Example Sentence 1: Impression: An exophytic cortical hypoechoic lesion likely complex cyst is noted of the midpole of the left kidney probably not representing the concerning lesion on CT scan which was discovered in the inferior pole of the right kidney.

Sentence 1 review: “An exophytic cortical hypoechoic lesion” are restated findings, not impressions.  It’s not until the second line, beginning “complex cyst”, do we hear the radiologist’s impression.  Next, the report restates another finding  (location = “midpole”).

-“which was discovered” is  a long way of saying “found”

a few side notes to this point

• “is noted”  – doesn’t help, remove.
• there is no “midpole”. By definition the poles are “each extremity of the axis”. There are  only two poles; no midpole. I just say “mid-” as in 4 cm cyst mid left kidney or 4 cm mid left renal cyst.
• the first example sentence is long and has multiple prepositional phrases (of the, of the, in the, of the)

But then the report takes a twist. After restating findings and impression of a left-sided cyst, the author says “probably not representing the concerning lesion on CT”. This is a long sentence to end by saying the finding is NOT the important finding. Better to start by saying what is the important finding.

Also, the author describes a mid left renal lesion, and says it probably doesn’t represent the  right lower pole renal lesion seen on prior CT. Probably? How could a left renal lesion ever represent a right renal lesion?

Example Sentence 2: Rather, there is a hypoechoic to anechoic structure in the inferior pole of the right kidney which appears to be stable since the CAT scan measuring approximately 12 mm.

-“there is a hypoechoic to anechoic structure” – is a restatement of findings. No impression is given (cyst or solid) for this lesion.

-“inferior pole”; say lower pole instead. Also say upper pole instead of superior pole. Upper and lower are 2 syllable words, superior and inferior are 4 syllable words.

-does the CAT scan measure 12 mm? Put adjectives close to the words the modify. Example sentence 2 would be less ambiguous if it began “Rather, there is a 12 mm hypoehoic to anechoic structure…”

Example Impression:

Impression: An exophytic cortical hypoechoic lesion likely complex cyst is noted of the midpole of the left kidney probably not representing the concerning lesion on CT scan which was discovered in the inferior pole of the right kidney. Rather, there is a hypoechoic to anechoic structure in the inferior pole of the right kidney which appears to be stable since the CAT scan measuring approximately 12 mm.

Example has a reading ease 28.9 and grade-level 17.6.

potential rewrite: Impression: Indeterminate 12 mm right lower pole kidney lesion, stable since the prior CT scan. Complex mid left renal cyst.

Edited impression has reading ease 54.7 and grade-level 8.

example sentence: “Normal appearance of the adrenal glands bilaterally.”

The “appearance” of a structure is all we have to observe, and is implicit in the description of any finding. Stating it doesn’t add information for the reader. Removing “appearance” leaves: Normal adrenal glands bilaterally.

Since we are using the plural form “glands”, and since the normal condition is for bilateral adrenal glands,  we don’t need to say “bilaterally”.

suggested rewrite: “Normal adrenal glands.”

The example sentence has Flesch-Kincaid reading ease score of 6.3 and grade-level 14.1. The edited version has reading ease 34.6 and grade-level 9.2.

There are moderate atherosclerotic vascular calcifications of the thoracic aorta without aneurysm.

–Atherosclerotic calcifications can only be vascular. It’s redundant to use the adjective “vascular”.

-“without aneurysm” is and adjective phrase whose intent is to modify aorta, but actually modifies calcifications.

-don’t need to say “There are”. If there weren’t calcifications, you couldn’t describe them.

possible rewrite: Moderately calcified aorta. No aneurysm.

Example  sentence has Flesch-Kincaid grade level-15.9

Repeating “in the” for each anatomic segment is laborious to read.

“A site of metastatic disease” is unnecessarily verbose. Removing “a site of” doesn’t change the meaning.   Could say, “no metastatic disease in the skull base, neck, chest, abdomen, pelvis or thighs.”

But since the exam is a PET-CT from skull base to thighs, can simply say “No findings of metastatic disease” without fear of being misunderstood.

No findings of metastatic disease (as i suggest saying), excludes metastatic disease at the skull base, in the neck, in the chest, in the abdomen, in the pelvis or in the proximal portion of thighs. But it’s actually more comprehensive. The example sentence doesn’t exclude possible metastases in the included portions of head, arms and shoulders.

Suggested rewrite is Flesch-Kincaid grade level-10.0.

“Impression: No significant or acute pelvis or left hip abnormality or significant interval change in appearance since 4/21/2014.”

Flesch reading ease: 25.8

– it’s redundant and rarely helpful to repeat the type of exam in the impression. For example, if the report header is Exam: Unenhanced CT brain, it’s more concise to conclude Normal study or Normal brain than “Normal unenhanced CT brain”.

-it’s not necessary (adds no information) to say “interval change” instead of just “change” when the prior date is given.

-saying “appearance” adds no information. Appearance is what we see on images. The task is to observe, describe and interpret the appearance.

rewrite: Impression: No significant or acute abnormality. No change from 4/21/14.

Flesch reading ease of the edited version is 55.8, meaning the rewrite is more than twice as easy to read as the original.

The clinical question to be answered is “what is causing my patient’s chronic cough”?

GERD and post-nasal drip are common causes.  COPD (emphysema and chronic bronchitis), pertussis, tumors, ACE inhibitors are others. By definition the chronic forms of these diseases do not show an “acute” consolidation.

Saying “no pneumothorax” is an impertinent negative. Pneumothorax is not a cause of chronic cough.

The impression “No acute cardiopulmonary disease” doesn’t address the clinical question. For example, lung cancer is not an acute cardiopulmonary disease.

Saying “No cardiopulmonary disease” is more comprehensive and more concise than “No acute cardiopulmonary disease”.

Better still, saying “Normal study. No findings to explain cough.” answers the question and lets the referring physician know the radiologist understood the purpose of the exam.

Abdominal aorta is significantly atherosclerotic however not significantly dilated.

Significant means important, of consequence.

If the aortic atherosclerosis is important, it warrants further description. Things like location (infrarenal, diffuse), calcified or soft plaque, visceral vessel ostial involvement etc. should be reported. (If there is no contrast, then I think “calcified” is better than “atherosclerotic”, since you can’t assess non calcified atheromas.)

Saying the aorta is not significantly dilated gives the impression that it is dilated. If it is dilated, is it mildly dilated? If it’s not dilated, then say something like “the aorta is not dilated”, or “aorta had normal caliber” or “no aneurysm”.

rewrite: The infra-renal aorta is moderately calcified but not dilated.

There is one thyroid gland. There is not a “right gland” and “left gland”. There are right and left lobes of the thyroid gland. There is no benefit to saying “right gland” instead of “right lobe”.

The statement: “Result: The right and left lobes of the thyroid gland were evaluated.” is unhelpful, incomplete, and ultimately unnecessary.

First, The right and left lobes of the thyroid gland were evaluated. is not a “Result”.

Next, It’s obvious from the reported findings that the isthmus was also evaluated.

The sentence is unnecessary. Do we ever not evaluate both lobes on a thyroid ultrasound?  Further, reporting measurements makes it evident both lobes (and isthmus) were examined. How else could we give measurements?

Possible rewrite:

Result: The right lobe measures 4.3 x 1.4 x 2.2 cm. The left lobe measures 4.9 x 0.9 x 1.5 cm. Isthmus is 2 mm thick.

Comparison: 5/14/2014

Compared with what?

As a report reader I find a “Comparison:” section more cosmetic than useful. But if used, at a minimum state body-part and modality in addition to date.

I don’t find listing comparison exams as helpful as reporting them in-line. For example, it is easier (and quicker) to comprehend  “Tumor unchanged from 5/14/14 chest CT” than “Tumor unchanged from the comparison CT”. In the second example the reader must refer to the “Comparison:” section. This distracts their attention, takes more time, and slows  comprehension,

“There is atelectasis present at the lung bases.”

How bad is the atelectasis? Is it something to worry about?

This report is just a radiologist thinking out loud.  Saying something like “mild dependent atelectasis” at least gives the  idea that it’s an insignificant finding. (I may argue an insignificant finding shouldn’t be mentioned.)

If there is “significant” atelectasis, describe the degree as subsegmental, segmental, lobar etc., and try to identify the cause (passive, compressive, obstructive, cicatricial).