Management of incidental findings in patients

Abstract

There are major differences how to deal with incidental findings in study participants and patients. While a study participant might see himself as part of a research project, he is less likely to expect diagnoses from cross-sectional imaging examinations. In contrast, a patient in a clinical setting undergoes imaging examinations for a particular reason, that is, to exclude, confirm, or follow up a certain diagnosis. Therefore, the patient expects a particular – positive or negative – report related to the original clinical question. Additional findings not related to the initial indication for the examination are generally reported. These incidental findings need to be handled carefully both by the reporting radiologist and by the physician in charge. Well-considered recommendations given by the radiologist are the most important part of handling incidental findings responsibly. Depending on certain parameters, such as the chosen modality or the image quality, differentiating between “normal” and “pathological” becomes a real challenge for several incidental findings. The reporting radiologist has to decide how to report and assess those incidental findings. By now, there are several recommendations by different societies and committees that can help radiologists in the assessment of incidental findings. In this chapter, we aim to give a brief overview of the most helpful recommendations, which refer to the most frequently occurring incidental findings on thoracic and abdominal CT or MRI.