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Book review |
As the title implies, this book is directed at candidates preparing for the new FRCR Part 1 examination in physics.
It is presented in six sections, each divided into sub-sections, covering all aspects of the syllabus in logical order. The questions are mostly multiple choice, with a few requiring a short descriptive answer, and simulate the type of question asked in the examination. In short it is a "crammer".
Does the book fulfil its purpose? The short answer is "probably yes". There are almost 250 questions here, with quite a lot of repetition in the MCQs, each with answers and sometimes a short explanation. Enough of the answers are correct for a candidate who absorbs the book assiduously to pass the examination.
I have two main concerns. First, the authors were extremely unwise not to involve a qualified medical physicist working in diagnostic radiology as a co-author or, at the very least, an advisor. As a consequence there are many mistakes, ambiguities and even errors of principle – I registered more than 60.
Examples of mistakes are (a) Thallium-67 (sic) (pg 88 A13); (b) how can the risk of inducing fetal cancer be estimated if the dose to the mother is not stated? (pg 75 Q9).
Ambiguities arise because the scope of knowledge of physics of the authors is clearly limited. For example (a) "the Compton attenuation of an X-ray beam is inversely proportional to the beam energy" (pg 12 Q7) – not in the diagnostic range it isn't; (b) "the half value layer increases with photon energy" (pg 10 Q4) – it decreases at absorption edges, a most important practical phenomenon in diagnostic radiology.
There are also some major errors of principle, notably in respect of quantum noise. Noise (strictly quantum noise) is not inversely to the number of X-rays (strictly the number of X-ray photons) (pg 117 Q20). It is directly proportional to the square root of the number of photons. This whole question, and others, confuse the concepts of noise and signal to noise ratio and certainly will not help the reader.
More worryingly, far too many (almost all) the questions require purely factual recall. How many candidates will remember, or indeed should need to remember, 10 minutes after the examination that Magnification = F/(F–P), not (F+P)/(F–P)? If this over-emphasis on factual recall reflects accurately the content of the examination, and I suspect it does, this is a trend in the wrong direction.
MCQs can be broadly divided into four categories, knowledge, understanding, application and extension of knowledge. Physics is important for radiologists because it helps them to understand the imaging process, the complex inter-relationships between image quality and patient dose, and the application of new technology to their subject. Even this first phase of physics training should encourage radiologists to think.
If we persist in an approach to teaching and examination that is heavily weighted to factual recall (there are many parallels to the teaching of Latin here) the case for removing physics from the syllabus may become overwhelming. This would be a great loss. Radiologists would have a poorer understanding of the imaging process and their competence for maintaining the intellectual high ground over their clinical colleagues in respect of image interpretation would have been seriously weakened.
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