Avoiding the passive voice in a radiology report may seem easy to advise (see the earlier blog post "When the passive voice is to be avoided"). Easier to advise than to do. We’re so practiced in using passive voice mannerisms in reports that shifting to a more active voice may feel unnatural... almost like falling into a different verbal mannerism.

For instance, it may seem tempting to convert every instance of the passive voice into existential “There is/are…[x]” statements. But to do this would sound jarring to anyone reading the report. It may seem a graceless composition style. This is true.

Fortunately, there’s an easy way out… a way out in which you're probably already very skilled: normal speech.

For instance… use your imagination and pretend you are a spy for a secret government organization (your code name: RadLens007). You think there is suspicious activity occurring at a metro station, so you snap a quick photo from your pen camera:

Now, you can’t just send this photo off to your shadowy superior (code name: Argus1) without a little text annotation (appropriately encrypted, of course). What are you thinking? Why are you sending this photo?

Passive voice

One note you could write:

“Multiple persons on the platform are seen and it appears that they are going home because of the color of the sky, although going to work early in the morning cannot be excluded. More people leaving the trains than boarding the trains are noted and many tired faces are seen.  

   A yellow ID is noted around the neck of one of the men going down the stairway, and an appearance compatible with one of our agents is seen. No overt threats depicted. Suspicious activity is suspected, however.  A person at the top of the ascending escalator with a black briefcase is noted, most likely a male. A combination of morphologic features, compatible with a known suspect, and a suspicious unsecured briefcase are shown.”

I actually found it a little difficult to write this paragraph with so much passive voice... but every time it seemed too unnatural, I’d think of radiology reports, and then I’d receive some inspiration.

Existential statements

An alternative would be to describe this scene mostly in “There is… [x]” statements.

“There are multiple persons on the platform and the color of the sky could represent morning or evening, although it appears that most of these people are going home. There are more people leaving the trains than boarding the trains. There are many tired faces.

There is a yellow ID around the neck of one of the men going down the stairway and his appearance is compatible with one of our agents. There are no overt threats. There is suspicious activity, however. There is a person at the top of the ascending escalator with a black briefcase, most likely with a male. The combination of morphologic features, compatible with a known suspect, and the unsecured briefcase are suspicious.”

Although this paragraph avoids the awkwardness of the passive voice, the repetition of the existential “There is…” is potentially a little awkward in itself. Similar to the first paragraph, this report was a little difficult to write this because I don't often string that many "There is/are... [x]" statements together.

Active voice

But imagine if I just gave you a piece of paper and told you to write your note, without you knowing this was an exercise. I’m guessing that 99.9% of people would write a note that’s mostly natural readable active voice. There will be some "There is...[x]" statements. There will also be active sentences describing the picture. I’ll try something like that right now:

“There are multiple persons on the platform who appear to be going home, given the color of the sky. It is possible that they are actually going to work in the morning, but more persons are leaving the trains than boarding the trains and there are many tired faces.

One of the men going down the stairs is wearing a yellow ID card. He appears to be one of our agents. There are no overt threats but there appears to be suspicious activity. The person at the top of the ascending escalator appears to be a male and has an unsecured black briefcase. The combination of morphologic features, compatible with a known suspect, and the unsecured briefcase are suspicious.”

I tried to match the content of all three reports as closely as I could. All three reports should have the same content and level of certainty, with only the styles differing. I've tried to leave some ambiguity to the substance of the report -- I wouldn't advocate that all radiology reports should be 100% certain -- but I'm trying to strip away the unnecessary ambiguity that creeps in with too much use of the passive voice.

If you were Argus1, which one would you prefer reading?


Photo is from wikimedia commons: "Shady grove" by Ben Schumin - Ben Schumin. Licensed under CC BY-SA 3.0 via Wikimedia Commons - original file

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  • Captura de tela 2015 01 03  s 08.48.57 tiny portrait
    Bruno Di Muzio16th Jul 2015 08:45 UTC

    Thanks Matt, it is a great discussion.

  • No photo
    sara18th Jul 2015 22:15 UTC

    a man with a black t-shit on the descending escalator was seen looking backward in an attentive way, was matched to be one of the escaping from someone, at a time one of the windows was opened !

  • 1 tiny portrait
    Pavel Radu20th Jul 2015 07:51 UTC

    Quality control: Low resolution, motion blurred photo. Would recommend an system upgrade of our pen cameras.

    Time of exposure: Since the photo was taken by "me" as the exercise prompts "you are a spy for a secret government" there is no doubt that i could perfectly pinpoint the exact hour of the photo,
    so no further speculation on the matter is needed.

    Pre-determined, internal analysis:

    There are 27 distinct individuals within the exposure, 19 with over 80% of distinguishable traits,
    5 with partial trait information and 3 with overlay or minimal degree of facial recondnition information.

    There is a man that wears a yellow ID tag around his neck , consistent with details of our undercover agent.
    His appearance associated with the loosening of 2 shirt buttons might possibly suggest mild level of tiredness and possible lack of focus.

    There is a man walking one step in front of him, darker shade of skin, checking his communication device, consistent with details
    of our undercover bodyguard. By not paying attention ot the person of interest and checking his electronic device in a public area would recommend re-assignment.

    Suspicious activity and threat management: Grade Delta 2

    There is a white male, wearing a yellow shirt and grey tie making direct eye contact with our agent, his moving incidence might suggest careful examination without the imminent possibility to act.
    Noted as medium threat level with id correlation required.

    There is a male with an unsecured briefcase on top of the staircase. Both of the hands on the briefcase, associated with the direction of his glance suggests zero interest for our target. (most likely just fastening his grip on his belongings.)
    POSITIVE ID match on Lin-Kuei, 3'rd level Yakuza assassin wearing a pink and white top and blue jeans. EXTREME caution is required.

    Conclusion: Tired Agent, Clumsy Bodyguard, Yakuza Assassin.

  • No photo
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Publication date: 15th Jul 2015 15:19 UTC

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