Wet Read: No. Do NOT measure that.

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“Resist the urge to measure normal nodes.” — Pat Hudgins, MD

I have ranted about this particular topic before, but … back to the well. There are times when I open a report and I know with confidence who read the prior study. Know how? No, it’s not the grammar, or the use of certain phrases, or even the style.

It’s the number of measurements.

If I see four paragraphs on a normal exam and many sections where the majority of the text is along the lines of “5.3 × 4.2 × 1.5 mm,” I know the likely culprit. So, here I go again. Let’s rant about measurements.

This is clearly a problem of the current age — we didn’t face this issue in the era of wax pencils and acetate film. The electronic caliper is a marvelous tool. You click on a point and then you move to another point and you click again and you get the exact distance. To amazing accuracy. You can get some of these down to 0.01 mm accuracy.

Or can you? Are we that precise? Anyone remember Heisenberg?

Here’s the deal for me: If I have to measure it, it isn’t abnormal. I’ve been doing this for a while, and I know what 2 cm looks like. I measure big things — if they matter. I measure things when the measurement actually is a critical issue (tumor sizes for staging or follow up). I measure things I’m reporting for the first time so the clinician knows that it is really big or not so big (Is it bigger than a breadbox or smaller than South Dakota?).

I don’t measure normal stuff. I take immense pride in deleting normal measurements on studies I’m reading out with a resident or fellow. And I tell them Dr. Hudgins’ words of wisdom so they know I’m not alone in this.

And, for all you who measure to the tenths place, or even the hundredths place — just stop it. You’re crazy. You know, when you’ve had a few coffees in the morning, there is no reproducible difference between 3.6 mm and 1 mm. There just isn’t.

I’m really looking forward to the AI era when the PACS measures everything and does the comparison and I don’t have to even contemplate measuring anything. If the PC wants to waste its time, I’m cool with that. Seriously. It may even delay the day when machines take over the world. Wouldn’t that be awesome? The machines wanted to take over, à la The Terminator, but they got bogged down measuring all the normal nodes.

Keep doing that good work. Mahalo.

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Phillips CD.  Wet Read: No. Do NOT measure that..  Appl Radiol.  2018;47(12):32.

By C. Douglas Phillips, MD, FACR| December 03, 2018
Categories:  Section

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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