RANZCR case reporting examination

Last revised by Joshua Yap on 14 Oct 2023

The RANZCR case reporting examination is part of the RANZCR Phase 2 examinations. It is one of two components comprising the clinical radiology written examinations, with the other component being the multiple choice examination

Trainees have a maximum of three opportunities to complete both clinical radiology written examinations. Both examinations must be sat together on the first attempt, however, if a trainee fails one of the two examinations, they are only required to resit that failed examination at their next opportunity.

The passing standard is set by the relevant examination review panel using formal standard-setting procedures. As well as achieving the overall passing standard, candidates must achieve minimum standards in a determined number of examination components in order to pass.

The examination is typically attempted in the third year of training after completion of (or together with) the pathology examination.

Format

The examination is 3 hours in duration and consists of:

  • short cases: 20 questions, worth 3 marks per question

    • will only ask for the most likely diagnosis (only a single phrase needed)

    • 1 modality, e.g. x-ray, mammogram, fluoroscopy such as contrast swallow or hysterosalpingogram

    • only 1 or 2 images per case, up to maximum of 3, e.g. ankle x-ray

  • medium cases: 10 questions, worth 6 marks per question

    • will ask for findings (4 marks) and likely diagnosis (2 marks)

    • generally 1 modality per case with multiple series, e.g. 1 or 2 limited series of ultrasound, CT, or MRI; single x-ray with a short series of CT, etc.

  • long cases: 5 questions, worth 12 marks per question

    • will ask for 3 or 4 answer headings: findings, likely diagnosis, differential diagnosis, and further investigation and management

    • often multiple modalities presented per case, up to 3

Each case is presented with a clinical history and relevant imaging with one or several different imaging modalities. Imaging modalities, planes, phases, and sequences are labeled.

Whereas previously the cases were presented as "hard-copy" films, since April 2013 the cases have been delivered electronically via a PACS viewer (Practique). As with any PACS viewer, cross-sectional images are scrollable, and there are imaging tools such as magnification, windowing, measurements, etc. All the images are downloaded locally prior to the commencement of the examination to prevent slow loading times during the examination.

Answers are typed into text boxes under the following headings:

  • findings

  • likely diagnosis

  • differential diagnosis

  • further investigation and management

There is no negative marking, normal cases, or "instant fail" cases.

Currently, the examination is delivered on the Practique system at a local Cliftons venue.

Content

There are seven topic areas covered in the examination with the following approximate weightings:

  1. abdominal (20%)

  2. breast (9%)

  3. musculoskeletal (12%)

  4. neuroradiology / head and neck (20%)

  5. obstetrics and gynecology (9%)

  6. pediatrics (10%)

  7. thoracic and cardiovascular (20%)

Technique

This examination tends to be the most time-constrained of all the RANZCR Phase 2 written exams. A possible technique is to limit each answer to:

  • 2 minutes per short case question

  • 6 minutes per medium case question

  • 12 minutes per long case question

This leaves 20 minutes at the end to review answers.

As all the images are downloaded locally prior to the commencement of the examination, it is possible for you to have a quick look at all the cases first and answer the ones you know best before tackling the more challenging cases. Some trainees advocate starting with the more complicated long case questions first and working backwards.

The four text boxes (findings, likely diagnosis, differential diagnosis, and further investigation and management) provide the structure for your answer, with subheadings not required; however subheadings may be useful when describing findings for multiple modalities in a single text box, e.g. x-ray, CT, MRI, etc. Bullet points are generally advocated, especially when describing the findings (which tends to be the "longest" of the answers and generates the most marks). Common abbreviations are generally accepted. In some long cases, there is no differential, in which case the differential diagnosis box is not included. All modality techniques, phases, and sequences are listed.

As with the RANZCR Phase 1 examinations, typing skills are important, and improving your typing speed will essentially provide you with more time to complete the exam. One tip is to type, rather than dictate, a few of your reports during your day to day work.

Useful resources to aid in preparation for the case reporting examination include:

NB: Details are correct at the time of writing. Please check with RANZCR for updated details. 

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