from JACR

1. Speaking of Language
● June 2015 ~
● Journal of the American College of Radiology
B. J. Hillman.
J Am Coll Radiol. 2015;12(6):544.
Habit
Laziness
Unwillingness to be on the line
Jargon
Clichés
Defensive language
Meaningless phrases
The limits of my language
means the limits of my world.
— Ludwig Wittgenstein
“
”

2. Misuse of the Term Nonspecific
● Nonspecific
○ The appearance of a finding could be attributed to a number of
etiologies
● Clinicians may think
○ Hedging on their responsibility
○ A lack of confidence or even incompetence
● One or two small white matter foci in a 60-year-old patient
○ Technically nonspecific
○ A common finding that is normal for this age
S. J. Kuzminski.
J Am Coll Radiol. 2016;13(4):362.
A statement regarding whether the nonspecific finding is normal or abnormal,
providing a differential diagnosis, or suggesting additional follow-up greatly improves the
value of the report.

3. Keep “As Above” Out of the Impression
● Most important is the impression
● Many referring physicians go directly to the impression
● As Above
○ No value in the impression
○ Failing to indicate which among them are important
J. K. Hoang.
J Am Coll Radiol. 2015;12(10):1009.
Impression:
Degenerative changes in the
lumbar spine as above.
Impression:
Degenerative disease in the lumbar spine at
multiple levels. Given the location of the
patient’s radicular symptoms, this could be due
to severe spinal canal stenosis at L4-L5 and
severe right L5-S1 foraminal stenosis.

4. There Is No Such Thing as a “Mid-Pole”
S. Munn.
J Am Coll Radiol. 2015;12(7):656.
It has no mid-pole, nor does a magnet, a battery, a kidney, or a patella
(not to mention a nipple).
● Pole
○ Two opposite ends of an axis running through a sphere or similarly shaped object
○ Two thoughts or functional opposites (battery)
● Reference to the patella, the kidney, and even the nipple
A small calculus is evident in the
mid-pole of the right kidney.
“middle left kidney”
“mid-left kidney”
“middle part of the left kidney”
“mid-portion of the left kidney”

5. Recommend Clinical Correlation: A
Common but Meaningless Phrase in
Radiology Reporting
S. J. Kuzminski.
J Am Coll Radiol. 2016;13(4):362.
Radiologists should omit the nebulous “recommend clinical correlation” from their reports
and provide specific diagnoses and recommendations.
Flakey calcifications in the left
breast. Recommend clinical
correlation to determine if biopsy
is required.
How clinical correlation ?!?!
● Potentially infuriating to referring clinicians
○ The radiologists believe they have not done their jobs ?!
○ The radiologists are now instructing them to do so ?!
● Diagnostic uncertainty
○ Provide differential diagnoses
● Clinical information is available
○ Estimations of the likelihood of each of the various diagnostic possibilities

6. Avoid “Cannot Exclude”: Make a
Diagnosis
● Imaging appearances of the DD can be identical
● Radiologist lacks the confidence
● Assume the radiologist is being defensive
● Radiologist should advise on whether further imaging is
indicated to make the diagnosis
J. K. Hoang.
J Am Coll Radiol. 2016;13(5):490.
Impression:
Right lower lobe
consolidation most likely
represents pneumonia.
Cannot exclude malignancy.
Impression:
Findings most likely represents pneumonia.
Given the known risk factors for malignancy, a
repeat study in 6 weeks would help identify an
underlying mass.