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Alphabet soup (with comments from Hamlet)
When acronyms cause confusion

Rinckside 1997; 8,1: 1-3.

edical terminology cannot exist without abbreviations. For many terms there are short names, ranging from the common ones understood by everybody, like TB for tuberculosis, ECG for electrocardiogram, to SIH for somatotropin-inhibitory hormone, understood only by those who deal with it every day.

Generally speaking, abbreviations are necessary because they facilitate daily medical routine. Who wants to say ‘computed tomography’, ‘magnetic resonance imaging’ or ‘endoscopic-retrograde cholangiopancreaticography’ when it takes less than one second to pronounce CT, MRI, or ERCP? Or, as William Shakespeare described it:

Brevity is the soul of wit.
(Shakespeare, Hamlet; II.ii.)

There are clear advantages in using abbreviations that are well known from everyday usage: If you sit in a bar and utter "G & T" twelve times in half an hour you will be drunk a lot faster than the guy at the next table who says:

"Waiter, another gin and tonic, please".

He can say this only six times per half hour.

More matter, with less art.
(Shakespeare, Hamlet; II.ii.)

There has been an explosion of abbreviations and acronyms in radiology during recent years, particularly in MR imaging. Abbreviations shorten or substitute an understood or stipulated word or phrase, whereas acronyms are made up of the initial letters of a term and often sound familiar to existing words.

Unfortunately, when reading medical articles in journals or books, the abbreviations you find in the text are in many instances not explained because many authors believe that your brain works like their’s. Very often, however, you have no idea what specific abbreviations or acronyms mean.

There are simple rules – not always obeyed – for the use of abbreviations in articles. No abbreviations should be used in titles and abstracts; abbreviations should be spelled out the first time they occur in the text; and if the publication is very long, a list of abbreviations should be included in an appendix to the article or book chapter.

It gets even worse if there might be a double meaning. For instance, is IQ image quality or intelligence quotient, PC phase contrast or personal computer, ADC analog-to-digital converter or apparent diffusion coefficient, ROI region-of-interest or return-on-investment, GE gradient echo or General Electric?

The Books of Abstracts of the 1996 meeting of the International Society of Magnetic Resonance in Medicine in New York provide sufficient examples: What on earth is ERPF? Is it an exclamation by ducks? We, the poor readers, have to find out ourselves.

Alas, poor Yorick!
(Shakespeare, Hamlet; V.i.)

Most abbreviations and acronyms used in radiology are rooted in the English language because, like it or not, it is today’s international medical language. Different languages have different medical abbreviations and acronyms, however, and sometimes they spill over from one language to the other.

In German, the Scandinavian languages and Russian, MRT is used for magnetic resonance tomography, instead of the English MRI. When reading "MRT" in an English text, you still can conclude that the authors mean MRI. SIDA, of course, means AIDS.

Sometimes, however, you find abbreviations you do not necessarily recognize: SEP (French: sclérose en plaque) should rather read MS in English (multiple sclerosis).

The avalanche of recent radiological acronyms was broken loose by a streak of lightning, the FLASH, which stands for "fast low angle shot". It was described by Axel Haase and his collaborators as the basic gradient-echo sequence [3], and then it was taken over by Siemens. Today the company sells a different pulse sequence under the same name without having changed the acronym. Similarly, FISP has also two meanings and describes two different pulse sequences in MR imaging.

If you think that FISP describes a wasp with pronun­ciation problems, you are wrong. In this case, you should read one of the numerous overviews of such acronyms and abbreviations or, simply, the List of Acronyms of the TRTF/EMRF Basic Textbook [[1]. Unfortunately, because of the explosive propagation of acronyms, even this thorough compilation might be in­complete.

Many different acronyms describe similar procedures, which adds to the problem. Several suggestions have been made about cleaning up this disorder by creating generic names for functional groups of pulse sequences.

Spin-echo (SE) and inversion-recovery (IR) sequences would stay as they are. The gradient-echo (GRE, not GE) sequences would be grouped into S-GRE (spoiled gradient-echo), CE-GRE (contrast-enhanced gradient-echo), and R-GRE (refocused gradient-echo). All Turbo-SE, fast SE, and RARE sequences would be combined under the umbrella term RSE (rapid spin echo). However, there is no common agreement yet on this terminology.

Since the late 1980s, companies have tried to outmaneuver one another by coining new acronyms that should be easy to pronounce and have a certain marketing and sales (or sex?) appeal – exactly how much appeal remains to be determined by the reader.

Though this be madness, yet there is method in it.
(Shakespeare, Hamlet; II.ii.)

Unfortunately, often this moderately offensive company slang is not understandable to outsiders who are not exposed to the company's products. Nevertheless, it is used for scientific publications and creeps into the scientific literature, such as into abstracts of scientific meetings.

By and large, there is no substantial difference between companies and research groups at universities or other institutions creating clever new acronyms; their purpose is the same, namely to profile and promote themselves. The result is utter confusion, followed by disregard for such presentations.

Absolute confusion can be created by not writing the acronyms in capital letters but in small letters. What do you do with a ‘rare’ pulse sequence? Personally, I prefer a well-done pulse sequence. (To kill this joke completely, I believe that RARE is a well-done pulse sequence).

In one article, I found the acronym SELESTRA for spin echo, long echo, short TR acquisition (TR = 600 ms, TE = 50 ms). Firstly, this acronym is inconsistent, as are many other acronyms (long echo, instead of long echo time or TE). Secondly, it is completely unnecessary and irrelevant. Just mentioning ‘TE was chosen at 50 ms, TR 600 ms’ gives readers all the information they need without confusing them with SELESTRA.

Some people believe that they have contributed to science just because they made up what they consider to be a "funny" acronym. Sometimes acronyms can diminish or even completely destroy the value of a pulse sequence.

This is the very coinage of your brain.
(Shakespeare, Hamlet; III.iv.)

Guess where RODEO (rotating delivery excitation off-resonance) originates. Texas, of course.

I always thought PIPS was a chicken's disease, but it also can be applied to MR imaging. FLAT TIRE is an acronym for fluid-attenuated turbo inversion recovery, while FLAT BRAIN does not exist yet. EPISTAR describes echo-planar imaging in the stars – most likely somewhere in the Milky Way. CEPI, IEPI, and SEPI are European relatives of the yeti, the Himalayan snow man.

Let’s continue:

“PRESTO, bring me my FASTCARD and be FAST, BRISK and HASTE. STIR the SPARE PASTA for DANTE with the STEAMed and SMASHed RARE SPIDER and the ROAST PEAR. I SENSE a PILS and a GRAPPA.

"Oh god, I swallowed my fake SAPPHIRE.

“Don’t be CRITICAL with this FAIR and COSY SUPER DIET because we want to BURP and BURST. FREEZE and SHORTen your CRAZED RAGE, otherwise you might be visited by the ONG [oblique Nyquist ghost]. RISE early and be SMART and not SISSI! Even you MOLLI, ShMOLLI, and SANDRA.

“What a MESS! Let’s FLASH this acronymania down the …”

There needs no ghost, my lord, come from the grave, to tell us this.
(Shakespeare, Hamlet; I.v.)

I hope that we will never see a new pulse sequence from France: magnetization-enhanced rapid double-echo, or MERDE.

To be frank and fair: some acronyms describing pulse sequences or procedures are necessary and to the point, and they give a name to a specific diagnostic tool.

However, Shakespeare commented on all of them:

Thou comest in such questionable shape.
(Shakespeare, Hamlet; I.iv.)

Most acronyms do not contribute anything new in terms of substance; they are only packaging. In the era of environmental protection, we do not need them. Rather, we need some orientation in the bewildering jungle of acronyms. The fundamental idea of facilitating communication between inventors and users by shortening terminology is positive, but playing around with it has no advantage for the already confused customer. Such customers or other scientists will strike back sooner or later by leaving the marketplace or scientific area.

Finally, I would like to apologize to those individuals, companies, and research groups whose acronyms were not included here, but there is not enough space for all of them. I also apologize to those whose creations have been selected.

As already mentioned, not all of them are bad or useless. My choices were made purely on the basis of emphasizing the point or just because the terms fitted nicely into the text.

I must be cruel, only to be kind.
(Shakespeare, Hamlet; III.iv.)

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Reference

1. Rinck PA. Contrast Agents. in: Rinck PA. Magnetic Resonance in Medicine. A Critical Introduction. 12th ed. BoD, Norderstedt, Germany. 2018|2020. ISBN 978-3-7460-9518-9.

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Citation: Rinck PA. When acronyms cause confusion. Or: Alphabet soup (with comments from Hamlet). Rinckside 1997; 8,1: 1-3.

A digest version of this column was published as:
When acronyms cause confusion.
Diagnostic Imaging Europe. 1997; 13,3: 19-21.

Latest updated print version: Rinck PA. Alphabet Soup (with comments from Hamlet). in: Rinck PA. Magnetic Resonance in Medicine. A Critical Introduction. 12th ed. BoD, Norderstedt, Germany. 2018|2020. ISBN 978-3-7460-9518-9. pp. 159-162.

Translated into Portuguese, Russian, German, and Chinese.

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