Reporting ('long cases')

6 cases in 60 minutes


Each case may comprise of one or more imaging modalities (often a combination of two or more), for example ultrasound images, CT scan and a plain radiograph.  You must report all 6 cases.  For each you will be given a brief history and relevant clinical data to help and guide you (as in day to day practice).

You will need to type your report in the spaces provided on the screen.  They are divided into the following sections to help you communicate your report clearly:

  • Observations:  Record observations from all the imaging studies available, including relevant positive and negative findings.
  • Interpretation:  State interpretations of the observed findings; e.g. whether the mass or process is benign, malignant or infective, giving your reasons.
  • Principle diagnosis:  The single diagnosis based on the interpretations above.  If a single diagnosis is not possible, give the most likely differential diagnosis here.
  • Differential diagnosis:   For some questions this will be left blank, however if a single diagnosis is not possible then differentials other than the most likely differential diagnosis should be included here.  These should be few and brief and you must indicate why these are less likely than the main or principle diagnosis above.
  • Further management:  Include any further investigations or future management here.

 

What is the scoring system?

The long cases component of the exam is marked out of 8.  Scores from the two viva components, long cases and rapids are combined to give a total score out of 32.  The overall pass mark is 24 and candidates must obtain a mark of 6 or above in a minimum of two components to pass.

 

Individual cases are marked out of 8 as shown below:

Candidate responseMark
No answer offered 3
Fail: significant observations missed; correct diagnosis not made 4
Borderline: appropriate if there are two main diagnoses in the case but only one is mentioned; some observations missed 5
Pass: most observations made correctly; principal diagnoses correct 6
Good Pass: additional relevant material included in a "pass" grade answer 7
Excellent: a perfect answer, clear and confident 8

(half marks may be awarded)

(Source: Final Examination for the Fellowship in Clinical Radiology (Part B) Scoring System. Published by: The Royal College of Radiologists)

 

Following the marking each candidate will have a score between 18-48 (minimum mark for each case is 3).  An overall reporting mark (out of 8) is then awarded using the table below:

Total marksOverall mark
18-25 4
25½-28
28½-31 5
31½-34
34½-37 6
37½-40
40½-43 7
43½-46
46½-48 8

(Source: Final Examination for the Fellowship in Clinical Radiology (Part B) Scoring System. Published by: The Royal College of Radiologists)

 

Top tips for the 2B long cases

 

  1. Report as you would in day to day practice

    • Think about what information you include in your day to day reporting and simply type the same.  If normally you would recommend urgent surgical referral, then write 'Recommend urgent surgical referral'  If normally you would refer to the lung MDT, then write 'referral to the lung MDT is advised' etc.  Your clinical knowledge and experience should help your interpretation and guide your search for additional features.  Relevent neagtives should be included e.g. absence of metastatic disease in sites common for a particular malignancy.

  2. Write someting in EVERY section for EVERY case!

    • Even if you don't have a clue about the answer, simply by typing something sensible in each box, you will get at least 4 marks for that question.  So attempt all cases.

  3. Timing is everything

    • Anyone can write a decent report after spending half an hour looking at the images, however it is very difficult to spend an average of 10 minutes on each case.  You will not have time to check your answers so you have to be very very strict with time management.  We recommend aiming to spend no more than 7-8 minutes on each case to allow time for difficult cases or those needing a lot of description.  It may be that case number 6 is the longest and hardest and if you have 5 minutes left at the end it will not be enough!

  4. Practise typing under pressure

    • You will be typing so fast you hands will probably ache.  Practising will really help.  Try reporting 3 CT scans in 30 minutes and typing the reports as you go.

  5. Use bullet points and keep answers succinct

    • You wont have time to type full sentences (unless you're a particularly good touch typer) so use bullet points.  It keeps things clearer, makes it easier for you to see if you have missed anything and makes it easier for the examiners to mark.

  6. Watch this short instructional video from the RCR

  7. Practice on the RCR examination demo site

    • The RCR have developed their own software for the examination and you should practise using this software on their demo website prior to the exam.  You will require a PIN number to access the long cases examination demo.  Unlike in previous exams, you will NOT have the opportunity to practice immediately prior to the start of the examination at venues, so practising on this demonstration site is essential to help you become familiar with the exam format!  Here are the links:
    • RCR exam demonstration site
    • Long cases exam PIN access number

  8. Do NOT use acronyms or abbreviations!

    • Many clinical errors have arisen from the use of acronyms and what is common in one institution may not be common elsewhere.  Avoid if at all possible!

  9. Report imaging in chronological order

    • If there is more than one radiograph / imaging modality then check the dates and report each one in chronological (time) order.

  10. Use our up-to-date list of all UK FRCR 2B courses, recommended books and online resources

 


The long cases component is one of three parts of the Final FRCR (Part B) exam.  Information on the two other components can be found below:

 

If you have anything you would like to add to this page or know of any useful tips/resources for future exam candidates, then please contact us and we will consider adding to this page!