FRCR 2B (CR2B) is the final hurdle of the Fellowship of the Royal College of Radiologists, and it tests something different from the written papers: whether you can look at images and report them safely, quickly and clearly. These are the FRCR 2B tips we give our own trainees for the new-format exam that started in June 2025.
The FRCR 2B format (since June 2025)
| Component | What happens | Time |
|---|---|---|
| Short case reporting | 25 plain radiographs: write short statements of your observations, diagnosis and recommendation. Normal films are not included; facial bone and spine films may appear (counted as MSK). | 120 minutes |
| Long case reporting | 6 cross-sectional cases (CT, MRI, ultrasound or nuclear medicine), typed under set headings. | 75 minutes |
| Oral | 12 cases over two sessions. Each session has a pair of examiners and each examiner shows three cases. You cannot go back to a previous case. | 2 sessions |
The rapid reporting session of the old exam has gone. Every candidate now sits the new format, whatever their previous attempts, and the RCR says the standard needed to pass has not changed. Short and long cases are double-marked, and in the oral, communication is scored per session and weighted to count as much as each of the other skill domains. Read the RCR's own candidate guidance and sample cases before you book.
Short cases: 25 films in 120 minutes
That is almost five minutes per film, which sounds generous until you meet a subtle fracture. The key change from the old exam is that every film is abnormal, so if you see nothing, keep looking.
- Check the basics first: patient age (paediatric or adult), projection, side markers and any second view.
- Look at the obvious, then the review areas. Satisfaction of search is the commonest reason for dropped marks.
- Write short, specific statements: "Displaced fracture of the scaphoid waist. Refer to orthopaedics/fracture clinic."
- Always give a recommendation that fits the finding: further view, CT, urgent referral or follow-up.
| Region | Review areas and classic misses |
|---|---|
| Chest | Apices (Pancoast, pneumothorax), behind the heart (left lower lobe collapse), hila, below the diaphragm (free gas), bones (rib metastases), lines and tubes |
| Wrist and hand | Scaphoid, lunate/perilunate dislocation, base of thumb (Bennett), carpometacarpal dislocations |
| Elbow | Fat pads, radiocapitellar line, anterior humeral line, ossification centres in children (CRITOE) |
| Shoulder | Posterior dislocation (lightbulb sign), Hill–Sachs, acromioclavicular joint |
| Pelvis and hip | Shenton's line, pubic rami, sacral foramina, slipped upper femoral epiphysis (Klein's line), avulsions in adolescents |
| Knee and ankle | Lipohaemarthrosis, Segond fracture, tibial plateau, base of fifth metatarsal, Lisfranc alignment, talar dome |
| Abdomen | Free gas (Rigler's sign), bowel obstruction, volvulus, calcification, foreign bodies |
| Paediatrics | Foreign bodies, non-accidental injury patterns, round pneumonia, intussusception, developmental hip dysplasia |
Long cases: 6 cases in 75 minutes
That is 12 to 13 minutes per case. Your report is typed under headings covering observations, interpretation, principal diagnosis, differential diagnosis and further management. The commonest way to fail long cases is spending 25 minutes on one beautiful report and rushing the last two.
- Set a timer per case and move on at 13 minutes, even if you are not finished. You can return if time allows.
- Lead with the key finding. "There is a 4 cm enhancing mass in the head of the pancreas with biliary dilatation" scores before a tour of normal organs.
- Use relevant negatives that change management: no liver metastases, no vascular encasement, no free fluid.
- Commit to one principal diagnosis, then give a short, sensible differential, not a list of ten.
- Management should be specific: MDT discussion, tissue sampling route, staging investigation or urgent referral.
The oral: 12 cases, two sessions
The oral now runs on the RCR's online platform. Examiners assess observation, interpretation, management and communication. Communication counts as much as each of the other domains, so how you speak matters.
- Describe, then interpret: "This is an axial contrast-enhanced CT of the abdomen. The abnormality is in the right kidney…"
- Give a diagnosis early. Examiners cannot reward a correct answer you never say.
- If you don't know, reason aloud: location, density or signal, enhancement, and what fits the patient's age.
- Say what you would do next: "I would discuss this with the referring team today and recommend CT angiography."
- Don't dwell on a bad case. You cannot return to it, and the next case is a fresh start.
A 12-week FRCR 2B plan
| Weeks | Focus | Daily habit |
|---|---|---|
| 1–3 | Chest and MSK radiographs, review areas | 20 plain films a day with written one-line reports |
| 4–6 | Long cases: body CT, neuro, MSK MRI | Two timed long cases a day under the exam headings |
| 7–9 | Paediatrics, abdomen films, nuclear medicine, ultrasound | Present 5 cases aloud to a colleague or consultant |
| 10–12 | Full mock exams and weak areas | One full timed short-case set and one long-case set every 3–4 days |
CR2A knowledge underpins the oral, so keep doing a few SBAs a week. Our FRCR 2A guide and the complete FRCR exam guide cover dates, fees and international venues, including Pakistan.
Frequently asked questions
What is the FRCR 2B exam format now?
Since June 2025, CR2B has short case reporting (25 radiographs in 120 minutes), long case reporting (6 cross-sectional cases in 75 minutes) and an oral of 12 cases over two sessions. Rapid reporting is no longer part of the exam.
Are there normal films in FRCR 2B short cases?
No. The RCR states normal radiographs are not included in the short case reporting component, so every film has an abnormality.
How long should I prepare for FRCR 2B?
Most candidates need 3–6 months of regular reporting practice after passing CR2A, with timed long cases and oral practice in the final 6–8 weeks.
Can I sit FRCR 2B in Pakistan?
The RCR has offered CR2B at international venues including Pakistan, India and Egypt. Check the RCR website for the venues and booking windows of your sitting, as international places fill quickly.
Exam format from the Royal College of Radiologists: CR2B changes and guidance, checked November 2026.