Incidental finding characteristics that warrant communication
New research highlights characteristics that indicate incidental findings should be considered more high-risk and in need of further analysis.
Whether radiologists should report incidental findings on imaging exams is highly debated, but findings regarded as having greater risk warrant communication between radiologists and referring providers. Determining the risk is not only challenging, but it also can be accompanied by serious clinical and legal ramifications.
“While most [incidental imaging findings] are low-risk lesions, their clinical management is often challenging because they occasionally include high-risk lesions,” corresponding author Seitaro Oda MD, PhD, from the Department of Diagnostic Radiology at Kumamoto University, and co-authors explain. “In other words, additional interventions for IIFs can lead to overtreatment, while underestimation of IIFs can result in overlooking high-risk lesions, with serious implications for patient health.”
To streamline the communication of IIFs at their institution, experts at Kumamoto University Hospital in Japan integrated a machine learning-based platform that alerts providers of incidental findings in their EMR. The alert system identifies high-risk findings and facilitates communication between providers.
Experts from the organization recently conducted an assessment on the system’s effectiveness and identified trends in incidental findings that indicated they should truly be categorized as high-risk. This involved analyzing more than 50,000 exams over a period of two years.
Of those studies, around 1% contained high-risk incidental findings. Nearly two-thirds of the incidental findings required follow-up only, while 23% needed therapeutic intervention. Out of 219 incidental findings that were given a confirmed diagnosis, 60% were deemed malignant and around half required surgery.
The team was able to identify three factors commonly associated with findings that were truly high-risk—imaging protocols for aortic valve implantation planning, imaging area (especially whole-body imaging) and orders from the cardiology department.
“We believe that understanding the clinical characteristics of high-risk ICTFs is necessary not only for radiologists but also for ordering clinicians, and that communication between them is crucial,” the group writes. “Our study outcomes provide essential information for radiologists to recognize these risk factors of high-risk ICTFs during routine interpretation of CT imaging studies.”
The authors suggest that although the system requires human intervention (radiologists must initiate the communication), it can be easily integrated into PACS without workflow disruptions.
Learn more about the analysis in Academic Radiology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.