Reviewer: Douglas E Pfeiffer, MS (Boulder Community Hospital)
Description: The Royal College of Radiologists in the United Kingdom is responsible for setting the curriculum for its two specialties (clinical radiology and clinical oncology) and assessing the learning outcomes of the curricula. Competency is demonstrated through an examination process. Demonstration of competency in all stages of the program leads to the award of Fellowship of the Royal College of Radiologists (FRCR). The written exam has a format of 40 multiple choice questions (MCQs), each of which comprises a stem, which is a question or a statement, followed by five response options. Each option may be true or false and there is no restriction placed on the number of true or false options. This book follows the same format. Part one is a set of nine tests with 40 questions in each; part 2 is an answer key with short explanations.
Purpose: This is a study guide for those preparing to sit for the physics module of the first FRCR examination in clinical radiology. The FRCR exam is based primarily on Farr's Physics for Medical Imaging, 2nd edition, Allisy-Roberts (Elsevier, 2008), which is probably the best preparatory book and is one of the references for this work. Other similar study guides are available, both online and in print, but some are outdated due to recent changes in the exam syllabus.
Audience: The audience is those sitting for the physics module of the first FRCR exam. While based in the U.K., the FRCR is taken by many radiologists in other countries to augment their certifications. Given the content and structure of the book, it will serve as a good study guide for these individuals as an adjunct to more complete physics books, such as Farr's.. Beside their clinical, research, and academic interests, the authors are involved in the FRCR examination process at different levels. They therefore have good insights into the structure and content of the examination.
Features: The structure of the book is straightforward. The first part is a set of nine examinations of 40 questions each in the FRCR exam style. Each question is answered in the second part, with a brief explanation of why the statement was true or false. The questions exactly follow the syllabus of the examination regarding the topic of the question and the number of questions in each topic. The depth and breadth of the questions in the syllabus structure are very good. The book suffers from a few problems, however. First, there are numerous grammatical and typographical errors. The grammatical errors can be distracting and make it difficult to understand the question without reading it several times. Perhaps it is a feature of the actual FRCR exam, but the authors make statements in absolutes where, in reality, the physics is more nuanced. For example, it is stated that DNA damage leads to cell death, which, if literally and solely true, would greatly reduce concerns about health effects. It is the cells that are not killed but have DNA damage that present the majority of stochastic effects. Context is important. A second example is the repeated assertion that increasing pitch reduces patient dose. This is only true if all other technical factors are held constant. This was true for the first helical scanners, but almost all modern scanners now adjust mAs automatically to compensate for changes in pitch. Pitch is used for controlling artifacts or reducing scan time, but not affecting dose. The book also struggles with errors. For example, one item, regarding MRI, states that "FLAIR stands for fluid-attenuated inversion recovery." In part 2, the answer reads "False. FLAIR stands for fluid-attenuated inversion recovery." Clearly, the answer is true. In another test is the statement "Gamma ray - has a lifetime of several years." In part 2, the answer is "True. The half-life of 60Co is 5.27 years." One does not usually speak of the lifetime of a gamma ray, and the answer explanation has little to do with the exam question. In another test, it is stated that 99Mo has a half-life of six hours, whereas it is actually 66 hours.
Assessment: This book presents nine sets of 40 multiple-choice questions following the format and content specifications for the physics module of the first FRCR examination in clinical radiology. The questions in part 1, while suffering from grammatical and typographical errors, present an excellent opportunity to get a feel for the actual exam and to identify readers' strong and weak points. While the answers in part 2 have potentially helpful explanations, the errors may give readers pause in accepting them at face value, leaving them to seek confirmation or further information, as few references are presented in the book. Other options, such as First FRCR in Physics (https://www.onexamination.com/exams/radiology/first-frcr-physics#QuestionBrowser) and the book, MCQs for the First FRCR, Vardhanabhuti et al. (Oxford University Press, 2010), offer a similar approach of questions and answers with explanations.