The emerging categorization of quality assessment, utilized now by most accrediting agencies in medical education divides the roster of evaluation into six distinct areas of inquiry and measurement, They are medical knowledge, professionalism, system based practice, practice-based learning, patient care and interpersonal and communication skills. All of these competencies are important for physicians, both those in training and those beyond residency. For radiologists, despite our distance from direct contact with patients as an essential component of most of our daily work, they are still no less important.

We must be knowledgeable and concerned with our patients even as we are mostly at a remove from them. Also we must be aware of and participate in the management of care locally in the context of national regulations. And, of course, we have to be good communicators. sharing and receiving expertise in our conversations with referrers. Perhaps more than other specialists, our communication skills relate to the written word as manifest in our dictated reports. So this competency must be in the forefront of our commitment to quality [1].

Now more than ever to maintain the excellence of the enduring statements we render, we have to skillfully recognize imaging findings and the implication of those findings through written expressions that must be clear, succinct and apt. Why now more than ever before? Because our reports will likely be read not only by the doctors and other caregivers we know and see and talk with on a daily or regular basis, but also our reports must be unambiguous and comprehended by clinicians we do not know but with whom we will be linked through the widening availability of the electronic medical record. When a patient is treated elsewhere at some distance from you and at some time in the future, the message of your report will be essential by itself inasmuch as clarification may be more difficult to render to supplement what you have proffered in the first place. And the individual, remote in place and time who reads it may not be a physician. So what you relate must be intelligible to everyone qualified to provide care. Hence, the language of the report must be pitched to the level of medical sophistication enjoyed by a physician assistant or nurse practitioner.

Under this potentially extended distribution of the fruits of your expertise, highly specialized vocabularies become an impediment to understanding. Jargon does have its psychological benefits for those who profess and comprehend it. It reinforces exclusivity, sometimes affording a comforting smugness to know that you are one of the cognoscenti who can converse with a special word roster to others as informed as you are even though outsiders are excluded. It lets you share confidence through the use of coded phrases and terms. But jargon and its coconspirator, abbreviation, are in themselves potentially dangerous because they inhibit widespread communication and consultation. They do not promote comprehension but serve to restrict it. The pertinent slogan should be: if you want to be understood by a few, use jargon but if you want to be not misunderstood by many, use English. In the context of a radiologist’s written reports, the level of medical English to strive for is intelligibility by primary care physicians or their surrogates (PAs and their like).

With that as a background, we should look with a discerning eye at some patterns of expression that have infiltrated the customary parlance found in many radiology reports. The purpose is to expose and root out habitual misuses we have become comfortable with but which can engender confusion leading to mistaken conclusions and sometimes, to the uninitiated, bewilderment and befuddlement-all of which by the way serves to weaken our ethos as experts.

I have compiled a list of 64 things you should not say or write, each of which has frequently appeared in radiology reports from everywhere. But their frequency and commonness should not be a justification for their continued use because misinformation, ambiguousness and obfuscation should not be our stock in trade. We can do better, we are expected to do better in this objective category, and the recognition and removal of errors and foibles of expressions will lead to better care. I have disaggregated these pesky problem terms into distinct groupings, each with a common theme within the rubrics of figures of speech. With regard to precision, our dictation must be as specific as possible about what is being observed and commented upon. Everything that is extraneous to the satisfaction of this principle should be avoided even though such words and phrases have become encrusted through habit and custom. Those that perpetuate less than a rigorous literal exposition that can be immediately and unequivocally comprehended should be deleted from your lexicon.