How to Prepare for the RANZCR Clinical Radiology Part 2 Exam in 2026: What You Actually Need to Know

A practical guide for RANZCR clinical radiology trainees sitting the Phase 2 (Part 2) examination in the next twelve months. PRIMEX started in 2025 when an anaesthetic trainee at a regional NSW hospital built study tools for the ANZCA Primary. It now covers 21 Australasian specialty exams because trainees from each specialty asked us to build for them. The RANZCR Clinical Radiology Part 2 Exam curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

The exam at a glance

The RANZCR Clinical Radiology Part 2 (Phase 2) Examination sits at the back end of training. Most trainees attempt it in the final years of the five-year RANZCR clinical radiology pathway, after passing Part 1 (Anatomy and Applied Imaging Technology) earlier in training. Part 2 is the diagnostic and reporting examination. Part 1 tested anatomy and physics in a controlled written format. Part 2 tests whether you can hold a film up, describe what you see, give a sensible differential, and recommend the next step under pressure across every domain of clinical radiology. Pass all four components and you complete the fellowship requirements. Fail and you re-sit at the next available diet, with the candidate report as your roadmap.

The single biggest difference from Part 1 is the breadth of clinical reasoning required. Part 1 rewards depth in anatomy and a controlled set of physics principles. Part 2 rewards a structured approach to images you have never seen before, in domains as different as paediatric chest, breast MRI, neuro stroke imaging, and interventional procedural planning. The question is not "do you know the anatomy" but "can you report this case, justify your differential, and tell the referring clinician what to do next".

Format

• Pathology Written Paper: 3 hours, 100 MCQs and 10 SAQs (six marks each) covering applied pathology as it relates to radiology. PMQs (Pictorial MCQs) embedded in the MCQ section since 2024. Cell injury, neoplasia, inflammation, vascular pathology, and metabolic disease are tested through their radiological correlates rather than as histopathology in isolation
• Radiology MCQ Paper: 2 hours, 100 single-best-answer MCQs across all clinical domains, no negative marking. Pattern recognition, appropriate next investigation, and management decisions feature heavily
• Case Reporting Examination: 3 hours, 35 image-based cases scored across short (3 marks, 20 cases), medium (6 marks, 10 cases) and long (12 marks, 5 cases). Entirely image-dependent: X-ray, CT, MRI, ultrasound, mammography, fluoroscopy
• OSCER: 7 stations, 25 minutes each, run over 2 days. Domains: Thoracic and Cardiovascular, Neuroradiology and Head and Neck, Abdominal, Musculoskeletal, Breast, Obstetrics and Gynaecology, Paediatrics. Two examiners per station, approximately 8 cases per station. All 7 stations must pass independently
• All three written papers must pass before OSCER access is granted. Components are not compensable across each other. If 1 to 2 OSCER stations fail, only those need resitting at the next sitting

Sittings and timing

• Two examination diets per year, traditionally one in the first half of the calendar year and one in the second
• The written components run on dedicated paper days; the vivas and OSCER are scheduled across separate days at the host institution
• Result release follows a structured timeline set by the college; check the RANZCR Trainees portal for the current diet
• Re-sit at the next available diet if you are unsuccessful in any component, with the candidate report telling you which component failed and which were borderline
• As of 2026, check the RANZCR website for current dates, host centres, and any diet-specific changes before locking in your study plan

Pass marks and standardisation

RANZCR uses standard-setting against the candidate cohort and the marking schedule rather than a fixed percentage cut score. The college does not publish a standardised numerical pass mark for the Part 2 exam in the way some colleges do. Recent first-attempt pass rates for the full Part 2 examination sit broadly in the seventy to eighty percent range in published cohort data, but the figure varies by component and by diet, and the cohort is small enough that single-sitting numbers move year to year. Treat any single quoted figure as approximate. The college publishes a candidate report after each diet that breaks down performance by component and domain. That candidate report is the most useful document you will read in the re-sit cycle, because it tells you which domains cost you marks rather than guessing.

Day-of logistics

• Photo identification required, usually a current driver licence or passport
• The Pathology, Radiology MCQ, and Case Reporting papers are delivered in dedicated test rooms, with the Case Reporting paper requiring structured typed reports against displayed images
• Vivas are held face-to-face at the host centre with two examiners per station, working through 8 to 10 cases per station in 25 minutes
• OSCER stations rotate by bell, so timing discipline at the station level matters as much as content knowledge
• No personal materials at the desk: no phone, no smartwatch, no paper reference cards, no own pens. Bathroom breaks are escorted and the clock keeps running
• Reading time is built into the case duration in the case reporting paper, not added on top, so train at exam pace from the first practice case you write

What the college actually tests

The PRIMEX RANZCR Part 2 curriculum holds 171 mapped learning objectives drawn from the RANZCR Clinical Radiology Learning Outcomes (Version 1.3, January 2024). The structure follows the published Phase 2 syllabus: Pathology (Section 5.1, 13 LOs), Diagnostic Radiology across all clinical domains (Sections 6.1 to 6.10, 105 LOs), and Procedural Radiology (Sections 7.1 to 7.11, 53 LOs). The breadth is the point. The Part 2 paper is engineered to test reporting and management across the entire scope of clinical radiology, not depth in any single sub-specialty, so a trainee who neglects breast, paediatrics, or interventional will find a paper that punishes them.

The seven clinical domains plus pathology and procedures

The mapped sections in the PRIMEX curriculum file cover Thoracic and Cardiovascular, Abdominal, Neuroradiology and Head and Neck, Musculoskeletal, Paediatrics, Breast, and Obstetrics and Gynaecology, with applied Pathology and Procedural / Interventional Radiology integrated through the same case material. Each domain holds between roughly five and thirty-six learning objectives, with the largest sections being General Diagnostic Radiology (36 LOs) and Procedural Consent and Image-Guided Intervention (36 LOs). Topic-level reviews link through to study notes, structured case practice, MCQ generation, viva simulation, and the flashcard pool.

The highest-yield areas to anchor your study

Thoracic and cardiovascular imaging

• Lung cancer staging on CT and PET-CT, including TNM 8th edition descriptors, mediastinal nodal stations, and the imaging features that change resectability
• Interstitial lung disease patterns: UIP, NSIP, DIP, and the differential between idiopathic pulmonary fibrosis and connective tissue disease related ILD on HRCT
• Pulmonary embolism on CTPA, RV strain markers, and the limits of CTPA in the borderline patient with a non-diagnostic study
• Aortic pathology including dissection (Stanford A and B), penetrating ulcer, intramural haematoma, and post-treatment follow-up of TEVAR and open repair
• Solitary pulmonary nodule assessment under the Fleischner Society 2017 guidelines, with separate pathways for solid, part-solid, and pure ground-glass nodules
• Mediastinal mass localisation by compartment, the four Ts of the anterior mediastinum, and the imaging features that distinguish thymoma from lymphoma from germ cell tumour

Abdominal and pelvic imaging

• Liver lesion characterisation on multiphase CT and MRI: HCC under LI-RADS v2018, FNH versus adenoma, hypervascular metastases, haemangioma, and the role of hepatobiliary contrast agents
• Pancreatic adenocarcinoma staging including resectability criteria, vascular involvement, and the differential of cystic pancreatic lesions (IPMN, mucinous cystic neoplasm, serous cystadenoma)
• Acute abdomen approach: appendicitis, diverticulitis, perforation, and the structured CT report that gives a surgeon a decision rather than a description
• Bowel obstruction differentiation between mechanical and ileus, transition point identification, and the imaging features of strangulation that escalate to operative management
• Renal mass characterisation under Bosniak v2019 for cystic lesions and standard reporting for solid renal masses, including RCC subtypes and the angiomyolipoma fat sign
• Rectal cancer staging on MRI: T-stage relative to the mesorectal fascia, extramural vascular invasion, mesorectal nodal involvement, and the criteria that change neoadjuvant therapy decisions

Neuroradiology and head and neck

• Acute ischaemic stroke imaging including non-contrast CT signs, ASPECTS scoring, CT perfusion criteria for thrombectomy, and the DWI-FLAIR mismatch in the unwitnessed onset patient
• Intracranial haemorrhage classification by location, the imaging predictors of expansion, and the differential of non-traumatic subarachnoid haemorrhage
• Brain tumour grading and post-treatment imaging: glioma grading on MRI, glioblastoma versus solitary metastasis, and pseudo-progression versus true progression after radiotherapy
• Demyelination on MRI: the McDonald 2017 criteria, dissemination in space and time, and the differential of tumefactive demyelination from neoplasm
• Head and neck squamous cell carcinoma staging including perineural spread, retropharyngeal nodal involvement, and the imaging features that change surgical planning
• Thyroid nodule reporting under ACR TIRADS (TR1 to TR5) with FNA size thresholds, and the imaging features that suggest medullary or anaplastic thyroid cancer

Musculoskeletal radiology

• Bone tumour assessment using the Lodwick grading of aggressiveness, periosteal reaction patterns, matrix mineralisation, and the age-based differential of common benign and malignant lesions
• Arthritis pattern recognition: erosive versus non-erosive, distribution, and the imaging features of seronegative spondyloarthropathies, gout, and CPPD
• Knee internal derangement on MRI: meniscal tear classification, ACL and PCL tears, articular cartilage grading, and the post-operative meniscal repair
• Rotator cuff and shoulder MRI: full versus partial thickness tears, tendinosis, biceps anchor pathology, and the labral tear nomenclature
• Stress fractures and bone marrow oedema: the differential of marrow oedema by location, the high-yield sites of stress injury, and the imaging features that distinguish stress fracture from infection
• Paediatric MSK including developmental dysplasia of the hip, Perthes disease, slipped upper femoral epiphysis, and the non-accidental injury pattern with classic metaphyseal lesions and dating of fractures

Breast imaging

• BI-RADS 5th edition lexicon and category assignment from BI-RADS 0 (incomplete) through BI-RADS 6 (biopsy-proven malignancy), with the management implications of each
• Calcification morphology and distribution: the BI-RADS descriptors, the calcifications that mandate stereotactic biopsy, and the high-yield mimics of malignancy
• Breast MRI for high-risk screening, problem solving, and the post-treatment breast: kinetic curve patterns, non-mass enhancement, and the implant rupture appearances
• The dense breast: supplemental imaging options, breast tomosynthesis, and the case for whole-breast ultrasound or contrast-enhanced mammography
• Axillary nodal assessment, including the imaging features that suggest involvement, and the role of pre-operative axillary ultrasound and biopsy

Paediatrics and obstetrics and gynaecology

• Neonatal chest radiology: respiratory distress syndrome, transient tachypnoea of the newborn, meconium aspiration, and persistent pulmonary hypertension
• Paediatric abdominal emergencies: intussusception (target sign on ultrasound, ileocolic versus small bowel only), pyloric stenosis on ultrasound, and malrotation with midgut volvulus
• Paediatric brain tumours by compartment, with the posterior fossa differential of medulloblastoma, pilocytic astrocytoma, ependymoma, and brainstem glioma
• First trimester ultrasound: viability criteria, ectopic pregnancy diagnosis, and the differential of pregnancy of unknown location
• Adnexal mass characterisation under O-RADS, with the ovarian features that mandate gynae-oncology referral and the limits of ultrasound for borderline tumours
• Placental abnormalities: placenta praevia, placenta accreta spectrum, and the imaging features that change delivery planning

Interventional and procedural radiology

• Consent for image-guided procedures: the structured consent conversation, complication rates, and the documentation that survives a coronial review
• Vascular access including tunnelled catheters, ports, and the complication rates of PICC lines and central venous catheters by site
• Hepatic intervention: TACE for HCC, TIPS indications and contraindications, hepatic biopsy in the cirrhotic patient, and the post-procedure surveillance pathway
• Biliary intervention including PTBD, internal-external biliary drainage, and the management of malignant biliary obstruction in the patient who is not a candidate for ERCP
• Drainage of intra-abdominal collections, the catheter size selection by collection viscosity, and the imaging features that escalate to surgical management
• Vertebroplasty and kyphoplasty indications, complication rates, and the cement leakage patterns that matter on post-procedure imaging

Common pitfalls that fail candidates

• Reporting in narrative paragraphs rather than a structured systematic format; the marking schedule rewards the candidate who organises an answer by perception, interpretation, diagnosis, and management, in that order
• Skipping the management recommendation because the diagnosis is the satisfying part to write; management sub-parts often carry the marks that separate a borderline candidate from a clear pass
• Quoting outdated reporting lexicons, particularly BI-RADS 4th edition rather than 5th, or LI-RADS v2014 rather than v2018, when the marking schedule was written against the current version
• Anchoring on a single diagnosis early in the case, ignoring the second-order findings that change the differential, and failing to update the report when the imaging shifts the answer
• Running long on the early cases and finishing the last two cases under-developed; case-by-case time discipline in the reporting paper is the single most reliable predictor of a finished paper
• Treating the OSCER as something to start preparing only after the written components, when most successful candidates are already practising station-format communication during the written run-up
• Defaulting to a metropolitan-protocol answer when the case stem is set in a remote or low-resource context; examiners write rural and outreach scenarios deliberately and reward candidates who adjust transfer timing, telehealth use, and consultant escalation accordingly
• Imprecise reporting language in the case reporting paper. Phrases like "some abnormality is noted" or "appearances are non-specific" lose marks the marking schedule was written to reward for precise descriptors of size, density, location, and morphology

Realistic study timelines

The right run-up depends on how much real reporting time you have already accumulated, how strong your sub-specialty exposure has been, and how heavy your clinical roster is during the study window. The plans below assume a working trainee on a normal full-time roster with on-call commitments, not a study-only year. Adjust honestly. If your week genuinely contains no protected hours, the four-month plan is not for you.

Nine-month plan, around 8 to 10 hours per week

• Months 1 to 3: read across the curriculum at a topic-a-day pace, building a one-page summary for every PRIMEX study note. Anchor each summary on a current ACR Appropriateness Criteria pathway or a RANZCR position statement rather than a textbook chapter
• Months 4 to 5: start writing untimed case reports, one per night plus a longer block on weekends. Focus on writing in marking-schedule format from the first case (perception, interpretation, diagnosis, differential, management)
• Months 6 to 7: shift to timed case reports at the case length implied by the marks (around five minutes for short cases, ten for medium, fifteen for long). Begin viva practice once a week per domain to keep the spoken format fresh
• Months 8 to 9: full mock case reporting papers at exam pace, then review against model answers. Re-loop on weak domains the candidate report from past diets has flagged. Run a viva block per week per domain
• Last two weeks: light retrieval practice using flashcards, no new content, sleep hygiene

Six-month plan, around 12 to 15 hours per week

• Months 1 to 2: rapid pass through the 171 learning objectives, reading the PRIMEX study note for each and tagging the topics where your clinical exposure has been thin. Map your weakest domains honestly, not the ones you wish were weak
• Months 3 to 4: untimed case reports each weeknight, structured to your weakest tag list first; weekend blocks for guideline reading on stroke imaging, lung cancer staging, breast BI-RADS, and rectal cancer MRI
• Month 5: timed case reports alternated with viva station practice in voice mode for the seven domains. Add two MCQ blocks per week, each twenty questions under timed conditions
• Month 6: two full mock case reporting papers in mock conditions, candidate report review, focused remediation on the bottom-three domains. Run two viva blocks per week, rotating domains

Four-month plan, around 18 to 22 hours per week

• Month 1: triage your weakest five domains, read the relevant study notes, and start writing two case reports per night without timing. Run one viva block per week
• Month 2: timed case reports every weeknight, weekend mock blocks of three to five cases at exam pace; introduce viva station practice three times a week, rotating domains
• Month 3: two full mock case reporting papers, candidate report review, second loop on weak domains with structured cases at exam pace. MCQ blocks four times a week
• Month 4: maintenance only. Light flashcards, sleep, and a final read-through of high-yield reporting lexicons (BI-RADS, LI-RADS, TIRADS, Bosniak v2019, Fleischner 2017, PI-RADS v2.1, O-RADS)

The single biggest mistake people make

The pattern that breaks competent candidates is leaving structured case reporting practice until the last six weeks. You spend month one through month four reading textbooks and watching teaching cases, you build a folder of beautifully organised notes by sub-specialty, and you tell yourself the writing will come once you have learned the content. It does not work that way. Writing a RANZCR Part 2 case report under time is a separate skill from knowing the radiology, and it is the only skill the marking schedule actually rewards. If your first timed case report is six weeks out from the paper, you spend the run-up rebuilding your writing speed instead of fixing content gaps. You sit the exam at the limit of how fast you can put a structured report onto the page, which is exactly when the marks haemorrhage on the medium and long cases at the back of the paper. Start writing case reports in month one. Rough, ugly, untimed reports are fine. The point is to make the format reflexive, so that on the day the radiology is the only thing you have to think about. The candidates who pass cleanly are usually the ones who wrote the most case reports, not the ones who looked at the most teaching cases.

How PRIMEX helps

• Case reporting grader: write a structured radiology report, get a sub-part-by-sub-part breakdown against the RANZCR marking schedule with model answers at examiner standard. Available inside the app and on the public SAQ grader for unauthenticated trial use.
• Curriculum tracker: all 171 mapped learning objectives are visible on the RANZCR Part 2 app page with progress tracking by section, so you can see at a glance which domains have been studied and which need attention.
• Ask PRIMEX: a question-and-answer interface that returns guideline-aligned answers across RANZCR, ACR, and Fleischner Society content, useful when you want a quick sanity check on a reporting decision or a differential.
• Seven-domain viva simulator with voice mode: domain-specific case stations across Thoracic and Cardiovascular, Abdominal, Neuro and Head and Neck, MSK, Paediatrics, Breast, and Obstetrics and Gynaecology, with examiner-style prompting and follow-up questions that mirror the real viva.

Worked topic deep-dives

Three high-yield topics drawn straight from the PRIMEX RANZCR Part 2 study notes. Each one is a teaser; the full note carries the complete imaging approach and reporting detail.

Aortic dissection

Aortic dissection is the most common nontraumatic acute aortic emergency, with in-hospital mortality of 20 to 25 per cent overall. An intimal tear lets blood enter the media, creating a false lumen separated from the true lumen by an intimomedial flap.

• The dissection propagates antegrade or retrograde, and the false lumen may stay patent, thrombose, recommunicate or rupture into the pericardial, pleural or peritoneal space.
• It sits within the acute aortic syndrome spectrum, overlapping with intramural haematoma and penetrating ulcer, which can be hard to distinguish.
• Hypertension and advancing age are the most common predisposing factors, with cystic medial degeneration in Marfan and bicuspid valve as key others.

How it is examined: the film reading expects recognition of the flap and false lumen and placement within the acute aortic syndrome spectrum. Common pitfall: mistaking a thrombosed false lumen for intramural haematoma without weighing the overlap.

Read the full note →

Thyroid and parathyroid scintigraphy

Nuclear medicine of the thyroid and parathyroid adds functional information to the anatomical data of ultrasound, CT and MRI, exploiting differential uptake and washout of specific radiopharmaceuticals.

• Tc-99m pertechnetate is the most widely used diagnostic agent but is not organified, so it does not reflect iodine incorporation when dyshormonogenesis is suspected.
• I-123 is preferred when organification must be assessed, for radioiodine uptake measurement, or for a pre-therapy scan, with a lower dose than I-131.
• Sestamibi imaging localises hyperfunctioning parathyroid tissue before minimally invasive surgery.

How it is examined: the paper tests matching the radiopharmaceutical to the clinical question and its limitations. Common pitfall: using pertechnetate to assess organification, which it cannot show.

Read the full note →

Deep vein thrombosis: endovascular diagnosis and treatment

Deep vein thrombosis is a significant source of morbidity through acute symptoms, the risk of pulmonary embolism, and post-thrombotic syndrome. The radiologist's role spans diagnosis and interventional therapeutics.

• Diagnosis is primarily by ultrasound, with catheter venography where indicated.
• Interventional options include catheter-directed thrombolysis, pharmacomechanical thrombectomy, balloon angioplasty and venous stenting.
• Catheter venography is a two-dimensional luminogram that may underestimate external compression or intramural pathology.

How it is examined: the paper expects the indications, contraindications and complications of the endovascular options. Common pitfall: over-reading a venographic luminogram and missing external compression.

Read the full note →

Frequently asked questions

Related study guides

• RANZCR Part 1 2026 Study Guide
• RCPA Anatomical Pathology 2026 Study Guide