RANZCR AIT common mistakes
RANZCR AIT · Understand the traps and how to avoid them.
Committing to a single diagnosis on a film before systematically checking all regions, so a second finding (e.g. a subtle pneumothorax, bone lesion, or missed second nodule) goes unreported.
Trainees under time pressure pattern-match to the most obvious abnormality and stop searching once a satisfying diagnosis is found; satisfaction of search is reinforced because practice cases often contain only one finding.
What to do instead
Use a fixed anatomical search sequence on every case (lines/tubes, airway, bones, cardiac, diaphragm, effusion, fields, gastric bubble, soft tissue) and dictate findings in that order before synthesising an impression; deliberately re-scan the whole image after forming the diagnosis.
Describing findings without localising them precisely (e.g. 'upper zone opacity' instead of naming lobe, segment, or relation to fissures and pleura).
Trainees focus on the character of the abnormality and treat localisation as obvious, but the examiner is assessing whether the candidate can translate 2D images into 3D anatomy, a core Phase 1 skill.
What to do instead
For every finding, state the lobe/segment, laterality, and relation to landmarks (fissure, hilum, pleura, diaphragm); practise by covering the report and reconstructing the lesion's position from the description alone.
Confusing the modality or sequence that actually answers the clinical question, e.g. recommending CT for a suspected acute cord compression or MRI for a suspected pneumothorax, or proposing contrast when it is contraindicated.
Candidates memorise lists of investigations per disease but do not anchor them to the clinical scenario, urgency, and patient safety constraints tested in Phase 1 protocol questions.
What to do instead
For each protocol question, state the clinical question, the fastest test that answers it, and any contraindication or safety check (renal function, pregnancy, pacemaker, allergy) before naming the study.
Missing secondary or 'review area' findings on CT and MRI because attention is fixed on the organ system named in the referral.
Phase 2 cases are often referred with a specific question, and trainees scroll quickly to that organ, neglecting the rest of the volume; the exam deliberately includes incidental but important findings.
What to do instead
Adopt a structured read for each body region (e.g. for staging CT: primary, nodes, liver, lungs, bones, peritoneum, complications) and verbalise a deliberate check of review areas before concluding.
Failing to synthesise findings into a ranked differential with the most likely diagnosis first, instead giving an unstructured list of possibilities.
Trainees fear being wrong and hedge with long lists, but Phase 2 marking rewards a prioritised differential justified by the imaging features and clinical context.
What to do instead
End every case with a one-line most-likely diagnosis, one or two alternatives with the discriminating feature that would favour them, and the next step; practise phrasing this in under 30 seconds.
Not reporting the pertinent negatives and their significance, e.g. omitting 'no free gas', 'no biliary dilatation', or 'no cord signal change' when these determine management.
Candidates describe what they see rather than what the referring clinician needs excluded; pertinent negatives require knowing the complications and mimics of the suspected diagnosis.
What to do instead
For each major diagnosis, list the complications and mimics that must be excluded on the available study and state them explicitly in the report; build a personal checklist per common diagnosis.
Giving a management recommendation that is not actionable or not matched to the findings, e.g. 'further imaging' without specifying which study, or recommending biopsy when the imaging is diagnostic and follow-up is appropriate.
Phase 3 assesses whether the candidate can act as a consultant; vague recommendations reveal a gap between image interpretation and clinical decision-making.
What to do instead
State the recommendation as a specific action with a timeframe and the reason it changes management (e.g. 'contrast CT abdomen within 24 hours to exclude abscess before drainage'); justify against local guidelines where relevant.
Ignoring the clinical information and previous imaging provided, so the report does not answer the question asked or fails to note that a finding is new, stable, or resolving.
Trainees treat the image as the whole task and skim the referral; comparison is time-consuming and under-rehearsed in practice.
What to do instead
Before interpreting, write the clinical question in one line and check prior studies; explicitly state interval change for every significant finding in the impression.
Poor communication and structure under viva conditions: rambling findings, using jargon without explanation, and not pausing to allow the examiner to redirect.
Candidates rehearse content but not delivery, so anxiety produces disorganised speech and lost marks for structure even when the interpretation is correct.
What to do instead
Rehearse a fixed scaffold aloud ('study, quality, findings by system, impression, differential, recommendation'), time each section, and practise with a colleague who interrupts with follow-up questions.
Overlooking technical adequacy and artefacts, interpreting a film that is rotated, under-inspired, or degraded by motion as if the findings were real, and not stating limitations.
Trainees assume provided images are diagnostic and skip the quality check; examiners include suboptimal studies specifically to test this.
What to do instead
Open every case with a 10-second quality statement (projection, rotation, inspiration, penetration, artefact) and qualify any finding that could be artefactual; if the study is non-diagnostic, say so and name the repeat study needed.