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On Using the Term Infiltrate in Radiography Reports

Margarita Asenjo, MD^*, and Basilio J. Anía, MD^,

^* Department of Radiology, Hospital Materno-Infantil de Las Palmas, Avda Maritima del Sur, s/n 35016 Las Palmas GC, Spain
Universidad de Las Palmas de Gran Canaria, Las Palmas, Spain. e-mail: masenjog@terra.es
Hospital Dr Negrín, Las Palmas, Spain.

Editor:

The special report published in the April 2005 issue of Radiology (1) has brought up a controversy about prohibiting the use of the term infiltrate in radiology reports. Drs Patterson and Sponaugle conclude that infiltrate is a nonspecific and imprecise term when used as a radiographic descriptor and that the use of this term does not enhance patient care. We think that to forbid writing infiltrate in a chest radiography report is unjustified.

First, more than half of the respondents to the survey had graduated within the past 3 years, and only 30.5% of respondents were staff physicians. This puts the level of evidence at rock bottom. If the quality of evidence is at its lowest when based only on the opinions of respected authorities or experts in the subject (2,3), what can be made of a survey of (mostly) inexpert clinicians?

Second, the term infiltrate is still used in the most recent edition of Reeder and Felson's Gamuts in Radiology (4): Gamut F-43 is titled "Localized Chronic Pulmonary Infiltrate," and gamut F-43A is "Chronic Pulmonary Infiltrate in a Child."

Last, Drs Patterson and Sponaugle suggest using opacity or opacification instead of infiltrate to increase the clinician's understanding. However, we think that infiltrate is a purposefully imprecise term that describes something in between an interstitial pattern and a consolidation. Otherwise, according to the rules of "non-" nosology (5), we would perhaps be forced to use some awkward term such as noninterstitial nonconsolidative pattern.

References

1. Patterson HS, Sponaugle DN. Is infiltrate a useful term in the interpretation of chest radiographs? physician survey results. Radiology 2005;235(1):5–8.[Abstract/Free Full Text]
2. The periodic health examination. Canadian Task Force on the Periodic Health Examination. Can Med Assoc J 1979;121:1193–1254.[Medline]
3. Centre for Evidence-Based Medicine. http://www.cebm.net/levels_of_evidence.asp. Accessed June 22, 2005.
4. Reeder MM, Bradley WG. Reeder and Felson's gamuts in radiology. New York, NY: Springer-Verlag, 2003.
5. Ellman MS, Feinstein AR. Clinical reasoning and the new "non-" nosology. J Clin Epidemiol 1993;46(6):577–579.[CrossRef][Medline]

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