Radiology is changing faster than any other specialty. We’ve moved from “back-room doctor” to front-line decision maker, with scanners multiplying and throughput accelerating. In that context, shared rules are not bureaucracy—they’re safety nets. Rule #1 (“Obey the Rules”) isn’t about blind obedience; it’s about reducing variability, protecting patients, and communicating clearly under pressure.

What McCoubrie is really saying

In a witty, satirical tone, McCoubrie argues that radiology needs rules because our work is globally homogeneous and technically driven. A CT scanner in Tipperary works like one in Timbuktu; what varies is how people use it. Rules align practice so that quality doesn’t depend on which radiologist or which day of the week the patient gets.

Why radiology needs rules (now more than ever)

• Throughput ↑, attention ↓: Modern lists cram complex cases into busier schedules. Rules preserve thinking time for the hardest scans.
• Global tech, local habits: Shared heuristics reduce unhelpful variation between teams and sites.
• From back room to front line: Communication rules prevent misunderstandings when radiologists face clinicians—and patients—directly.
• Safety culture: Agreed processes (checklists, sign-off steps) catch errors before patients feel them.

Turning Rule #1 into daily practice

Here’s a pragmatic, department-ready checklist you can start using tomorrow:

1. Standardise the skeleton: Use consistent report templates (history → technique → key findings → differentials → recommendation). Variation lives in content, not structure.
2. Protect thinking time: Ring-fence blocks for complex cases and MDT prep. Interruptions are managed, not accidental.
3. Name the uncertainty: Say what is likely, what is possible, and what test would resolve it. Ambiguity is allowed; confusion isn’t.
4. Close the loop: For critical or unexpected findings, confirm receipt with the responsible clinician. Document the handover.
5. Own your comparison: Always state comparison date(s) and what changed. “Stable” without a date isn’t stable.
6. Commit to “one next step”: Every actionable report ends with a single, concrete recommendation (not three options).
7. Debrief by design: Weekly, low-blame case reviews to refine rules and share “good catches”.

For trainees: Rules as cognitive scaffolding

Rules aren’t crutches; they’re scaffolding. In exams (FRCR 2A/2B) and on call, they free working memory for the case in front of you. Start with structure, then earn your deviations with experience and data.

For consultants: Deviate deliberately, not casually

Expertise isn’t ignoring rules; it’s knowing when and why to adapt them. If you break the house style, document the rationale. Make it teachable, repeatable, and auditable.

An action plan for your department (30 days)

• Week 1: Agree a default report template per modality (one page each). Publish it.
• Week 2: Define “critical result” and the contact pathway. Add a report macro to document the handover.
• Week 3: Pilot a 2×60-minute “quiet reading” block for complex cases. Measure callbacks and addenda.
• Week 4: Run a no-blame review of 10 cases with ambiguous wording. Rewrite together; update the style guide.

Bottom line: Read the rules. If you agree, obey Rule #1. The point isn’t obedience; it’s reliability.