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Banned: Top 8 words or phrases to avoid in radiology reportsBy Philip Ward, AuntMinnieEurope.com staff writer

October 30, 2013 -- To highlight common expressions that can mislead, misinform, or misdirect referring physicians, the radiologyreport needs to be re-examined, and it is vital to eliminate the lexicon of clichés that undermine a radiologist's work because of theirvagueness, warns a respected global expert in a hard-hitting editorial.

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The dictated report is probably more important today than ever before -- it reveals radiologists' interpretive expertise and hasbecome central for the assessment of the value they aim to provide, noted Dr. Stephen R. Baker, professor and chair of thedepartment of radiology at Rutgers New Jersey Medical School (NJMS), in Newark, U.S.

"The advent and dissemination of the electronic medical record (EMR) promises to make our dictations readily available,independent of the constraints of geography. Hence, persistent use of specific phrases understood only locally and radiology jargonin general may each not be comprehended or be comprehensible by distant, nonspecialist caregivers who receive our reports and

then act on them," he wrote in an article published online by the European Journal of Radiology on 27 October.

In the era of team approaches to healthcare, a well-crafted, pertinent, and unambiguous narrative is essential to enhanceradiologists' reputation and facilitate the successful interaction between them and their clinical colleagues, he added.

Baker, who is president of the Society of Chairmen of Academic Radiology Departments and editor-in-chief of EmergencyRadiology, has identified the following eight terms that he regards as unhelpful and redundant, often because of their subjectivequalities:

1. Cannot rule out, or cannot be excluded

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These two phrases are identical in meaning, and often they are included in a report to avoid the retrospective insinuation that a lesslikely diagnostic possibility did not get a mention in the radiologist's narrative, he said. But each term is meaningless as astatement of the radiologist's ability to discern and clarify, and to include either term is in effect to offer a tautology, not an insight.

"What is needed instead is to provide the best diagnoses based on radiologic, historical, physical, and laboratory findings, not aflippant cover for everything even remotely likely. Referring physicians want the most compelling diagnosis described andexplained," Baker stated.

2. Minimal

This word often is used as a synonym for tiny or small, but it is not identical in connotation or denotation to either. Tiny and small areadjectives of comparison, and they are relative terms, whereas minimal implies a fixed boundary, a limit below which anabnormality of lesser length or volume cannot be discerned, he explained.

"Often a finding with dimensions less than what is ascribed as minimal could be observable. Instead of declaring something to beminimal, we as anatomists need not make such a claim. Instead we should measure the dimensions of the abnormality so that itcould be compared with future depictions of the same finding and then estimates of enlargement or shrinkage could bedetermined," Baker wrote, adding this can help avoid the rhetorical trap that on a subsequent examination one could be compelledto admit that a radiodense or lucent lesion even smaller than its so-called minimal dimensions is recognizable.

3. Hardware

Radiologists must understand the pathology and use the vocabulary familiar to each of the generalists and specialists they serve,and it is good practice and policy to label the implements and procedures whose images we observe with the appropriate terms, inprecise and specific detail.

To call them collectively "hardware" should raise questions about whether our interpretations are merely pro forma exercises inirrelevancy instead of being a focused consultation relevant to the clinical issue at hand. The use of "hardware" serves to relegatethe radiologist to the role of a mere observer, not an expert analyzer of a device's identity, position, and purpose, according toBaker.

4. May represent

Typically, this expression immediately precedes the listing of just two clinical choices that each correspond to the sameradiographic pattern of abnormality, and it needlessly magnifies uncertainty, he argued.

"Either one is a legitimate possibility but other entities distinctly are not and are characteristically not mentioned by name. Forinstance, it may represent 'an infiltrate or edema in the lung.' But claiming that it may represent does not eliminate the plausibleconsideration that it could be a manifestation of some other entity," he wrote. "Customary use of this term is apt to eventually castthe radiologist as one who repeatedly seeks an 'out' when a more appropriate definiteness is required."

5. Questionable

Vagueness is a trait that you do not need to display as a trademark of your reports, and the opinion you render should be amanifestation of your skills and your confidence about them, Baker advised.

"You should expunge 'questionable' from your list of acceptable words. For one thing 'questionable' does not relate to an estimationof your extent of uncertainty. And it also creates unnecessary confusion about the origin of that uncertainty."

6. SuspiciousBy verbal and written communication, radiologists should reveal themselves to be vitally involved in the care of patients and yetmeasured in the articulation of judgments, and this requires offering diagnoses on the basis of sound, careful, unemotionalassessment. Words like "suspicious" display subjective reactions that don't rely on the careful evaluation of evidence. Thedeclaration of "suspicions" about the presence of an abnormality without the accompaniment of forthright reasoning is notreassuring to referring physicians, he stated.

7. Within normal limitsA chronic "malady" liable to affect all specialties of medicine is the "disease" of the insidious infiltration of jargon, and you must getrid of it from consultations, both oral and written. Often it takes the form of added words that gives a notion an air of heightenedemphasis, seeming to impart a sense of augmented perspicacity to what could be false or silly, he explained.

Within normal limits is such a phrase when there are no agreed upon limits beyond or less than which a finding would be deemedabnormal. "If there are no measurable borders to ascribe or discern, the simple term 'normal' is more apt than 'within normal limits.'By so doing, you will not have to fumble around when a referrer asks you to describe to him or her what those limits are when thereare, in fact, none."

8. Clinical correlation suggested or requestedThis phrase does not protect a radiologist from being sued, with the exception of its stylized adaptation as part of the lingo of breastradiology diagnosis, Baker asserts. Referring physicians tend to regard its use as trivial and of no value, and may be offended by it.Moreover, with the advent of the EMR, the clinical characteristics of the patient's illness and knowledge of his or her medical historyare now available to the radiologist with the click of a mouse, so use of the phrase "clinical correlation requested" is now not just amanifestation of a radiologist's heedlessness of its implications, and a mark of his or her laziness to acquire that clinical correlation.The phrase should be abandoned as a concluding sentence in a radiologist's report, he wrote.

The points covered in the editorial are part of the NJMS's policy for radiology reports, Baker concluded.

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What clinicians want from radiology reports, August 3, 2011

Medicine is not mathematics -- radiology reports are opinions, June 27, 2011

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