FRCR Part 1 (Radiology) - CR1 -advice for candidates (anatomy module)

Setting the pass mark

A ‘modified’ Angoff method is used to set the pass mark for this exam. This involves the examiners evaluating each question and providing an estimate as to how likely a minimally competent candidate would know the correct answer. Each item is scored on the basis of the percentage of ‘minimally competent’ candidates who should know the correct answer. These scores are collated and presented at a standard setting meeting. After discussion of the questions, the examiners again score the questions, and the mean of the post-discussion scores is used to set the initial standard.  

The final pass mark is determined after the exam using the Hofstee compromise method. This takes account of candidate performance in the exam alongside judgements made by standard setters. The candidate cohort and pass rate will vary from sitting to sitting. 

Marking

The exam platform utilises automated marking, which is programmed with acceptable answers. The answers are provided by a group of examiners who are all UK consultant radiologists. After the exam, these programmed answers are matched with candidates' responses and marks awarded by the system accordingly. All answers will be reviewed by examiners and awarded an appropriate mark. 

Scoring scheme

Marks are awarded for precision of anatomical description. This is a core skill for a clinical radiologist and should be mastered at an early stage. Each question is marked on a scale of 0, 1 or 2.  

• A fully accurate answer will gain 2 marks.  
• A less accurate answer will be awarded 1 mark.  
• Incorrect answers will be awarded 0 marks.  

Vague or imprecise answers (e.g. “liver” when the fully correct answer is “segment VIII of the liver”) will also be awarded 0 marks. 

How we ensure full coverage of the curriculum

Each exam paper is blueprinted which ensures coverage of the curriculum. We also take great care to ensure that individual radiographic modalities and different body parts are given equal weight. The blueprint weighting is as follows. 

Dimension	Category	%
Anatomy Body Area	Abdomen, Pelvis	25
	Head, Neck, Spine	25
	Musculoskeletal	25
	Thoracic, CVS	25
Anatomy Modality	Contrast	10
	CT	22
	MR	22
	US	18
	XR	28
Anatomy Patient Age	Adult	95
	Paediatric	5
Anatomical Variant	Non-normal variant	95
	Normal variant	5

Each exam will cover aspects of paediatric radiological anatomy, as discussed below. 

We also test recognition of anatomical variants. Whilst there are limitless variations of what might be considered normal, we seek to test knowledge of anatomical variations that are either common and/or have ‘clinical significance’. By this, we mean an anatomical variant that may be mistaken for pathology or can predispose to certain diseases. 

Pathology

The images used demonstrate normal anatomy - this exam does not test pathology. Occasionally, minor age-related changes may be present on an image, but this will not be tested. 

Radiology techniques

This knowledge is not specifically required. Questions will not ask about how the images were acquired or anything specific about the imaging technique.  

All arrows are intended to indicate anatomical structures, and are not indicating radiographic artefacts, instruments, catheters or the contrast agent itself. 

Obviously, enough needs to be known about the modality to recognize the radiological anatomy as demonstrated by a particular technique. For example, when looking at an arterial-phase contrast-enhanced CT, candidates should be able to distinguish between an unenhanced vein and an enhanced artery. 

Paediatric radiology

Every exam will contain some paediatric radiology. This may be in the form of radiographs, fluoroscopy, ultrasound or cross-sectional imaging. It is important to know the anatomy of the growing skeleton and to be able to recognise common normal variants. It is also important to be able to recognise the appearances of the growing skeleton on the different imaging modalities.  

Candidates must be able to identify all the different parts of the growing bone and should be able to distinguish between epiphyses, apophyses and epiphyseal growth plates. For example, candidates who describe an epiphysis or apophysis as a secondary ossification centre will lose one mark as this answer is only partially correct. 

Fetal imaging and neonatal cranial ultrasound

Neither of these are on the syllabus and therefore will not be included in the exam. 

Level of detail required in answers

We seek the degree of detail that would be appropriate for a written radiology report. We are very careful about arrow placement for the exam questions, indicating a single structure or a specific part of a larger structure. The examiners therefore seek accuracy and precision, with highest marks being awarded to specific and accurate details. 

Accurate anatomical description of segmental vascular anatomy 

The exam demands accuracy in vascular anatomy when vessels have segmental nomenclature. This is relevant to current clinical practice. 

For example, candidates will lose marks if providing the answer, “left middle cerebral artery” when the arrow(s) are indicating the “M1 segment of the left middle cerebral artery”. 

Similarly, “cavernous segment of the right internal carotid artery” or the equivalent “C4 segment of the right internal carotid artery” is expected; candidates answering “right internal carotid artery” will be deducted marks. 

Specificity of muscles and tendons 

When an image depicts both muscle and tendon, candidates should specify the specific anatomical structure to which the arrows point. 

For example, an image may show arrows indicating the “tendon of the left infraspinatus”. Marks will be lost for candidates who incorrectly state, “left infraspinatus” or “left infraspinatus muscle.” Equally, for arrows indicating a muscle belly, marks will be lost if candidates incorrectly specify the structure as a tendon. 

Anatomical terms 

The mark scheme considers the differences of terminology across the world. We expect answers in English (rather than Latin), using accepted anatomical terms. We explicitly recognize the Terminologia Anatomica, an international standard for anatomical terminology. 

Acronyms and abbreviations 

Candidates should not use acronyms and abbreviations in their answers. What is commonplace in one institution may not be so elsewhere. Many clinical errors have arisen from the use of acronyms, so being precise and using the correct terminology is vital for both clinical practice and for this exam.  

For example, arrows indicating the “Superior mesenteric artery” should be answered as such. Marks will be lost for use of the acronym “SMA” and for other abbreviations as it does not demonstrate to the examiners that candidates are aware of the correct terminology.  

Lateralisation of paired and unpaired structures 

In broad terms, we expect candidates to denote whether the left or right side is arrowed if both sides of a paired structure are shown on the image. Marks will be deducted if laterality is not specified on an arrowed paired structure as this is crucial to safe practice. 

If a single structure is presented (e.g. a left-hand radiograph), then this will be identified in the stem of the question and laterality will not be required in candidates’ answers. For example, if the question denotes the hamate on a single left-hand radiograph, then an answer of “hamate” alone would be sufficient for full marks. If candidates state a laterality in this instance, then the laterality must be correct otherwise marks will be lost. 

Structures with multiple anatomical parts 

This is a post-graduate medical exam of radiological anatomy and as such a high degree of accuracy is indicated. Candidates should be cognisant of laterality and its relevance. 

For example, an arrow pointing to the “head of the left epididymis” should be answered as such. It should not be answered as “left head of the epididymis” as this wrongly suggests that an epididymis has a right and a left head. The left epididymis has a single head as does the right. 

The above may be extrapolated to other paired structures. For example, “Lens of the left globe”, not “left lens of the globe” and “Tail of the left hippocampus”, not “left tail of the hippocampus.” 

Unpaired structures 

Equally, anatomical accuracy is demanded for unpaired structures when a side is clearly marked. For example, arrows pointing to “the left side of the trachea” should be answered as such and not “left trachea”, which is not an anatomical structure. 

Arrows denoting the “left coronoid process of the mandible”, should be answered as such and not as “coronoid process of the left mandible”. The mandible is a solitary anatomical structure with multiple parts. 

Arrows denoting the “splenic artery” should be answered as such and not as “left splenic artery” as this is not an anatomical structure. 

This theme extends to accurate nomenclature of other body parts. For example, “spinous process of the L1 vertebra” would be correct as opposed to an answer of “spinous process of the L1 vertebral body”. The vertebral body and spinous process are separate segmental anatomical parts of a vertebra.

Spelling mistakes

The exam is not a spelling test and the examiners may overlook minor spelling mistakes or typing errors such as transposed letters, providing the intended answer is unambiguous. Certain anatomical structures, however, have similar names, sometimes differing by only one letter (e.g. ileum and ilium). Care should be taken over these as confusion could arise in clinical practice and mistakes in naming similar-sounding structures will be penalised.  

Other common mistakes to avoid 

Many errors relate to failing to read the question. 

• Most questions relate to simply naming the arrowed structure, but some questions are not written in this format. They may test anatomical knowledge related to that particular structure (e.g. “name the artery supplying the arrowed structure”). 
• Some questions very specifically ask for a single answer and candidates who provide two answers, even if both are correct, will lose marks (e.g. “name one muscle that attaches to the arrowed structure”). 
• The question header mimics the detail that would be supplied in clinical practice. Occasionally, further information is provided, for example, to help with orientation for a particular image such as ultrasound (e.g. “Transverse Abdominal ultrasound”). Candidates should pay particular attention to this text.