The motive behind starting RadioGyan.com was to provide concise information to radiology residents and practitioners on specific topics which are often neglected during residency. The FRCR exam is one such topic. I have always had a lot of questions about the FRCR exam and the lack of definite answers for these was one of the main reasons for me not being inclined to take up the exam. Currently, a lot of radiology residents in India are taking up the exam, however, there are still a lot of residents (like me) who have had queries regarding the exam. And just like me, these residents shy away from the exam because of that. The aim of this blog post is to clear these queries so that all residents have a clear idea about the FRCR exam, the pattern, and preparation.
I have not appeared for the exam and I am as ignorant about as you guys are. We wanted the guide to be as definitive as possible hence we requested Dr. Inthulan Thiraviaraj if help us write one and he readily obliged. Dr. Inthulan Thiraviaraj has been excellent at academics and has recently cleared the exam. He was more than happy to write this up.
A big shout out to all the radiologists who sent out questions to us via the Google form. We had more than 100 replies from all parts of the world. That helped us compile all these questions. Dr. Inthulan Thiraviaraj has put in a lot of research in answering the questions and we have tried to include links to books/ online resources wherever relevant. We can’t thank Dr. Inthulan Thiraviaraj enough for compiling this blog! If you too would like to share your experience do contact me or drop a message in our telegram group!
We know that this blog took a lot of time but we have given it our best to answer all your queries to the best of our knowledge. Click here for a sneak peek into the making of the blog!
Over to Dr .Inthulan!
Introduction to FRCR exam:
Most of you first heard about the FRCR exam during residency and would know friends or seniors giving this exam. You might have given one or two steps yourself but still have questions about the time taken to complete, expenses involved, advantages of the degree, study materials required, courses available and how to approach the exam.
I obtained my FRCR in May 2018 but my journey began in March 2015, a few months after my residency at KEM! My understanding of the exam has helped me guide many of my friends and colleagues and when Amar approached me to write this chapter for his website, I found the perfect opportunity to share my insight with all of you.
This is primarily for radiologists trained in India and answers the poll we posted a few days ago. A number of changes have also occurred in the past 2 years relating to the conduct of exams and the readers are directed to refer to the official website for latest updates. I have tried to give you an overview of the exam, introduce you to the components, help you plan your pathway and provide relevant information which is otherwise unavailable on official sites. Relevant links to books and for further reading are provided in the subsections.
Overview of the exam:
- What is the FRCR exam?
The Royal College of Radiologists(RCR) conducts a three-step examination after which the candidate is inducted as a Fellow of the RCR.
- How many steps to complete the exam and obtain the degree?
There are three steps involved.
- First FRCR Examinations (FRCR Part 1) – Two modules:
- Final FRCR Part A Examinations (FRCR2A): Two MCQ based written papers.
- Final FRCR Part B Examinations (FRCR 2B):
- Rapid Reporting.
- Oral examination.
- When and where are the exams conducted?
FRCR exam dates can be found on the RCR website. All three components of the exam are held in U.K., Singapore, and Hong Kong with the schedule as follows:
|United Kingdom||Singapore||Hong Kong|
|FRCR Part 1||Spring (March), summer (June) and autumn (September)|
|FRCR2A||Summer (June) and winter (December)|
|FRCR 2B||Summer (Apr) & autumn (Oct)||Summer||Autumn|
- What is the approximate time taken to complete all three steps?
If you appear for all exams consecutively, with minimum breaks, and pass all exams in the first attempt, and have the best chances in ballot selection it will take 1.5 to 2 years to complete.
- What are the eligibility criteria for the FRCR exam?
|FRCR Part 1 |
|Anyone who is undergoing radiology training or has completed training can attempt FRCR Part I. There is no minimum training requirement. |
|FRCR Part 2A |
|After passing both modules of FRCR part 1 and with 24 months of radiology training, you can apply for FRCR 2A. Your training must be acknowledged and certified by your head of department stating that he/she has read the FRCR curriculum and that you have received adequate training in all those areas specified. Hence a letter from your HOD with relevant information, declaration, sign, signature, and date is required for your 2A application. |
|FRCR Part 2B |
|Once you have passed 2A, and have completed 34 months of training (similar declaration required), you can apply for 2B. |
- What is the best time in my career to undertake the exams?
- Part I is best attempted during residency.
- Best time to appear for part 2 is after your post-graduation exams. However, it is possible to attempt the exam in your 5th semester, before your M.D. exam.
- Is PLAB required to sit forthe FRCR exam?
No. With PLAB you can obtain a GMC registration and theoretically apply for a training post or job in the U.K.
- Can I write the exam after MBBS?
No. Ongoing or past radiology training in mandatory to apply for these exams.
- Can I write the exam after DMRD/ What is the eligibility for the FRCR exam?
You can attempt Part 1 and 2A. However, you require 34 months of supervised training, in a teaching college to apply for 2B. Hence with 24 months of DMRD alone, you will not qualify for 2B.
- Can I write the exam after DNB Radiodiagnosis?
- Can I write the exam after MD Radiodiagnosis?
- How will FRCR help me in my career in India/ What is the value of FRCR in India?
- An additional degree always gives extra credit.
- More so, due to the high standards of the exam and the preparation required, your knowledge and reporting skills will definitely improve. The emphasis of the FRCR exam is to ensure that you are a SAFE radiologist. This will reflect in your practice.
- FRCR has less relevance in government service or stand-alone private practice, especially if you are a sonologist.
- Apart from personal and professional growth, FRCR will add credential when you apply for corporate hospitals and tertiary care centers.
- Will FRCR help me to practice teleradiology for foreign countries?
Yes. There are approved teleradiology services for which holding an FRCR will grant you license to report for out of hours U.K. reporting. This will reflect on your earnings. That said, this should not be the only reason to apply for FRCR as the cost and effort of exam far outweighs any potential benefit.
- How will FRCR benefit me in applying for jobs in the UK?
- Once you hold an FRCR degree, you can apply for GMC registration with a license to practice. You will have to clear IELTS exam and obtain a Good standing certificate from the Medical Council of India. You can simultaneously apply for jobs either directly or through agencies.
- At present, there are plenty of job (and fellowship) opportunities in the U.K. and is unlikely to saturate in the next 5 years.
- Interest to work, train or migrate to the U.K. is the single, most appropriate reason to undergo FRCR.
- How will FRCR benefit me in countries outside the U.K.?
FRCR is a well-recognized degree and will add weight to your application for jobs or fellowships elsewhere, especially in the Middle East and Singapore.
After completion of FRCR, you can further your career in the U.K. and eventually apply for C.E.S.R. (Certificate of Eligibility for Speciality Training) which is the IMG equivalent of CCT (Certificate of Completion of Training). CESR will help you attain full qualification to practice in the U.K. and will recognize you as a consultant elsewhere. I am hesitant to add anything further as I have not completed CESR myself and I do not fully comprehend the process. It is a topic for another time!
- What is the probability of clearing FRCR after training in India?
There is a high probability that you will clear the exams if you are well motivated and determined. There is no point in completing one or 2 steps and giving up. Passing rate varies for each exam. It is a competency exam and not a competitive exam. How others perform is irrelevant. Physics module and FRCR2B are the most difficult to clear.
- What is the approximate cost for each exam and in total?
|FRCR Part 1||(£298 per module) |
|₹50 to 70,000 (UK). |
₹25 to 35,000 (Singapore)
|4 day stay |
₹ 15 to 20,000 (UK)
15 to 25,000 (Sg)
|Each course costs ₹20,000 to ₹1,00,000||1.2 to 1.5 lakhs|
|FRCR2A||(£400) ₹36,000||Same as above||2 to 3 days||80,000 to 1 lakh|
|FRCR 2B |
|(£558) ₹50,000#||Same as above||5 days minimum||1 to 4 lakhs.##|
|Post FRCR||Annual membership fee of £ 248.|
* Charges as of 2018.
** Flight and local transport. Prices vary according to the time of booking and how early you book. Singapore visa is cheaper (~ 2500 INR) and takes 48 hours for processing. Documents required are fewer and straightforward. UK visa (~10,000) takes longer and more is strict.
*** Stay is cheaper with shared accommodation. Recommended using tubes with a travel card for local commuting in Sg and U.K.
# 2B in Singapore has to be taken along with MMed which costs 3,790SGD (₹1,90,000). You cannot apply for FRCR2B exam alone in Singapore.
## For my FRCR exam in April 2018, I stayed in the U.K. for 1 month, attended 2 courses, shared accommodation with two of my friends and spent a week on sightseeing. It cost us 5 lakhs each, all inclusive.
FRCR exam Part I:
- How many modules and how does the application process work?
- There are two modules, Anatomy, and Physics.
- Anatomy module:
- Consists of 100 image-based questions, displayed on ‘practique’
- Due to the limitation on the number of computers available, application selection happens through a ballot system. Hence it is possible to get selected for Physics but not Anatomy.
- There has been a recent increase in the number of centers and therefore this will be less of a problem, in the future.
- Physics module:
- Every application for the physics module is generally approved because it is a written exam with 200 (40 x 5) true or false questions.
- There are 40 stems with 5 sub-questions each. Answers are marked on an OMR sheet.
- No negative marking.
- It is advisable to undertake both exams together to save time and travel expenses.
- There is no difference is attempting the exam in Hong Kong, Singapore orthe U.K. in terms of difficulty level or probability of passing. In fact, the questions across the centers are the same and synchronized in time.
- Are FRCR exam centers available in India?
- At present, no FRCR exam centers are available in India.
- What is the recommended study material?
- The physics exam is predominantly based on Farr's Physics for Medical Imaging. If you are attempting the exam after your postgraduate exam and familiar with imaging physics, then reading Farr's Physics for Medical Imaging is sufficient. One or two revisions should suffice. It is a very concise book with less than 200 pages but each line is important. Few questions, especially from MRI and advanced imaging are not covered in Farr’s.
- If you are attempting it as a resident, Farr's Physics for Medical Imaging can be difficult to understand and ‘Christensen's Physics of Diagnostic Radiology’ can be used as a reference or pre-read before reading Farr’s.
- MCQs for the First FRCR (Oxford Specialty Training: Revision Texts) – by Vardhanabhuti and Gray James is the MCQ book I followed and found very useful and representative of the exam questions. Every chapter of this MCQ book follows that of Farr's Physics for Medical Imaging and it is ideal to do them together.
- FRCR Physics Notes: Beautiful revision notes for the First FRCR Physics exam is also a good resource.
- By the end of the first year of residency, you should have sufficient knowledge to identify most of the radiological anatomy required for this exam.
- Dedicated reading is required in DSA and vascular anatomy, cardiac imaging, MSK images, Barium and IVU studies.
- The book recommended is Imaging Atlas of Human Anatomy’ by Abrahams.
- You can refer to the normal anatomy reference guide at RadioGyan.com here: Normal Imaging Anatomy for revising region specific radiology anatomy.
- Free anatomy questions here:
- What is the time required for preparation?
For post PG attempt 1 to 3 months are sufficient depending on your work schedule, consistency and capacity.
- What is the strategy for exam preparation?
- The best strategy to clear Physics is to read Farr's Physics for Medical Imaging thoroughly, attempt every question and be vigilant about tricky questions.
- Some questions have statements directly quoted from Farr's Physics for Medical Imaging with a small change that alters the whole meaning. If you are not careful you are likely to get misled.
- Most questions are direct but some questions involve applied knowledge and reasoning.
- There is no negative marking and every question should be attempted. As they are true or false questions, you have 50% chance of answer it right, even if you guess blindly.
- Sample question and answer paper for physics module as follows:
- You will have to answer 100 questions in 90 minutes. So you have less than 1 minute per question. Speed is the key. Try to answer at least 50 questions by the end of 40 minutes and complete the paper in 80 minutes.
- Do not waste time on a single question. If you are unable to answer a question, flag mark it and come back to it after completing the rest of the exam.
- Each question has an image displayed with one or more arrows. This will be accompanied by a written question usually asking you to identify the structure. However, some questions are about the function of that structure. For example, the nerve supply to the muscle marked or the site of drainage of a duct of the gland pointed. If you simply identify the structure and not answer the question, you will lose a mark.
- Be as specific as possible but not to the extent of making it wrong. For example, if an arrow points to the right hippocampus, you will be awarded full or half a mark if you answer it as the right medial temporal lobe or right temporal lobe. However, if you answer it as Dentate gyrus while the arrowhead points at Alveus you will be marked wrong.
- ALWAYS mention the side. You will lose half a mark if you do not mention it. It is a good habit to always begin the answer by writing the side so that you don’t forget it later.
- Remember that your pass mark is percentile based and many will score more than 90%. It is relatively an easy exam but even a few mistakes can cost you a lot.
- Familiarize yourself with the practique software before the exam.
- Online resources:
- What to do if I have cleared physics but not anatomy?
There is no alternative but to keep applying for anatomy ballot.
7. What are FRCR part 1 exam dates for 2019?
Here are video instructions for the web based exam platform practique for FRCR part 1 and FRCR Final 2B:
FRCR exam Part 2A
- What is the exam syllabus?
The major systems covered are Cardiothoracic and Vascular, MSK and trauma, GI, GU including adrenals, OBGY, Paediatric, CNS and Head & Neck. The RCR provides detailed information on syllabus and curriculum. : Clinical Radiology Spectrum.
- What is the exam structure?
- From December 2017, 2A consists of two papers, each containing 120 single best answer questions (SBAs), across the spectrum. The duration of each paper is three hours, both conducted on the same day.
- Until 2017, 2A comprised of 6 modules, which can be taken together or individually. A total of 6 attempts were allowed to clear all modules. This no longer exists. Even if you are yet to clear only 1 modality you have to complete 2A as per the new exam structure.
- What are the recommended books to follow?
- RCR has a very good FAQ section on 2A and has all the necessary information about the exam paper. FRCR exam Final part A guide.
- Due to the change in pattern, the MCQ books may not be representative. I attempted 2B in the old format and even then I found the questions that appeared in the exam to be very different from the MCQ books I used. A good understanding of radiology is required to clear this exam and every modality is given equal weightage. Most people find cardiothoracic and MSK to be the most difficult subjects in the exam mainly due to the way we train in India.
- MCQ books can be used as a guide at best, a means to stay focused and to self-evaluate rather than forming a basis for your preparation.
FRCR 2A notes compiled by Dr. Tamer Elhiti :
- Gastrointestinal radiology.
- Genitourinary system.
- Cardiovascular and Thoracic
- CNS and Head & Neck
- Musculoskeletal Radiology And Trauma
- General Snippets
There is a nice podcast for the FRCR 2A preparation which you can listen to during commute or when you are too lazy to open your books. You can access it here: FRCR 2A revision podcasts
- When can I take this step of the FRCR exam?
The best time is within 1 or 2 years of completing residency.
5. What are FRCR part 2a exam dates for 2019?
Advice for FRCR 2A exam from Fazel Rahman Faizi,a third-year radiology resident in Kabul, Afghanistan who cleared his FRCR 2A exam in his first attempt:
First, one should start preparing with a textbook like Grainger (unless you are a consultant with lots of experience). I only did Grainger essentials system-based followed by MCQs from that particular system. After that, I revised Crack the core along with its videos which I found it very useful and exam oriented. I recommend revising this book at least two times (the last time one week before the exam).
MCQs are useful but do not overwhelm yourself with too many MCQs as the real exam is more difficult and little different from the current MCQ books. Many questions in the real exam were next to step questions and tested the depth of the knowledge.
The most useful MCQ books for me was GET THROUGH FRCR 2A ( the latest version) and OXFORD. Online MCQs (FRCRexamprep.co.uk) was also very useful.
FRCR exam Part 2B
- Where should I take this exam?
It is my personal opinion to take the exam in U.K.
- How does the application process work for a U.K. attempt?
- Once your application for 2B is approved, your application number will enter a rolling ballot system. Let me explain rolling ballot with a hypothetical situation:
Your waiting list number is 250.
Number of slots available is 100.
Number of U.K. candidates applying for the current session is 40.
Number of slots available to Non-UK candidates will be 100 – 40 = 60.
First 60 in the rolling ballot will then be invited.
If 20 of them don’t accept the invitation, next 20 will be invited and so on.
Once the session is over, depending on the number of non-U.K. candidates who took the exam, your rolling ballot number will get revised. In this example, 250 – 60 = 190.
- Usually, the number of slots available in U.K. is 250 to 260. But depending on how many opt in or out, candidates with waiting list number as high as 400s might get an invitation. But this comes close to the exam (few days to 2 months prior). U.K. visa will also take time to process. So unless you prepare in advance, you will end up declining the slot and wait.
- If you sit for the exam and fail, you will have to re-apply and wait all over again.
- At present, it takes a minimum of 1.5 to 2 years to get the slot. So start preparing after 1 year, assuming you will get the next slot.
- How does the Singapore exam work?
- Singapore conducts a joint FRCR/MMed exam once a year, usually summer. The exam is the same as FRCR exam but you get an additional degree called MMed (their MDRD equivalent). You have to pay an additional 1.9 lakh rupees for the MMed application. You cannot apply only for FRCR exam and skip MMed. I am not aware of any benefits of obtaining MMed in Singapore, India or elsewhere.
- Rapid reporting and long cases are the same and synchronized to the exam happening in U.K.
- In Viva, at least two of the examiners are British and the other two are from Singapore.
- What are the courses available in India?
- Dr. Ian W Turnbull International FRCR 2B Course
- Chennai FRCR course
- Bangalore Columbia Asia FRCR course.
- RITA FRCR Part 2B Training Program
- FRCR 2B preparatory course – Mumbai
- Bangalore FRCR 2B tutorial day – updates on REF India
- SouthWest FRCR course – Kochi (for the first time in India!)
- Are the courses available in India sufficient to clear the exam?
- Courses in India give you a fair idea about the exam and will help in preparation. They are less expensive than courses abroad and you will save on travel expenses also. Few people I know of, have attended only this and cleared the exam. But I strongly recommend you to do at least one course in the U.K. just before your exam.
- The main difference is in the viva practice sessions. In the U.K. courses, there are a number of examiners from the NHS and are not jet lagged. There will be a fair number of local trainees and you will learn as much from them as with the examiners or cases. The way local trainees handle a difficult situation, correct a mistake they have made or discuss a case is different from the way we are used to. Listening to U.K. trainees’ answer at a viva session will help you in the exams.
- What are the courses available abroad?
Most good courses get fully booked 6 months to 1 year in advance so kindly book in advance.
- Revise Radiology (20% for RadioGyan users)
- Northwick Park FRCR 2b Rapid Reporting Courses
- Northwick Park FRCR 2b Rapid Reporting Courses
- Edinburgh 2 day FRCR Course
- Edinburgh 1 day FRCR Course
- East Midlands FRCR 2B Course
- East Midlands FRCR 2B reporting course
- Aunt Minnies for FRCR 2B Course
- Neuroradiology for FRCR 2B
- South West FRCR Courses
- King’s FRCR 2B Revision Course
- Norwich Radiology Academy FRCR 2B Course
- Aintree FRCR 2B Course
- Aintree Bones and Chest FRCR 2B Course
- South Thames Rapids Course
- South Thames Written Course
- South Thames FRCR 2B Run Through Exam Course
- Peninsula FRCR 2B Revision Course
- Heart of England FRCR 2B Revision Course
- Heart of England Long Case/Rapid Reporting Course
- Luton and Dunstable FRCR 2B course
- Royal Free Hospital FRCR 2B Course
- Royal Free Hospital Rapid Reporting Course
- London FRCR Radiology Courses
- Coventry FRCR IIB Course
- Oxford FRCR 2B Course
- FRCR 2B Master Course
- VIVA-Rad Course
- Greyscale FRCR 2B Course
- Greyscale FRCR 2B Written Course
- London FRCR 2B Preparation course
- Southend FRCR 2B Rapid Reporting & Long Cases Course
- How many courses are required before the exam?
At least one Indian course before or during your FRCR exam preparation and one or two U.K. courses before your exam is my personal recommendation. It depends on your level of confidence, experience in radiology and language skills.
I attended 3 in India and 2 in the U.K. It is simpler to take an extra course than to repeat the exam.
- What are the books available and recommended for this step?
- What is the strategy for Rapid reporting?
- This is the make or break of the 2B exam.
- You have to report 30 cases (mostly radiographs) in 35 minutes. There will be a mix of normal and abnormal radiographs(40 to 60% each) and each pack will reflect an X-ray bundle from trauma referral.
- Online reporting resources:
- FRCR scholar: I found this one to be the best among them. It is a paid course.
- FRCR tutorials by Dr. Sameer Shamshuddin has free packs available.
- FRCR assist: Free online modules and paid courses available.
- Radiology spotters at RadioGyan.com
- RadioGyan radiology Telegram Channel, Telegram Group and WhatsApp groups
- Do at least one or 2 packs a day, every day for one or two months before the exam.
- With good preparation, it is definitely possible for you to get an 8 on 8 in Rapid reporting. This will compensate for any misfortunes in Long cases or viva.
- To understand this, first read the scoring system of FRCR 2B here: Scoring system FRCR Scoring system FRCR exam.
- You will now understand that if you get an 8 in rapids, even a 6 in long cases and 5+5 in viva will earn you a pass. However, if you fail in Rapids, it will take an enormous effort to compensate.
- You will undertake Rapids and Long cases on Day 1 of the exam and viva is spread over the next few days (typically Monday to Friday). A good performance in Rapids is very reassuring (half the battle won!) and that very confidence will help you sail through Viva.
- If you perform badly in Rapids, you will become very anxious and pressurized during your viva and perform badly under stress.
- I gave FRCR 2B twice. Once, in Singapore 2016 when I performed badly in Rapids (score of 5) and ended up failing the exam by 1 mark.
- The next attempt in U.K. 2018 when the former happened. This story is not an exception but the usual scene of most people who fail the exam. Rapids will be your boon or your bane.
Tips for FRCR 2B rapid reporting (RR) by Dr. Nazahat Pasha
In the rapid reporting component of the examination, there is no margin of error. One is certain to fail even with a score of 26/30 in rapid reporting (unless one performs exceptionally well in viva or reporting session).
- It is very important to always follow a comprehensive checklist of all review areas for each body part. It is essential to exclude all expected pathologies in a given radiograph.
- Attempt as many mock examinations or packets (i.e. sets of 30 plain films with approximately 15-17 abnormal films) as possible. More of such exposure will improve your performance in the actual examination by fine-tuning your review areas and developing a habit of looking at the edge-of-the-film abnormality.
- Never forget to look at the side marker, to avoid missing dextrocardia or situs inversus.
- Any pathology in the examination setting has to be definite with no inter-observer conflict (even if subtle). In the examination, you would find most abnormalities easily identifiable. If you are unsure or confused, it is likely a normal film. If you are finding it difficult to detect an abnormality, then the film is likely normal. During the examination, just adapt your routine practice of reporting plain films. It’s a different situation in examination due to the non-availability of clinical information. This will increase your level of difficulty and may lead to overcalling normal films, which you need to avoid. Imagining abnormalities also must be avoided. Avoid wasting time by not pondering too long over a difficult-to-diagnose film. You should have sufficient time remaining to re-check all normal films.
- If there are multiple views in a case, check them with attention. Such cases are mostly abnormal. Most of the times, the abnormality is evident only in one view. If you don’t have enough time, just mark these type of cases as abnormal.
- If you are short of time, then don’t waste time counting the exact rib number or toe; just mention fracture rib or metatarsal. If you are short of time, it is appropriate to write “#” instead of “Fracture”. Also, it is appropriate to use short forms if you are short of time.
- There is no negative marking in rapid reporting, so you must answer all the questions. During the last few minutes of the examination, if you are short of time, just mark all remaining cases as normal. You have nothing to lose in this scenario.
- Please note that in the actual examination, normal and abnormal cases can be clumped together. For example, if you come across 4 or 5 normal films in a row, don’t be tempted to overcall pathology. Develop a habit of trusting your instincts.
- If you are short of time or are confused about the specific name of a fracture or a radiological sign, then it is appropriate to write a brief description of the abnormality instead of writing a wrong name.
- Most abnormalities in the examination will be relatively easy to diagnose. Most of the films will have a single significant abnormality. Even if there are more than one, it will be part of a single diagnosis (e.g. tibial plateau fracture associated with knee lipohaemarthrosis). If not, then write the most clinically significant one (e.g.: pneumoperitoneum over gallbladder calculi). In rare cases where you find two pathologies like pneumothorax and a lung mass, or osteoporosis and a vertebral wedge compression fracture, or pneumomediastinum with a rib fracture and you are confused, then it is appropriate to write all important pathologies.
- A systematic and consistent approach is a must to be successful in the rapid reporting component of the examination. Apply a uniform technique when attempting mock tests so you can judge your reporting style and know if you are over calling or under-calling the abnormality.
- In case of a fracture extending into an adjoining joint, mentioning intra-articular extension is important to secure a full mark. In skeletal radiographs, always look for soft tissue swelling which may point to an underlying bone fracture. Similarly, foreign bodies and soft-tissue gas may also serve as pointers to significant adjoining abnormality. Always check and trace the outline of each bone in a radiograph with attention. Erosions / foreign body/lines/ tubes should always be specifically looked for.
- A prosthetic valve, laminectomy, calcified hilar lymph nodes, fused vertebrae, splenomegaly, soft tissue calcification except for vascular calcification, severe osteoarthritis, basal ganglia calcification in child etc. are ABNORMAL.
- Basal ganglia calcification in adult, calcified lymph nodes in abdomen etc. are NORMAL.
- In knee, shoulder and skull x-ray films, always look for a fat-fluid level.
- Images are digitized and displayed on OSIRIX workstation
- Normal or abnormal – if abnormal must write down a diagnosis
- Can write with a pencil or pen (both will be provided)
- There is only limited space for the answer, think before you write! (another good reason to use a pencil)
- Abbreviation ok to use – Rt (right), Lt (left), hash sign # (fracture)
- Can get 0.5 if the answer is incomplete
- Only ONE finding per film – if more than one usually related to the same mechanism (e.g. Rib fracture + lung contusion from trauma)
- Normal variant = normal (e.g. Cervical ribs)
- Congenital abnormality = abnormal (e.g. Spina bifida, right-sided aortic arch)
- Expect films with gross fracture – so obvious even medical students can diagnose
- Most abnormal films have unequivocal findings once you spot them
- A small number (? 1-2) of discriminatory films with very subtle findings designed to test good candidates
- RR is likely to break or make you – many good candidates have tripped and fallen over RR over the years. RR should be your top priority – can’t stress this enough. It is the only component of the exam candidates stand a realistic chance of scoring full mark by getting all 30 plain films right – which will give you a lot of room for error in Viva (VV) and Long Case (LC). On the other hand, it’s also extremely easy to screw up RR because of the strict pass mark (27/30) – one tiny mistake may cost you the entire exam!
- Rapid reporting checklist
- Skull radiograph checklist
- Fracture – depressed
- Sphenoid air-fluid
- Air in orbit and skull
- FB in the eye
- Lytic lesions in the skull
- Upper C spine – dens
- Skull radiograph checklist
- Facial bones radiograph checklist
- Fluid in maxillary sinus
- Don’t call blow out – say orbit floor #
- C-spine radiograph checklist
- AA distance
- Harris ring
- Prevertebral soft tissue
- 3 lines
- Fracture – Chance, peg, hangman fracture.
- Facet – perched
- Lumbar and thoracic spine radiograph checklist
- Lung mass / lobar collapse
- Paraspinal soft tissue
- Empty VB sign – each VB should have accompanying posterior elements – vertebra plana
- Pedicles – mets
- SI joint
- Calcified aortic aneurysm
- Chest radiograph checklist
- Air: Pneumothorax, pneumomediastinum, pneumoperitoneum, surgical emphysema
- Apices – nodule or pneumothorax
- Bones: shoulder dislocation, clavicle fracture, humerus fracture, missing pedicle, check ribs last (missing rib, lytic area, notching, fractures)
- Cardia: heart chamber enlargement, pericardial effusion, retrocardiac region
- Mediastinum – tracheal deviation, paratracheal stripe
- Collapse: veil, retrocardiac triangle, RML, RUL
- Diaphragm: lesion behind the diaphragm
- Hila, mediastinum – esophagus
- Lungs – call it NODULE or consolidation – not mass or pneumonia
- Pleura – CP and cardiophrenic recess
- Soft tissue – Breast shadow, neck mass, axilla (look for clips etc.)
- Shoulder radiograph checklist
- Dislocation or #
- AC joint
- Bankart lesion
- Lung – mass, PTX
- Ribs – # or lytic lesion
- Wrist radiograph checklist
- Triquetral fracture on lateral
- Scaphoid fracture will have 4 views
- Hamate hook # on lateral and AP
- Scapholunate dissociation
- Distal radius # – impacted fracture
- Buckle, torus, SH #
- AVN of lunate and scaphoid
- Hand radiograph checklist
- MC or phalange #
- Foreign body
- Abdomen radiograph checklist:
- Bones, stones, solid (organs), liquids (bile, urine), gas (extraluminal, mural, intraluminal)
- Bowel – obstruction, hernial orifice
- Foreign body
- Colitis – thumb printing, toxic megacolon
- Pneumo – look if the gas takes the shape of the kidney, Rigler, PV gas or pneumobilia, retroperitoneal gas, GB or urinary bladder air
- Soft tissue – hepatosplenomegaly, psoas outline, kidneys, pelvic mass, missing spleen
- Calcification – aortic aneurysm, appendicolith, gallstone, renal stone, uterine fibroid, dermoid, pancreatic, hydatid
- Bones – sacroilitis, ivory vertebra, missing pedicle, missing VB (collapse), lytic lesion in pelvis, AVN, Lower ribs
- Lung base– bronchiectasis
- SI joint
- Avulsions – AIIS, pubic tubercle
- Looser zones
- Iliac wing #
- SUFE, Perthe
- Impacted NOF fracture
- Hernial orifices
- Lower limb
- Knee radiograph checklist
- Tibial plateau
- SONK in femur
- Segond and Pelligreni Steida lesion
- Patella alta and baja
- Ankle radiograph checklist
- Tibial, fibular #
- Lateral talar #
- Talar dome – OCD: look carefully in the part overlapping the fibula
- Base of 5th
- Tarsal coalition
- Foot radiograph checklist
- Base of 5th vs apophysis
- Lis franc – alignment
- Stress # – periosteal rxn only
- AVN – Freiberg
- Malleolar #
- Lateral talar #, anterior calcaneal#
- What is the strategy for Viva?
- A detailed analysis is beyond the scope of this post. Read the initial pages of any of the above books or the RCR website for details about the exam.
- Some general tips are as follows:
- You should be able to vocalize your thoughts as you are undertaking each case.
- Do not allow long pauses or answer in one or two words.
- The examiner will always try to help you and will NEVER mislead you. He or she will behave like a clinical colleague who has come to discuss a case and not as a radiology professor.
- Always listen to the examiner.
- Even if an X-ray, MRI and Bone scan are of the same patient, each is marked separately. So make sure you state all your findings for each.
- Take every case as a new one however good or bad your last case has been.
- Practice as much as possible with a friend or faculty and by presenting aloud.
- Prepare a script for common cases. For example, in a necrotizing enterocolitis – say that you are not able to see the femoral capital ossification center and hence think that the infant is a pre-term. Describe the mottled air shadow over the colon and say that you are concerned of NEC. Say that you are searching for free air and specifically for a football sign or Rigler’s sign etc. Next, comment on branching pattern of air over liver shadow and state that you are aware that this need not be a poor prognosticator by itself in contrast to adults. Also, say that the visualized lung fields shows/does not show signs of hyaline membrane disease. Ask for the accompanying chest radiograph because you feel that a child with NEC might require explorative laparotomy and because of the high incidence of HMB in preterm, as a part of good clinical practice, you wish to ensure safety during anesthesia.
- Additional information is available in www.rcr.ac.uk → Clinical Radiology →Examinations → First Final FRCR Part B Examination→ Examiners’ reports.
- What is the size of the monitor used to display images?
In FRCR 2B Viva, images are displayed on an iMac. Examiner has a separate screen that is not visible to the candidates. The images we see will appear on OsiriX software. A single apple mouse is shared by both examiner and the candidate. Pan, zoom, window options are available to us. However, it is good etiquette to ask the examiner before changing the window.
- Does mouse used have a central wheel for scrolling?
No. It is an Apple Magic 2 without a central wheel.
- Do they use a Windows-based system for practice or use Apple workstation?
Rapids and Long cases are windows based Pratique software. Dell or HP or a similar system/monitor. A regular wired mouse such as Logitech is available and so is a keyboard to type in the answers.
- Do they give warning before time is up for reporting?
Yes. Periodic warnings are given in both written modalities. A clock display is also projected.
- What are FRCR part 2b exam dates for 2019?
- Where are pass rates for the FRCR exam?
You can access the pass rates for previous FRCR exams on the RCR website.
I would like to acknowledge the constant support and friendship of Dr. Ulhaas Shankar Chakraborty throughout our residency and FRCR journey.
All the best to each one of you! Remember
Thank you Dr. Inthulan once again! Hopefully, we have answered all your questions. If you have more questions you can comment below or contact us. Also, you have already cleared the exam, let us know your experience and how prepared for the exam!
We wish you all the best for the exam! If you found this post helpful, share this with your friends and colleagues.
Additional resources :
- RCR Junior Radiologists Forum examination guidance FRCR exam guidance
- Radiology Cafe:
- FRCR exam 2B advice.
- MedMantra FRCR exam guide
- Passing the FRCR exam 2B
You can access other FRCR related resources here:
FRCR exam preparation – An alternative take! We already have published a couple of articles on preparation for the FRCR exam including a comprehensive guide. In this guest post, Dr. Pooja Hegde would like to share her FRCR exam preparation strategy! It is a very interesting take on the exam, definitely something that no one would have […]
FRCR 2B exam – Recent experience and a few tips and tricks! This a guest post by Dr. Saurabh Joshi, a colleague and a good friend of mine who recently cleared the FRCR 2B exam. He shares his experience and tips and tricks that helped him sail through all the steps. He has also contributed […]
FRCR 2A notes by Dr. Tamer Elhiti Dr. Tamer Elhiti had compiled excellent hand-written notes for the FRCR 2A exam. He has also agreed to share all these FRCR 2A notes with all of us for FREE. He has covered the exam topics under the following headings: Gastrointestinal radiology. Genitourinary system. Cardiovascular and Thoracic CNS and […]
The motive behind starting RadioGyan.com was to provide concise information to radiology residents and practitioners on specific topics which are often neglected during residency. The FRCR exam is one such topic. I have always had a lot of questions about the FRCR exam and the lack of definite answers for these was one of the main […]
More Radiology resources
- Radiology resources – RadioGyan.com
- Normal Imaging Anatomy modules.: Learn and revise imaging anatomy. Links are divided by anatomy and modality.
- Cases: Radiology cases with important diagnostic points.
- Videos: Radiology videos from other websites with important teaching points highlighted.
- Spotters: Sets of 10 radiology spotters, one minute for each spotter.
- Articles: Descriptive articles on common imaging topics, including Journal club.
- Guide for first-year radiology residents.
- Guide for final year radiology residents.
- Guide to the FRCR exam
- Software: Links to common radiology software.
- Recommended Books for Radiology Residents.
- Radiology Conferences: Updates about upcoming radiology conferences and CMEs.
Disclaimer: Every effort has been undertaken to assure the authenticity of information. However, the essence comes from the author’s personal experience. The Royal College promptly replies to any questions asked and will be in accordance with the latest information. In case of doubts, do email them and update the forum. This is ONLY a guide to help you get basic information. Candidates are advised to check the FRCR website and the websites mentioned in the above post for the latest information. The FRCR logo is for representative purposes only. The RCR is not affiliated to this website.