–“Findings concerning for malignancy” is an impression and should be reserved for that section of the report
-interjecting the pleural effusion description when giving lung findings is disorganized an distracting to the reader
potential rewrite: Soft tissue occludes the right mainstem and lower lobe bronchi. Right lower lobe consolidation with no air bronchograms. Rightward mediastinal shift indicating volume loss.
Example: There is a solid filling defect in the right mainstem bronchus. It is occluding the right mainstem bronchus and extends into peripheral branches of the right upper lobe bronchus.
filling defect n.
A defect in the contour of part of hollow viscus, as seen by x-ray after contrast medium has been introduced, indicating the presence of a tumor or foreign body.
-the example sentence incorrectly describes an endoluminal lesion as a filling defect. Something has to be filled to see a filling defect. Airways are empty.
Example: “Abnormal appearance of the wall of the mid transverse colon, the wall is thickened and findings are concerning for malignancy within the transverse colon.
-3 prepositional phrases: “of the wall”, “of the mid transverse colon”, “within the transverse” colon”.
-should not need to say “transverse colon” or “wall” twice each in one sentence.
-“Abnormal appearance” is not a useful impression, particularly when the subsequent impression is “concerning for malignancy”. I don’t think it would ever be said “Normal appearance concerning for malignancy”, so don’t need to say “abnormal appearance”.
potential rewrite: Thickened mid transverse colon concerning for malignancy.
The example sentence has 24 words . The edited version has 7.
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Example: IMPRESSION: Stable multiple pulmonary nodules in the bilateral lungs.
-You could not say “lung bilaterally” or “lungs unilaterally”. If there are lungs (plural form), they are bilateral.
– I suspect the author’s intent was to say the nodules (not the lungs) are bilateral
-where else can pulmonary nodules be other than in the lungs? Don’t need to say “pulmonary”
potential rewrite: Multiple stable lung nodules bilaterally.
-“No intra-abdominal or retroperitoneal adenopathy.” – The retroperitoneum and its contents are part of the abdomen; no need to say both. Adenopathy is a common misnomer; adeno means “gland” and lymph nodes are not glands. I think it’s simpler and more direct to say “No abnormal lymph nodes”. If specific pertinent negatives are warranted, then specifics should be given. For example “No abnormal peripancreatic or para-aortic lymph nodes”.
–“Examination of the pelvis demonstrates that the prostate gland, seminal vesicles, and urinary bladder are normal.” – “Examination of the pelvis” is unnecessary meta-discourse. Where else can the prostate gland, seminal vesicles and urinary bladder be found?
-likewise the phrases “Examination of the lung bases” and “Examination of the osseous structures” give no useful information and should be omitted.
This report is a good example of why a dedicated “Comparison” section is often unhelpful. The dictating radiologist states the comparison exam date three times. (Although never states what kind of exam is being compared.) Stating the comparison date once, in-line with the specific finding being compared is the easiest for the reader.
–“postsurgical change related to the prior median sternotomy.” A prior median sternotomy is postsurgical change. There is no need to say “postsurgical change”. The sentence is also ambiguous. Is the postsurgical change related to the prior sternotomy, or is the enlarged mediastinum related to the prior sternotomy?
-“…improved compared to the 19 June 2014 exam.” – can be more concisely stated “…improved since 6/19/14.”
–“Multiple bilateral healed rib fractures are demonstrated.”
Example: Constellation of scintigraphic findings consistent with positive treatment response evidenced by marked interval improvement in the overall appearance of the diffuse heterogeneous osseous uptake as described above.
On the Flesch Reading Ease scale where higher scores mean easier reading, the example scores -14.8. (The Harvard Law Review averages around 30.)
Editor comments: An important principle of clear writing is to use a word’s most common meaning. “Constellation”, as used in the example, violates this principle. Further, the words “constellation of” are unnecessary. Omitting them leaves “Scintigraphic findings consistent with positive…”; which tells the reader the same thing.
-Positive treatment response should be consolidated into either “Complete response” or “Partial response”, depending on the findings.
-don’t need the word interval; removing it doesn’t change the meaning
–evidenced by marked interval improvement in the overall appearance – “marked improvement” is an impression, not evidence. Evidence is a finding from which a conclusion is formed. Decreased FDG activity is evidence of improvement and treatment response.
–diffuse heterogeneous osseous uptake as described above – “diffuse heterogeneous” is a finding and doesn’t need to be repeated in the report impression. The author highlights the redundancy by pointing out the finding is as “described above”.
potential rewrite: Partial treatment response evidenced by a marked decreased in skeletal FDG activity.
The edited version has 12 words and Flesch Reading Ease of 32.5.
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example: IMPRESSION: A focus of low signal, in the left anterior epidural space at the L2-L3 level along the posterior aspect of the L3 vertebral body may represent a disc osteophyte or extruded disc material, and results in mass effect on the emerging left L3 nerve root.
possible rewrite: IMPRESSION: Inferiorly extruded L2/3 disc or osteophyte compresses the left L3 nerve root origin.
Editor remarks: In the example sentence “A focus of low signal” is a finding and does not need to be repeated in the impression. There are 5 prepositional phrases: in the, at the, along the, of the, on the. This a sure sign that a sentence can be written more clearly. Describing a finding as anterior to one reference point and posterior to a different reference in the same sentence is confusing. Something that has mass effect on the “emerging left L3 nerve root” has to be posterior to the L3 vertebral body. “Emerging nerve root” could be confusing. It could mean emerging from the theca or from the foramen. The reader if forced to interpret the meaning which slows comprehension.
The example sentence has 47 words and a 22.6 reading level. The edited version has 15 words, 13.1 reading level, and is less ambiguous.
Example sentence: In the right upper lobe there is a calcified granuloma measuring 6 mm in diameter.
Potential rewrite: Calcified 6 mm right upper lobe granuloma.
The example sentence has 14 words and a Gunning Fog index of 16.7. The edited version has 6 words and Fog index of 8.5.
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
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.