RANZCR Clinical Radiology: Free Preparation Guide and Learning Test Study Guide

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A scan obtained for abdominal pain shows an unexpected finding requiring immediate surgical assessment. Contact the responsible clinical team directly, explain its urgency, confirm receipt and document the discussion alongside the formal report.

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Before an image-guided biopsy, a patient nods but cannot explain what tissue sampling involves. Arrange an appropriate interpreter, discuss benefits, risks and alternatives, and check understanding before seeking the patient's decision about proceeding.

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A Māori patient has missed several appointments and describes mistrust after previous encounters. Explore the experience without blame, offer cultural support, and agree on communication and appointment arrangements that address the patient's stated barriers.

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A paper reports excellent accuracy for a new test in patients already selected for surgery. Before changing a community referral pathway, examine whether milder disease and alternative diagnoses were represented and whether verification was applied consistently.

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Among 1,000 patients, 100 have disease. A hypothetical test identifies 90 of them and gives 90 false-positive results. Its positive predictive value is 90 divided by 180, or 50%, despite 90% sensitivity.

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A department finds inconsistent documentation of urgent-result communication. It defines a documentation standard, measures baseline compliance, introduces a structured reporting field and repeats measurement using the same eligibility criteria and denominator after implementation.

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A patient returns to the ward after drainage while microbiology results remain pending. Handover should specify catheter status, immediate observations, unresolved results, escalation concerns and the team responsible for reviewing results and coordinating further care.

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Assume a point source produces 80 arbitrary exposure units per minute at one metre. At two metres, the predicted rate is 20 units per minute. Remaining there for half as long halves accumulated exposure again.

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Using an assumed sound speed of 1,540 metres per second, an echo returning after 100 microseconds corresponds to a depth of 0.077 metres, or 7.7 centimetres. The calculation includes the outward and return journeys.

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A superficial tendon is sharply depicted with a high-frequency transducer, but a deep abdominal target is poorly visualised using the same settings. Choose a lower-frequency transducer and optimise depth and focus for the deeper examination.

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A vessel shows little Doppler shift when insonated nearly perpendicular to its course. Reposition the transducer to obtain a more favourable beam–flow angle before concluding that flow is very slow or absent in that segment.

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A hypothetical CT protocol uses 200 mAs. Reducing it to 50 mAs would approximately double quantum noise under otherwise identical conditions. Decide whether that increase remains acceptable for the particular lesion contrast and clinical task.

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Two hypothetical scans both have CTDIvol of 8 mGy. Coverage of 25 centimetres gives a dose-length product of 200 mGy·cm, whereas 40 centimetres gives 320 mGy·cm. The difference arises from coverage, not increased CTDIvol.

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An oxygen cylinder is proposed for entry into the scanner room, and its MR safety status is unknown. Keep it outside the controlled area while appropriate equipment is obtained; pausing image acquisition does not remove the static-field hazard.

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Compare an unenhanced T1-weighted spin echo at illustrative TR/TE 500/10 ms with a T2-weighted spin echo at 3,000/100 ms. CSF is relatively dark on the first and bright on the second. Normal white matter is brighter than grey matter on T1 weighting; the relationship reverses on T2 weighting. Simple water-rich oedema is usually T1 dark and T2 bright. These appearances follow relaxation and timing, not interval change.

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A trainee describes PET as simply a rotating gamma camera examination. Correct the mechanism by distinguishing coincident annihilation-photon detection from SPECT projection acquisition, then explain why either may be combined with CT for anatomical localisation.

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For an idealised tracer with physical half-life of six hours and biological half-life of three hours, reciprocal effective half-life is one-sixth plus one-third per hour. Effective half-life is therefore two hours in that compartment.

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A radiograph includes substantially more anatomy than required. Tightening collimation addresses unnecessary irradiation and scatter production. Adding a grid without correcting the field would target detector scatter while leaving the unnecessarily large irradiated volume unchanged.

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During a prolonged catheter procedure, the operator needs intermittent position checks rather than continuous observation. Use brief appropriately configured imaging runs, review exposure indicators and reserve higher-detail acquisition for steps where it changes procedural decisions.

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A dataset contains several scans per patient. Before splitting it for model development, group examinations by patient so that an individual's studies cannot appear in both training and final testing and inflate apparent generalisation.

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A model tested mainly on one scanner type is proposed for a network using several manufacturers and protocols. Examine performance across the intended equipment and patient groups before assuming the reported average applies throughout the network.

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An AI triage flag disagrees with a radiologist's review. Assess image quality and clinical context, inspect the suspected finding and resolve the discrepancy through the clinical workflow instead of accepting either judgement solely because of its source.

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After a scanner software upgrade, staff notice more AI alerts without corresponding disease. Compare performance with the earlier baseline, investigate acquisition changes and manage continued use or revalidation according to the identified effect on clinical safety.

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An imaging description places a mass in the cerebellum. Localise it to the infratentorial compartment first, then evaluate whether it arises within cerebellar tissue or from an adjacent structure and how it displaces surrounding anatomy.

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MRI shows a lesion inside the dural sac that displaces the cord but does not arise within it. Describe the location as intradural extramedullary, then use morphology and clinical context to refine the differential diagnosis.

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A histological diagram labels a small artery and bile duct together beside a larger thin-walled vascular channel. Identify the channel as a portal venous branch rather than a hepatic venous outflow structure within that triad.

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When reviewing a liver vascular diagram, trace a vessel receiving blood from central veins into the outflow system. Classify it with hepatic venous drainage, rather than grouping it with the portal vessels accompanying arterial and ductal branches.

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MRI shows a mass lateral to the pharynx and anterior to the internal carotid artery. It replaces prestyloid fat, pushes the pharyngeal wall medially and the carotid artery posteriorly, and remains continuous with the deep parotid lobe through a widened stylomandibular interval. These relationships favour a deep-parotid mass extending into the prestyloid space, rather than a primary carotid-space lesion.

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A left-sided central catheter descends along the left mediastinal border. CT shows it within a vein continuous with the left jugular/subclavian confluence and an enlarged coronary sinus entering the right atrium. Report persistent left superior vena cava and its drainage. This explains the unusual catheter course and alerts clinicians to altered access and pacing-lead anatomy.

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CT shows a pancreatic-associated collection behind the posterior parietal peritoneum but anterior to the left anterior renal fascia. The kidney and its enclosing fascial envelope are displaced posteriorly without fluid surrounding the kidney inside that envelope. Localise the collection to the anterior pararenal space rather than the perirenal space.

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A patient has nocturnal thumb, index and middle-finger paraesthesia, little-finger sparing and weak thumb opposition. Ultrasound shows median nerve swelling immediately proximal to the tunnel and flattening beneath the transverse carpal ligament beside swollen flexor tendon sheaths. Together these findings localise compression to the carpal tunnel; isolated ulnar neuropathy would not explain this sensory pattern.

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After a damaging stimulus, tissue shows scattered shrunken cells with condensed chromatin and membrane-bound fragments being engulfed by neighbours: this favours apoptosis. Swollen cells with ruptured membranes and extracellular cellular debris instead support necrotic morphology.

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A pathology description reports replacement of one mature epithelial cell type by another after a persistent environmental stimulus. Classify the change as metaplasia, then separate that finding from any independently described dysplasia, invasion or malignant diagnosis.

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Two enlarged tissues are compared microscopically. One contains larger individual cells without an increased count; the other contains more cells. Describe the first as hypertrophy and the second as hyperplasia, despite their similar gross enlargement.

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A biopsy report describes abnormal epithelial cells confined to their site of origin and explicitly states that adjacent tissue invasion is absent. Interpret the finding as in situ disease rather than reclassifying it from lesion diameter alone.

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A pathology report assigns a high grade, while staging investigations show a lesion confined to its primary site. Record both findings accurately rather than converting the high grade into an unsupported statement that distant metastatic disease is present.

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An examination demonstrates an occluded vessel but does not establish irreversible downstream tissue injury. Report the obstruction and relevant perfusion findings without automatically treating the terms embolus, local thrombus and completed infarction as equivalent conclusions.

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Two specimens from inflamed tissue show different patterns: one is dominated by an early neutrophilic response; the other combines persistent mononuclear inflammation with fibrosis. Explain the acute and chronic processes rather than relying solely on reported symptom duration.

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Follow-up imaging after tissue injury shows a residual structural abnormality while symptoms and other indicators improve. Consider the possibility of repair and scar, compare the trajectory with earlier studies and avoid equating every residual abnormality with ongoing injury.

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A patient develops sudden weakness and speech disturbance. The initial noncontrast CT shows no haemorrhage. Explain that this answers a crucial treatment-related question but does not, by itself, exclude early ischaemic stroke or remove the need for further assessment.

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After a fall, CT shows a 12-mm hyperdense left convexity crescent, left ventricular compression and 6-mm rightward shift. Example impression: Acute left convexity subdural haematoma with significant mass effect and 6-mm rightward midline shift; urgent neurosurgical assessment required. A lentiform, suture-limited collection would instead favour epidural haemorrhage.

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A stable child has right lower quadrant tenderness and an intermediate clinical probability of appendicitis, without evidence of complication. Choose a targeted ultrasound examination as the initial study and plan how its result will be integrated with clinical reassessment.

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A toddler with episodic distress and vomiting has a persistent 3.5-cm right upper abdominal target containing echogenic mesenteric fat and nodes, with bowel extending into the ascending colon. Example impression: Ileocolic intussusception; urgent paediatric radiology and surgical assessment for reduction. Document perfusion, fluid and obstruction rather than reporting a target sign alone.

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An intrauterine embryo measures 5 mm without cardiac activity: report uncertain viability and arrange repeat ultrasound after at least seven days. If neither location is identified, follow the pregnancy-of-unknown-location pathway with serial hCG and reassessment. Instability or worsening symptoms requires urgent reassessment.

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CT shows fluid-filled jejunum up to 4 cm, an abrupt distal ileal transition and collapsed terminal ileum and colon. Example impression: Mechanical small-bowel obstruction with a distal ileal transition point. No obstructing mass identified. State separately whether compromised enhancement or a closed-loop configuration is present.

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A febrile patient with leukocytosis has equivocal gallbladder ultrasound. If the remaining question is acute cholecystitis and gallbladder filling, cholescintigraphy is appropriate; contrast-enhanced CT is useful when complications or alternative causes are prominent concerns. In a patient without fever or leukocytosis whose main uncertainty is duct obstruction, MRI/MRCP directly assesses the ducts.

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An older patient remains unable to bear weight after a fall despite negative hip radiographs. Request further fracture assessment with an appropriate noncontrast MRI or CT rather than attributing the symptoms to soft-tissue injury solely from the radiographs.

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A patient has low clinical probability of pulmonary embolism and a negative D-dimer using the applicable assessment pathway. Explain why pulmonary vascular imaging is not automatically required, rather than ordering CTA simply because breathlessness prompted consideration of embolism.

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A breathless patient with fluid overload has new bilateral perihilar opacities, Kerley lines and small bilateral effusions on an erect PA film. Example impression: Pulmonary vascular congestion with interstitial and alveolar oedema and small bilateral pleural effusions. A unilateral focal opacity without congestion would require greater consideration of pneumonia.

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MRI shows focal left subarticular L4–5 disc material with a 9-mm displaced component attached through a 4-mm base, extending caudally and compressing the traversing left L5 root. Example impression: Left subarticular L4–5 disc extrusion with caudal migration and left L5 root compression. Retained continuity means sequestration has not been established.

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A patient with back pain develops urinary retention and saddle numbness. Escalate for urgent clinical assessment and lumbar MRI to evaluate suspected cauda equina compression rather than scheduling a routine outpatient radiograph or conservative follow-up alone.

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A 24-year-old woman with a new palpable breast lump usually starts with targeted ultrasound. A 27-year-old man with an indeterminate palpable breast mass usually starts with diagnostic mammography or tomosynthesis. A 22-year-old man with a suspicious mass and nipple retraction requires the suspicious-examination pathway despite being below the usual male age threshold.

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CT shows sigmoid diverticula, an inflamed diverticulum centred within marked fat stranding and a short thickened segment, without abscess or free gas. Example impression: Acute sigmoid diverticulitis without collection or free perforation. State any focal mass-like component that prevents exclusion of underlying neoplasia.

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A clinician remains concerned about a firm focal mass despite normal imaging. Verify site correlation and discuss further tissue assessment rather than offering reassurance solely because the imaging report lacks a suspicious finding at the symptomatic location.

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A pulmonary CTA has adequate central arterial enhancement but severe basal respiratory motion. Example impression: No central pulmonary embolus. Basal segmental and subsegmental arteries are inadequately assessed because of motion; peripheral embolism cannot be excluded in these regions. Discuss further investigation if the unresolved question would change management.

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A pathologist explains that classification of a lesion requires assessment of tissue architecture. Plan an image-guided core biopsy if appropriate for the lesion and risk assessment, rather than assuming a fluid or cellular aspirate will answer the same question.

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A lesion is conspicuous on CT but cannot be identified reliably with ultrasound. Review CT-guided access and intervening anatomy rather than attempting ultrasound guidance solely to avoid radiation when the intended target cannot be confidently seen.

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An accessible abdominal abscess requires continuing evacuation. Explain why a drainage catheter may be left in place after initial aspiration, with ongoing review of output and clinical progress rather than treating needle entry as completion of care.

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A patient becomes tachycardic and hypotensive with worsening pain and bloody drainage: prioritise resuscitation and urgent bleeding assessment, using imaging only as stability permits. If observations are stable but output abruptly stops and the cavity remains large, check for kinking, blockage or a catheter retracted from the cavity. If output continues but CT shows a separate undrained locule and fever persists, reassess drainage coverage; an additional catheter may be needed.

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A biopsy needle clearly entered a suspicious lesion, but pathology reports insufficient material for diagnosis. Describe the result as nondiagnostic and plan how to obtain adequate information rather than treating target access as proof that malignancy was excluded.