Syllabus for First FRCR Examination

INTRODUCTION

It is intended that the syllabus should be delivered through approximately 30 hours of formal physics teaching. For those undergoing specialist training in the UK, this would usually be scheduled over an eight week period starting in early October with the intention that trainees sit the First FRCR Examination at the Winter sitting in early December. Further elements of physics, as detailed in the syllabus for the Final FRCR Examination, should be taught later in the first year of training.

AIMS

The aim of the examination is to ensure that candidates have a sound knowledge of the basis of physics related to diagnostic imaging. This includes a detailed understanding of the principles of diagnostic imaging equipment and the properties of diagnostic images. Candidates should be able to describe the factors affecting image quality and patient dose and be able to use equipment correctly. When linked with their subsequent radiology training, this will enable safe and effective application of medical diagnostic imaging techniques for the benefit of patients. Furthermore, within the current UK framework for radiation protection of staff and patients, candidates will understand the basis for radiation protection guidance and have the knowledge to enable them to act as qualified practitioners within the remit of the UK legislation.

OBJECTIVES

The candidate should be able to demonstrate an understanding of

• the structure of the atom, the types of radiation and the modes of radioactive decay
• the important electron and photon interactions with matter and state how they vary with energy and properties of the material
• attenuation in terms of absorption, scatter, HVL, and understand the inverse square law
• the basic physics of the production of x-rays
• radiation quantities and units: activity, Kerma, absorbed dose, equivalent dose, effective dose and the relationships between these quantities
• the biological effects of radiation on tissue
• stochastic and deterministic effects of radiation
• radiation risk, risk values and understand how factors such as age affect these values
• the concept of radiation risk from medical exposures to patients
• the requirements for the protection of staff and members of the public arising from their use of radiation and the extent to which they are responsible for safety within the overall radiation protection framework
• the UK regulations governing the medical exposure of an individual and of their own and other people’s responsibilities
• their own responsibilities regarding the restriction of the environmental impact of their use of radiation
• measures of image quality
• the basic physics of image receptors
• the physics of CT imaging with particular reference to factors affecting image quality and dose
• nuclear medicine physics with particular reference to factors affecting image quality and dose

SYLLABUS

1. Fundamental Physics of Matter and Radiation
   1. Basic Physics

      Fundamental properties of matter and radiation decay
      Interactions of ionising radiation with matter, including contrast agents

   2. Radiation Hazards and Dosimetry

      Biological effects of radiations
      Risks of radiation
      Principles of radiation protection
      Kerma, absorbed dose, equivalent dose, effective dose and their units

2. Practical Radiation Protection
   1. General Radiation Protection

      General radiation protection
      Radiation protection of the patient including pregnancy, infants and children
      Radiation protection of staff and members of the public
      Use of radiation protection devices

3. Statutory Requirements and Non-Statutory Recommendations
   1. Ionising Radiations Regulations 1999

      Responsibility for radiation safety
      Local rules and procedures
      Role of radiation protection adviser and radiation protection supervisor
      Classified workers
      Restriction of exposure (through design, systems of work and ppe)
      Dose limits
      Equipment used for medical exposures
      Notification of incidents
      Dose constraints for comforters and carers
      Routine inspection and testing of equipment
      Notification of incidents

   2. Ionising Radiation (Medical Exposure) Regulations 2000

      Responsibilities of referrer, operator, practitioner, employer and medical physics expert
      Patient identification and consent
      Dose recording and diagnostic reference levels
      Adequate training and local entitlement
      Employer procedures
      Quality assurance programmes, clinical evaluation of exposure and clinical audit
      Notification of incidents
      Research exposures, including ethics committees and dose constraints
      Health screening

   3. Other relevant legislation
      • Medicines (Administration of Radioactive Substances) Regulations 1978
      • Radioactive Substances Act 1993
4. Diagnostic Radiology and Radionuclide Radiology
   1. General Principles

      Projection and tomographic images
      Analogue and digital images
      Image display
      Image quality, including contrast, spatial resolution and noise

   2. X-Ray Production and Radiology

      Production of x-rays
      General and mammographic x-ray equipment
      Film-screen radiography
      Digital and computed radiography
      Factors affecting radiation dose and image quality

   3. Fluoroscopy and Fluorography

      Image intensifiers and digital detectors
      Operator controlled variables
      Measurement of image quality
      Factors affecting radiation dose and image quality

   4. Computed Tomography

      Basic physics of CT
      Factors affecting radiation dose and image quality

   5. Patient Dosimetry

      Methods
      Diagnostic reference levels, including high dose techniques
      Magnitude and measurements

   6. Radionuclide Imaging

      Fundamentals of the gamma camera
      Properties of radiopharmaceuticals
      Factors affecting radiation dose and image quality
      ARSAC
      Radiation protection requirements for

      • Handling of radionuclides
      • Conception, pregnancy and breastfeeding
      • Arrangements for radioactive patients
      • Keeping of radioactive substances
      • Disposal of radioactive waste

EXAMINATION STRUCTURE

• The examination is held three times a year – normally in the second week of March, June and December.
• Candidates are restricted to a maximum of three attempts at the examination.
• No minimum period of clinical experience or clinical radiology training needs to have been completed in order to enter the examination nor is confirmation of course attendance required. The application form does not require the signature of the head of the candidate's training scheme.
• The examination comprises a single paper of 25 multiple choice questions, which is of 1¼ hours in duration.
• Candidates are able to sit the examination at five UK venues (Birmingham, Bristol, Edinburgh, London and Manchester) and three non-UK venues (Dublin, Hong Kong and Singapore).
• Candidates who made 1-3 unsuccessful attempts at the First FRCR Examination prior to the introduction of the current format (including attempts at examinations that granted exemption from it – details of which can be found separately in the document Regulations for the Examination) are permitted up to three attempts at the current format examination. Candidates who made four unsuccessful attempts at the First FRCR Examination prior to the introduction of the current format examination at the Winter 2002 sitting (including attempts at examinations that granted exemption from it) are not permitted to enter the current format examination.
• No exemption is granted from the First FRCR Examination on the basis of success in any other examination.