Original articleCommon Incidental Findings on MDCT: Survey of Radiologist Recommendations for Patient Management
Introduction
Advances in CT spatial and temporal resolution have improved radiologists' ability to identify small or subtle findings. In conjunction with increasing CT utilization, this has fueled the rate with which incidental findings are discovered. However, published guidelines for the management of many incidental findings are only just emerging [1, 2, 3, 4, 5]. Valuable information is derived from investigations aimed at distinguishing clinically significant findings from those that do not warrant additional workup [6, 7, 8, 9, 10], systematic evaluations of the literature [1, 4], and consensus statements [2, 3]. Another source lies in guidance from experienced radiologists at high-volume centers. Accordingly, the purpose of this study was to evaluate for agreement among body CT attending radiologists, both within departments and across academic institutions, for the management of a number of commonly encountered incidental findings on body CT.
Section snippets
Methods
This study was approved by the Johns Hopkins Hospital institutional review board, with a waiver of the requirement for informed consent. A survey was designed to query radiologists about 12 common incidental findings on body CT (Appendix). Participating radiologists were instructed to assume that the patient was a 45-year-old woman with no history of malignancy. Respondents could select from a list of possible interpretative practices or write in responses.
Three geographically dispersed
Results
A total of 27 radiologists participated, 7 from institution A, 12 from institution B, and 8 from institution C. The participants had an average of 15.7 years in practice (range, 1.5-30 years), with 16 having ≥10 years of experience (defined as experienced radiologists), and 10 having ≥20 years of experience. The majority (67% [18 of 27]) had completed fellowships that included CT.
Table 1 lists the most commonly selected interpretation for each finding. The rate of agreement ranged from 30% to
Discussion
Analysis of abdominal imaging utilization trends between 1996 and 2005 revealed that the use of CT and CT angiography increased by 141% [11], representing the greatest increase among imaging modalities. Rising utilization is fueled in a large part by improvements in resolution, which have expanded the clinical indications for CT imaging and improved the diagnostic accuracy. However, a repercussion of rising utilization is increasing identification of unsuspected findings. For those that are not
Conclusions
Our survey discloses 2 important pieces of information. The first pertains to evolving agreement for managing certain incidental findings, including thyroid nodules, coronary artery calcification, lung nodules, ovarian cysts in postmenopausal women, spleen lesions, and short small bowel intussusception. It is important to note that at present, 100% agreement was not identified for the management of any of these 12 findings. An equally essential discovery is the lack of agreement across academic
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