Initial Attempts to Modify Dictation Practice

Abstract

t f 9 r t W c DESCRIPTION OF THE PROBLEM Radiology’s march toward universal structured reporting represents an effort to address many issues in reporting quality [1]. It is the best way to clarify our message, ensure thorough and safe reporting, and be valuable to referring clinicians. Instrumental to this is consensus on the use of appropriate terms [2-5]. Words can be deleterious to a report if they are unclear, misleading, or carry negative connotations. Many inappropriate or inaccurate terms have endured simply by tradition. The variability of reporting language and style also remains a concern for the specialty [6-8]. For example, one study found 14 terms used to describe the same entity on chest radiographs [8]. The clarity of terminology is imortant in providing valuable inforation and ensuring safety, similar o the value of universal protocols escribed in the surgical literature, n decreasing adverse outcomes and ncouraging thoroughness [9-12]. he development of universal clasification systems and lexicons, uch as BI-RADS and the develping Liver Imaging Reporting and ata System, seeks to address many f these issues [1,3,13]. The “radiologic hedge” has been pecifically addressed, suggesting hat a lack of commitment cannot e altogether avoided in our speialty but that no more than one uch evasive term or qualification hould be used in a sentence [6]. In an early attempt to address the nternal uniformity of reporting anguage at our institution, we hose to focus on the use of the erms gross and grossly. The terms ere not part of the RadLex uniersal lexicon at the time of this study, and we hoped that these terms would be interesting to study, exploring issues of style, clarity, and the redundant hedge. We wanted to test the willingness to adhere to language guidelines promulgating precision and to gauge devotion to the hedge (and the double hedge). These terms are typically used to mean obvious or discernible, in the context of a technical limitation or a study not tailored to the evaluation of a given pathology. However, the term gross can also be defined as repellent, disgusting, or corpulent, potentially offending a lay reader. Although the terms could readily be replaced, we questioned any value of legal protection from such terms of doubt. Most examples in our reports invoked the terms to alert the reader to limitations in technique. These were usually redundant, as they accompanied another hedge or explicit elucidation of incomplete evaluation (in boldface type):