Author Archives: Ppotok

is noted

ex.”Atherosclerotic calcification is noted in the aortic arch.”


“is noted” is unnecessary and can be omitted with no loss of information to the reader. The sentence can be rewritten:
“Atherosclerotic calcification in the aortic arch.”

This is an extremely common clear writing faux pas. A descriptive sentence appearing in a report IS the note! No need to waste words telling the reader you noted a finding while they are reading your note about the finding.
I’d rewrite the example sentence simply as “Atherosclerotic aorta.” or “Calcified aortic arch.”
The vast majority of times we describe a calcified aorta on chest radiograph it’s more or less just thinking out loud. Rarely is this information of clinical use. If you want to say it,  make it as brief as possible. 

imprecision

“The cardiomediastinal silhouette is enlarged but stable.”


On a frontal chest radiograph the superior and posterior mediastinum are visible parts of the “cardiomediastinal” silhouette. (The superior mediastinal silhouette is composed of the vascular pedicle, and the posterior mediastinum is defined by the descending thoracic aorta on the left and azygoesophageal recess on the right.)
Saying the “cardiomediastinal silhouette is enlarged” indicates enlargement of not just the heart, but the other cardiomediastinal constituents too. If the goal is to describe cardiomegally, saying “the cardiac silhouette is enlarged” is more precise. Stated more concisely, “Enlarged cardiac silhouette.”

utilize within

One of the fundamental principles of clear writing is never use two words when one will do. The frequently reported “atherosclerotic change” says no more than “atherosclerosis.”

Simplify whenever possible. Say “use” instead of “utilize”, and “in” instead of “within”.

demonstrate or show

“views of the abdomen demonstrate calcific densities in the liver and spleen, compatible with changes of chronic granulomatous disease.”   Flesch-Kincaid reading level 15.4

More concisely written:
“abdominal image shows granulomas in the liver and spleen.” Flesch-Knicaid reading lever 8.8

Radiologists demonstrate things (see below). Images show things. “Show” is the better word in this case, and it’s also one syllable instead of three. As often as these words are used the savings to the report reader add up quickly. 
Hepatic and splenic granulomas are an Aunt Minnie. Don’t need spend time describing them. 
 

verbose consolidation

“There are consolidative changes throughout the bilateral upper and lower lobes, with the greatest degree of involvement in the right lower lobe.” – Flesch-Kincaid reading level 13.9

“Bilateral upper and lower lobe consolidation, worse in the right lower lobe.” – Flesch-Kincaid reading level 10.7

proximal distal

PICC is an acronym for “peripherally inserted central catheter”. Written “PICC line”, it technically translates to “peripherally inserted central catheter line.” Since that’s redundant, omit “line” to shorten.
Also, I call the external catheter end a hub, not a proximal tip. If there’s no proximal tip, there is no need to specify “distal” tip.
Describing the SVC as either proximal or distal is not good reporting practice. People frequently misunderstand the meaning. Say upper, mid or lower SVC to avoid confusion.
I’d rewrite #1 as “New right-sided PICC to the lower SVC.” Can even omit the word “tip” without fearing ambiguity since “to” expresses the catheter’s extent, limit or destination. The edited version is shorter, unambiguous and more easily understood (Flesch-Kinkaid 4th grade level compared with the original 7th grade.)

increased hypermetabolism

I’d rewrite #1 as “Hypermetabolic right perihilar mass consistent with lung cancer.”
This exam was not in comparison to an earlier study, therefore “increased hypermetabolic activity” is redundant.  Should just say “hypermetabolic acitivty” or “increased metabolic acitivity”. 
If comparing with a prior hypermetabolic lesion, could say “increased hypermetabolic activity” or “decreased hypermetabolic activity” to indicate the change. They both make me think about what the author is relaying; particularly “decreased hypermetabolic acitivity” which sounds like an oxymoron, although it is not.
(Of note; “hypermetabolism” = “hypermetabolic acitivity”. No need to use two words when one will do.)
I say, “more hypermetabolic” or “less hypermetabolic” to indicate a change.

expanded and clear

“The lungs are symmetrically expanded and clear,” does not unambiguously describe normal as frequently intended. Clear, symmetrically over- or underexpanded lungs also fit this description.

A more precise description is: “The lungs are normally expanded and clear.”


correlate and compare



As a report reader, I don’t see the benefit of sub-categorizing prior exams as comparison or correlative. They are all prior exams.  Adding more report section headers detract from the point of section headers, which is to draw the reader’s attention to important information.

I don’t think a separate Comparison section is necessary or warranted. I will expound on that thought in a future post.




more words to say less

“There is no focal infiltrate.”

This statement doesn’t explicitly exclude diffuse or multifocal infiltrate. It’s an example of using more words to say less.

“There is no infiltrate,” excludes focal, multifocal, diffuse, and any other infiltrate.

N.B. Infiltrate is not recommended by the Fleischner Society, and has be replaced by other descriptors. The term opacity, with relevant qualifiers, is preferred.