Incidental findings in emergency imaging: frequency, recommendations, and compliance with consensus guidelines

Hanna, Tarek N.; Shekhani, Haris; Zygmont, Matthew E.; Kerchberger, James Matthew; Johnson, Jamlik-Omari

doi:10.1007/s10140-016-1378-1

Cited by 26 publications

(8 citation statements)

References 42 publications

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“…and 43% by Munk et al . Hann et al ., meanwhile, reported detecting incidental findings in 64% of cases in an investigation of emergency outpatient services. With regard to the body region, incidental findings are most commonly recognized in the ovaries, lungs, liver, and kidneys .…”

Section: Discussionmentioning

confidence: 93%

“…Hann et al ., meanwhile, reported detecting incidental findings in 64% of cases in an investigation of emergency outpatient services. With regard to the body region, incidental findings are most commonly recognized in the ovaries, lungs, liver, and kidneys . The frequency is considered higher among patients who undergo whole‐body CT than in those who undergo selective CT .…”

Section: Discussionmentioning

confidence: 99%

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Incidental findings on whole‐body computed tomography in trauma patients: the current state of incidental findings and the effect of implementation of a feedback system

Kumada

Murakami

Okada

et al. 2019

Acute Medicine & Surgery

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Aim Whole‐body computed tomography (CT) for trauma occasionally reveals significant incidental findings not related to trauma, which require an adequate response. In this study, we examined the current state of incidental findings in trauma patients on whole‐body CT and the effects of the feedback system. Methods The subject sample included trauma patients who underwent whole‐body CT while being examined for trauma during the 2‐year period, with the interpretation of the CT reported by a radiologist. The frequency and recognition of incidental findings and the involved body region were investigated. The state of incidental findings before and after implementation of a radiography report feedback system was also examined. Results During the study period, whole‐body CT revealed incidental findings in 79 of 199 trauma patients (40.1%). The mean age of the 79 patients with incidental findings was 62.8 ± 19.5 years, and the mean injury severity score was 16.6 ± 10.0. No difference was observed in the severity of trauma, age, or length of hospital stay. The incidental findings were related to the liver/gallbladder in 22 patients, kidneys in 17, lungs in 14, and the intracranial area in 13. The recognition rate of incidental findings after the implementation of the feedback system increased from 23.3% to 32.6%. Conclusions Considering that not all incidental findings are accurately recognized, a proper feedback system is required. A feedback system is beneficial and a need to ensure improvement in the recognition of incidental findings.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Incidental findings on whole‐body computed tomography in trauma patients: the current state of incidental findings and the effect of implementation of a feedback system

Kumada

Murakami

Okada

et al. 2019

Acute Medicine & Surgery

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“…Advances in cross-sectional imaging have led to the discovery of innumerable incidental liver lesions [2][3][4]. Such lesions will be detected in up to 30% of individuals older than 40 years [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Although most are benign, in many cases, further workup can be difficult to avoid.…”

Section: Nature and Scope Of The Problemmentioning

confidence: 99%

Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee

Gore

Pickhardt

Mortelé

et al. 2017

Journal of the American College of Radiology

106

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The ACR Committee on Incidental Findings presents recommendations for managing liver lesions that are incidentally detected on CT. These recommendations represent an update from the liver component of the ACR 2010 white paper on managing incidental findings in the pancreas, adrenal glands, kidneys, and liver. The Liver Subcommittee-which included five abdominal radiologists, one hepatologist, and one hepatobiliary surgeon-developed this algorithm. The recommendations draw from published evidence and expert opinion and were finalized by informal iterative consensus. Algorithm branches categorize liver lesions on the basis of patient characteristics and imaging features. They terminate with an assessment of benignity or a specific follow-up recommendation. The algorithm addresses most, but not all, pathologies and clinical scenarios. The goal is to improve the quality of care by providing guidance on how to manage incidentally detected liver lesions.

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“…Studies have shown that there is significant heterogeneity in radiologist classification of AIFs and characterization of the risk associated with each, and almost a third of recommendations were discordant with societal guidelines. 5 In addition, some patients may not have a PCP, or have a PCP outside of the health system, making it difficult to notify a PCP of the finding. Furthermore, for patients who are in the ED or in the hospital as an inpatient, they may have much more pressing health issues which overshadow an AIF detected on imaging during their stay.…”

Section: The Current Approachmentioning

confidence: 99%

System-driven longitudinal follow-up of incidental imaging findings

Plecha

Sommer

2023

BJR

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Increasing utilization of cross-sectional imaging has resulted in more clinically significant incidental findings being discovered. However, the current approach for handling these findings is commonly inconsistent, and relies greatly on the efforts of individual clinicians. Making sure every actionable incidental finding is handled in a consistent and reliable manner can be difficult, especially for a large health system. We propose an approach to handling incidental findings aimed at improving patient follow up rates, which involves implementing system level processes that standardize the reporting of incidental findings, notification of clinicians and the patient, and centralized monitoring of longitudinal patient follow up. We will lay out a general framework for standardized reporting of incidental findings by the radiologist using software integrated into the daily workflow. This should enable simultaneous notification of the ordering clinician, the patient’s primary care provider, and an incidental findings navigator. The navigator will “close the loop” by working with clinicians to notify the patient of the finding, coordinate patient follow up, and document the finding and long term follow up. We hope this can serve as a basic framework to help large health systems design an incidental findings workflow to improve follow up rates and reduce patient harm.

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Incidental findings in emergency imaging: frequency, recommendations, and compliance with consensus guidelines

Cited by 26 publications

References 42 publications

Incidental findings on whole‐body computed tomography in trauma patients: the current state of incidental findings and the effect of implementation of a feedback system

Incidental findings on whole‐body computed tomography in trauma patients: the current state of incidental findings and the effect of implementation of a feedback system

Management of Incidental Liver Lesions on CT: A White Paper of the ACR Incidental Findings Committee

System-driven longitudinal follow-up of incidental imaging findings

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