Why candidates lose marks in the RANZCR exams

RANZCR examiner reports repeat themselves from sitting to sitting. Most marks are not lost on rare facts; they are lost on how answers are written and on the same core gaps. These are the themes that come up most.

Weak plain film interpretation: lobar collapse patterns, the trauma chest radiograph, the abdominal radiograph and non-standard musculoskeletal views. Examiners keep saying: report lots of x-rays.
Listing differentials when the question asks for the single most likely diagnosis, or giving more answers than requested.
Vague or incomplete findings, writing the diagnosis as a finding, and wrong terminology (calcification for ossification; not using IOTA or O-RADS descriptors for an adnexal mass).
Unstructured answers and scrolling through image stacks too fast, skipping routine search steps such as confirming a mammographic lesion on two views.
Thin hands-on ultrasound experience, which shows in obstetric and gynaecological cases (the most-failed OSCER station in 2026 S1).
Phase 1 labels without side or vertebral level.
Phase 1 physics: confusing cumulative air kerma with peak skin dose, dose-length product with effective dose, and what percentile a diagnostic reference level sits at; vague accounts of iterative reconstruction.
Pathology answers that describe the imaging instead of the gross and histological appearance, and stems misread.

What this looks like when it is marked

A Case Reporting · medium case question, an answer of the kind examiners see every sitting, and how a point-by-point marking guide scores it.

Question · 6 marks

A 46-year-old woman with right upper quadrant discomfort and normal liver function has a multiphase CT of the liver. Describe the findings (4 marks) and give the most likely diagnosis (2 marks).

Answer

There is a haemangioma in segment VII of the liver measuring 4 cm. Differentials include hypervascular metastasis, hepatocellular carcinoma and focal nodular hyperplasia.

✓Solitary 4 cm lesion in segment VII1/1

✗Arterial phase: peripheral, discontinuous nodular enhancement, matching the aorta0/1

✗Portal venous and delayed phases: progressive centripetal fill-in, following the blood pool0/1

✗Pertinent negatives: no washout or capsule; non-cirrhotic liver0/1

✓Diagnosis: hepatic (cavernous) haemangioma, as a single answer1/2

You named the diagnosis instead of describing the findings, so the four finding marks were lost. Examiners want the enhancement pattern that earns the diagnosis. Then the differential list diluted a correct single answer. When the question asks for the most likely diagnosis, give one.

How to practise against these

Reading a list of mistakes changes little. What changes the score is writing or speaking answers under exam conditions and being marked against specific points, so you can see exactly which one you missed. Do that for every area, weakest first, and repeat the ones you got wrong until they stick.

Know the references examiners expect: RANZCR Clinical Radiology Learning Outcomes (category 1 topics prioritised); ARPANSA codes and diagnostic reference levels; state and territory radiation licensing; BreastScreen Australia; National Lung Cancer Screening Program; RANZCR iodinated and gadolinium contrast guidelines; MRI safety; BI-RADS, O-RADS and IOTA, LI-RADS, TI-RADS, Lung-RADS, Fleischner, Bosniak 2019; Practique PACS-style viewer for Case Reporting; Phase 1 online proctored in 2026.

Where do you stand?

Thirty questions across every area, scored by area with a plain verdict. Free.

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Not affiliated with the Royal Australian and New Zealand College of Radiologists (RANZCR).