Radiologist champions the ‘value of uncertainty’ in imaging reports

In an effort to reduce vague and ambiguous language in radiology reporting, some within the profession recently have pushed for the elimination of specific phrases that denote uncertainty.

But uncertainty can sometimes be a necessity, according to a commentary authored by Barry S. Leitman, MD, of the NYU School of Medicine, and published online in the Journal of the American College of Radiology.

“As radiologists, we strive for precision and a crisp reporting style. However, this is easier to accomplish with high-tech imaging such as CT or MRI, in which the images provide clear assessments of the anatomy and pathology,” wrote Leitman. “When interpreting lower tech images such as bedside radiographs, it is understood that the accuracy and precision of the imaging data are limited by technical factors, lack of patient cooperation, and overlay of multiple external and internal structures.”

He cites an example involving an imaging finding of bilateral perihilar airspace disease, which can be attributed to pneumonia, pulmonary edema or a number of other causal factors. Without readily available knowledge of a patient’s medical history or current state of health, Leitman would typically include the phrase “clinical correlation is recommended” in his report.

“My lack of clinical certainty compels me to add this phrase,” he wrote. “In a more perfect world, an electronic medical record would be available, complete, and easy to use, so that we could make the correlation ourselves. This has yet to occur.”

Leitman says his experience as a thoracic radiologist who reads hundreds of radiographs a week has led him to embrace a lack of certainty and to appreciate its value in radiology reporting.

“I have come to live with uncertainty,” he concludes. “I feel that in reporting these imprecise examinations, the use of phrases that convey our lack of certainty is perfectly appropriate and, in fact, may be the better way to report these images.”