The content on this page has been obtained from the official FRCR Physics syllabus, which can be accessed here.
Matter and Radiation
| Content | Examples of Expected Knowledge |
| Structure of matter, the atom and the nucleus Interaction of electrons and photons with matter | Understand basic atomic structure, including electron shells & energies. –> Atomic Structure Atomic Structure Atomic Mass, Atomic Number, Electronvolts Nature and properties of charged particle and electromagnetic radiation –> Electromagnetic Radiation Understand how ionizing radiation interacts with atoms and molecules, especially those in human tissues. –> Interaction of Photons with Matter Interaction of photons with matter over energy range 10 keV to 1 MeV –> Interaction of Photons with Matter Have knowledge of the photoelectric and Compton interactions, including the likelihood depending on photon energy and the atomic number of the atoms in the matter. –> Photoelectric Effect Compton Scatter Probability of Interaction – Principles Probability of Photoelectric and Compton Interactions Electron energy in solids –> Interactions of Electrons with Matter Understand how electron energy is dependent on the elements of matter and the physical form of that matter. |
| Filtration of x-ray beams | Understand the spectrum of energies in x-ray production and how and why the energy distribution might be changed by materials placed in the primary beam in order to improve image quality and/or reduce patient radiation exposure –> Tube Potential, Filtration and the X-ray Spectrum Molybdenum Target and Filter |
| Nuclear stability | The combination of protons and neutrons have a direct implication on whether a nucleus is stable and how that relates to radioactive decay. –> Introduction to Radioactivity Radioactive Transformations |
| Mechanisms of radioactive transformation | Isomeric transition Electron capture –> Electron Capture Beta emission Alpha emission Gamma ray emission –> Alpha, Beta, Gamma Emission Characteristic x-rays –> Interactions of Electrons with Matter The X-ray Spectrum |
| Nuclear energy states and gamma emission | Energy levels within nuclei and the implications for the energies of gamma rays emitted by clinically used radionuclides. –> Alpha, Beta, Gamma Emission Emission Energies Applications of Radioactive Transformation |
| Activity and radioactive decay | Understand the definition of activity and how it is measured. –> Measuring Radioactivity Measuring Radioactivity Understand physical, biological and effective half-lifes and how these factors relate to patient dose. –> Absorbed and Effective Dose |
| Background radiation | Have knowledge of background sources of radiation. –> Natural Radiation |
| Artificial radionuclides and their production | How radionuclides are produced using: –> Radionuclide Production Cyclotrons –> Cyclotron Fission products –> Fission Products Nuclear Fission Generators and elution –> Radionuclide Generators |
| Radiopharmaceuticals and their production | How radionuclides are incorporated into clinically useful molecules. Shelf life, quality assurance. –> Radiopharmaceuticals Radiopharmaceutical Quality Control |
Common themes for multiple imaging modalities
| Content | Examples of expected knowledge |
| Structure of images | Pixels and voxels Bit depth, windowing and dynamic range Greyscale and colour images Multimodal images and colour overlays |
| Image quality | Understand and recognise issues with the following · Signal to noise ratio (SNR) · Contrast · Resolution (spatial/temporal) · Artefacts Understand the differences between acquired spatial resolution and reconstructed spatial resolution, and common reasons for this. Understand how different acquisition parameters are interrelated and how changing one impacts on others, e.g. in MR how SNR, spatial resolution and acquisition time are interrelated. Recognise the appearance of common image artefacts and understand their causes. |
| Signal processing, image reconstruction and reformatting | Nyquist sampling Image registration Image post-processing Understand the concepts of · Multiplanar reformats · Curvilinear reconstructions · maximum intensity projections · minimum intensity projections · surface and volume rendering |
| Quality assurance | Understand the role of acceptance testing of new imaging equipment, technology and software, including artificial intelligence. Understand the importance of QA as part of an imaging service and any regulatory implications. Have a knowledge of QA recommendations from manufacturers and professional bodies guidance Have an awareness of accreditation schemes such as Quality Standard for Imaging (QSI) |
| Management of radiological imaging | Understand concepts of · DICOM and image metadata · Image compression (lossless and lossy) and implications of this · anonymisation & encryption · Image consistency between different display units · Display monitor requirements for viewing diagnostic images Understand the role and concepts of · PACS (Picture Archiving and Communications Systems) · RIS (Radiology Information System) · Teleradiology |
Radiography & Fluoroscopy
| Content | Examples of expected knowledge |
| Construction, function and operation of computed and digital radiographic systems | Gain a knowledge and appreciation of physical and engineering components and processes involved in the production of radiographic images Understand the impact of changing basic exposure factors – kVp, mA, time, mAs – on the x-ray beam, the patient dose and image quality |
| X-ray tube and x-ray beam | Understand why specific components are used in the production of x-rays (dependent on the radiographic modality) and how the primary beam is delineated. Understand how heat is generated and dissipated from the ray anode and the limitations in clinical imaging. Understand the effect of filtration on the X-ray beam, image quality and patient dose. Awareness of common materials used and the reasons for their selection. |
| Image receptors for computed and digital radiography | Have a knowledge of the materials, structure and function of the image receptors. Understand how a latent image is produced and retrieved for computed radiology and the device in which the image is first held. Understand how the image is read and initially stored by digital radiology systems. |
| Scatter rejection | Understand the use of grids, x-ray energy, air gaps can reduce the impact of scattered radiation in images. Have a knowledge of the practical use and construction of grids, including; moving or stationary, grid ratio, grid lines per cm and materials used. How to use kV/mA dose curves, the grid, collimation, magnification and/or compression in order to reduce the effect of scatter on image quality. |
| Contrast media – iodinated, barium and air | The physical nature of contrast materials and the interaction of x-rays relative to patient tissues gives an understanding of their uses. |
| Dual energy radiography | Understand how two energy spectra are created and used to measure bone density and what the systems might look like. |
| Mammography | Understand the specific anode angles, anode materials, filtration, grid, exposure settings and collimation, etc. used to gain the maximum contrast within radiation sensitive soft tissue. |
| Radiographic tomography and tomosynthesis | Understand how these systems can increase soft tissue contrast by using tomography. |
| Construction, function and operation of a fluoroscopy system | Understand the concept of a c-arm (or equivalent) and the use of Automatic Brightness Control and Automatic Exposure control (with kV/mA dose curves). kV/mA dose curve selection and setting. Know the difference between fluoroscopy and fluorography and the image quality/dose implications. Understand how automatic brightness control works and how best to use the system with and without contrast or in the presence of bone and/or soft tissue |
| Image receptors for fluoroscopy – image intensifier and flat panel detector | Understand the basic principles of image receptors used for fluoroscopy To be able to identify and understand how the imaging chains affect the image quality |
| Image digitisation | Understand the specific implications of digitisation on · Applied dose per frame · Artefacts · Data storage |
| Angiography with contrast media, including digital subtraction techniques | Understand how multiple images during injection of contrast materials can be used to increase contrast in vascular systems by reducing the structured noise due to the patient’s anatomy. |
Radionuclide Imaging
| Content | Examples of expected knowledge |
| Construction, function and operation of a gamma camera/scanner | Understand how the gamma camera is operated in planar mode. Patient positioning, body contouring, mechanical safety. |
| Imaging collimators | How they are made, significance of the dimensions and shapes of the holes and how to assess which are suitable for each clinical application. How the physical dimensions of the collimator holes and septa affect sensitivity and spatial resolution. Storage and handling requirements. |
| Image receptor – scintillation detector | Factors relevant to the care and maintenance of the detector, temperature and mechanical safety. |
| Scatter rejection | Understand how the pulse height analysis is used to reject some of the scatter at the expense of sensitivity |
| Mechanisms and quantification of radiopharmaceutical localisation | Use of regions of interest. Use of activity time curves and their analysis. |
| Static, whole-body, dynamic and gated imaging | Understand the different modes of data acquisition and how these impact on setting PHA window, collimation choice, and acquisition duration. |
| Radiation safety and factors affecting radiation dose | Choice of radionuclide, radiopharmaceutical, administered activity and administration method. CT image quality requirements of localisation and attenuation imaging may result in different dose (kV, mA, etc.) and z-axis range. |
| Construction, function and operation of a rotating multi-head gamma camera | How does the gamma camera gantry operate in SPECT mode. Patient contouring and safety. Step and shoot or continuous rotation. How are the camera camera and CT gantries located in the system. |
| SPECT/CT | CT for localisation or attenuation correction. The need for correct image registration. |
| Image reconstruction, scatter & attenuation corrections | Filtered back projection and iterative techniques. Understanding of time-of-flight in PET. The selection of pixel size, field of view, reconstruction filters. Other forms of data analysis based on time activity curves, gated acquisition, etc. Understand the impact of X-ray contrast agents on attenuation correction in radionuclide imaging, e.g. PET-CT |
| Construction, function and operation of a multi-detector PET-CT ring system | Understand the layout of a typical PET-CT gantry, in particular, the locations of the annihilation photon detectors and their collimation. |
| Data acquisition | 3D & 2D acquisition |
| Standardised uptake value (SUV) and quantification | Definition with factors affecting and need for harmonization between scanners. |
| PET/CT | Impact of CT for attenuation correction in SUV and artefacts, e.g. movement |
Radiation Safety
| Content | Examples of Expected Knowledge |
| Radiation safety and factors affecting radiation dose | Understand the terms Absorbed Dose, Equivalent dose and effective dose Have knowledge on how equivalent and effective doses of staff and patients are estimated in clinical practice. Radiation risk Gain an appreciation of the likelihood of stochastic and deterministic effects for different exposures occurring in clinical practice. Have knowledge of the typical annual background dose rate and the population doses received from common x-ray and Nuclear Medicine procedures |
| Statutory Legislation | Hierarchy of recommendations, legislation and guidance Knowledge of the Ionising Radiations Regulations 2017 and Approved Code of Practice & Guidance (L121) including · Risk assessment, restriction of exposure and dose monitoring · Duty holders such as Radiation Protection Adviser and Radiation Protection Supervisor · Designation of working areas, Local Rules and Systems of Work · Dose limits, dose constraints and classification of employees · Requirements relating to pregnant staff · Training requirements Knowledge of the Ionising Radiation (Medical Exposure) Regulations 2017 and Guidance (June 2019) including · Justification, optimisation and dose limitation · Requirements for carers and comforters · Employer’s procedures · Diagnostic reference levels · Notification and reporting of radiation incidents · Duty holders and their training and responsibilities Environmental regulations, including variations within UK regions. Exposures for research, health screening and medico-legal purposes |
| Practical management of radiation doses to patients, staff and the general public | Radiation detectors and dose meters Measurement of absorbed dose and dose rate in air Use of PPE and radiation shielding |
| Practical management of radiation doses in Radiology | Typical dose-area products, entrance surface doses and effective doses in radiography and fluoroscopy Detector dose indicators Factors affecting radiation dose Time, distance and shielding for dose reduction Children, staff and pregnant patients |
| Practical management of radiation doses in Nuclear Medicine | Contamination and environmental dose rate monitoring Activity measurement with radionuclide calibrator Typical activities and effective doses Factors affecting radiation dose Time, distance and shielding for dose reduction Children and conception, pregnancy and breast-feeding in patients Storage, handling and transportation of radioactive substances Storage and disposal of radioactive waste Administration of Radioactive Substances Advisory Committee and Notes for Guidance |
Computed Tomography
| Content | Examples of expected knowledge |
| Construction, function and operation of a CT scanner | Knowledge of the basic construction of a CT scanner. –> Scanner Design and Types of Scanner Note the need for significant cooling of the x-ray tube and how it may impact on acquisition. Observe and question how the scanner is controlled from the workstation and discuss the acquisition parameters. z-axis collimation, filtration and field of view. Table motion and linear projection for aligning prior to scanning. kV and mA settings. Understanding of mA modulation techniques and the effect on patient dose Scout images |
| Axial and helical scanners | Understand the geometry of axial and helical scanning and the effect on acquisition. |
| Multi-slice scan acquisition | Understand the multi-slice acquisition process. |
| Image reconstruction | Filtered back projection and iterative reconstruction and the implications for patient dose and image quality. –> Image Reconstruction The z-axis collimation and the reconstructed slice width. Digital filtering of the images during reconstruction. |
| Advanced CT imaging techniques | CT angiography, CT fluoroscopy and gated imaging CT perfusion and physiological principles underpinning functional assessment |
| Radiation dose to patients, staff and the public | The effect of Dose Length Product, the kV, collimation and beam filtration with respect to patient dose and image quality. How to approach technique optimisation / dose reduction. How patient dose is estimated. Typical dose rates to staff and how these are managed. The definition of Controlled Area and how it is physically defined and managed. |
| Radiation safety and factors affecting radiation dose | Proximity, duration and shielding when staff are near to the gantry. |
Magnetic Resonance
| Content | Examples of expected knowledge |
| Creation, detection and spatial localisation of the MR signal | Nuclear magnetic resonance –> Principle of NMR Precession about magnetic fields (B0 and B1) –> Magnetism and Principles of NMR Equilibrium magnetisation (M0) –> Principle of NMR (4:08). Longitudinal (Mz) & transverse magnetisation (Mxy) –> MR Signal –> Transverse and Longitudinal Relaxation Magnitude and phase of transverse magnetisation –> MR Signal T2* Relaxation Dependence of MR signal on the strength of the static magnetic field, B0 –> Signal Detection Overview of MR hardware –> The Hardware: Magnets and Coils Slice selection –> Slices and Spatial Localisation Axial Slice Selection Basic understanding of k-space · Relationship between k-space and MR image –> K-Space · Frequency-encoding –> Frequency Encoding · Phase-encoding –> Phase Encoding · Awareness of different k-space trajectories and their advantages/disadvantages 2D versus 3D sequences –> 2D TOF 3D TOF |
| Basic contrast mechanisms | T1. Understand the concept of MR signal saturation T2 T2* –> Relaxation T1 and T2 Relaxation Mechanisms –> T1, T2 and PD Weighted Imaging –> T2 vs T2* T2* Relaxation Understand the impact of relaxivity of gadolinium-based contrast agents on T1-weighted and T2*-weighted MR images. –> Contrast Agents Understand the difference between a contrast-weighted MR image and a quantitative image (map) Understand the extension of T2*-weighted MRI to susceptibility-weighted imaging (SWI) |
| Basic MRI sequences & common variants | Spoiled gradient echo, spin echo –>Gradient Echo Spin Echo Gradient Echo vs Spin Echo –> Fast Gradient Echo –> Three Types of Gradient Echo –> Spoiled T1 vs bSSFP T2/T1 Multiple echo variants (TSE/FSE, EPI) –> RARE/FSE/TSE Single Shot FSE/TSE or HASTE –> Gradient Echo Planar Imaging –> TSE Single shot versus multi shot –> Single Shot FSE/TSE or HASTE Pulse sequence diagram –> Slices and Spatial Localisation Basics of steady-state sequences |
| Frequency-dependent techniques | Understanding of chemical shift: fat & water –> Fat Chemical Shift –> Chemical Shift Artefact (of the First Kind) and Echo Planar Imaging Chemical Shift (of the second kind) and DIxon Methods Fat saturation –> Fat Suppression In-phase & out-of-phase TEs, Dixon –> In and Out of Phase Awareness of MR spectroscopy (MRS) and appropriate TEs for particular clinical questions –> Principles of Magnetic Resonance Spectroscopy (MRS) In-vivo MRS MRS Signal – Single Voxel and Spectroscopic Imaging Clinical Applications |
| T1-dependent techniques | Inversion recovery (IR) –> Inversion Recovery Principles Suppression: STIR & FLAIR. The role(s) of TR (and T1) in determining null point –> STIR Fat Sat vs STIR –> FLAIR 3D T2 FLAIR Enhanced T1W, e.g. MPRAGE Phase-sensitive IR –> Inversion Recovery Principles |
| Diffusion MRI | Diffusion weighting, relationship with underlying cellularity –> Principles of Diffusion Imaging b-values, ADCs and calculated b-values –> Principles of Diffusion Imaging Potential perfusion contribution to ADC Awareness of diffusion anisotropy –> Principles of Diffusion Imaging Processing, Display and Applications |
| Acceleration techniques | Awareness of acceleration techniques (no need to understand how they work in detail) and their impact on image quality & potential artefacts · Zero-filling (interpolation) · Half-Fourier –> Scan Parameters and Scan Time · Parallel imaging –> Parallel Imaging Methods · Simultaneous multislice (multiband) · Compressed sensing –> Compressed Sensing · Temporal sharing (TWIST/TRICKS) –> Temporal Interpolation and K-space Sharing |
| Flow-related MR techniques | Dynamic contrast-enhanced (DCE) Perfusion MRI · Dynamic susceptibility contrast (DSC) · Awareness of Arterial spin labelling (ASL) · Dynamic contrast-enhanced (DCE) for myocardial perfusion, oncology MR angiography (MRA) techniques, · Time of flight –> Time of Flight MR · Contrast-enhanced –> Contrast Enhanced MRA · Phase contrast –> Phase Contrast MRA · Awareness of other non-contrast enhanced MRA options –> Non-contrast MRA |
| MR artefacts and artefact reduction techniques | An understanding of the causes and potential olutions for a wide range of artefacts found in MRI Motion artefact, respiratory gating, navigated sequences, saturation bands, radial-type k-space acquisitions –> Motion B0 inhomogeneities, various sources –> B0 Inhomogeneity o Metal –> Metal Artefact and Artefact Reduction Sequences o Air/tissue interfaces B1 inhomogeneities, especially at 3T –> B1 Inhomogeneity RF interference –> RF Interferences o Instantaneous (RF spikes) o Continuous RF interference Phase wrap –> Phase Wrap Truncation artefact (Gibb’s ringing) –> Gibbs Ringing Chemical shift, receiver bandwidth –> Chemical Shift Artefact (of the First Kind) and Echo Planar Imaging Chemical Shift (of the second kind) and DIxon Methods Suppression of signal from cross talk, use of interleaved slice ordering –> Slice Cross Talk Fat-water swaps in Dixon MRI –> Dixon Fat-water Swaps Poor geometry-factor with high acceleration factors in parallel imaging –> Artefact Associated with Parallel Imaging |
| MR safety | Awareness of MHRA guidelines as the primary MR safety reference for UK Understanding of MR safety framework, definitions, roles & responsibilities –> Guidelines · MR Responsible Person –> Classification of People in MRI · MR Safety Expert –> Classification of People in MRI · MR Authorised Persons –> Classification of People in MRI · MR Environment –> Classification of People in MRI · MR Controlled Access Area –> Classification of People in MRI · MR Safe/ MR Conditional/ MR Unsafe/ MR Unlabelled –> Regulations and Standards for MR Safety Labelling Awareness of safety issues, particularly with regards implanted devices and emergency situations · Attraction, torque –> Static Magnetic Field · RF heating: SAR, B1+rms, SED –> Time Varying Magnetic Fields · Contrast agents (see generic contrast agent section) –> Contrast Agents · Magnet quench –> Cryogens Awareness of recommendations for scanning patients with implanted devices without the device manufacturer’s approval, e.g. “off-label” –> Regulations and Standards for MR Safety Labelling Understand the safety issues associated with gadolinium-based contrast agents –> Contrast Agents · Linear versus Macrocyclic-based agents · NSF · Gadolinium deposition/retention |
| Quality assurance | Awareness of the importance of QA in MR to identify failing elements in phased array coils. Awareness of the need for QA to help establish reproducibility of quantitative MR techniques. |
Ultrasound
| Content | Examples of expected knowledge |
| Nature and properties of ultrasound waves. | Non-ionising mechanical wave. Define wavelength, speed, elasticity, density, impedance, energy and power. –> Principles of Ultrasound Acoustic Impedance Pressure, Power & Intensity |
| Propagation and interaction of ultrasound waves with matter | Absorption – individual relaxations, frequency dependency. –> Attenuation and Absorption Reflections / transmission. Relation to wavelength & Impedance relations and organ boundary delineation. –> Reflection Scatter – Rayleigh scattering and relation of particle size to wavelength. Speckle. Doppler implications. –> Scattering Reinforcement and Cancellation of Waves – Speckle Refraction – speed of sound variation. Implications for artefacts. –>Refraction Refraction Artefact Diffraction – Sidelobes / grating lobes. Implications for artefacts. –> Terms Used in Ultrasound Attenuation. dB scale / frequency / depth dependence. –> Attenuation and Absorption |
| Basic Design and construction of ultrasound transducers | Production and detection of ultrasound. –> The Piezoelectric Effect, Transducers, Damping and Q Pulse Transmission and Reception Parts of a transducer and implications for imaging performance. –> Array Transducer Construction and Different Types of Array Continuous waves and pulses. –> Continuous Wave Doppler Pulse Wave Doppler Backing layer for axial resolution. –> The Piezoelectric Effect, Transducers, Damping and Q Ultrasound Imaging Performance, Spatial/Contrast Resolution and Slice Thickness matching layers for energy transfer. –> The Piezoelectric Effect, Transducers, Damping and Q Lens for out of plane focus. –> Ultrasound Imaging Performance, Spatial/Contrast Resolution and Slice Thickness |
| Beam shapes and focusing from transducers arrays. | Influence of beam shape and focusing on lateral / axial and out of plane resolution from 1D, 1.5D, 2D arrays. –> Beam Formation, Focussing and Steering Ultrasound Imaging Performance, Spatial/Contrast Resolution and Slice Thickness To know how to produce a representation of the beam thickness. –> Ultrasound Imaging Performance, Spatial/Contrast Resolution and Slice Thickness |
| Image acquisition, reconstruction & Imaging modes | pulse echo principle –> Pulse Transmission and Reception Scanned & non-scanned modes TGC and relationship to tissue attenuation –> Time Gain Control Transmit and receive focusing –> Beam Formation, Focussing and Steering Apodisation. –> Terms Used in Ultrasound |
| Scanner functionality & image optimisation | Output Power –> Pressure, Power & Intensity depth –> Time Gain Control Aliasing, Scale/Pulse Repetition Frequency, Depth Gain –> Time Gain Control Dynamic range –> Dynamic Range focus(s) –> Beam Formation, Focussing and Steering Harmonic Imaging –> What is Harmonic Imaging? compound imaging –> Compound Imaging line density –> Frame Rate Colour Doppler Processing persistence –> Post processing – gamma correction, mapping, edge detection |
| Doppler Ultrasound | Basic principles: Doppler equation –> Continuous Wave Doppler CW operation –> Continuous Wave Doppler PW operation –> Pulse Wave Doppler Nyquist limit –> Aliasing Gate size and position –> Setting Up the Sample Volume, Steering and Angle Correction Doppler angle. –> Setting Up the Sample Volume, Steering and Angle Correction Effect of Insonation Angle on Doppler Frequency Beam/Vessel Angle Error Angle Dependence and Pulsed Wave Sampling Advantages / disadvantages of CWD, PWD, CFD, PD. –> Aliasing Aliasing, Scale, Sensitivity Angle Dependence and Pulsed Wave Sampling Misalignment ErrorsBeam/Vessel Angle ErrorIntrinsic Spectral BroadeningColour Doppler Processing |
| Advanced techniques & their clinical uses. e.g. Contrast Ultrasound, Tissue Optimisation, Elastography, 3D. | CEUS. Basic properties. Principles behind wash-out curves. Clinical uses in liver and kidney. –> Contrast Microbubbles Harmonics. Production & propagation. Influence on image quality w.r.t. beam shapes, clutter artifact, tissue type etc. –> What is Harmonic Imaging? Tissue Optimisation – speed of sound adjustment. Clinical uses in breast. Strain, shear wave, ARFI. Clinical uses in liver, breast, thyroid. Basic principles and clinical advantages / disadvantages. |
| Clinical Artefacts & how to overcome them. | Enhancement. Shadowing –> Enhancement and Attenuation Reflection –> Reflection mis-registration refraction –> Refraction Artefact grating lobes –> Terms Used in Ultrasound reverberation –> Reverberations comet trail aliasing –> Aliasing, Scale/Pulse Repetition Frequency, Depth Aliasing Aliasing, Scale, Sensitivity colour bleed flash mirror –> Mirror Artefact |
| Safety. Physical effects. Safety indices. Safety guidelines. | Basics on types of energy transfer to tissue. Heating Introduction and Summary of Mecanisms Thermal Effects streaming Introduction and Summary of Mecanisms cavitation –> Mechanical Effects – Cavitation mechanical damage. –> Introduction and Summary of Mecanisms Thermal and mechanical indices. –> Mechanical and Thermal Indices Definitions and links to physical effects and scan modes. –> Intensity Terms and Current Regulations Overview of BMUS guidelines. –> Maximum Exposure Times for Embro and Foetus Practical Advice and Guidelines |