Rad reports should not include 'cannot exclude'

Radiologists need to stop writing “cannot exclude” in their reports, according to a recent commentary in the Journal of the American College of Radiology.

Jenny K. Hoang, MBBS, of the department of radiology at Duke University Medical Center, wrote that the phrase is overused and adds no additional value to patient care.

“Radiologists should list only pertinent differential diagnostic considerations and advise on the need for further imaging needed to confirm a diagnosis,” Hoang wrote. “Radiologists’ skills are most valuable when they are used to make diagnoses, not exclude them.”

Hoang provided an example, pointing out that “cannot exclude malignancy” doesn’t help the referring physician at all. A more helpful way to get that point across, she wrote, would be: “Findings most likely represents pneumonia. Given the known risk factors for malignancy, a repeat study in 6 weeks would help identify an underlying mass.”

Hoang also wrote that this phrase is used so regularly that referring physicians “may roll his or her eyes” at the very sight of it.

In a follow-up interview, Hoang told RadiologyBusiness.com about a trend she’s noticed related to saying “cannot exclude.”  

“I haven’t noticed any differences between ages or subspecialties of the radiologist, but there does seem to be a correlation between the quality of the trainee and their reports,” she said. “The excellent residents and fellows are not only great at detecting the findings, interpreting findings, but also spend time thinking how they will sound in their reports. They don’t use ‘cannot exclude’ and other jargon quite as frequently.”

The commentary was a continuation of Hoang’s “Speaking of Language” series, which looks at different bad habits radiologists display in their writing. Back in June, she wrote about how radiologists should not use jargon to describe a normal finding.

Another recent journal about a bad habit found in radiology reporting was written by Richard B. Gunderman, MD, from the Indiana University School of Medicine’s department of radiology, and Laura A. Steinmeyer, a medical student at Indiana University. They wrote about the use of passive voice in radiology discourse in July for Academic Radiology.