The undesirability of acronymsBMJ 2009; 338 doi: https://doi.org/10.1136/bmj.b2016 (Published 20 May 2009) Cite this as: BMJ 2009;338:b2016
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Acronyms have become a part of our language, of any language, be it
the technical jargon or in common usage. There are literally thousands of
initialisms, abbreviations and neologisms used in different disciplines.
are simple arrangements of letters that are to be pronounced as in
bees, while others become incorporated as new words, that can become
transformed into verbs or adjectives.
Em-vee-pee is the most valuable player or professional (MVP) in a
season, but in Cardiology it becomes a mitral valve prolapse. Drop the P
replace it for an A (MVA) and, lo and behold, you have an statistical
tool (Multivariate Analysis, such as ANOVA [Analysis of Variance], among
others), an abortion method that involves the suction of an embryo (Manual
Vacuum Aspiration), a patient involved in a motor vehicle accident, or, as
parent of a 9- and a 12-yr old daughter knows, a recent computer-animated
3D feature film from Dream Works Animation and Paramount Pictures
(Monsters vs. Aliens). This movie includes several fender-benders, which
be further categorized into motor vehicle collisions (MVCs), road traffic
accidents (RTAs), or personal injury collisions (PICs), to mention a few.
PIC, incidentally, is the Spanish version of intracranial pressure
infrequently measured in patients with traumatic brain injury (TBI),
medical acronym that is also used for a tracheobronchial injury which can
occur as a result of trauma, or for the radiotherapeutic technique of
body irradiation used in preparation for HSCT (Hematopoietic Stem Cell
Transplantation). By the way, PICC might be the People’s Republic of
largest casualty insurance company (People’s Insurance Company of China),
but I am quite sure that most colleagues identify the acronym as
with the intravenous access introduced in the middle of the seventies as
alternative to subclavian punctures, the peripherally inserted central
TBI also refers to another feature film, in this case a 2002
action thriller based on a novel by Robert Ludlum, about a special agent
fights his PTSD (Post Traumatic Stress Disorder) while he tries to unveil
(Central Intelligence Agency) conspiracy. The Bourne Identity (TBI) would
become the first part of a trilogy of action films, expected to be
followed by a
fourth part to be released in the summer of 2010.
There are many modern art museums around the world, but MoMA makes
one think first of New York’s fabulous venue, unless the name is heard by
Russian native of the Sakha Republic, who most probably would associate
Moma with the name of a local river.
The plot thickens (TPT): some acronyms are understood in different
languages, while others attain a word status as they are translated from
language to another. Common examples are the acronyms for several non-
governmental organizations (NGOs). The North Atlantic Treaty Organization
(NATO) becomes the OTAN both in Spanish and in French (Organización del
Tratado del Atlántico Norte, and Organisation du traité de l'Atlantique
Medical acronyms are just an example of the dissemination of this
idiomatic practice, that some have traced to several centuries before our
As the English language has become preponderant in the scientific
literature, many physicians around the world adopt acronyms that could be
otherwise untranslatable. In my field of work, my favorite acronyms refer
technical descriptions of magnetic resonance imaging (MRI) sequences. I
believe that their names are evidence of the sense of humor (obscure as it
may seem) that physicists possess: how else can one explain homophonous
names such as FLAIR (FLuid Attenuated Inversion Recovery) and FLARE (Fast
Low Angle Recalled Echoes)?
It might not be FAIR (Flow sensitive Alternating Inversion Recovery)
assume that these acronyms are found in HASTE (Half-Fourier Acquisition
Single shot Turbo spin Echo). Maybe the experts in engineering and quantum
physics are evoking favorite foods such as PASTA (Polarity Altered
spaTial selective Acquisition, also Pointwise Assessment of Streamline
Tractography Attributes, whatever that means) or ROAST (Resonant Offset
Averaging in the Steady sTate), or that preferred strategy games such as
CHESS (CHEmical Shift Selective imaging Sequence), simply FASCINATE (Fluid
Attenuated Scan Combined with Interleaved Non-ATtEnuation) them and
become inspirational when the time comes to christen their techniques.
Whoever came up with FIESTA (Fast Imaging Employing Steady sTate
Acquisition) was certainly overstated by the inventors of GRAPPA
(GeneRalized Autocalibrating Partially Parallel Acquisition) and
(Controlled Aliasing In Parallel Imaging Results IN Higher Acceleration).
someone ever presents a sequence dubbed MARTINI, one could only expect
to have at least two versions, to be chosen by the user’s own preference:
shaken or STIR –ed (Short Tau Inversion Recovery)!
Anyone who lets out STEAM (Stimulated Echo Acquisition Mode) in the
creation of such acronyms is sure to produce a SMASH (Short Minimum Angle
SHot) hit. Onomatopoetic or plain simply poetic?
…It is not RARE (Rapid Acquisiton with Relaxation Enhancement)
for LAVA (Liver Acquisition with Volume Acceleration)
to RISE (Rapid Imaging Spin Echo)…
Decades ago, when I had my first chance to visit an academic hospital
the United States, my own confidence on my command of the English
language was shattered when first confronted with an unexpected abundance
of terms that were unintelligible to me. Soon I came up with a diagnosis
my initial lack of understanding: an acute case of TMA-2KTO (Too Many
Acronyms to keep track of).
A triple A (AAA) can refer to an American automobile association or
disease that can be considered an important health issue (Abdominal Aortic
Aneurysm). Less frequently than it should be, it also refers to the most
important –and commonly forgotten- descriptors of the ideal qualities of
language: accuracy, adequacy and appropriateness.
Competing interests: No competing interests
Poetry uses the minimum number of words to convey the maximum
meaning. Unfortunately committees introducing acronyms tend to agree their
joint statements at the end of long meetings without the aid of a poet.
Perhaps the BMA might seek the help of the Poet Laureate to review all
acronyms currently in use in the NHS: a joint academic project between
and Medical departments with publication in a dedicated edition of the BMJ
would be historic, useful and fun!
In the meantime I wonder if Patient Excused Action (Cardiopulmonary
Events) - PEACE would be suitably unambiguous, effective and discreet for
use in palliative care?
Competing interests: No competing interests