Wet Read: And the count is...

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Not everything that counts can be counted, and not everything that can be counted counts.

—Albert Einstein

And he measured the wall thereof, an hundred forty four cubits, according to the measure of a man, that is, of the angel.

—Revelations 21:17

I believe you all know that I’m a neuroradiologist. Head and neck, brains, and spines. While this topic may be a special item and a pet peeve for me, it isn’t confined to those anatomic areas, however. Abdomens, chests, extremities, etc., and the people who read those studies—all of them can find this little rant can apply to them. What I’m going to discuss is the entity of pathologic obsession with enumeration—measurements or counting things. I am not going to deny for a moment that I have a few modestly obsessive tendencies, but I try to keep them in check. Some people let their freak flag fly, baby.

There are items that need to be counted. There are things that need to be measured. I’m not here to argue that point. I’d lose. I hate losing. Something got bigger—you report it. There are less things—you report it. You ALL know exactly what I mean, though. You have undoubtedly followed these people in reading a study. When I pull up a study, and there are those annoying little electronic calipers on EVERY image, I can pretty much tell you who read the study before. And, when I read the report, and over 10 instances of ANYTHING are documented, I also know who ventured down this path before me.

I think there is “being thorough” and it’s evil stepsister “being OCD.” I will provide examples. Lymph nodes live in the neck of human beings. Big or bad lymph nodes are pretty conspicuous. If I wanted to, I could count several hundred nodes on every scan. But, I don’t. Why? Because they are meaningless, that’s why. When I see 20 nodes measured, I turn off. When I see “there are 42 small 2- to 3-mm white matter lesions” in a report, I get a little sick. You know what goes through my head? Do I have to count them all and compare them? I have kept a copy of a report wherein someone measured 4 sebaceous cysts. In 3 dimensions. I’ve also kept a report with a measurement of the size of all skull base foramina.

A thorough and complete report is a wonderful thing. So is a meaningful report. Then, there’s obsession. Not the cologne. Mahalo.

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Wet Read: And the count is....  Appl Radiol. 

By C. Douglas Phillips, MD, FACR| May 04, 2013

About the Author

C. Douglas Phillips, MD, FACR

C. Douglas Phillips, MD, FACR

Dr. Phillips is a Professor of Radiology, Director of Head and Neck Imaging, at Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, NY. He is a member of the Applied Radiology Editorial Advisory Board.

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