The Long Cases / Reporting Section
The purpose of the Long Cases (officially known as “Reporting”) section of the FRCR exam is to test a candidate’s ability to rapidly assess multiple radiological studies of different modalities, spot the findings, and interpret them within the clinical context provided. The candidate then writes an answer that demonstrates their ability to properly structure and word a radiology report, and provide a recommendation to guide further management.
Report and Findings Format
The report format is broken up into sections as follows:
Observations / findings:
This is where you write down all the relevant findings in all of the provided imaging modalities of the case in question. Pathological findings need to be adequately described. This section tests your observational skills; strengthen them by practicing looking for all of the findings in a given study under time pressure. Once you have found the pathology, look for related or associated pathological findings. Knowledge of patterns of disease and associations is key to scoring a high mark. Mention the negative findings where appropriate. For example, if you have found a primary tumour, search for adjacent enlarged lymph nodes. If there are none, mention that as a negative finding.
It is recommended in this section that, when you are presented with a plain film and a cross-sectional study, to look at the cross-sectional study first. This will often give you insight as to what is abnormal on the plain film.
Remember, when describing a pathological finding, keep it concise. For example, rather than giving exact measurements, use words like ‘small,’ ‘medium’ or ‘large’. Rather than saying ‘mostly hyperintense with some small areas of hypointensity and a central iso-intense region,’ just say ‘heterogeneously hyperintense.’ Brevity is your friend in the long cases.
The trick is to briefly mention all of the positive and relevant negative findings, and move on. If you are going for a 7+ answer and you are doing very well for time, you may list some incidental findings (normal variants, simple renal cysts, cholelithiasis). Otherwise, do not waste precious time on such findings; you can always come back and mention them once you have solved all of the other cases.
In this section, you are describing the relevance of the findings: are they benign or malignant? Inflammatory or neoplastic? Infectious or autoimmune? Aggressive or non-aggressive? While reasons should be given as to how you have arrived at this conclusion, do not get too hung up over wording / stating this. If you have adequately described a lesion as having malignant/ benign characteristics, it is only logical that you will interpret it as such. Observations and interpretations may be combined in the same section, and this is accepted by the College. Whatever you do, do not repeat what you have written in the previous section as this will annoy the examiners and waste your time.
In most of the cases the College provides, there will be a single diagnosis that is the best fit. You should try to figure out what that is and enter it here. If you cannot think of a single diagnosis that fits best, then list the differential diagnoses with the most likely at the top.
List 1 – 3 diagnoses that are appropriate in the given case. In most cases, one or two differentials are sufficient. Do not list more than three, as the additional diagnoses are unlikely to be appropriate. In a few specific cases, the appropriate answer here would be ‘none.’ This is preferable to leaving the section blank, as it shows the examiner that you have thought of other possible diagnoses, and do not think that any of them fit in this case.
As a clinical radiologist, you are expected to be familiar with the greater management process of a given case. In this section, you are expected to recommend, when appropriate, additional investigations (both radiological and non-radiological), multi-disciplinary meetings, or urgent treatment by the physician / interventional radiologist.
We hope you have found these Tips and Tricks on the breakdown of the answer structure helpful. Feel free to contact us with any questions or observations.
The FRCR Longs Team