RANZCR Clinical Radiology Part 1 Exam 2026 Study Guide: What You Actually Need to Know

This is the practical 2026 study guide for radiology trainees sitting the RANZCR Clinical Radiology Part 1 Exam (Phase 1) in the next 12 months. It covers the structure of both papers, the 169 mapped curriculum learning objectives, realistic month-by-month timelines, and the failure mode that catches strong candidates the first time around. PRIMEX started in 2025 when an anaesthetic trainee at a regional NSW hospital built study tools for the ANZCA Primary. It now covers 21 colleges because trainees from each specialty asked us to build for them. The RANZCR Clinical Radiology Part 1 Exam curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

Exam structure: two papers, one sitting

The RANZCR Part 1 examination, also called the Phase 1 examination, is a written exam consisting of two separate papers sat on the same day. Both must be passed in the same sitting; you cannot bank one and re-sit the other. This is the gating event before clinical radiology trainees move from Phase 1 into Phase 2 training, and it is sat by registrars typically in their first or second year of the radiology SET programme.

The Physics paper (Applied Imaging Technology)

• 9 constructed-response questions (CRQs), 10 marks each, 90 marks total
• 60 single best answer multiple choice questions, 1 mark each, 60 marks total
• Total marks: 150
• Duration: 3 hours
• Material is drawn from the RANZCR Clinical Radiology Learning Outcomes, sections 2.1 (Theoretical Principles), 2.2 (Imaging Technology) and 2.3 (Radiation Protection and Patient Safety)

The Anatomy paper (Cross-Sectional Anatomy)

• 120 image labels, structured as 20 questions with 6 labels each
• 30 very short answer questions (VSAs)
• 20 short answer questions (SAQs)
• 60 single best answer MCQs
• Duration: 3 hours
• Material is drawn from sections 4.1 (Brain), 4.2 (Head and Neck), 4.3 (Spine), 4.4 (Thorax), 4.5 (Abdomen and Pelvis) and 4.6 (Upper and Lower Limbs)

Pass mark, weighting and scaling

RANZCR does not publish a fixed numerical pass mark for either paper. The college applies a standard-setting process to each sitting and reports a pass or fail outcome, with examiner reports describing the standard expected. As of 2026, both papers must be passed at the same sitting; partial passes are not carried over. Always verify current rules on the RANZCR website for your specific sitting.

Day-of logistics

• Both papers are written, sat in person at designated examination centres in Australia and New Zealand
• Two sittings per year, typically mid-year and end of year
• Image labels and SAQs are answered in the supplied booklet; precise anatomical nomenclature is required
• No calculator is required for the Physics paper; rough order-of-magnitude calculations are expected to be done by hand. Check the current candidate handbook for the year you are sitting
• The Anatomy paper image quality is the same as the original college source; you cannot zoom or adjust contrast

What the college actually tests

The RANZCR Clinical Radiology Learning Outcomes Version 1.3 (January 2024) define 169 Part 1 learning objectives across the Phase 1 sections. The breakdown matters because it tells you where to spend your hours.

• Section 2.1 Theoretical Principles: 24 LOs (atomic structure, X-ray production, photon interactions, attenuation, digital imaging fundamentals)
• Section 2.2 Imaging Technology: 83 LOs (radiography, fluoroscopy, mammography, ultrasound, CT, MRI, nuclear medicine including PET)
• Section 2.3 Radiation Protection and Patient Safety: 41 LOs (dosimetry, radiobiology, radiation protection principles, MRI and ultrasound safety, QA)
• Sections 4.1 to 4.6 Cross-Sectional Anatomy: 21 LOs covering all six body regions

That is 148 LOs sitting in physics-heavy territory and 21 LOs in anatomy. The anatomy LO count looks small; the marks weight is not. The Anatomy paper carries 120 image labels plus 30 VSAs plus 20 SAQs plus 60 MCQs, so the volume of practice required to hit precise terminology across all six regions is substantial. Plan accordingly.

Highest-yield topic areas

These are the areas that turn up year after year in examiner reports and CRQs. Master these properly and the rest of the curriculum gets easier because the principles repeat.

CT physics and dose descriptors. CTDI vol, DLP and effective dose are confused by candidates every sitting. You need to be able to define each, give the units (mGy, mGy.cm, mSv), explain how each relates to patient dose, and describe what changes each one. Iterative reconstruction, tube current modulation, pitch, and overranging versus overbeaming all attract CRQ marks.

MRI sequences, k-space and safety. Spin echo, gradient echo, inversion recovery (STIR and FLAIR), diffusion weighted imaging, and the contrast mechanisms behind each. K-space filling and the relationship between k-space position and image features. Specific absorption rate (SAR) determinants. Gadolinium contrast classification (linear versus macrocyclic) and nephrogenic systemic fibrosis. MRI safety zones and implant assessment.

Radiation dosimetry and protection. Absorbed dose (Gy), equivalent dose (Sv), effective dose (Sv), and the weighting factors that connect them. Occupational dose limit (20 mSv per year averaged over five years, with no single year above 50 mSv). Public dose limit (1 mSv per year). Pregnancy and dose. ALARA, justification, optimisation, dose constraints. Diagnostic reference levels.

Ultrasound physics and Doppler. Wave properties, piezoelectric effect, transducer design, beam formation, focusing. Acoustic impedance and reflection. Pulsed-wave versus continuous-wave Doppler. Aliasing, Nyquist limit, angle correction. Mechanical index and thermal index. Common artefacts (reverberation, shadowing, posterior enhancement, mirror, side-lobe).

X-ray production and image quality. Bremsstrahlung versus characteristic radiation. kVp, mA and time as image quality determinants. Half-value layer, filtration, beam quality. Modulation transfer function (MTF) and detective quantum efficiency (DQE) as detector performance measures. Scatter and grids.

Radiobiology fundamentals. Direct versus indirect DNA damage. Linear-quadratic model and alpha/beta ratio. The four Rs of radiobiology (repair, redistribution, repopulation, reoxygenation). Stochastic versus deterministic effects. Tissue reaction thresholds for skin, lens and bone marrow. Cell cycle phase sensitivity.

Cross-sectional anatomy by region. The Anatomy paper expects precise nomenclature across all six body regions. Highest-yield within each: Circle of Willis and dural venous sinuses (brain); temporal bone and cervical lymph node levels (head and neck); vertebral anatomy and spinal cord vascular supply (spine); mediastinal divisions, lung segments and coronary anatomy (thorax); Couinaud liver segments, retroperitoneal compartments and pelvic vasculature (abdomen and pelvis); rotator cuff, knee ligaments and brachial plexus (limbs).

Contrast agents and adverse reactions. Iodinated contrast media classification (ionic versus non-ionic, low versus iso-osmolar), contrast-induced nephropathy risk factors, and pre-medication protocols for previous reactions. Gadolinium-based contrast agent stability (linear versus macrocyclic), gadolinium retention and the patient groups in whom macrocyclic agents are preferred. Ultrasound contrast agents (microbubbles) and CEUS principles. RANZCR has its own published contrast guidelines; expect at least one contrast-themed CRQ stage at every sitting.

Digital imaging, PACS and quality assurance. DICOM standard structure, PACS architecture and workflow, lossless versus lossy compression and acceptable ratios in radiology, display calibration to the DICOM Greyscale Standard Display Function. Quality assurance programmes covering acceptance, commissioning and routine testing across CT, MRI, ultrasound and mammography. Section 2.3 has been refreshed in version 1.3 (2024) to reflect dose management systems, so candidates sitting in 2026 should not rely on older revision notes for this area.

Common pitfalls that fail candidates

• Missing units. RANZCR examiner reports cite this every sitting. HVL without cm, dose without mSv or mGy, frequency without MHz. The marker cannot give the mark even if the value is correct
• Imprecise definitions. CTDI vol and CTDI weighted and DLP are not interchangeable. Equivalent dose and effective dose are not the same. SAR is not a single number; it depends on flip angle, TR, B0, sequence type, patient mass
• Confusing T1 and T2 relaxation mechanisms. T1 is longitudinal recovery driven by spin-lattice energy transfer. T2 is transverse decay driven by spin-spin dephasing. Many candidates can recite the definitions and still mix the mechanisms under exam pressure
• Colloquial anatomy. "The bit between" or "the front part of" loses marks. The Anatomy paper rewards correct standard anatomical nomenclature only
• Missing the "calculate" part of a CRQ. When a CRQ asks you to estimate a dose or compute a frequency, write the equation, substitute the values, and quote the answer with units. Even a wrong final number with correct method picks up partial marks
• Treating MCQs as content knowledge tests rather than discrimination tests. Single best answer means several options will be technically correct; you are picking the most correct. Trainees who do not practise this skill in timed conditions struggle on exam day

A realistic study timeline

Trainees underestimate Part 1 because the content looks like physics undergrad on paper. It is not. The exam tests precise application across two papers in one day, and the volume is real. The plans below assume you are working clinically full-time and can carve out study around that.

9-month run-up (around 8 to 10 hours per week)

• Months 1 to 2: Sections 2.1 and 2.2 first half (X-ray production, photon interactions, attenuation, fluoroscopy, mammography, basic CT). Read the relevant study notes, build flashcards, do MCQs as you go
• Months 3 to 4: Section 2.2 second half (MRI in depth, ultrasound, nuclear medicine including PET-CT). Begin anatomy in parallel; brain and head/neck
• Month 5: Section 2.3 (dosimetry, radiation protection, radiobiology, MRI and ultrasound safety, QA). Anatomy: spine and thorax
• Month 6: Anatomy: abdomen, pelvis, limbs. First pass of past CRQ-style questions in untimed conditions
• Month 7: Second pass through highest-yield areas. Start timed CRQ practice (one CRQ in 18 minutes; that is the rough budget for 9 questions in 3 hours minus reading time)
• Month 8: Image label drills daily. Mock exams in single 3-hour blocks; physics one weekend, anatomy the next
• Month 9: Full mock day (both papers). Spaced repetition only. Light study the week before; sleep wins this exam

6-month run-up (around 12 to 14 hours per week)

• Month 1: Sections 2.1 and the first half of 2.2. Brain anatomy in parallel
• Month 2: Second half of 2.2 (MRI, ultrasound, nuclear medicine). Head/neck and spine anatomy
• Month 3: Section 2.3. Thorax and abdomen anatomy. Start past paper questions
• Month 4: Pelvis and limbs anatomy. Timed CRQ practice begins. Image label drills three times a week
• Month 5: Mock exams. Identify weakest topic areas and revisit study notes for those LOs only
• Month 6: Full mock day. Spaced repetition cards. Light week before

4-month run-up (around 18 to 22 hours per week)

This pace is workable but tight. It assumes you have already met the basic physics content during medical school or earlier in radiology training, and you are using these months to consolidate, drill and test under exam conditions.

• Month 1: Read every study note across sections 2.1, 2.2 and 2.3. Build flashcards as you go. Daily anatomy practice from day one
• Month 2: First pass through the curriculum tracker. Confirm you have at least encountered every LO. Image labels three times a week. CRQ practice in untimed conditions
• Month 3: Timed CRQ practice. MCQ blocks of 60 in 60 minutes. Mock exam each weekend
• Month 4: Two full mock days. Targeted revision based on mock performance. Stop new content two weeks before sitting

The single biggest mistake people make

The pattern that breaks competent candidates on Part 1 is treating the Physics paper like a flashcard recall exercise. You do this and it looks fine in March: you can list the four photon interactions, you know CTDI is measured in mGy, you can name the four Rs of radiobiology. Then you sit a mock CRQ and get five out of ten because the question asked you to explain why a specific change in pitch on a CT scan affected image quality and dose, and you wrote a definition of pitch instead of an explanation.

The Physics paper does not test recall. It tests applied reasoning: given a clinical or technical scenario, can you identify the relevant physics, apply it correctly, and arrive at the right answer with the right units. CRQs are written in stages for this reason. Stage one might ask for a definition (recall); stage two asks for the mechanism (application); stage three asks you to predict an outcome (synthesis). Marks are weighted toward the later stages.

If you spend your first three months on cards alone, you will be confident going in and brittle on the day. Build the cards, but pair every cluster of cards with at least one CRQ-style scenario that forces you to combine three or four facts into a coherent answer. Do this from week one, not from month five. The candidates who walk out of the Physics paper feeling steady are the ones who practised assembling answers under time pressure for months, not the ones who memorised the most facts.

What to do in the final two weeks

The last fortnight is about consolidation and exam-day fitness, not new content. Stop reading new study notes by the start of week minus two. Focus on three things: spaced repetition flashcards through the highest-yield areas above, two timed mock papers (one Physics, one Anatomy), and image label drills. Sleep is the most underused exam-prep tool in radiology training; trainees who arrive on the day having slept properly for the past week consistently outperform their mock results, while those running on caffeine and broken sleep underperform theirs. Eat on the morning of the exam. Re-read the candidate handbook for your specific centre. Check the RANZCR site one more time for any late communication about your sitting; venue changes and timing tweaks happen.

How PRIMEX helps

• SAQ and CRQ grader. Write a constructed-response answer to a Part 1 physics scenario, get tier-graded feedback against a marking rubric that calls out missing units, missing values and missing mechanism explanations. Try the public version at primexstudy.com.au/grader before you commit to a subscription
• Curriculum tracker mapping all 169 LOs. Every LO from sections 2.1, 2.2, 2.3 and 4.1 to 4.6 is mapped to its corresponding study notes and flashcards on the RANZCR Part 1 landing page. Tick LOs off as you cover them; progress saves locally
• Ask PRIMEX. Targeted question answering grounded in the RANZCR curriculum content; ask "explain the difference between CTDI vol and CTDI weighted" or "what is the SAR in this scenario" and get a structured answer with the equations
• Anatomy identification practice. Image label drills across all six body regions (Brain, Head/Neck, Spine, Thorax, Abdomen/Pelvis, Limbs) using questions that require precise anatomical nomenclature, in proportion to the exam blueprint

Frequently asked questions

Related study guides

• RANZCR Part 2 2026 Study Guide
• RCPA Anatomical Pathology 2026 Study Guide