Myeloma Rocket Scientist: A ROSE By Any Other Acronym Would Smell As Sweet
Two of my roles are rather heavy on acronyms: being a space engineer and a cancer patient. NASA (itself an acronym, of course) is renowned for being fond of TLAs (three-letter acronyms). Sometimes this makes sense, as it can shorten long, technical terms to manageable length. However, sometimes it actually has the opposite effect; for example, the acronym for the two-syllable word "pilot" is the three-syllable PLT.
In the cancer area, terms can again be quite convoluted, so acronyms can help to simplify things. For instance, many of the treatments for multiple myeloma are made up of combinations of several separate drugs, and it is much simpler to refer to, for instance, VRD than to Velcade-Revlimid-dexamethasone.
In both fields, people sometimes forget, or do not all agree on, what any given acronym actually stands for. In the cancer field, CR is sometimes thought of as complete response, and sometimes as complete remission. Complete remission sounds better, with its connotation of being virtually a “cure,” but complete response (to a treatment) is presumably more accurate.
Similarly, in the space arena, an example of ambiguity is the RPM “back-flip” that later Space Shuttle flights performed when approaching the International Space Station. The RPM allowed the station astronauts to inspect the underside of the Shuttle for damage to the tiles. This maneuver is sometimes said to be short for rendezvous pitch maneuver, and sometimes R-bar pitch maneuver; nobody seems to be sure.
The reason I started thinking about acronyms lately is that I have just had a positron emission tomography (PET) scan. It wasn’t scheduled because I am having any problems that we had to delve into; my health seems to be very stable right now, with good blood test results (IgA and kappa light chains). My Revlimid-dexamethasone treatment dosage has even been cut back a bit over the past year or so as a result. Rather, the scan was because my oncologist would prefer that I have an X-ray “skeletal survey” every year, but I have been digging in my heels, as they never seem to raise anything in my case apart from false alarms.
For instance, the last time I had one some years ago, it appeared to show myeloma coming back in a lower vertebra. However, a follow-up magnetic resonance imaging (MRI) scan showed that this was just arthritis. (After worrying mightily while waiting for the results of this MRI, I remember phoning my wife to excitedly announce “I have arthritis!”.) So, since my doctor really wanted me to have some sort of scan this year, and I wasn’t a big fan of X-rays, we “compromised” on a PET scan.
As an engineer, it might be assumed that I would have studied in detail all the various tests that we go through. However, I hadn’t researched PET scans until recently. It therefore only then occurred to me that the P in PET stands for positron, or the anti-matter equivalent of the electron. This is pretty futuristic stuff! I tend to think of anti-matter as something that, since it is destroyed so readily by “regular” matter, can only occur in very exotic environments like neutron stars. Instead, it turns out that it is the basis for this type of somewhat common medical test.
In a PET scan, the patient is injected with a radioactive glucose analog that has a very short half-life. The analog is taken up by parts of the body with significant metabolic activity (for instance, cancer sites) and produces positrons that annihilate with electrons, causing gamma rays to be emitted. These are then used, in a sophisticated computerized imaging (tomography) system, to produce images of the activity. After my scan, the technician recommended that I not visit any federal facilities that afternoon, as I would be mildly radioactive and so might set off a Geiger counter! We don’t actually have Geiger counters at the entrance to NASA, but it seemed like a good excuse to take the afternoon off work.
I was quite excited at the idea of using all these exotic objects (radioactivity, positrons, gamma rays) to produce such useful images. However, the acronym PET is perhaps a shade heart-warming for something that involves matter-antimatter annihilation.
In similar fashion, there are stories that, many years ago, the military was interested in flying a space station to carry out reconnaissance. They considered calling it the manned orbital module, as no congressional budget committee could ever say no to MOM. Despite this plan, though, it somehow never materialized.
A contrasting case is MRI: the original name for this type of imaging was nuclear magnetic resonance (NMR), even though it uses no radioactivity. Rather, the “nuclear” in the name referred to the nuclei of atoms in the body that are set resonating by the applied magnetic fields. It was eventually decided that this name gave people the wrong impression, so it was changed to the less alarming magnetic resonance imaging.
I had expected that my PET scan would show pockets of myeloma in some bones somewhere, and wondered how that would make me feel about those areas of my body. Instead, though, it didn’t appear to show any signs of myeloma at all.
Of course, being such a sensitive test, it did end up finding something else to investigate, but it is unrelated to myeloma. There’s always something to deal with when it comes to the aging human body.
Trevor Williams is a multiple myeloma patient and columnist at The Myeloma Beacon. You can view a list of his columns here.
If you are interested in writing a regular column for The Myeloma Beacon, please contact the Beacon team at .
Being an engineer myself, I hate acronyms. The English language is such a wonderful language that grows and changes daily, keeping communication the most descriptive and detailed it can be, or not.
Acronyms change with the times and become extinct as 3 letters put together by diffferent people can take on dramatically different meanings. Let’s stop using acronyms. They don’t really save time. They confuse those not familiar with our technology and end up wasting time having to look up or explain them.
Sometimes I feel acronyms are used by some to make them feel above others who obviously don’t know what the acronym represents. In the professional life of an engineer, speaking for my 45 years of professional life, I mostly dealt with non-engineers. Therefore acronyms were out of my vocabulary. When dealing with individuals in my profession, acronyms were sometimes used.
Our doctors and professional care givers should work hard to speak to us in language that explains what is going on, free of acronyms. Just imagine how much better the doctor-patient communication could be.
Thanks for this witty and educational column about some of the acronyms we encounter in our medical lives, so to speak. MRI's, PET scans, and more! I have had annual X-ray skeletal surveys, and although there seems to be a lot to look at on them, the radiologists so far have not detected any additional damage! I hope that the health issue that turned up from you PET scan was not a serious matter. By the way, what does the acronym ROSE stand for?
Trevor - Thanks for an enlightening article. Your explanation of what a PET scan does was very well done. Like you, we have been excited when the activity on my husband’s PET scans have been arthritis and not myeloma. I do not think government can exist without acronyms. We worked for DOE (Department of Energy) at the NTS (Nevada Test Site) in the SSD (Safeguards and Security Department).
Fascinating column, thanks. Once in 2009 I had a thorium cardiac scan and went to a meeting at the Pentagon about week later with a few colleagues. We got credentialed and through the turnstiles, each waiting for all, when a young airman with a Geiger counter approached from the side and gently asked, "Has anyone here recently had a ... procedure?" I had honestly forgotten the scan but 'fessed up, and spared my coworkers. So much for what they tell patients about the half-life! You were right to give yourself the day off.
As for acronyms, though retired, I have worked intermittently as a professional translator and interpreter in multiple technical fields. Most U.S. government publication standards require full expansion of a term upon first use, followed by introduction of the acronym, in caps and square brackets, for all subsequent uses in the text. Glossaries are useful, but there they are, usually, an afterthought at the end of the textual slog. In general, wouldn't spoken technical language, and life, be much easier if we would all speak somewhat as well as we write!
Trevor -
For a humourous side to your great column, I have a little tale for you. We live in Canada directly on the international border between New Brunswick and Maine. When I say directly, I mean that as I write this I can look out the window and see the city of Calais across the river. The river itself is between 400-500 feet in width, so we are that close.
Our regional hospital is 110 km from our town in Saint John where most in-depth medical treatment is obtained. My husband, Bill, had his PET scan done there about 3 years ago during prep work prior to his autologous stem cell transplant. Being close to international borders, most patients are given written notices for customs agents if required.
Because we had to return back to Saint John the next day for other tests, we popped over the bridge to get gas when we got home from the city. That is the natural way of life here on the border since fuel is cheaper in the States. When we pulled up to the booth, the bells and whistles were just a blaring. We knew the border agent, and he says "Geez, Bill what have you been doing?" At the same time, 4 other agents came rushing out of the building hands on holsters. Protocol calls for you to park at the side, do paper work, and have the occupants and vehicle gone over with a Geiger counter. One officer kept telling Bill to move farther away from the car. He was lighting the box up so badly they could not get a proper reading on either me or the vehicle.
Thankfully, being a small town and knowing many officers, we all got a good laugh out of the whole experience. I told them we just wanted to shake up their day and give the newbies a chance to have the warning signals go off! The next day, Bill had more radioactive testing done, but we stayed away from the border for a few days until his glow went away.
Sorry to hijack your column, but it is always one of the stories we tell about this entire multiple myeloma journey. We ALL need to find humour in this when we can.
All the best to you.
I hope everyone (in the U.S., at least) had a good Thanksgiving! Ours was very relaxing and turkey-centric.
Eric, I see your point against acronyms. I have to admit, though, that I quite like them, at least within reason. Some of the newer ones (mine excluded, of course) are getting rather convoluted though, which you’re right doesn’t help to really convey any useful information.
Nancy, Hi again. No, the follow-up test did not show anything too bad, thank goodness. A suspicion that I have about X-ray skeletal surveys is that, since the radiologist who interprets mine is always informed that I have myeloma, they are predisposed to see evidence of the disease returning when they are really seeing something else. A similar thing happened with the PET scan also: they reported evidence of old lesions in vertebrae, whereas I have not had myeloma bone lesions. I presume that they were seeing the arthritis again, although I may be wrong about this. On your question about ROSE, there apparently is a NASA acronym ROSES, but in this case I was just attempting to channel my inner Shakespeare…
Patty, Thanks! Yes, arthritis can be good, depending on the alternatives. As for acronyms, my boss once got so sick of them that he sent an email stating, in all capitals: NO ACRONYMS! He was probably not too thrilled that I turned this into an acronym: No Objection to Acronyms - Conveying to Readers the Overall Nature of Your Message Succinctly.
MNash, That’s very interesting that it still set off the Geiger counter a week later! I just believed what they told me about it only lasting that day. Since we don’t have any detectors where I work, I don’t know if I would still have set one off when I went in the next day. I agree with you about spoken vs written language. There is also the question of the ambiguity of language: going from equations, which are very precise, to English (or presumably any other language) always seems to lead to imprecision and possible misunderstandings. As part of preparing for a mission, we have to turn our equations into written “requirements” statements. Almost any time that I’ve had to use one of these years later, I can’t fully understand what we were trying to say: ambiguity has crept in.
Nadine, That’s a good story for sure! Thanks for writing it. You’re right, finding humor where possible really helps. I hope your husband is doing well.