There is nothing like a seven-hour transcontinental flight (with
the exception of an international one) to help you focus on matters
of great significance and importance. It is the perfect isolation
chamber, if the in-flight movie is unappealing and your seat mate
is not too chatty. It is prime time to ponder Nobel-worthy
research, to prepare an acceptance speech for the RSNA Gold Medal,
or, if your goals are slightly less lofty, to catch up on your
backlog of journals without fear that your 3-year-old will spill
his or her apple juice on the critical pages. This aeronautical
think-tank is where I am at my most productive. Once airborne, the
lack of distractions allows me to solidify my thoughts, in this
instance, regarding a problem I have encountered in my practice of
radiology: the use and abuse of colloquialisms in medical
terminology.
We, as radiologists, are primarily consultants, and every report
we generate is a written consultation. As we do this 50, 100, even
150 times a day, we need to have our communication skills down-to
mean what we say and say what we mean. I am sure everyone can come
up with a list of their favorite malapropisms or misused terms.
Since I have the "bully pulpit" right now, I will share mine.
1. Lung "fields": I cringe anytime one of our residents uses
this phrase, which is not only meaningless, but also expensive. My
departmental administrators state that each word in a report has a
definite associated cost of transcription, printing, and physician
approval or corrections. I do not know what a lung "field" is; cows
stand in a "field"; Kevin Costner built a "field" of dreams, but
neither pulmonary texts nor medical dictionaries define a lung
"field" and, therefore, there is no way to classify it, either
medically or financially. Perhaps my distaste for this term has to
do with one of my mentors in residency, an internationally renowned
chest radiologist, who strictly forbade its presence in her
reports. One may use the term "lung zone" or merely "lung", but let
us please bury the "field".
2. "Nonspecific bowel gas pattern": What does this phrase mean
exactly? No one I have ever asked has provided a satisfactory or
consistent answer. If an image or radiograph is non-specific, it
has not enabled us to come any closer to a diagnosis. This term is
even more offensive than "fields", not to mention verbose and
superfluous. I refer the interested reader to an elegant essay by
Dean Maglinte in a previous issue of Applied Radiology (October
1997) as grounds for this phrase never seeing the light of day (or
night) again.
3. "Epicenter": This comes from the geologic nomenclature for
earthquakes, referring to the part of the earth's surface directly
above the seismic focus. In some radiologists' misguided thinking,
the term has been adapted to refer to the origin or center of a
lesion, for example, "the epicenter of the lesion is in the adrenal
gland."
There are many more of my terminological pet peeves, but
thankfully no major culprits come to mind at present. Let us do
what we can to rid the world of such radiological jargon. Our
referring clinicians, who may not be cognizant of the meaning of
such "buzz words," will understand and appreciate us all the more.
Now if you really want to get me started, just ask me about the
vicissitudes of flying these days....
Dr. Harris is Associate Professor of Radiology at Dartmouth
Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, NH; he
is also on the editorial
advisory board of this journal.