Monthly Archives: May 2013

x-rays

“2 view chest x-ray“

X-rays are electromagnetic radiation. They cannot be viewed. We view radiographs.

considerable activity

“There is considerable increased metabolic activity in the large mass at the base of the chest on the right. The approximate maximal SUV is 15.2.”


The words “considerable” and “large” are subjective, and should be replaced by more objective and helpful descriptors
The words “increased metabolic activity” can be replaced by “hypermetabolic.”
“Base of the chest” is vague and should be replaced by accurate anatomic descriptions to guide therapy.
The example sentence ends with 4 prepositional phrases: “in the”, “at the”, “of the” and “on the”. Many prepositional phrases are a red flag that the sentence needs to be restructured. 
The example sentence does not specify the size of the mass, so i’ll make one up. A rewritten sentence might look something like: 
“Hypermetabolic 6 cm right lower lobe mass showing max SUV of 15.2.”

The rewritten sentence is more concise, replacing two sentences (25 words) with only 11 words. But it’s also more precise and more complete. And I think more clear.



base of brain

“There is marked atherosclerotic calcification at the base of the brain.”

I’ve seen this imprecise description of carotid artery calcification many times. The “base of the brain” is the hypothalamus. The carotid arteries are below the base of the brain. 
Say something like; “Marked carotid atherosclerosis.”


another aorta is noted

“A mild degree of atherosclerotic calcification is noted within the arch of the aorta.”


“A mild degree of” = mild;
“is noted” should be omitted;
“within” = in;
“arch of the aorta” = aortic arch;
rewritten version: “Mildly calcified aortic arch.”

Since arch calcification is an Aunt Minnie would could skip the description jump right to the diagnosis, which is atherosclerosis. “Mild aortic atherosclerosis.” 

tautology

“Biconvex in shape.”

“Round in configuration.”
“5 mm in size.” 
All of these statements are redundant. 
Specifically, “biconvex” is a shape and can’t be anything else. You couldn’t say “biconvex in size” just like you couldn’t “5 mm in shape.”

reading

Meaningful Use regulations are going to require medical practices to provide patient access to medical test results within 4 days of the test.

The average person reads at the 7th grade level. To their benefit, medical jargon should be replaced by simple terms whenever possible. From a prior post, it’s likely that “normal kidneys” will cause fewer patient questions than “the bilateral renal units are unremarkable”.

passive voice

“A consolidation is not seen. A pneumothorax is not seen.”

Technical/scientific editors agree that in almost all circumstances using the active voice is better. These sentences should be rewritten like: “There is no consolidation. There is no pneumothorax.” or just “No consolidation. No pneumothorax.”
Active voice permits simpler sentence structure than passive voice. It reduces word count and allows easier reader comprehension.

uncommon description

“The bilateral renal units are unremarkable.”

Rewritten for conciseness and clarity: “Unremarkable kidneys.” 
If the clinical question was unrelated to the kidneys ex.”Epigastric pain, r/o pancreatitis” then I’d just say “Normal kidneys.”
Technical writing principles do not require use of full sentences. This allows for bullet lists, tables etc. which can improve clarity.

consistent wording

“Findings: Hypoventilatory changes are noted at the lung bases bilaterally.”


“Impression: Underventilatory changes at the lung bases bilaterally.”

– should not change from “hypoventilatory” to “underventilatory” in the impression to report the same condition. It can only serve to confuse.

-For the report reader to visualize the finding  “hypoventilatory changes”  they must know what radiographic findings are possible with hypoventilaton. Using descriptors like “linear basilar opacities” or “increased attenuation” helps the reader create a mental picture, which is the goal of description. These descriptors may also be quantified (segmental, subsegmental etc.)
-the phrase “… at the lung bases bilaterally” is redundant since “bases” is the pleural form of the word, and the lungs are bilateral. Saying “… at the lung bases” covers both lungs without saying “bilaterally.”
Rewritten: 
“Findings: Few linear bibasliar opacities.”
“Impression: Mild hypoinflation.”
N.B. –  Felson demonstrated that 25% of patients showed no difference between paired inspiration and expiration radiographs. Also, an endomorphic body habitus accentuates the appearance of hypoventilation.