From MCQ to hands-on: how radiographer training and hiring in India are moving toward practical skills
· 18 min read
Nobody in an X-ray room has ever been handed four options and asked to pick one. They get a seven-year-old who will not hold still, a trauma patient whose knee does not bend, a portable unit with a sticky brake and a ward full of people standing too close. The work is done with hands, eyes and judgement.
The gate to a government radiographer job in India has been something else: one hundred multiple-choice questions on a computer. Practical competence was assumed to follow the certificate.
That assumption is being dismantled, though less evenly than most of what you will read about it suggests. The classroom has moved a long way, in writing, with a deadline. The exam hall has moved by exactly one sentence. We read the notices and the 376-page curriculum handbook to separate the two.
The short version
Education: the NCAHP curriculum for Medical Radiology and Imaging Technology was launched on 23 April 2025 and is mandatory from academic year 2026-27. It requires at least 14 hours a week of studentship in every semester, simulation and skill labs in the early years, and a 2,400-hour internship.
Hiring: AIIMS CRE has not held a skill test for radiographers in any cycle. Since July 2025 its notices say "AIIMS reserves the right to introduce Skill Test for any group." ISRO's VSSC already tests radiographers hands-on.
So: the MCQ still gets you shortlisted. Train as though the next notice fills in the blank column.
What do the AIIMS CRE notices say about a radiographer skill test?
Several coaching portals list the selection process for AIIMS radiographer posts as "CBT, then skill test, then merit list". The notices do not say that. We went through the detailed advertisement for each of the four common recruitment cycles so far and looked up the radiographer row in the group table.
| Cycle | Notice | Group | Skill test column | "Reserves the right" clause |
|---|---|---|---|---|
| CRE-2024 | 171/2025, 7 Jan 2025 | 29 | Blank | Absent |
| CRE-2025 | 278/2025, 11 Jul 2025 | 22 | Blank | Present |
| CRE-4 | 355/2025, 11 Nov 2025 | 25 | Blank | Present |
| CRE-5 | 93/2026, 13 Jun 2026 | 25 | Blank | Present |
CRE-2024 is the cleanest case. Its scheme of skill test (Notice 17/2025) lists ten group codes: assistants, clerks and data-entry operators, stenographers, medical record staff, a Hindi translator, programmers, security officers, fire technicians and AC mechanics. The word "radiography" does not occur in it. Group 29 sat its CBT on the morning of 27 February 2025, and the result notice sent its qualified candidates straight to choosing institutes, under the heading "where no skill test is required".
Then, in July 2025, a sentence appeared under the group table that had not been there before:
"AIIMS reserves the right to introduce Skill Test for any group."
It has been in every notice since. The same notices spell out how such a test would work. It would be "qualifying in nature", with the merit list drawn from candidates who pass it, ranked on CBT performance. It would have its own admit card and be held at a few centres, "preferably in Delhi/NCR". AIIMS may cap how many candidates are called. And where only some posts in a group need the test, a candidate who clears the CBT but fails the skill test stays eligible for the posts that do not need it.
That is a finished mechanism waiting for a syllabus. Adding radiography to the skill-test annexure would take a page, and nobody outside AIIMS knows whether or when that page gets written. A candidate who assumes it never will is betting against the only new sentence in the document.
What the CBT looks like today
Vacancy counts swing a lot between cycles, which matters more to most candidates than the pattern does. By our count of the vacancy annexure, CRE-2024 carried 391 posts in the radiographer group, 341 of them at ESIC hospitals. CRE-5 carried 35. For Radiographic Technician Grade-I the notices ask for a three-year B.Sc. (Hons) in Radiography, or a diploma with two years of experience, at Pay Level 6.
Who already tests radiographers hands-on?
ISRO does. When the Vikram Sarabhai Space Centre advertised a Radiographer-A post in April 2023 (Advt VSSC-324), it ran an 80-question written test and then called candidates for a skill test at a ratio of five per post, with a minimum of ten. The skill test was "of qualifying nature only", passed at 50 out of 100 for unreserved candidates, and the final panel was drawn "in the order of marks obtained in the written test".
Set that beside the AIIMS clause and they match point for point: a pass-or-fail practical, with rank decided on paper. If AIIMS does fill in the blank column, this is the likely shape of it.
| Recruitment | Written stage | Hands-on stage | Rank decided by |
|---|---|---|---|
| AIIMS CRE, radiographer group | 100 MCQ, 400 marks, 90 min | None prescribed. Right reserved for any group since July 2025 | CBT score |
| ISRO VSSC, Radiographer-A (2023) | 80 MCQ, 90 min | Skill test for a 1:5 shortlist, qualifying at 50/100 | Written marks |
| AIIMS NORCET, nursing officers | Preliminary, then a second stage | None. Stage II uses case scenarios instead | Stage II |
The third row is the quiet precedent inside AIIMS itself. When NORCET went to two stages, the NORCET-6 notice described Stage II as "focused towards case scenario-based questions for testing nursing skills competency". Still MCQs, but built around what a nurse would do next instead of what they can recite. Most other radiographer recruitments, RRB paramedical and DSSSB among them, remain a written exam followed by document checks.
What did NCAHP change in the classroom?
Far more, and with a date attached.
The National Commission for Allied and Healthcare Professions Act (No. 14 of 2021) covers 57 professions in ten categories. Radiology and imaging technologists, along with radiotherapy technologists, medical physicists, nuclear medicine technologists and dosimetrists, sit in category 8. The Commission itself was constituted on 11 March 2024. On 23 April 2025 the Health Ministry launched its first ten competency-based curricula, Medical Radiology and Imaging Technology among them, and the notice issued the next day said institutions "may adopt these curriculums from academic session 2025-26" but that they "are to be mandatorily implemented from the academic session 2026-27 onwards".
That session is the one now starting. Admissions for it close on 30 September 2026.
The clause that matters
Under every "Radiology Clinical Education (studentship)" course, from the first semester to the sixth, the handbook repeats the same list. Two of its lines are new in 2025:
NCAHP MRIT curriculum, studentship requirements
"A minimum of 14 hours per week is considered as studentship in every semester."
"Provide simulation and skill labs for practising skills specific to the program in the initial years of observership/studentship."
The same list requires that "all practical skills must be supervised and recorded in a Logbook", and that transport be provided when the clinical site is off campus.
We checked the 2015-16 model curriculum from the Health Ministry for either sentence. Neither is there. That older handbook was advisory, and it counted "directed clinical education" as a block of hours per course. The 2025 version turns clinical time into a weekly floor that starts in week one, and it is binding.
Inside the six taught semesters the balance is already tilted toward doing. Each week has 36 contact hours, and the semester tables give most of them to practicals and clinical postings.
The internship year then rotates through the department, and the split tells you what the Commission thinks a working radiographer spends time on.
The handbook is just as direct about where all this should end up. The graduate "should be able to undertake all radiological and imaging procedures independently", "handle all radiological and imaging equipment independently", and be "able to evaluate images for technical quality". By the end of the internship a student should "differentiate a properly positioned and exposed radiographic image from a wrongly positioned and over or underexposed radiographic image". Every one of those is something you watch a person do. None can be ticked on an answer sheet.
OSCE and OSPE: what the handbook says, and what it does not
An Objective Structured Clinical Examination is a circuit. Candidates rotate through timed stations, each with one task and one examiner holding a checklist. Ronald Harden and colleagues described it in the BMJ in 1975, to get rid of the luck of the long case. The OSPE is its pre-clinical sibling for practical and lab skills.
The NCAHP handbook lists both among its assessment tools, next to the mini-CEX, direct observation of procedural skills, portfolios and multi-source feedback, and says this about our field:
"In radiography it tests radiographic positioning, radiographic image evaluation, and interpretation of results."
Here the blog posts and the handbook part ways. You may have read that the curriculum gives OSCE and OSPE 150 marks. We searched the document and it does not. OSCE and OSPE are named once in the abbreviations and once in the chapter on assessment methods, with no marks against them. The practical examination actually prescribed is 70 marks at the end of the semester (50 practical, 20 viva) plus 30 of continuous internal evaluation, in the form of "spotters, demonstration of equipment handling, case based discussions". The pass mark is 50%, separately in theory and practical.
There is a second awkward fact. The handbook's sharpest line, that the traditional year-end exam "basically assesses knowledge instead of assessing skills or competencies", was already in the 2015-16 model curriculum, word for word. India has known this for a decade. What 2025 added is compulsion and hours. The assessment format is still mostly left to the university.
That leaves room. A college can run its 50-mark practical as a proper station circuit tomorrow without asking anyone's permission, and the ones that do will have graduates who have been examined the way a skill test examines.
What a radiography OSCE circuit can look like
Neither NCAHP nor AIIMS has published a station list, so treat the one below as our worked example. It follows the three things the handbook says an OSCE tests in radiography and adds the two that departments complain about most in new staff: radiation protection done without prompting, and talking to the patient.
| Criterion | 3 · competent | 2 · borderline | 1 · not yet |
|---|---|---|---|
| Positioning | Correct projection, centring and collimation, unprompted | Minor misalignment, corrected when asked | Error left uncorrected, landmarks not identified |
| Exposure and equipment | Factors set accurately and quickly | Small error that would still give a usable image | Unsafe or non-diagnostic settings |
| Radiation protection | Shielding, distance, marker and pregnancy check without a prompt | One minor step missed | A breach that would expose staff or the wrong area |
| Communication | Clear explanation, checks identity, answers the patient | Correct but rushed or partial | No explanation, ignores distress |
Does simulation actually build the skill?
The clause asks colleges for "simulation and skill labs". Reasonable question: does practising on a simulator show up later on a patient? The radiography literature is small and honest about its limits, and it points one way.
The cleanest trial is from Monash. Sapkaroski and colleagues randomised 76 first-year students to a virtual-reality clinic or conventional role-play, then examined them three weeks later on a real person. For hand radiography the VR group did 36% better on digit separation, 11% better on palm flatness and 23% better on centring the ray over the third metacarpal (Simulation in Healthcare, 2019). That is one body part, and the authors do not claim more.
The study closest to the clinic is O'Connor and Rainford's at University College Dublin (Radiography, 2023). Ninety-eight students who had seven hours of VR radiography practice were compared with 93 from the year before on their clinical placement assessments.
A third study used an OSCE as the yardstick. Rowe and colleagues put 188 first-year students through 25 weeks of either VR or physical simulation and examined them with actors as patients. The VR group finished faster and made fewer errors in moving equipment and positioning the patient. On setting exposure there was no difference (Journal of Medical Radiation Sciences, 2023).
The reviews keep everyone's feet on the ground. Gårdling and colleagues' 2025 systematic review found VR gave an advantage in assessed equipment and patient positioning, then added that "VR alone does not guarantee increased performance" and that "research within this field is deficient". Chau and colleagues' scoping review of 33 papers concluded simulation is "complementary to and not a replacement for clinical placement". The handbook's own structure says the same thing: simulation in the early years, 2,400 hours of real lists at the end.
Why positioning is the skill worth drilling
When a radiograph is rejected and repeated, the patient takes a second exposure. Departments audit why it happens, and the audits agree with each other to a degree that is rare in this field.
That is the patient-safety case for a skill test in one chart. The error that most often sends a patient back under the tube is the one a written exam cannot see.
Medicine took this road first
None of this is new to Indian health education, only to allied health. The competency-based MBBS curriculum of 2018, in force from the 2019 batch, requires "certification of certain essential skills" and says that before internship the highest level of skill acquisition is a "show how" in a "simulated or guided environment". The Medical Council's 2019 assessment module says university examinations should use "multiple tools like case presentations, OSCE and/or OSPE". And the NMC's 2020 minimum requirements are blunt: "Every medical institution shall have a Skills Laboratory", of at least 600 square metres for an intake of up to 150, available from the day the college gets its letter of permission.
Compare that with the radiography handbook, where the simulation and skill lab is one bullet with no floor area, no equipment list and no inspection checklist. Allied health is walking the same road as medicine, about six years behind, and has not yet reached the part where someone measures the room.
Where the paperwork is thinner than the ambition
Four gaps are worth knowing about if you are choosing a college or running one.
There is no national exit exam yet. The Act lets the Commission hold one, and the registration regulations notified on 31 August 2026 make it a condition of registration. They also say that until the Commission specifies the exam, the university final "shall be construed as the exit examination". So for now your practical competence is certified by whoever ran your final practical.
Rules for recognising institutions are still "under process", in the words of the Commission's letter of 8 April 2026. Until they arrive, the curricula themselves are the minimum norms, and state governments or universities may inspect. A June 2026 letter from the Commission complained that "variations continue to exist in the duration, norms and structure" of courses, some of them at national institutes.
The staffing bar is high. For an intake of 20 the handbook asks for one professor, one associate professor, three assistant professors and two demonstrators, and a standalone institute needs an MoU with a hospital doing at least 100 investigations a day across X-ray, procedures, CT and MRI. Many colleges will meet the 14 hours on the timetable before they meet it in the department.
The diploma's future is unsettled. The task force that wrote the handbook chose not to submit a diploma curriculum and asked for the course to be phased out within five years. A Commission letter of 3 August 2026 lists a Diploma in Medical Radiology and Imaging Technology among curricula being drafted. Meanwhile AIIMS still accepts a diploma plus two years of experience. Nobody should plan a career around either document alone.
What to do with all this
If you are a student or candidate
The CBT is still the whole merit list, so keep doing question practice. Alongside it, ask to be examined: positioning against a checklist, image critique out loud, a timer running. Keep your logbook properly, because it is the one record of what you have done with your hands. Count your studentship hours, and ask where they went if they fall short of 14.
If you run a programme
2026-27 is the mandatory year. Timetable the studentship so it is visible, and build the skill lab around repetition: phantoms, a console students may get wrong, image sets with planted faults. Convert the end-semester practical into a station circuit, write the checklists first, and train examiners on them. More stations beat longer stations.
If you hire radiographers
You do not need to wait for AIIMS. Twenty minutes at a phantom and a viewing station tells you more than a second interview. Keep it pass or fail and rank on the written score, as ISRO did, and the process stays defensible. Use the same stations in probation to find what a new joiner still needs.
Where a console simulator fits, and where it does not
We make one, so here is the plain account. A software simulator will not teach anyone to position a knee. That needs a phantom, a tube and a teacher standing next to you. What it does cover is the part of the rotation where scanner time is scarcest: four of the twelve internship months are CT and MRI, and no department lets a second-year student drive its only MRI on a full list.
On ScanFlo a student can run MRI and CT consoles as often as they like: choose the protocol, plan the slices, change the parameters, watch what that does to the image and the dose. For colleges, the university portal has 32 ready-made OSCE stations covering protocol selection, planning accuracy and parameter optimisation, some scored against a rubric and some measured automatically, with cohort scheduling and countersigned logbooks. That is stations 03 and 06 in the circuit above. The other four need a room.
If you are weighing careers beyond India, the hands-on question follows you: see our piece on what UK and Gulf licensing asks of radiographers.
A note on figures. AIIMS and NCAHP statements were read in the notices, handbooks and regulations listed below, as they stood on 18 September 2026. Recruitment notices are amended by corrigenda and the group numbering changes between cycles, so check the current advertisement before you apply. Vacancy totals and the weekly-hours split are our own counts from the published tables. Journal figures are quoted from the abstracts. The OSCE circuit and checklist are illustrations, not an official format. This article is general information, not recruitment or admission advice.
Sources
- NCAHP — Competency-based curriculum for Medical Radiology and Imaging Technology (2025) and Corrigendum-1, 6 May 2026
- NCAHP — Notice of 24 April 2025 on adoption from 2025-26 and mandatory implementation from 2026-27
- Press Information Bureau — launch of ten competency-based curricula, 23 April 2025
- NCAHP — Registration of Allied and Healthcare Professionals Regulations, 2026
- NCAHP — Letter of 8 April 2026 on curricula as minimum norms
- NCAHP — Who we regulate
- Ministry of Health and Family Welfare — Model Curriculum Handbook, Medical Radiology and Imaging Technology (2015-16), archived copy
- AIIMS Examination Section — CRE advertisements: Notices 171/2025, 278/2025, 355/2025 and 93/2026
- AIIMS — Scheme of skill test, CRE-2024 (Notice 17/2025)
- AIIMS — NORCET-6 advertisement (Notice 28/2024)
- ISRO VSSC — Advertisement VSSC-324, Radiographer-A
- Medical Council of India — Competency based undergraduate curriculum, Vol. I (2018), Assessment module for undergraduate medical education (2019) and NMC — Minimum requirements for annual MBBS admissions, 2020
- Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990;65(9 Suppl):S63-7. doi
- Harden RM, Stevenson M, Downie WW, Wilson GM. Assessment of clinical competence using objective structured examination. Br Med J 1975;1:447-51. doi
- Brannick MT, Erol-Korkmaz HT, Prewett M. A systematic review of the reliability of OSCE scores. Med Educ 2011;45:1181-9. doi
- Sapkaroski D, Baird M, Mundy M, Dimmock MR. Quantification of student radiographic patient positioning using an immersive virtual reality simulation. Simul Healthc 2019;14:258-63. doi
- O'Connor M, Rainford L. The impact of 3D virtual reality radiography practice on student performance in clinical practice. Radiography 2023;29:159-64. doi
- Rowe D, Garcia A, Rossi B. Comparison of virtual reality and physical simulation training in first-year radiography students in South America. J Med Radiat Sci 2023;70:120-6. doi
- Gårdling J, et al. The effects of virtual reality on clinical skills training in undergraduate radiography education: a systematic review. Radiography 2025;31:102911. doi
- Chau M, Arruzza E, Johnson N. Simulation-based education for medical radiation students: a scoping review. J Med Radiat Sci 2022;69:367-81. doi
- Reject analyses: Foos 2009, Hofmann 2015, Atkinson 2020, Haddad 2023, Bantas 2023, Serra 2024; reject-rate targets from AAPM task group 151 as cited in AAPM task group 305
Frequently asked questions
Is there a skill test for radiographers in AIIMS CRE?
Not so far. In CRE-2024 (Notice 171/2025), CRE-2025 (Notice 278/2025), CRE-4 (Notice 355/2025) and CRE-5 (Notice 93/2026) the Skill Test column for the radiographer group is blank, and the skill-test annexure covers only posts such as clerks, stenographers, programmers, fire and security staff and AC mechanics. What has changed is that since July 2025 every notice states "AIIMS reserves the right to introduce Skill Test for any group." If one is introduced it will be qualifying in nature, with merit still decided by the CBT score.
What is the AIIMS CRE exam pattern for radiographer posts?
A computer-based test of 100 multiple-choice questions worth 400 marks in 90 minutes, split into five timed sections of 20 questions and 18 minutes each. From CRE-2025 onward, 80 questions come from radiography and 20 from general knowledge, aptitude and computer knowledge (CRE-2024 used 75 and 25). Each question carries 4 marks with negative marking of one-quarter for a wrong answer. Qualifying marks are 40% for UR and EWS, 35% for OBC and 30% for SC, ST and PwBD candidates.
What does the NCAHP rule of 14 hours per week of studentship mean?
The NCAHP competency-based curriculum for Medical Radiology and Imaging Technology says "a minimum of 14 hours per week is considered as studentship in every semester", and that institutions must "provide simulation and skill labs for practising skills specific to the program in the initial years of observership/studentship". Studentship is supervised clinical and skills time, recorded in a logbook, and it runs from the first semester instead of being saved for the internship. The semester tables timetable 12 to 15 hours a week for it, earning one credit for every three hours.
Does the NCAHP MRIT curriculum make OSCE or OSPE compulsory?
No. The handbook names OSCE and OSPE among recommended assessment methods and says that in radiography an OSCE "tests radiographic positioning, radiographic image evaluation, and interpretation of results", but it allots them no marks. The prescribed practical examination is 70 marks (50 practical and 20 viva) plus 30 marks of continuous internal evaluation, in the form of spotters, demonstration of equipment handling and case-based discussion. Colleges are free to run that practical as a station-based OSCE, and the handbook clearly encourages it.
How long is the B.MRIT course and its internship under NCAHP?
Four years: six semesters of coursework followed by a one-year internship across semesters seven and eight. The handbook states 640 hours per semester and a minimum 2,400-hour internship, for 6,240 hours and 170 credits in total. The internship rotates through conventional radiography, mammography and PACS (4 months), special procedures (2), CT (2), MRI (2), ultrasound and Doppler (1) and interventional radiology (1).
Is NEET required for admission to B.MRIT?
Not at present. The original 2025 handbook based selection on NEET, but Corrigendum-1 dated 6 May 2026 removed that. Admission to B.MRIT is now on senior secondary (10+2) merit with Physics, Chemistry and Biology, conducted by the state, union territory or university, with lateral entry into the second year for holders of a diploma in the same discipline.
What is the eligibility for Radiographic Technician Grade-I at AIIMS?
The CRE advertisements ask for a B.Sc. (Hons) in Radiography (three-year course) from a recognised university, or a Diploma in Radiography with two years of experience. The post is at Pay Level 6 and the usual age band is 21 to 35. Some institutes word it differently (AIIMS New Delhi asks for the B.Sc. without a diploma route, with an age band of 18 to 30), so read the row for the institute you want.
How should I prepare for a possible radiography skill test?
Prepare for the practical your college already owes you, because the content overlaps. Be able to position standard projections on a phantom or a classmate against a checklist, critique an image for positioning and exposure faults and say what you would change, set a CT or MRI protocol for a stated clinical question, and run through radiation protection without being prompted. Practise under a timer with someone scoring you. Published skill tests of this type, such as ISRO VSSC's for Radiographer-A, are pass or fail: the aim is to be reliably competent, not brilliant.