Handling Abbreviations and Acronyms in Medical Translation

n the pursuit of fidelity and equivalence at the word level a translator must face numerous problems. This article provides a contribution to the issue of handling abbreviations and acronyms in medical translation, which are one of the most problematic lexical groups. It contains a summary of a research conducted between November 10 , 2008 and March 31, 2009, which was based on the observation of two different Internet medical discussion groups. The procedures for handling shortened forms provided here are universal and can be applied to all languages.

It needs to be pointed out at the beginning that the English words abbreviation and acronym are differently defined in various dictionaries and scholarly papers, leading to misunderstanding and chaos in nomenclature. As a matter of fact, not all of them recognize the lexical opposition of those two notions at all. Because of such a divergence, it is necessary to state which definition is adopted here.

It is worth noting that though the abovementioned definitions are common in literature, simultaneously, an acronym is itself very often defined by the word abbreviation.¹ Interestingly enough, the notion abbreviation seems to activate two parallel concepts. In loose parlance the term is used synonymously with shortened form and refers to basically everything that is a shorter form of something else—whether it is I'm (contraction), NHS (initialism), SARS (acronym), Dec (truncation), Interpol (syllabic abbreviation), or t.q.i.d. (Latin abbreviation)—without going into the details of linguistic processes taking place. In linguistics, however, the prevailing view is to perceive the two notions (acronyms and abbreviations) as two different groups and such an approach is employed in this article as well.

Acronyms and abbreviations (especially the ones originating from Latin) are one of the most commonly used elements in both written and oral medical communication. Many terms, such as names of disease entities (e.g. autosomal dominant polycystic kidney disease, not to mention one of the longest English words: pneumonoultramicroscopicsilicovolcanoconiosis), names of chemical compounds (e.g. 6-pyruvoyltetrahydropterin synthase), or therapies (e.g. transurethral laser-induced prostatectomy) hardly ever appear in their full, unwieldy form as it would simply hinder efficient communication. The widespread popularity of abbreviations is doubtless due to the historical tradition of the language of medicine, but also the economy in space and time they provide, so much needed in many medical emergency situations. Additionally, abridging enables medical professionals to code the true meaning of their utterances, making the content inaccessible to the patient, which at times is advisable for ethical reasons.

The disinclination to apply full terms results in most medical texts being lavishly strewn with shortened forms, often accompanied by no explanations whatsoever. In many situations they obscure the meaning, being the source of obscurity or ambiguity, for even within one specialty, several different terms may stand for one acronym (e.g. CF has over 20 medical meanings, MA over 25). In extreme cases, shortened forms may be illegible (e.g. handwritten prescriptions), or author-specific, being produced just for the sake of one particular text. To make matters worse, as specialized fields develop, the number of abbreviated forms coined annually is so great that a full dictionary update is doomed to failure, often leaving translators with no sources of reference at all.

The share of queries concerning abbreviations and acronyms in all queries at the medical_translation discussion group between 10 November 2008 and 31 March 2009 are summarized in the following table:

As can be observed, the ratio of all queries to those concerning abbreviations and acronyms is extremely high. Also, it needs to be highlighted that the questions concerned only with abbreviations and acronyms were compared against those concerning all the other terminological problems counted collectively (special medical terminology, synonymy, equivalence, ambiguity, polysemy, etc.). Thus, despite such an uneven division of the compared groups, abbreviation and acronym problems constitute an overwhelmingly high percentage of the total.

In an effort to verify the validity of the results presented above, an analogical study was conducted at the ATA_MedDiv group during the same period of time:

The results of the study prove that the issue of shortened forms in medical translation is crucial and should not to be underestimated. In 2005, in a struggle with the abovementioned pitfalls, The Joint Commission (an independent organization established in the United States to improve health care by working on legislation involving its quality and evaluating health care institutions) affirmed a "do not use" list of medical abbreviations which included particularly troublesome abbreviations, acronyms and symbols which are not to be used in medical writing. That such a formal undertaking was initiated proves that the problem has indeed been bothersome. The list is binding within the organization only; however, it could perhaps also be treated as a hint to translators to pay particular attention to dangerous abbreviations, acronyms, symbols, and dose designations when handling translations.

Both terms acronym and initialism are used to describe a lexical entity formed from one to several capitalized initial letters. The difference between them is that acronyms are pronounced as one, and form a new word, while initialisms are articulated as separate sounds.

As far as the practical handling of them in translation is concerned, short forms should not be used in titles, as there is no context available that would provide absolute explicitness. Within the text, the general modus operandi for translators is to define an acronym the first time it is used, i.e. introduce the term in its full form with its acronym in parenthesis, and then employ the short form only as in the example below:

Heart failure (HF) constitutes an increasingly serious problem of contemporary cardiology. [...] Annual mortality among patients with advanced HF exceeds 50%. The most frequent cause of HF is coronary artery disease with arterial hypertension. The general population of patients with systolic HF includes between 20 and 25% of cases with so-called idiopathic dilated cardiomyopathy not associated with coronary artery disease or hypertension [...]

In English, with the belief that the presence of all capital letters is sufficient to indicate that the word is a shortened form, punctuation is avoided in modern practice unless the word is taken from Latin. Translators must also remember that the definite article is never to be placed either before acronyms or initialisms. With Polish as a target text, the rules are more complex as declension comes into the picture. Acronyms ending in pronunciation with a vowel are not inflected (e.g. CSK—centralny szpital kliniczny, EEG—elektroencefalogram, EPO—erytropeotyna); otherwise, the declensional ending is spelled in small letters and separated from the acronym with a hyphen (e.g. LDL-u, ANF-em, EULAR-u) (Paruch 1992:11-12).

The style of writing acronyms requires special attention so that a translator does not end up with a paragraph cluttered with unexplained capital-letter combinations. As Górnicz rightly suggests, it is also a useful procedure to precede an acronym with its head word which can either be an element included in the acronym itself (e.g. zespół SIDS, hormon ACTH, wskaźnik BMI, czynnik GIF), its hypernym (e.g. substancja LSD, badanie MRI, enzym PCR), or hyponym (e.g. limfokina HRF). Consequent to this procedure is the fact that it is actually the head word that is subject to declension and not the acronym, which seems to be more convenient, neater and therefore most common. It also allows one to improve readability and ease the congestion of solid capital letters. It is worth observing that when translating an English term such as USG (ultrasonography) or PUVA (Psoralen plus ultraviolet A irradiation) into Polish, one should consider the target text receiver, i.e. the translation purpose (a claim based upon the skopos theory) (Schäffner 2001). It seems that, paradoxically, medical professionals will use the compound badanie USG or metoda PUVA, even though, theoretically, they do not need the explicitation, while in lay and highly informal communication bare abbreviation like skierowanie na USG or leczenie PUVĄ² are more likely to be used (Górnicz 2000:40).

In the case of the simplest, one-letter acronyms (e.g. A, which has at least 15 commonly used meanings), it is usually stated by the source text author at the beginning which meaning he or she has in mind. Two- and more-letter acronyms (three-letter ones being the most common by far) tend to be more often considered obvious and lack explanation in the source text, which may lead to misunderstandings. It has therefore been repeatedly stated by many scholars that translators should be encouraged to contact their clients and consult terminological problems in order to make sure they do not misinterpret any of the terms. Fischbach (2007:75) claims that it is perfectly right to ask clients for clarification, especially the manufacturers of new medical instruments. Contrary to polysemy, synonymous abridged forms may shorten various names of one and the same notion; for example, TUR and TURS are synonyms and both stand for trans-urethral syndrome, TGI and TTI for tracheal gas/trans-tracheal insufflation, FD and LD for fatal dose, NTR and DNR not to resuscitate/do not resuscitate.

Once the precise meaning of an acronym is established, the translator is faced with a dilemma of choosing the correct equivalent for it: a stage critical for the later quality of the target text. Generally speaking, translators may encounter two possible situations:

Acronyms are very frequently simply borrowed and adopted from English. They may get naturalized in target languages and it is a common procedure to leave the English acronym in translation the way it is in the original. The most vivid example could be AIDS, which, though being a shortening from English words, has been fully integrated into other languages. Despite the fact that the disease has its full name in Polish (zespół nabytego niedoboru/ upośledzenia odporności), introducing the acronym ZNNO/ZNUO (or any other in different examples) for the sake of just one text seems unreasonable. In such cases it is advisable to introduce the term in the full Polish form first, with the English acronym, preferably adding the unabridged italicized English form as in the following examples:

A different procedure is required if an acronym has its acronymic equivalent in the target language, e.g. atopic dermatitis (AD), is in Polish called atopowe zapalenie skóry (AZS), the latter practically always being used in Polish medical discourse. In such cases the source text acronym should be switched into the target text one, as in the example:

It is worth noting that for interlinguistic standardization it would be convenient to include the English unabridged and short names in footnotes, or in parentheses following the Polish ones.

The decision whether to keep to the original acronym or alter it to adapt to the target culture will once again depend upon the translator's competence, experience, specialized knowledge and persistence in investigating which terms are the established equivalents in literature of a particular discipline.

In the Polish to English translation shown below the HGB abbreviation was changed into HgB (Hb or Hgb would also be correct) which is used in this form in English. White blood count WBC remains the same, while the Polish PLT was changed into a full name: platelets (trombocyte count or trombocytes are optional). The latter choice may be justified by the fact that PLT in the context of blood count is a very rare abbreviation. This is probably due to the fact that PLT also stands for primed lymphocyte typing which is commonly used in English medical literature (1490 Google hits) and practically not present in the Polish (the Polish equivalent: odpowiedź pierwotnie pobudzonych limfocytów T is only found in 1 Polish journal article, "0" Google hits for PLT in this meaning).

The table below presents selected problems, posted by translators from all over the world, associated with translating acronymic terms gathered from medical discussion groups between 10 November 2008 and 31 March 2009:

Despite the obvious retreat of Latin from the medical terminology in the 20^th century, medical professionals, while communicating in the national languages, have also used international Latin-Greek terms (Marečková et al. 20002: 581). Even though English has to a great extent become the new lingua franca of medical communication, the privileged terminological position of Latin still remains unchanged. Strictly speaking, there are three most important corpora of terminology in which it plays the major role: anatomical nomenclature, terminology of clinical medicine, and pharmaceutical Latin.

In anatomy, Latin is present not only in the nominative singular and plural of nouns, but also in adjectives. Genitive nouns and graded adjectives are found as well, though there is a tendency to simplify them by abbreviating or circumventing oblique endings (e.g. in case reports, instead of status post bronchitidem doctors write bronchitis, status post). Marečková et al. also mention cases of terms of Latin origin presented in an English variation, i.e. mainly with anglicized suffixes, e.g. peptic ulcer, thromboembolic pulmonary hypertension, congenital omental cyst; while others are used by the English professional terminology in their original Latin wording, e.g. salpintis, nephrolithiasis, colitis cystica profunda, etc.

Since medical terminologies in the European languages are based on a fundamentally Latin nomenclature, it should not come as a surprise that words of Latin origin are also subject to abridgement processes. Thus, in anatomy one may sometimes encounter acronymic terms formed from Latin, e.g. SFI—sulcus frontalis inferior, CA—commissura anterior). However, this is rather rare as the English IFS—inferior frontal sulcus and AC&—anterior commissure (etc.) would be preferred.

In clinical writing, apart from the obvious use of the vernacular, traditional Latin terms are still widely present. Such texts also abound in abbreviations (e.g. tracheo-bronchiales dx., sin., reg. trochantericae lat. dx. et reg. femoris post. lat. sin. et patellae lat. dx.).

The third area, in which Latin has been preserved to a truly great extent, is pharmacology, and especially prescription-related writing. Equally true in both the United Kingdom and Poland is that in order to master this significant part of professional activity on the required level, a doctor has to acquire the specific Latin lexicon as well as a model of grammatical structure of the prescription-related texts (Marečková et al. 2002:585).

Latin prescription abbreviations are traditionally spelled in small italicized letters, with dots in-between. In most cases they are concerned with the administration of medicines (e.g. s.i.d.—once a day, b.d. or b.i.d.—twice a day, t.i.d.—three times a day, q.i.d. or 4 i.d. or q.d. or q.d.s.—four times a day, s.l.—under the tongue, p.v.—vaginally). Regardless of whether one is dealing with an Eng>Pol or Pol>Eng translation, they are naturally left the way they are in the original.

Latin abbreviations are a common source of translation problems. As the analysis of discussion groups has revealed, finding their unabridged form is often problematic. To make matters worse, such abbreviations do not only appear independently (e.g. in the signature of a prescription), but can also be a part of a compound, e.g. in an English text as in the example given by Górnicz (2000: 38): new bid dosage, in an advertisement of a new way of medicine administering, where the coincidence of the Latin abbreviation b.i.d. and the English word bid ambiguates the expression.

One of the posts included into the study raised the problem of translating prescriptions. In an Eng>Pol translation the translator could not decode the following abbreviations: "Ketonal in tbl., a 0,1, lag. 1, s. 2 + 1 tbl., Keto-spray, lag. 1, s. man. [?]".

To make matters worse, the prescription was illegibly handwritten, making the abbreviations (especially the last one) the more obscure. The final suggestions were the following: Ketonal in tbl.—Ketonal in tablets, a 0,1—100mg capsules, lag. 1 (or lg.—lagena—pack/package), s. 2 + 1 tbl. (signatura)—take one tablet twice a day, Keto-spray, lag. 1 (lagena— pack/package), s. man. (spray mane)—spray in the morning.

Other examples of posts associated with Latin abbreviations as sources of translation problems are presented in the table below:

The study discussed in this article was an attempt to verify the quantitative prevalence of abbreviation- and acronym-related problems in medical translations over other problematic lexical groups. Special attention was also given to investigating some basic procedures applicable in translating them. The statistical results have exceeded the primal expectations, with more than 40% of all posted queries pertaining to the abridged forms. It is worth pointing out that similar results were obtained in two unrelated discussion groups.

All the examples presented above seem to lead to the conclusion that most problems associated with translating acronyms stem from their inclination to cause ambiguity. Latin abbreviations, in comparison to acronyms, are far less prone to creating ambiguity. The main obstacle in handling them is to find their unabridged form which is very often obscure and not easily findable.

¹ "Acronyms are abbreviations that are formed using the initial components in a phrase or name." http://en.wikipedia.org/wiki/Acronym_and_initialism (23 April 2009)

² Interestingly, the abbreviation tends to appear with Polish inflection (907 Google hits)

Fischbach, Henry. Personal interview, by Cristina Márquez Arroyo. 2007. http://medtrad.org/panacea/IndiceGeneral/n25_semblanzas-marquez.pdf (23 February, 2009)

Marečková, Elena, František Šimon & Ladislav Červený. 2002. Latin as a language of medical terminology: some remarks on its role and prospects. http://www.smw.ch/docs/pdf200x/2002/41/smw-10027.pdf (20 March 2009)

Schäffner, Christina. 2001. The Skopos Theory. In Routledge encyclopedia of translation studies, ed. by Mona Baker & Kirsten Malmkjær. London/ New York: Routledge, pp. 235-238.

Dorland's Illustrated Medical Dictionary. 2007. Philadelphia: Saunders Elsevier.

Encyclopedia of Language and Linguistics. 2006. ed.-in-chief Keith Brown; co-coordinating ed. by Anne H. Anderson [et al.]. Amsterdam [etc.]: Elsevier.

Kijak, Ryszard. (2002). Słownik skrótów angielskojęzycznych w medycynie stanów ciężkich. Warszawa: IPiS.

Krzyżanowski, Janusz & Perlińska, Linda. 2007. Medical Slang&Acronyms: Słownik Angielsko-Polski. Warszawa: Wydawnictwo Medyk.

Merriam-Webster's Medical Dictionary. 1995. Springfield/ Massachusetts: Merriam-Webster, Incorporated.

Oxford Concise Colour Medical Dictionary. 2007. Oxford: Oxford University Press.

Paruch, Józef. 1992. Słownik skrótów. Warszawa: Wiedza Powszechna

Wielki słownik angielsko-polski PWN-Oxford. 2004. Warszawa: PWN

Wielki słownik polsko-angielski PWN-Oxford. 2004. Warszawa: PWN