Clinical Radiology remains one of the most competitive specialties in the UK, and for good reason. It is a run-through training programme that sits at the centre of modern patient care, offering a unique blend of diagnostics, procedures, technology, and teaching.

For entry in August 2026, the application process continues to involve MSRA-based shortlisting, followed by portfolio evidence submission for selected candidates, and a two-station online interview.

Understanding the Clinical Radiology ST1 application process is key to success. The following sections break down each stage in detail and provide a useful starting point, but it is important that applicants also refer directly to the official guidance on the Clinical Radiology pages from Health Education England, as requirements and scoring frameworks can be updated between recruitment cycles.

Why Choose Radiology?

Clinical Radiology is central to modern patient care, with imaging guiding diagnosis and management across almost all specialties. It offers a strong focus on problem-solving, anatomy, and clinical decision-making.

Training provides broad exposure to a wide range of subspecialties, including both diagnostic and interventional work, allowing flexibility in career paths and opportunities for procedural work across the specialty.

The perception that radiologists work in isolation is outdated – many subspecialties, such as breast, MSK and IR, are highly patient-facing and involve direct clinical interaction. Radiologists also play a key role in multidisciplinary teams, and the specialty continues to evolve with advancing technology. Training is generally well-structured, with a strong emphasis on learning, and consultant roles offer more predictable working patterns compared to many acute specialties.

Overall, it suits doctors who enjoy analytical thinking, collaboration, and working at the intersection of medicine and innovation.

Because of these benefits, Clinical Radiology ST1 is highly competitive. The official 2025 competition ratio data show 4,011 applications for 356 posts, giving a competition ratio of 11.27. Competition has increased in recent years. However, the passing of the Medical Training (Prioritisation) Act 2026 may change the landscape for priority applicants, although updated competition data reflecting this policy has not yet been released.

Whilst this may seem daunting, it should not put you off. Competition is high because the specialty is popular, and the training structure is attractive. Strong preparation can significantly improve your chances of success. It’s also worth noting that many applicants apply to multiple specialties which can inflate competition ratios and make them appear higher than they are in practice.

2026 Radiology Application Timeline

For the 2025–26 recruitment round for August 2026 entry, key dates include:

• Applications open on 23rd October 2025
• Application close on 20th November 2025
• MSRA exam takes place between 6th and 19th January 2026
• Portfolio upload opens by 13th February 2026
• Portfolio upload closes at 9am on 16th February 2026
• Interviews run from 23rd to 27th February 2026
• Initial offers are released on 24th March 2026

In practice, that means your preparation should start well before applications open in the Autumn.

How Do You Apply?

Applications are submitted via Oriel, the online application system for foundation and specialty training programmes. The Royal College of Radiologists (RCR) advises applicants to check the current person specification for the recruitment year they are applying in, rather than relying on previous years or older articles.

If you require a CREST form, the current application guidance states that it must be uploaded at the time of application, and for this round only the 2024 CREST form is accepted. The same guidance also notes that applicants declaring 18 months or more of radiology experience after foundation may have their eligibility reviewed.

What Role Does The MSRA Play?

For the 2026 round, all eligible applicants are required to sit the MSRA and previous MSRA scores cannot be reused.

The MSRA score is used for shortlisting, meaning it determines whether candidates progress to interview. Once candidates progress to interview, the MSRA score is no longer used in the final ranking. As Clinical Radiology is a competitive specialty, the cut off tends to be higher than some other specialties. In the 2025 recruitment cycle, the cut-off was 549.

A common pitfall is for applicants to focus heavily on portfolio preparation while underestimating the importance of MSRA performance, which can be decisive at the shortlisting stage. Meeting the MSRA cut-off for shortlisting significantly improves your chances – from roughly 1 in 12 to almost 1 in 2, particularly if you are geographically flexible.

Booking

The test is delivered through Pearson VUE. You will first receive an email from Pearson VUE with instructions to set up your account, followed by an invitation from Oriel (typically mid-December) to book your MSRA slot. As booking is first-come, first-served, ensure your account is ready in advance.

When choosing a date, consider your rota, on-calls, and any personal commitments such as Christmas leave. Aim for a nearby test centre to minimise disruption.

If you’re abroad (e.g. on an F3 year), the MSRA can be taken at any international Pearson VUE centre.

Structure

The MSRA consists of two sections – Professional Dilemmas (95 minutes) and Clinical Problem Solving (75 minutes) – with a total testing time of 170 minutes. Head to our dedicated MSRA page for a more detailed breakdown of the sections.

Preparation Resources

The Professional Dilemmas and Clinical Problem Solving sections have equal weighting, so it is important to adequately prepare for both.

Common revision resources include question banks such as PassMedicine and MCQBank, alongside the official MSRA sample questions and exam guidance. No single resource is essential, but it helps to practise both question volume and exam technique under timed conditions.

How Does The Portfolio Work?

For more detailed information on how to maximise your portfolio points, check out our dedicated article on the Clinical Radiology ST1 portfolio 2026.

The Five Domains

The Clinical Radiology ST1 portfolio review guidance for 2026 sets out five domains:

• Commitment to Specialty
  • This is the most important portfolio domain because it is double weighted.
  • The highest category requires multiple significant exposures to Clinical Radiology, and the guidance defines a significant exposure as at least 3 whole-day equivalent time attached to a radiology department. Taster weeks, foundation jobs, electives and radiology-based clinical research may all count where appropriately evidenced.
  • This is one of the highest-yield areas for applicants. Genuine radiology exposure is relatively achievable, scores well, and gives you useful material for interview answers.

• Leadership and Management
  • This domain rewards sustained leadership roles, with higher scoring categories given to more significant or more senior positions, particularly those linked to radiology or healthcare.
  • The guidance expects roles to have lasted at least 6 months.
  • This does not mean you need a national title. A meaningful local role with clear responsibility is often more convincing than a nominal position with little substance.

• Teaching and Training
  • This domain includes formal teaching experience and training in education.
  • Higher categories include formal postgraduate teaching qualifications (such as a PGCert) or major contributions to organised teaching programmes for >3 months, while recognised teaching-methods courses of at least 2 days can also score.

• Audit and Quality Improvement
  • This domain rewards completed audit and QI work, especially where the applicant led the project and where it produced a real change in practice. The highest category requires two or more radiology-related projects that resulted in change.
  • If you are still early in your application journey, this is another high-yield area. A clean, closed-loop, imaging-related QI project can strengthen both portfolio and interview performance.

• Academic Achievements
  • This section includes postgraduate research degrees, publications, and presentations. A particularly important update is that intercalated and additional undergraduate degrees are no longer scored in line with national specialty recruitment policy. Only postgraduate academic achievements count here.

Understanding The Scoring System

Each domain outlined above has pre-defined categories (A-E), and you must select the single category that best reflects your highest level of achievement.

Scoring is standardised across domains:

• Category A = 4 points
• Category B = 3 points
• Category C = 2 points
• Category D = 1 point
• Category E = 0 points

Most domains are scored out of a maximum of 4 points. However, Domain 1 (Commitment to Specialty) is double-weighted, meaning it can contribute up to 8 points. As a result, the total portfolio score is out of 24 points.

A few key principles to keep in mind:

• Only your highest category counts: You do not accumulate points within a domain – your score is based solely on the single best category you meet.
• Only completed achievements count: The official guidance makes it clear that only completed achievements should be claimed. Works in progress should not be included!
• Evidence must match exactly: if your uploaded evidence does not clearly demonstrate the criteria for your selected category, you risk being downgraded or scoring zero.
• Domains are capped: Additional achievements beyond the top category will not increase your score further.

Evidence Submission

When applying in October/November, applicants must self-select the category they believe they meet in each domain on Oriel. For every domain, you are required to enter a concise title and date for the piece of evidence you intend to submit. It is important to get this right first time: once the application is submitted, these entries cannot be amended. If the evidence you later upload does not clearly match what you originally declared, that domain may score zero.

Applicants are then invited to upload their supporting evidence in February. All evidence must relate to achievements that were fully completed by the application deadline (20th November 2025). The portfolio evidence upload deadline is 16th February 2026. Anecdotally, supporting documents themselves (for example, a consultant letter) can be dated after the application deadline, provided they clearly verify that the achievement itself was completed before applications closed.

Following shortlisting, the top 800 candidates are invited to upload their portfolio evidence. However, being invited to upload evidence does not guarantee an interview.

The Interview

The interview is held online via Qpercom Recruit. Applicants attend one interview only, even if they apply broadly across the UK, and even applicants applying to both Nuclear Medicine and Clinical Radiology only attend a single interview.

For the 2026 round, interviews take place from 23 to 27 February 2026. There are two stations, each lasting up to 15 minutes.

The Stations

One of the most important points for applicants is that the portfolio is no longer separate from interview performance. The current application guidance states that the portfolio review is incorporated into Interview Station A, with a panel member reviewing the uploaded evidence before the candidate enters. Two questions in that station are based on two uploaded portfolio domains.

This means your portfolio should not just be chosen to maximise points. It should be chosen to maximise points and give you something meaningful to talk about.

Station A includes:

• Two portfolio questions
• One question on understanding of the specialty
• One skills question

Station B includes:

• A clinical scenario prioritisation question
• A question on coping with pressure and managing uncertainty
• A question on team involvement

Before the interview, candidates must show photographic ID and pan the room with their camera. Note-taking during the interview is permitted but you cannot bring pre-prepared notes into the station.

How to Prepare

• Prepare clear, structured examples for recurring interview themes:
  • Teamwork and multidisciplinary working, leadership, resilience, and managing pressure or burnout come up year after year. It helps to have concise examples ready that show what you did, why it mattered, and what you learned.
• Go beyond a basic “why radiology?” answer:
  • For the “understanding of the specialty” component of the interview, candidates are frequently expected to discuss broader issues such as teleradiology and outsourcing, artificial intelligence, evolving workforce roles and scope of practice, and the role of radiology within wider NHS service pressures.
  • Read recent official guidelines (e.g. RCR) and papers, talk to trainees and consultants, and think about your own reflections on the issues within the specialty.
• Speak to current trainees and consultants:
  • This helps develop a more nuanced and realistic understanding of the specialty and comes across more naturally at interview, reflecting the kinds of discussions that are actually happening within radiology. It helps to avoid relying on generic, commonly repeated points that many candidates tend to use, and instead allows for more authentic, individualised answers. This can help set you apart by moving beyond standard themes and demonstrating a clearer, more personal understanding of the specialty.
• Practice!
  • Rehearse your answers out loud and most importantly, do mock interviews – the more the better. Even if you feel unprepared, mocks are really valuable for simulating real conditions and gaining diverse feedback.
  • Where possible, arrange mocks with radiology trainees or consultants, or use paid services, booking early as they fill up quickly. Some of these organisations have WhatsApp groups which can help you secure new slots as they become available.

Interview Resources

• Person Specification –  found here. This should be your starting point. Make sure you have prepared examples that demonstrate each skill or attribute listed. This is what is used to mark you in the interview.
• Medical Interviews by Olivier Picard – A highly regarded book that breaks down common interview question types with example answers. While not radiology-specific, many candidates have found it helpful for structuring answers. It is also available to buy as an online version.
• Radiology Cafe –  Offers a curated list of radiology interview questions and tips. Other forums and blogs also share useful question banks.
• Mock Interviews & Coaching –  A number of companies provide paid mock interview services, including RadCast, MediBuddy and Humberside Radiology. These can be expensive but often simulate the real interview environment more closely than informal practice with friends.
• UKRST & RadCast –  Both have produced insightful YouTube videos on radiology interview technique, including mock questions and tips.

Appointability and Ranking

This is an area many applicants misunderstand.

The official offers guidance states that appointability is based on interview performance alone. To be appointable, candidates must achieve an overall score of 48, score at least 22 in each station, have no score of 1, and achieve at least 6/10 combined unweighted on the clinical prioritisation question. Portfolio score does not determine appointability.

However, once appointable candidates are identified, ranking for offers is based on:

• 40% portfolio
• 60% interview.

Preferencing

The final step is ranking your job preferences on Oriel, which can be a time-consuming process. You’ll be asked to rank approximately 90 individual job options in one go. You may rank as many or as few as you wish. 

Before starting, take time to reflect on what matters most to you:

• Open to working anywhere? Rank all available posts to maximise your chances of securing a position.
• Focused on interventional radiology? Prioritise posts that offer this subspecialty.
• Restricted by geographic preferences (e.g. due to family or a partner)? Be selective and only rank locations you would realistically be willing to take.
  • Because of how the upgrades process works, ranking posts you would definitely not accept can be detrimental. This is because by the hold deadline, you must either accept or decline your offer (if you have one). If you are offered a post you don’t want, you either accept it and risk being stuck in an undesirable location (with no guarantee of an upgrade), or decline it, which automatically withdraws you from the radiology application process and makes you ineligible for subsequent upgrades to posts you may have been willing to accept.
• Interested in traditional training or a radiology academy? Ensure these posts are ranked highest.

Avoid defaulting to others’ preferences — your rankings should reflect your own goals, whether based on geography, training structure or lifestyle.

Offers, Upgrades and Rejections

Initial offers are typically released in late March. Historically, these have preceded publication of final applicant rankings. However, in the 2025/26 cycle, rankings were released before preferencing closed and before offers were made.

If you receive an offer, you can:

• Accept – You secure the post.
• Accept with upgrades – You hold the offer, but may be automatically upgraded to a higher-ranked post if it becomes available.
• Reject – You withdraw from the process and will not be considered further.

There are usually around four rounds of offers, with preferencing re-opened between rounds. If you don’t receive an offer initially, there may still be further opportunities.

The UKRST typically publishes anonymised data showing MSRA, portfolio, and interview scores for each post. These can help gauge the competitiveness of different roles.

What About Interventional Radiology?

If you are interested in Interventional Radiology, you still make a single Clinical Radiology application. Applicants can preference both IR and non-IR posts, and the Medical Hub explains that IR pathway trainees can later revert to Clinical Radiology, while non-IR trainees can still apply competitively for IR from ST4.

Top Tips For Applicants

Start early.
Radiology rewards organised applicants. Evidence collection, consultant sign-off, taster weeks and QI projects all take longer than expected.

Prioritise the MSRA.
A brilliant portfolio is useless if you do not get through the early stages.

Maximise commitment to specialty.
It is double weighted, and it is one of the most achievable domains to improve.

Choose evidence you can talk about.
Your portfolio now directly shapes interview questions.

Do not over-claim.
Only submit completed, verifiable achievements.

Practise the actual station format.
Prepare for portfolio discussion, specialty insight, prioritisation, teamwork and uncertainty, not just generic “why radiology?” questions.

If you have any questions, feel free to leave a comment below. Wishing you the very best of luck with your application!

References:
1) Radiology Cafe: Radiology Cafe. Available at: https://www.radiologycafe.com/
2) NHS England: Clinical Radiology. Medical Hub. Available at: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/clinical-radiology

Written by Dr Pareya Ahmad (Senior House Officer)
Reviewed and edited by Dr Olivia Parish (MTB Radiology Lead)
With contributions from previous article by Dr Alex Schuster Bruce