delivery platform for the written components.

To provide the best chance of giving a correct response, it is essential that plain images, particularly in the Rapid Reporting component but also the Reporting component, are enlarged to full screen and sometimes further enlarged (zoomed) to achieve maximum spatial resolution. This is achieved by double-clicking on the image window in the middle of the question/answer screen. All image manipulation parameters in the drop-down box (top left of screen) remain functional. Double-clicking on the full screen image will return to the question/answer screen.

Rapid reporting session

Candidates are reminded that there is considerable variation in the number of normal versus abnormal cases between exam sittings.
Abnormalities should be described accurately and fully to avoid the  award of half-marks or no marks for the candidate’s response.

Examples provided previously are reiterated below:

Identifying a fracture but failing to identify that this is a pathological fracture. If an underlying lesion is visible this should be stated, and if possible, characterised e.g.” fracture through simple bone cyst”

Identifying a fracture but failing to accurately describe its anatomic position e.g. if there is a fracture through the base of the fifth metatarsal on a radiograph of the foot, the following responses would not score any marks, as the Examiners cannot be certain that the candidate has identified the correct area of abnormality:

• Fracture
• Lucent line through metatarsal
• Fracture through metatarsal
• The following responses would gain a half-mark:
• Fracture fifth metatarsal
• Fracture metatarsal base

The following response would gain a full mark:

• Transverse fracture base of fifth metatarsal
• Fracture base fifth metatarsal

Identifying a single fracture in a well-recognised fracture complex, where a second fracture would be expected e.g.:

• Noting only one fracture in paired bones which normally fracture together (radius and ulna, tibia and fibula)
• Noting only one fracture in a ring structure (mandible, pelvis)

Identifying an abnormality but failing to accurately localise it e.g. identifying a posterior mediastinal mass, but calling it anterior, or identifying a renal tract calculus but mistakenly stating this lies in the kidney instead of the ureter or vice-versa.

Candidates at recent sittings have been particularly poor in their interpretation of cervical spine radiographs. Where they have identified an abnormality, they have frequently mis-classified it.

Candidates need to distinguish between unilateral and bilateral facet dislocation, fracture-dislocations and isolated fractures.

Normal variants that can cause symptoms will not be included, e.g. accessory navicular, supracondylar spur.

Normal variants that do not cause symptoms may be included and the correct response for such images would be “normal”.

Candidates are reminded to keep comments short and precise regarding the site and nature of the abnormality identified on an image considered abnormal in order to maximize the opportunity to score full marks (see Spring 2019 report for more detail).

Minor changes of degenerative arthritis should be regarded as normal for the purpose of classifying the image as normal or abnormal.

Reporting session

Candidates are reminded that an adequate answer should be provided for all six cases as two or three detailed responses are rarely sufficient to compensate for poor or brief answers to the other cases and allow a
passing score to be achieved. Appropriate allocation of their time  between cases is essential to achieve this – a bit less for the straightforward cases and a bit more for the more complex cases.

The experience and clinical knowledge of the candidate should be used to guide their search for additional features, help their interpretation of the findings (e.g. the patient’s age, acute/chronic presentation) and prompt the inclusion of relevant negative observations (e.g. absence of metastatic disease in sites common for a particular malignancy). Features that may affect the patient’s  subsequent management should be considered where appropriate.

The management of the patient should go beyond referral to an appropriate MDT, and the candidate should provide the advice they would give to that MDT whenever possible.

Short sentences and/or bullet points are preferable to long sentences or eloquent prose, particularly for recording the candidate’s observations.

Oral components

Candidates are reminded that:

All modalities of imaging shown provide the same opportunity for scoring marks (plain images, US scans, CT scans, MRI scans, radionuclide imaging, contrast studies). Each modality shown is a separate opportunity for scoring marks when a different set of candidate skills can be assessed, even if more than one modality is
shown for the same patient, e.g. a chest plain image followed by a CT scan of the chest for the same patient usually represents two mark scoring opportunities.

Plain images are the starting point for several patients shown in the oral components of the exam, so as much information as possible should be extracted from these before requesting another modality. The information obtained from the plain image or any other initial imaging modality should inform the observations and interpretation of any subsequent modality. Ultrasound is frequently overlooked in favour of CT or MRI as the next modality for further investigation, even when it may be more appropriate (e.g. children).

Candidates should try to determine themselves when they have extracted as much as they can from the images presented to them in order to summarise, discuss diagnoses and further  imaging/management as appropriate, end the scoring opportunity and move forward to another (either another modality for the same
patient or a different patient and pathology).

Anatomy, assessment of plain images and clinical aspects relevant to the images shown are important components of the oral assessment. Discussion of patient management should go beyond referral to an
appropriate MDT, and the candidate should provide the advice they would give to that MDT.

Barely pausing for breath and talking incessantly does not easily give an examiner the opportunity to guide candidates to summarise, discuss patient management or assess the depth of their knowledge by additional questions as appropriate. Mumbling and muttering makes it difficult for the examiners to hear what the candidate is saying and to know whether or not what they are saying is correct. Candidates are encouraged to speak clearly and at a steady pace with short pauses as appropriate.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

SITTING MARCH 2022

The Examining Board has prepared the following report on the March 2022 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This
information should be made available as widely as possible.

General comments

This diet of the FRCR 2B examination was held from 25th of March to 1st of April 2022. The long case and rapid reporting components were held on the 25 th of March and the oral examination from 28th of March to the 1st of April.

282 candidates applied for the exam. 216 took the exam, of which 158 were sitting the exam for the first time. 98 were UK candidates, of which 30 were sitting the exam for the first time.

There were 30 NHS contributors and 154 global candidates.

Six venues were used for the sitting including India.

Overall pass rate was 82.9%, while the UK pass rate was 84.5% (first timers 89%). NHS contributor pass rate was 80% and global pass rate was 82.4%.

Rapid Reporting Session

The rapid reporting component was conducted without any technical issues.
All candidates completed their examination
Based on candidate response and analysis of the marks, one case was found to be sub-optimal and all candidates who
attempted the question were given full marks for that question irrespective of their answer.

Reporting Session

The long case reporting part was also conducted without any issues.
The cases were scored very well by the candidates and the pass rate was high.

Oral components

As is the current practice, the oral examinations were carried out from Monday to Friday using MSTeams and OSIRIX. All
examiners were stationed in the Royal College premises and the candidates were remote in external centers, both
nationally and abroad.
Apart from some minor sporadic technical issues the examination went well and all candidates were examined without
any disruption.
One candidate was awarded the Gold Medal for exceptional performance
The results were tabulated and published in time.

Feedback/Advice for Candidates

Rapid Reporting

Analysis of the data of performance of Rapid Reporting shows that there is a significant tendency of
unsuccessful candidates to overcall abnormalities. Please remember that there are normal images in the set
mistaking normal images as abnormal can be a cause of failure
Please remember that all images have a single abnormality (unless the combination of abnormalities form part
of the diagnosis – e.g., Montaggia fracture dislocation)
Please ensure that you have answered all questions
While reporting images of appendicular skeleton – you are expected to mention side of the abnormality only if
such annotation is given on the image.

Long case reporting

Time management seems to be the biggest factor in poor performance in long case reporting. Please decide on a strategy and ensure that you have allocated equal time for each question.
Tendency to write long answers for the cases you are confident is another common mistake.
Long cases are marked using a stratified marking criterion and hence brevity and tabular format is more useful than free flowing prose. Mentioning the same fact in different parts of your answer does not get you extra marks.
Please attempt all questions – describing the abnormalities even in a case where the exact diagnosis is not known to you might enable you to score some valuable marks which will contribute to the overall score and can make the difference between pass and fail in this component

Oral examinations

Speak clearly and audibly. Most microphones and speakers these days have inbuilt noise cancelling algorithms and hence it assumes a softly speaking candidate as external noise and cuts it off resulting in being inaudible to the examiners
Practice oral examinations using OSIRIX and MSTeams prior to the exams. It is of paramount importance to get used to the functionalities of the system, especially scrolling through image stacks. This will go a long way in making the day less stressful and for the candidate to perform to their maximum capability.
Please listen to the examiner when a new case is being shown. Eagerness to concentrate on the image might mean that you miss the very valuable information provided by the examiner pertaining to that case.
When you are being shown a chest or abdominal x-ray, please resist the temptation to advise cross-sectional imaging before fully analyzing the image shown. The chest or abdominal x-ray is shown for a reason and hence do due justice to it.
Please remember that paediatric, breast and vascular imaging are all part of the syllabus and hence there is a strong likelihood that you might be shown cases from these specialties
For international candidates – please remember that FRCR examination is designed for UK trainees and hence pathologies which are common in UK even when they are uncommon in other parts of the world will be part of the exam. You are also expected to be aware of the common diagnostic and management pathways that are part of the core health care service in this country.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

June 2022 Sitting

The Examining Board has prepared the following report on the June 2022 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This
information should be made available as widely as possible.

General comments

This sitting was held from 17th to the 24th of June. The long case and rapid reporting components were held on the 17th of June and the oral examination from 20th to 24th of June.

234 candidates applied for the exam. 216 took the exam, of which 153 were sitting the exam for the first time.
18 withdrawals were due to delayed visas and illness.
30 were UK candidates, of which 27 were sitting the exam for the first time.
There were 9 NHS contributors and 177 global candidates.
Six venues were used for the sitting including India.

Overall pass rate was 60%, while the UK pass rate was 83% (first timers 89%). NHS contributor pass rate was 33% and global pass rate was 57%.

Rapid Reporting Session

The rapid reporting component was conducted without any technical issues.
There were no major issues with the cases selected due to the vigorous standard setting process in place
The overall pass rate was 66.7% and no remedial action was required

Reporting Session

The long case reporting part was also conducted without any issues. The questions proved to be well discriminatory
between good, average, and poorly performing candidates.
The overall pass rate was 77.8%

Oral components

As is the current practice, the oral examinations were carried out from Monday to Friday using MSTeams and OSIRIX. All
examiners were based at the RCR with candidates remote in external centers, both nationally and abroad.
Apart from some minor sporadic technical issues the examination ran well and all candidates were examined without
any disruption.

The Gold Award

Two candidates making their first attempt were in the running for the Gold Award for exceptional performance. The
candidate with the highest oral scores was recommended by the examiners.
The results were tabulated and published in time

Feedback/Advice for Candidates

Rapid Reporting

Analysis of the data of performance of Rapid Reporting shows that there is a significant tendency of unsuccessful candidates to overcall abnormalities. Please remember that there are normal images in the set mistaking normal images as abnormal can be a cause of failure
Please remember that all images have a single abnormality (unless the combination of abnormalities form part of the diagnosis – e.g., Montaggia fracture dislocation)
Please ensure that you have answered all questions
While reporting images of appendicular skeleton – you are expected to mention side of the abnormality only if such annotation is given on the image.

Long case reporting

Time management seems to be the biggest factor in poor performance in long case reporting. Please decide on a strategy and ensure that you have allocated equal time for each question.
Tendency to write long answers for the cases you are confident is another common mistake.
Long cases are marked using a stratified marking criterion and hence brevity and tabular format is more useful than free flowing prose. Mentioning the same fact in different parts of your answer does not get you extra marks.
Please attempt all questions – describing the abnormalities even in a case where the exact diagnosis is not known to you might enable you to score some valuable marks which will contribute to the overall score and can make the difference between pass and fail in this component

Oral examinations

Speak clearly and audibly. Most microphones and speakers these days have inbuilt noise cancelling algorithms and hence it assumes a softly speaking candidate as external noise and cuts it off resulting in being inaudible to the examiners
Practice oral examinations using OSIRIX and MSTeams prior to the exams. It is of paramount importance to get used to the functionalities of the system, especially scrolling through image stacks. This will go a long way in making the day less stressful and for the candidate to perform to their maximum capability.
Please listen to the examiner when a new case is being shown. Eagerness to concentrate on the image might mean that you miss the very valuable information provided by the examiner pertaining to that case.
When you are being shown a chest or abdominal x-ray, please resist the temptation to advise cross-sectional imaging before fully analyzing the image shown. The chest or abdominal x-ray is shown for a reason and hence do due justice to it.
Please remember that paediatric, breast and vascular imaging are all part of the syllabus and hence there is a strong likelihood that you might be shown cases from these specialties
For international candidates – please remember that FRCR examination is designed for UK trainees and hence pathologies which are common in UK even when they are uncommon in other parts of the world will be part of the exam. You are also expected to be aware of the common diagnostic and management pathways that are
part of the core health care service in this country.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

January 2023 sitting

The Examining Board has prepared the following report on the January 2023 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

General comments

142 candidates applied for the exam. 134 candidates took the exam with an overall pass rate of 48.5%. The UK pass rate was 42.9%, the Global pass rate was 49%.

Rapid Reporting Session

Marks were lost by candidates who failed to accurately locate the abnormality.

Although there is only a single pathology in any single case where there are linked abnormalities candidates need to describe both to score full marks e.g. where there is a pathological fracture an answer of fracture willonly score half marks. If there is an underlying lesion this should be described e.g. fracture through a simple bone cyst.

Identifying the abnormality but not identifying the side (where two are shown) will result in a part score. Identifying the wrong side will result in no marks being awarded. For example, on a CXR, a report of
pneumothorax will result in a part score. An answer of left  pneumothorax will not be awarded any marks if the abnormality is on the right.

Reporting Session

Bullet points or short sentences are preferable to long sentences.

Features that may affect the patient’s subsequent management should be identified where appropriate.

Oral components

We are aware of some issues with oral case display on Teams.  Candidates should be aware that this platform does not have all the functionality of a PACS workstation, particularly scrolling is slower. To help candidates adjust to this there is a practice case shown to them before the examination starts. This allows them to familiarise themselves with the functionality of the system and for the examiners and invigilators to address any unforeseen issues with the system before the active session start.

There can be a lag in the movement of the pointer on the candidate’s side. The examiners are aware of this and will make appropriate allowance for this.

Candidates should pay attention to the clinical information given by the examiners. If they fail to use this when synthesizing their observations, they may lose marks.

Communication is an important skill for a radiologist. Candidates will be rewarded for accurate, succinct and clear expression of their observations, clinical reasoning and patient management. Rambling, imprecise inaccurate answers will lose marks. If the candidate mumbles it is difficult for examiner to know what they are saying and scoring information may be lost.

Feedback/Advice for Candidates.

Please note that any candidate considering an appeal must have either completed an incident form at the exam venue on the day or logged any adverse matter on the exam hub within 48 hours of the exam component.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

MARCH 2023 SITTING

The Examination Board has prepared the following report on the March 2023 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examination and help those who train them. This information should be made available as widely as possible.

General comments

305 candidates took the examination of which 143 were sitting the examination for the first time. There were 14 NHS contributors and 185 global candidates. The overall pass rate was 40%. The UK candidate pass rate was 52%. The Global pass rate was 34% with global first timers having a pass rate of 36%.

Examination Preparation.

Candidates are strongly recommended to watch the instructional advice available on the RCR website.This familiarisation is likely to help them with the examination, particularly improving their knowledge of the functionality of the Practique platform. It is clear from questions asked that not all candidates do this, wasting their own time and causing them avoidable stress.

Rapid Reporting Session

It was particularly apparent in this section, but noted in other sections of the examination that candidates at this sitting were less secure in their plain film interpretation than recent cohorts. Candidates and training schemes may wish to consider this when planning their examination preparation and training.

For rapid reporting cases and in all other sections if there is a medical device present e.g. a NG tube candidates should state if it is in a satisfactory position or not (and if not, what is wrong with the position and what action is advised.)

Candidates should be aware that there is considerable variation in the number of normal cases between sets and trying to assess whether they have found sufficient abnormal cases to determine whether the remainderare normal is unlikely to be a successful strategy.

Marks continue to be lost by candidates who failed to accurately locate the abnormality. Although there is only a single pathology in any single case where there are linked abnormalities candidates need to describe both to score full marks e.g. where there is a pathological fracture an answer of fracture will only score half marks. If there is an underlying lesion this should be described e.g. fracture through a simple
bone cyst.

Reporting Session

Candidates should pay attention to the clinical information given as it may assist in narrowing their differential diagnosis.

Bullet points or short sentences are preferable to long sentences.

Features that may affect the patient’s subsequent management should be identified where appropriate including pertinent negatives e.g. where a diagnosis of malignancy is made the presence or absence of
tumour spread to recognised sites is expected.

Oral components

Candidates should pay attention to the clinical information if given by the examiners. If they fail to use this when synthesising their observations, they may lose marks.

Communication is an important skill for a radiologist. A good general scheme is to describe the finding of the case, give an interpretation of the observations, offer a preferred diagnosis with a short differential (if
appropriate.) Only then should they ask for further imaging and if they do, they should explain how it will contribute.

We are aware of some issues with oral case display on Teams. With the help of the IT team at the College we are looking to see how these can be improved.

However, candidates should be aware that this platform does not have all the functionality of a PACS workstation, particularly scrolling is slower. To help candidates adjust to this there is a practice case shown to them before the examination starts. This allows them to familiarize themselves with the functionality of the system and for the examiners and invigilators to address any unforeseen issues with the system.

There can be a lag in the movement of the pointer on the candidate’s side. The examiners are aware of this and will make appropriate allowance for this.

If candidates experience other problems with this platform, they should let the examiners know at the time so they can make appropriate allowance/take appropriate action.

Feedback/Advice for Candidates.

Please note that any candidate considering making an appeal must have logged any adverse matter on the RCR website within 48 hours of their examination.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

June 2023 SITTING

The Examining Board has prepared the following report on the June 2023 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examinations and help those who train them. This information should be made available as widely as possible.

General comments

217 candidates took the exam, of which 150 were sitting the exam for the first time. There were 11 NHS contributors and 152 global candidates. The overall pass rate was 68%. The UK candidate pass rate was 83%. The Global pass rate was 63% with global first timers having a pass rate of 62%.

Examination Preparation

Candidates are strongly recommended to watch the instructional advice available on the RCR website. This familiarization is likely to help them with the exam, particularly improving their knowledge of the functionality of the Practique platform. It is clear from questions asked that not all candidates do this, wasting their own time and causing them avoidable stress.

Rapid Reporting Session

For rapid reporting cases and in all other sections if there is a medical device present e.g. a NG tube candidates should state if it is in a satisfactory position or not (and if not, what is wrong with the position and what action is advised.)

Candidates should be aware that there is considerable variation in the number of normal cases between sets and trying to assess whether they have found sufficient abnormal cases to determine whether the remainderare normal is unlikely to be a successful strategy.

Marks continue to be lost by candidates who fail to accurately locate the abnormality. Identifying the abnormality but not identifying the side (where two are shown) will result in a part score. Identifying the wrong
side will result in no marks being awarded. For example, on a CXR, a report of pneumothorax will result in a part score. An answer of left pneumothorax will not be awarded any marks if the abnormality is on the right.

Reporting Session

Candidates should pay attention to the clinical information given in this and the oral sections as it may assist in narrowing their differential diagnosis.

Bullet points or short sentences are preferable to long sentences when answering.

Features that may affect the patient’s subsequent management should be identified where appropriate including pertinent negatives e.g. where a diagnosis of malignancy is made the presence or absence of
tumour spread to recognized sites is expected.

The management of the patient should go beyond referral to an appropriate MDT, and the candidate should provide the advice they would give to that MDT whenever possible.

Oral components

Candidates should expect to see a range of modalities during the examination. As well as the previously documented plain film weakness (provided in the March 2023 report) some candidates are showing significant weakness in other modalities including US and MRI. Candidates are expected to be well prepared in the interpretation of all modalities for this exam.

Communication is an important skill for a radiologist. A good general scheme is to describe the finding of the case, give an interpretation of the observations, offer a preferred diagnosis with a short differential (if
appropriate.) Only then should they ask for further imaging and if they do, they should explain how it will contribute.

We are aware of some issues with oral case display on Teams. We have put in place a number of processes to allow the examiners to review what the candidates are seeing to ensure the examination is as fair as possible. Unfortunately we do struggle when the IT does not perform to standard, but when this is identified as a significant problem remedies which may include extra time or a new time slot will be offered.

Candidates should, however, be aware that this platform does not have all the functionality of a PACS workstation, particularly scrolling is slower. To help candidates adjust to this there is a practice case shown to them before the examination starts. This allows them to familiarize themselves with the functionality of the system and for the examiners and invigilators to address any unforeseen issues with the system.

There can be a lag in the movement of the pointer on the candidate’s side. The examiners are aware of this and will make appropriate allowance for this.

If candidates experience other problems with this platform, they should let the examiners know at the time so they can make appropriate allowance/take appropriate action as above.

Feedback/Advice for Candidates.

Please note that if they are considering an appeal a candidate must have logged any adverse matter on the RCR website within 48 hours of their exam.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

OCTOBER 2023 SITTING

The Examination Board has prepared the following report on the October 2023 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examination and help those who train them. This information should be made available as widely as possible.

General comments

This was the largest ever sitting of FRCR 2B. 400 candidates took the exam in October 2023 and were examined in 10 centres in the UK, Egypt, Malta and India. 266 candidates passed giving an overall pass rate of 67%. UK candidates had a pass rate of 74% while the pass rate for global candidates was 54%. Three candidates achieved an overall score of 29, the Gold Medal being awarded to the candidate who scored highest in the two oral components.

Examination Preparation

It is apparent that not all candidates familiarise themselves with the written exam examination software platform, Practique, before sitting the exam and this puts some candidates at a disadvantage. There is a demonstration site available through the RCR website where candidates can familiarise themselves with how images in the rapid reporting and long case exams are displayed and manipulated and we strongly recommend that all candidates login to this demonstration site and practice answering questions well in advance of their scheduled written exams. The exam delivery software is not a PACS so, by necessity, scrolling, image magnification and changing window settings may take longer than in normal clinical practice.

Rapid Reporting Session

As has been stated in previous reports, the number of normal cases varies considerably between exam sittings. Anatomical variants that do not cause symptoms should be reported as normal, as should minor, age-related degenerative change. Abnormalities, when present, should be described accurately and fully to avoid losing one of the two marks awarded for a correct answer. Answers should be concise and clear. Location of fractures should be anatomically precise, and where a paired structure is shown (e.g. ribs, clavicles, and scapulae on CXR or images showing both hands or feet), it is essential to state left or right in the answer. Failure to do so will lose the candidate a mark and incorrect laterality (e.g. stating that a right radial buckle fracture is on the left) will lose the candidate both marks. If a fracture is secondary to underlying bone pathology such as a benign bone cyst or a bony metastasis, both the fracture and the underlying pathology must be described. The examiners noticed that candidates appeared less secure in plain radiographic interpretation, particularly in paediatric cases, and many marks were lost by overcalling of normal cases. Candidates will benefit from more plain radiographic experience to improve their likelihood of passing this component of the exam.

Reporting Session

Good time management is essential for success in this component of the exam and candidates should ensure that they have attempted all questions. It is almost impossible to pass if one or two questions have not been answered so it is better to write incomplete answers for all six questions than to write detailed answers for fewer than six questions. The clinical details contain relevant information and help to narrow the list of possible diagnoses, so make sure it is read. Structure the report according to the mark sheet. Bullet points are the best way to list the observations and findings. Not all boxes need to be completed for all cases, so please don't duplicate information in your report as it makes the question more difficult to mark. Make sure you discuss further patient management and, rather than just referring the patient to a particular MDT, show the examiners that you know what action the clinical team will likely take based on your report. Please ensure that CTs are viewed on all relevant windows as would be done in clinical practice. Candidates lose marks for missing important findings having failed to view lung or bone windows.

Oral components

Before the oral starts you will be shown a test CT case to make sure that you are confident in knowing how to scroll through an image set. This may be a little slower than on PACS, so do not rush. The number of images in each case is limited to ensure you have adequate time to review the entire stack. Use of the left and right arrow keys on the keyboard often provides smoother navigation through the images than the mouse wheel. The examiners have a separate monitor to review the candidate screen, so if significant problems with scrolling occurs the examiners may allow the candidate extra time to ensure they have had a fair assessment. Please do not attempt to adjust the imaging. If you would like to view another window setting, please ask the examiner.

Listen carefully to the examiner when each new case is shown - the information provided will aid case interpretation. Please speak clearly and audibly. This is particularly important when being examined remotely over MS Teams. Practice of viewing cases in tutorials using MS Teams and OsiriX before the exam will make the experience less stressful. During the oral exam you will be shown a variety of imaging modalities including plain radiographs, ultrasound, nuclear medicine, and contrast studies to test different areas of the curriculum. The oral exam is designed to test observational skills, radiological knowledge, analytical skills and clinical reasoning, clinical safety and management and communication skills. When presented with an image or image stack, describe the findings, interpret the observations, and suggest a diagnosis or list of possible diagnoses to be considered given the clinical history. Only after this has been done should the candidate ask for further imaging. Candidates need to demonstrate competence across the whole core curriculum including paediatric, breast and vascular imaging. Candidates are expected to be aware of the common diagnostic and management pathways in the NHS.

Feedback/Advice for Candidates

Please note that if considering an appeal, a candidate must have logged any adverse matter on the RCR website within 48 hours of the exam.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

JANUARY 2024 SITTING

The Examination Board has prepared the following report on the January 2024 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examination and help those who train them. This information should be made available as widely as possible.

General comments

247 candidates took the exam of whom 141 were sitting the exam for the first time. There were 53 UK trainees, 15 NHS contributors and 179 global candidates. The overall pass rate was 45%. The UK candidates had a pass rate of 47%. The pass rate for global candidates was 45%. A global candidate was awarded the Gold Medal. Candidates attended 10 centres (in UK, Egypt, India, and Malta).

Examination Preparation

It is apparent that not all candidates familiarise themselves with the written exam examination software platform, risr/assess (previously known as Practique), before sitting the exam and this puts some candidates at a disadvantage. There is a demonstration site available through the RCR website where candidates can familiarise themselves with how images in the rapid reporting and long case exams are displayed and manipulated and we strongly recommend that all candidates login to this demonstration site and practice answering questions well in advance of their scheduled written exams. The exam delivery software is not a PACS so, by necessity, scrolling, image magnification and changing window settings may take longer than in normal clinical practice.

Rapid Reporting Session

As has been stated in previous reports, the number of normal cases varies considerably between exam sittings. Anatomical variants that do not cause symptoms should be reported as normal, as should minor, age-related degenerative change. Abnormalities, when present, should be described accurately and fully to avoid losing one of the two marks awarded for a correct answer. Answers should be concise and clear. Location of fractures should be anatomically precise, and where a paired structure is shown (e.g. ribs, clavicles, and scapulae on CXR or images showing both hands or feet), it is essential to state left or right in the answer. Failure to do so will lose the candidate a mark and incorrect laterality (e.g. stating that a right radial buckle fracture is on the left) will lose the candidate both marks. If a fracture is secondary to underlying bone pathology such as a benign bone cyst or a bony metastasis, both the fracture and the underlying pathology must be described. The examiners noticed that candidates appeared less secure in plain radiographic interpretation, particularly in paediatric cases, and many marks were lost by overcalling of normal cases. Candidates will benefit from more plain radiographic experience to improve their likelihood of passing this component of the exam.

Reporting Session

Good time management is essential for success in this component of the exam and candidates should ensure that they have attempted all questions. It is almost impossible to pass if one or two questions have not been answered so it is better to write incomplete answers for all six questions than to write detailed answers for fewer than six questions. The clinical details contain relevant information and help to narrow the list of possible diagnoses, so make sure it is read. Structure the report according to the mark sheet. Bullet points are the best way to list the observations and findings. Not all boxes need to be completed for all cases, so please don't duplicate information in your report as it makes the question more difficult to mark. Make sure you discuss further patient management and, rather than just referring the patient to a particular MDT, show the examiners that you know what action the clinical team will likely take based on your report. Please ensure that CTs are viewed on all relevant windows as would be done in clinical practice. Candidates lose marks for missing important findings having failed to view lung or bone windows.

Oral components

Before the oral starts you will be shown a test CT case to make sure that you are confident in knowing how to scroll through an image set. This may be a little slower than on PACS, so do not rush. The number of images in each case is limited to ensure you have adequate time to review the entire stack. Use of the left and right arrow keys on the keyboard often provides smoother navigation through the images than the mouse wheel. The examiners have a separate monitor to review the candidate screen, so if significant problems with scrolling occurs the examiners may allow the candidate extra time to ensure they have had a fair assessment. Please do not attempt to adjust the imaging. If you would like to view another window setting, please ask the examiner.

Listen carefully to the examiner when each new case is shown - the information provided will aid case interpretation. Please speak clearly and audibly. This is particularly important when being examined remotely over MS Teams. Practice of viewing cases in tutorials using MS Teams and OsiriX before the exam will make the experience less stressful. During the oral exam you will be shown a variety of imaging modalities including plain radiographs, ultrasound, nuclear medicine, and contrast studies to test different areas of the curriculum. The oral exam is designed to test observational skills, radiological knowledge, analytical skills and clinical reasoning, clinical safety and management and communication skills. When presented with an image or image stack, describe the findings, interpret the observations, and suggest a diagnosis or list of possible diagnoses to be considered given the clinical history. Only after this has been done should the candidate ask for further imaging. Candidates need to demonstrate competence across the whole core curriculum including paediatric, breast and vascular imaging. Candidates are expected to be aware of the common diagnostic and management pathways in the NHS.

Feedback/Advice for Candidates

Please note that if considering an appeal, a candidate must have logged any adverse matter on the RCR website within 48 hours of the exam.

FINAL FRCR PART B EXAMINATION FOR THE FELLOWSHIP IN CLINICAL RADIOLOGY

MARCH 2024 SITTING

The Examination Board has prepared the following report on the March 2024 sitting of the Final Examination for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Examination Board that the information contained in this report should benefit candidates at future sittings of the examination and help those who train them. This information should be made available as widely as possible.

General comments

217 candidates took the exam of whom 111 were sitting the exam for the first time. There were 62 UK trainees, 8 NHS contributors and 147 global candidates. The overall pass rate was 54%. The UK candidates had a pass rate of 72.5% with UK first timers having a pass rate of 68%. The pass rate for global candidates was 48% with global first timers having a pass rate of 40%. No candidate achieved a high enough score to be considered for award of a Gold Medal. Candidates attended 9 centres (in UK, Egypt, India, and Malta). There is plenty of excellent advice for candidates and trainers in the exam reports from previous years so this report will just re-emphasise the key points.

Examination Preparation

It is apparent that not all candidates familiarise themselves with the written exam examination software platform, risr/assess (previously known as Practique), before sitting the exam and this puts some candidates at a disadvantage. There is a demonstration site available through the RCR website where candidates can familiarise themselves with how images in the rapid reporting and long case exams are displayed and manipulated and we strongly recommend that all candidates login to this demonstration site and practice answering questions well in advance of their scheduled written exams. The exam delivery software is not a PACS so, by necessity, scrolling, image magnification and changing window settings may take longer than in normal clinical practice.

Rapid Reporting Session

As has been stated in previous reports, the number of normal cases varies considerably between exam sittings. Anatomical variants that do not cause symptoms should be reported as normal, as should minor, age-related degenerative change. Abnormalities, when present, should be described accurately and fully to avoid losing one of the two marks awarded for a correct answer. Answers should be concise and clear. Location of fractures should be anatomically precise, and where a paired structure is shown (e.g. ribs, clavicles, and scapulae on CXR or images showing both hands or feet), it is essential to state left or right in the answer. Failure to do so will lose the candidate a mark and incorrect laterality (e.g. stating that a right radial buckle fracture is on the left) will lose the candidate both marks. If a fracture is secondary to underlying bone pathology such as a benign bone cyst or a bony metastasis, both the fracture and the underlying pathology must be described. The examiners noticed that candidates appeared less secure in plain radiographic interpretation, particularly in paediatric cases, and many marks were lost by overcalling of normal cases. Candidates will benefit from more plain radiographic experience to improve their likelihood of passing this component of the exam.

Reporting Session

Good time management is essential for success in this component of the exam and candidates should ensure that they have attempted all questions. It is almost impossible to pass if one or two questions have not been answered so it is better to write incomplete answers for all six questions than to write detailed answers for fewer than six questions. The clinical details contain relevant information and help to narrow the list of possible diagnoses, so make sure it is read. Structure the report according to the mark sheet. Bullet points are the best way to list the observations and findings. Not all boxes need to be completed for all cases, so please don't duplicate information in your report as it makes the question more difficult to mark. Make sure you discuss further patient management and, rather than just referring the patient to a particular MDT, show the examiners that you know what action the clinical team will likely take based on your report. Please ensure that CTs are viewed on all relevant windows as would be done in clinical practice. Candidates lose marks for missing important findings having failed to view lung or bone windows.

Oral components

Before the oral starts you will be shown a test CT case to make sure that you are confident in knowing how to scroll through an image set. This may be a little slower than on PACS, so do not rush. The number of images in each case is limited to ensure you have adequate time to review the entire stack. Use of the left and right arrow keys on the keyboard often provides smoother navigation through the images than the mouse wheel. The examiners have a separate monitor to review the candidate screen, so if significant problems with scrolling occurs the examiners may allow the candidate extra time to ensure they have had a fair assessment. Please do not attempt to adjust the imaging. If you would like to view another window setting, please ask the examiner.

Listen carefully to the examiner when each new case is shown - the information provided will aid case interpretation. Please speak clearly and audibly. This is particularly important when being examined remotely over MS Teams. Practice of viewing cases in tutorials using MS Teams and OsiriX before the exam will make the experience less stressful. During the oral exam you will be shown a variety of imaging modalities including plain radiographs, ultrasound, nuclear medicine, and contrast studies to test different areas of the curriculum. The oral exam is designed to test observational skills, radiological knowledge, analytical skills and clinical reasoning, clinical safety and management and communication skills. When presented with an image or image stack, describe the findings, interpret the observations, and suggest a diagnosis or list of possible diagnoses to be considered given the clinical history. Only after this has been done should the candidate ask for further imaging. Candidates need to demonstrate competence across the whole core curriculum including paediatric, breast and vascular imaging. Candidates are expected to be aware of the common diagnostic and management pathways in the NHS.

Feedback/Advice for Candidates

Please note that if considering an appeal, a candidate must have logged any adverse matter on the RCR website within 48 hours of the exam.

Final FRCR Part B Exam for the Fellowship in Clinical Radiology:

June 2024 sitting

The Exam Board has prepared the following report on the June 2024 sitting of the Final Exam for the Fellowship in Clinical Radiology. It is the intention of the Fellowship Exam Board that the information contained in this report should benefit candidates at future sittings of the exam and also be of use to those who train them. This information should be made available as widely as possible.

General comments

254 candidates sat the exam of whom 146 sat for the first time. Candidates attended 11 exam venues (in the UK, Egypt, India, Malta and Pakistan).

Due to a technical issue with the rapid reporting component, candidates were unable to enter answers for two abnormal cases. This was caused by a bug in the delivery platform, risr/assess (previously called Practique), that has now been corrected. A post exam review of the images used for the rapid reporting using the candidate view confirmed that there were no issues with image quality for any of the cases. Further checks have also been added to the exam's routine quality assurance processes.

Deciding how best, and most fairly, to compensate the candidates for the technical disruption resulted in a delay of one week in the publication of results and the decision to waive the appeal fee of £500. This led to a higher than usual number of appeals and some candidates changing from a fail to a pass.

The pass rates, following the completion of the Stage 1 appeal process, are as follows:

The highest score was achieved by a UK candidate who has been awarded the Gold Medal.

The following sections are designed to give information to trainers and candidates planning to sit or re-sit future diets on how candidates can perform well in both the written and oral components of the FRCR 2B.

Exam preparation

It is apparent that not all candidates familiarised themselves with the exam platform, risr/assess, before sitting the exam, which put some candidates at a disadvantage. There is a demonstration site (and video) available via the RCR website where candidates can familiarise themselves with how images in the rapid reporting and long case components are displayed and manipulated. We strongly recommend that all candidates log on to this demonstration site and practice answering questions well in advance of their scheduled exam. The exam platform is not a PACS so, by necessity, scrolling, image magnification and changing window settings may take longer than in normal clinical practice.

Rapid Reporting session

As has been stated in previous reports, the number of normal cases varies considerably between exam sittings. Anatomical variants that do not cause symptoms should be reported as normal, as should minor, age-related degenerative change. Pathology, when present, will not be subtle so cases should not be reported as abnormal unless the candidate has observed a definite abnormality that, if pointed out to a first-year radiology trainee, would be clearly recognised and understood. A systematic approach to image interrogation is advised to avoid missing 'edge of image' findings. Abnormalities, when present, should be described accurately and fully to avoid losing one of the two marks awarded for a correct answer. "Fractured radius" is not a sufficiently detailed answer either for the examiners or for clinical practice. "Undisplaced, intra-articular fracture of right radial head with associated joint effusion" or "Salter-Harris II physeal fracture of the left distal tibia" are examples of the level of detail that is expected in the rapid reporting component.

Reports should be concise, and acronyms should not be used, to avoid misinterpretation. ROM, for example, can mean 'removal of metal', 'range of movement', 'range of motion' or 'rupture of membranes'. If there is a right upper lobe collapse, a candidate will not gain additional marks for describing all the signs that have led to that diagnosis. They will, however, gain marks for observing the presence or absence of a visible hilar mass and providing a diagnosis of the likely cause of the lobar collapse.

All images will have clear side markers, and the candidate should assume that the side-marker is correct. Where a paired structure is shown (e.g. ribs, clavicles, and scapulae on CXR or images showing both hands or feet), it is essential to state 'left' or 'right' in the answer. Failure to do so will lose a mark and incorrect laterality (e.g. stating that a right radial buckle fracture is on the left) will lose both marks. Where an unpaired body part is shown, it is not essential to state the side to gain full marks, but it is good clinical practice to include the side, taking care to make sure that the correct side is chosen. If a fracture is secondary to underlying bone pathology, such as a benign bone cyst or a bony metastasis, both the fracture and the underlying pathology must be described.

The examiners note that candidates appear less confident in plain radiographic interpretation, particularly in paediatric cases, and many marks are lost by overcalling of normal cases, failing to mention the laterality or getting the side of the pathology wrong. Candidates would clearly benefit from more plain radiographic experience to improve their likelihood of passing this component of the exam.

Reporting session

Good time management is essential for success in this component of the exam and candidates should ensure that they have attempted all questions. It is almost impossible to pass if one or two questions have not been answered so it is better to write incomplete answers for all six questions than to write detailed answers for fewer than six. The clinical details contain relevant information and help to narrow the list of possible diagnoses, so candidates should make sure to read and remember this information before viewing the images and writing the report. Candidates should structure the report according to the mark sheet prompts (observations, interpretation, principal diagnosis, differential diagnosis, and management). Bullet points/short lists are the best way to list the observations and findings. Not all sections need to be completed for all cases, so candidates should avoid repeating the same information in multiple sections as this makes the question more difficult to mark.

Candidates should discuss further patient management, rather than just referring the patient to a particular multidisciplinary team (MDT), to show the examiners that they know what action the clinical team will likely take or what further investigations may be requested based on the report. Marks will be lost for over-investigation or unsafe practice, and candidates should demonstrate knowledge of normal rules and methods for alerting critical findings to the referrer in the NHS. Finally, candidates should ensure that CTs are viewed on all relevant windows as would be carried out in clinical practice. Candidates will lose marks for missing important findings having failed to view lung or bone windows.

Oral components

Before the oral components start candidates will be shown a test CT case to make sure that they are confident in knowing how to scroll through an image set. This may be a little slower than on PACS, so candidates should not rush. The number of images in each case is limited to ensure candidates have adequate time to review the entire stack. Use of the left and right arrow keys on the keyboard often provides smoother navigation through the images than the mouse wheel. The examiners have a separate monitor to review the candidate screen, so if significant problems with scrolling occur, the examiners may allow the candidate extra time to ensure they have had a fair assessment. Candidates should not attempt to adjust the imaging. If they would like to view another window setting, they should ask the examiner. Examiners are provided with detailed information about the issues to be considered for those candidates awarded additional time, so candidates should be reassured that both pairs of examiners will be fully aware of the requested adjustment(s).

Candidates should listen carefully to the examiner when each new case is shown - the information provided will aid case interpretation. They should not be afraid to ask the examiner to repeat this information if necessary. An examiner may ask a candidate to clarify certain points but none of their questions will be designed to trick the candidate or to make them doubt their original diagnosis. In many cases the precise diagnosis will not be clear, as in real life, and an examiner simply wants to find out what a candidate would advise to help move the diagnostic pathway forward. Candidates should not be afraid to change the diagnosis as they progress through the case, if they feel this is appropriate. Candidates should speak clearly and audibly. This is particularly important when being examined remotely over Microsoft Teams. Similarly, if a candidate cannot hear the examiner clearly, they should ask the examiner to repeat the question. Practice of viewing cases in tutorials using Microsoft Teams and OsiriX before the exam will make the experience less stressful.

During the oral exam candidates will be shown a variety of imaging modalities including plain radiographs, ultrasound, nuclear medicine, and contrast studies to test different areas of the curriculum. The oral components are designed to test observational skills, radiological knowledge, analytical skills and clinical reasoning, clinical safety and management and communication skills. When presented with an image or image stack, candidates should describe the findings, interpret the observations, and suggest a diagnosis or list of possible diagnoses to be considered given the clinical history. Only after this has been done should the candidate ask for further imaging. Candidates need to demonstrate competence across the whole core curriculum including paediatric, breast and vascular imaging. As in the written reporting components, candidates should avoid simply referring the patient to a particular multidisciplinary team (MDT) and show the examiners that they know what action the clinical team will likely take or what further investigations may be requested. Candidates are expected to be aware of the common diagnostic and management pathways in the NHS.

Feedback/Advice for candidates

Should a candidate experience an incident during an exam, that they feel impacted their performance, they should alert an invigilator or - in the case of the orals - an examiner so, where possible, a solution can be found. The candidate is also strongly advised to submit an incident form at the venue (provided by an invigilator) or online via the Exam Hub within 48 hours of the exam. The recording of the incident will enable the candidate to refer to that incident should they need to appeal. (For more information, please see the Appeals Policy.)