I have a confession to make. While in high school, I think I could have broken my CD player (now I'm dating myself) pressing the back button to repeat and repeat and repeat the 1993 hit song by the Swedish group Ace of Base, “The Sign”
The Sign. Copyright 1993.
– it was one of my absolute favorites. At the time, it was purely avocational, purely listening pleasure when I wasn't (or sometimes was) dutifully doing my homework. And yet now I wonder: was there a reason for this repeat listening after all?
I make this confession by way of explanation for what has (partially) inspired Clinical Imaging'
s new-in-2022 column, “I saw the sign.” Imaging signs are defined as “recognizable, characteristic patterns used to describe abnormalities visualized on imaging modalities that ultimately aid in the diagnosis and subsequent treatment of disease.”
- Marshall Geoffrey B.
- Farnquist Brenda A.
- MacGregor John H.
- Burrowes Paul W.
Signs in thoracic imaging.
When radiologist Dr. Benjamin Felson — who coined the term “Aunt Minnie” — was questioned about his inclination to name signs, he answered that “the name saves time, helps you remember the sign, and advertises it… They say what I mean.”
Additionally, as Kumaresh et al. point out, “There are a few signs in radiology which are based on many common objects or patterns that we come across in our routine lives. The objective behind the association between such common objects and the corresponding pathologies is to make the reader understand and remember the disease process.”
- Kumaresh A.
- Kumar M.
- Dev B.
- Gorantla R.
- Sai P.V.
- Thanasekaraan V.
Back to basics – ‘must know’ classical signs in thoracic radiology.
Thus, towards the end of saving time, saying what we mean, and remembering, as well as consonant with our journal's value of education and its mission to publish work which advances knowledge and positively impacts patient care and the profession of radiology, Clinical Imaging
is pleased to launch “I saw the sign” – yes, an Ace of Base inspired- column for the journal which will promote education, mentorship and sponsorship.
While other imaging organizations or leaders have similar offerings — such as the ACR's “Case in Point”,
- American College of Radiology (ACR)
Case in point.
or “From the Cookie Jar,” fabulously named by its newly minted Editor-in-Chief, Christine “Cookie” Menias
– the strengths of “I saw the sign” will be at least three: 1) mentorship AND sponsorship, 2) history or medicine; and 3) whimsy. First, no matter who sees the sign to be written about, participating in “I saw the sign” will require mentorship and sponsorship because we are going to require that the first author be a medical student, resident or fellow – this individual must write the first draft, conduct the literature review and ultimately be the first and corresponding author and takes care of the submission at https://www.editorialmanager.com/clm/default1.aspx
. To facilitate this process for potential first time authors, a possible outline for this special type of Brief Communication is available here
. So if you are still in training and see a sign and or this article, then show them to an approachable attending; if you are an attending, then is there a strong trainee who you can mentor to draft this article? For example, last year, the division chief of breast imaging at Weill Cornell Medicine (WMC), Dr. Michele Drotman, despite her very demanding clinical and administrative duties, mentored one of the breast imaging fellows at WMC, first author Dr. Yvonne Estrin, in the publication of “Re-pitching the tent sign
.” This excellent brief piece describes, “a subtle mammographic finding that …refers to localized retraction of the breast parenchyma causing a characteristic inverted ‘V’ shape, or tent sign”.
Re-pitching the tent sign: a case report.
Second, each “I saw the sign” submission must include either medical history and or information about the historical context or evolution of the naming of the sign, which may be eponymous (one of my favorite words, which my father, an English major in college, taught me). There are many radiologists who make their signs eponymous by naming the sign after themselves – or others do it for them. For example, in her 2019 Clinical Imaging
publication highlighting the second female ACR gold medal winner, Dr. Alice Ettinger, author Dr. Kirti Magudia includes the previously less well-known information that Dr. Ettinger “helped multiple Jewish physicians escape Germany, including Richard Schatzki, after whom Schatzki's ring is named”.
Alice Ettinger: pioneer of fluoroscopy and exceptional teacher.
A photograph of the person for whom the sign is named or of the common object inspiring it, as well as inclusion of pathology images for “rad-path” correlation, is strongly encouraged for this column as well.
Third, and last but not least, whimsy. As one of my favorite authors, Gretchen Rubin, noted on a 2017 podcast, “Try This at Home: Introduce a note of whimsy. A little whimsy is a way to poke fun at yourself, lighten a difficult situation, or just make life more light-hearted”.
Podcast 146: Introduce a Note of Whimsy, Use Color to Foster Mindfulness, and Debating the Four Tendencies with “By the Book”.
So yes, I've poked a little fun at my teenage self in the opening paragraph here, and yet more important than this, given the difficult situation all of us have been living through these past two years with COVID-19, as well as the seriousness and often life changing nature of some of the signs to be raised in future columns for the patients in which we find them – it is my hope that “I saw the sign,” with its '90s musical origin may lighten a difficult situation or just make your professional work a little more engaging or light-hearted as you research the medical history and origins of the signs you, or your colleagues, see. As a tangential example, it added a little whimsy to the journal when Dr. Geraldine McGinty achieved which I believe to be another “first” in 2020 by publishing a movie review in a radiology journal about how “Radioactive” fails to tell the true Curie story”.
“Radioactive” fails to tell the true Curie story.
So why not continue to push the envelope in 2022 with a column inspired by a '90s rock band?
Clinical Imaging: the radiology journal which pushes the envelope.
Thank you to Clinical Imaging Editorial Board members, present and past, who have raised the importance of a resident and fellow section and or one on signs.
Published online: February 10, 2022
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