In the preceding essay on the radiology report, or at least my particular take on what should be in it and what should not. I began with a recitation of conventions or habits that should be subject to scrutiny. For the sake of improvement I will now continue with this roster of bad habits before considering at a later session what is our obligation as communicators in the radiology report.

Although vagueness can infuse many reports, sometimes there is too much exactness. For example, consider the rating of the degree of pneumothorax. When we say that there is a 50 % pneumothorax we are almost always incorrect, because we are making a linear inference about a volumetric phenomenon. If we would assume that the hemithorax is a sphere then with a reduction of the expanse of the lung to one half of its width the decline in volume is really one half times one half times one half. Hence a supposed 50 % pneumothorax is really a 7/8th or 87 % pneumothorax. Since we cannot on plain films make a precise volumetric ascertainment, there is inappropriate exactness in describing a percentage to it. Rather, I use the five M’s, miniscale, mild, moderate, marked and massive to provide a semi-quantitative measure of the extent of pneumothorax as evidenced by its depiction on one frontal chest image.

I recently read a paper where an attempt was made to quantify numerically a pneumothorax on CT. Here, I think is an example of too much information. Unless a need can be satisfied by such a calculation it really is the demonstration of a distinction without a difference.

Another tendency is to personify pathology. For example, many might say that an infiltrate is improving. Yet, infiltrates having no personality cannot improve. They can only lessen or worsen. A patient can improve but the infiltrate can only change physically not subjectively. Similarly, we can mix up object and subject when we personify anatomy. On a CT one might say, the kidneys reveal a stone. Yet the kidneys have no capability to reveal anything. What is going on the kidney is revealed by what is seen on the image. It is the examination with images that reveal the pathology. The kidneys and all other organs have no intrinsic broadcasting facility.

Now moving on to style, there is a tendency to use a passive voice in dictating reports to the point of annoying monotony. The classic example is the word “there”. As defined in the dictionary, one meaning of there is that it is a functional word to introduce a sentence or clause in which the subject follows the verb. That is the way it is used in radiology reports. Now if we say there twice, as in there, there, we employ a condescending phrase urging calm. If we would use there thrice, it could be in the form of an explanation referring to a place or thing or phenomenon some distance from you or your listeners. As in there, there, there! But if we use there 4 times or more in one paragraph, we run into the boring stylistically inappropriate radiology report. As in there is followed by there are, followed by there is, followed by there are. Try to avoid the passive. Also try to avoid too many theres, only one or two belong in any paragraph.