Skip to main content
Top
Published in: Emergency Radiology 2/2016

01-04-2016 | Original Article

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

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

Published in: Emergency Radiology | Issue 2/2016

Login to get access

Abstract

The purpose of this study was to evaluate the frequency of incidental findings (IFs) in emergency department (ED) imaging reports and evaluate the adherence of imaging recommendations to consensus societal guidelines for IFs. A retrospective review of consecutive ED computed tomography (CT) and ultrasonography (US) reports from two university-affiliated EDs over a 2-month period was performed. Each imaging report was reviewed in its entirety, and incidental findings were documented along with recommendations for additional imaging. Imaging recommendations were compared to published societal guidelines from the American College of Radiology (ACR) and Fleischner Society. Three thousand one hundred thirty-one total cases consisting of 1967 CTs and 1164 US contained 514 incidental findings (16.4 %), with 329 CT IFs (64 %) and 185 US IFs (36 %). The ovary was the most common organ for an IF (n = 214, 42 %). Of all IFs, 347 (67.5 %) recommendations were concordant with societal guidelines and 167 (32.5 %) were discordant. 39.8 % of CT recommendations were discordant, while 19.5 % of US recommendations were discordant (p < 0.0001). Incidental findings are commonly encountered in the emergent setting. Variable adherence to societal guidelines is noted. Targeted radiologist education and technological solutions may decrease rates of discordance.
Literature
3.
go back to reference Hall WB, Truitt SG, Scheunemann LP, Shah SA, Rivera MP, Parker LA et al (2009) The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism. Arch Intern Med 169(21):1961–1965. doi:10.1001/archinternmed.2009.360 CrossRefPubMed Hall WB, Truitt SG, Scheunemann LP, Shah SA, Rivera MP, Parker LA et al (2009) The prevalence of clinically relevant incidental findings on chest computed tomographic angiograms ordered to diagnose pulmonary embolism. Arch Intern Med 169(21):1961–1965. doi:10.​1001/​archinternmed.​2009.​360 CrossRefPubMed
4.
go back to reference Heller MT, Harisinghani M, Neitlich JD, Yeghiayan P, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 3: white paper of the ACR Incidental Findings Committee II on splenic and nodal findings. J Am Coll Radiol 10(11):833–839. doi:10.1016/j.jacr.2013.05.020 CrossRefPubMed Heller MT, Harisinghani M, Neitlich JD, Yeghiayan P, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 3: white paper of the ACR Incidental Findings Committee II on splenic and nodal findings. J Am Coll Radiol 10(11):833–839. doi:10.​1016/​j.​jacr.​2013.​05.​020 CrossRefPubMed
5.
go back to reference Khosa F, Krinsky G, Macari M, Yucel EK, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, Part 2: white paper of the ACR Incidental Findings Committee II on vascular findings. J Am Coll Radiol 10(10):789–794. doi:10.1016/j.jacr.2013.05.021 CrossRefPubMed Khosa F, Krinsky G, Macari M, Yucel EK, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, Part 2: white paper of the ACR Incidental Findings Committee II on vascular findings. J Am Coll Radiol 10(10):789–794. doi:10.​1016/​j.​jacr.​2013.​05.​021 CrossRefPubMed
6.
go back to reference Patel MD, Ascher SM, Paspulati RM, Shanbhogue AK, Siegelman ES, Stein MW et al (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 1: white paper of the ACR Incidental Findings Committee II on adnexal findings. J Am Coll Radiol 10(9):675–681. doi:10.1016/j.jacr.2013.05.023 CrossRefPubMed Patel MD, Ascher SM, Paspulati RM, Shanbhogue AK, Siegelman ES, Stein MW et al (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 1: white paper of the ACR Incidental Findings Committee II on adnexal findings. J Am Coll Radiol 10(9):675–681. doi:10.​1016/​j.​jacr.​2013.​05.​023 CrossRefPubMed
7.
go back to reference Sebastian S, Araujo C, Neitlich JD, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 4: white paper of the ACR Incidental Findings Committee II on gallbladder and biliary findings. J Am Coll Radiol 10(12):953–956. doi:10.1016/j.jacr.2013.05.022 CrossRefPubMed Sebastian S, Araujo C, Neitlich JD, Berland LL (2013) Managing incidental findings on abdominal and pelvic CT and MRI, part 4: white paper of the ACR Incidental Findings Committee II on gallbladder and biliary findings. J Am Coll Radiol 10(12):953–956. doi:10.​1016/​j.​jacr.​2013.​05.​022 CrossRefPubMed
9.
go back to reference MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP et al (2005) Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 237(2):395–400. doi:10.1148/radiol.2372041887 CrossRefPubMed MacMahon H, Austin JH, Gamsu G, Herold CJ, Jett JR, Naidich DP et al (2005) Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology 237(2):395–400. doi:10.​1148/​radiol.​2372041887 CrossRefPubMed
11.
go back to reference Lehnert BE, Sandstrom CK, Gross JA, Dighe M, Linnau KF (2014) Variability in management recommendations for incidental thyroid nodules detected on CT of the cervical spine in the emergency department. J Am Coll Radiol 11(7):681–685. doi:10.1016/j.jacr.2013.12.007 CrossRefPubMed Lehnert BE, Sandstrom CK, Gross JA, Dighe M, Linnau KF (2014) Variability in management recommendations for incidental thyroid nodules detected on CT of the cervical spine in the emergency department. J Am Coll Radiol 11(7):681–685. doi:10.​1016/​j.​jacr.​2013.​12.​007 CrossRefPubMed
13.
go back to reference Rosenkrantz A, Matze B, Foran M, McMenamy J (2013) Recommendations for additional imaging on emergency department CT examinations: comparison of emergency- and organ-based subspecialty radiologists. Emergency Radiology 20:149–153CrossRefPubMed Rosenkrantz A, Matze B, Foran M, McMenamy J (2013) Recommendations for additional imaging on emergency department CT examinations: comparison of emergency- and organ-based subspecialty radiologists. Emergency Radiology 20:149–153CrossRefPubMed
14.
go back to reference Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report. 2010(26):1-31 Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report. 2010(26):1-31
15.
27.
28.
go back to reference Kirschner J, Shah K, Runde D, Newman D, Godbout B, Wiener D et al (2014) Patterns in computed tomography utilization among emergency physicians in an urban, academic emergency department. Emerg Radiol 21(6):577–581. doi:10.1007/s10140-014-1237-x CrossRefPubMed Kirschner J, Shah K, Runde D, Newman D, Godbout B, Wiener D et al (2014) Patterns in computed tomography utilization among emergency physicians in an urban, academic emergency department. Emerg Radiol 21(6):577–581. doi:10.​1007/​s10140-014-1237-x CrossRefPubMed
30.
go back to reference Johnson P, Horton K, Megibow A, Jeffery R, Fishman E (2011) Common incidental findings on MDCT: survey of radiologist recommendations for patient management. Journal of the American College of Radiology 8:762–767CrossRefPubMed Johnson P, Horton K, Megibow A, Jeffery R, Fishman E (2011) Common incidental findings on MDCT: survey of radiologist recommendations for patient management. Journal of the American College of Radiology 8:762–767CrossRefPubMed
31.
go back to reference Shuaib W, Vijayasarathi A, Johnson JO, Salastekar N, He Q, Maddu KK et al (2014) Factors affecting patient compliance in the acute setting: an analysis of 20,000 imaging reports. Emerg Radiol 21(4):373–379. doi:10.1007/s10140-014-1209-1 CrossRefPubMed Shuaib W, Vijayasarathi A, Johnson JO, Salastekar N, He Q, Maddu KK et al (2014) Factors affecting patient compliance in the acute setting: an analysis of 20,000 imaging reports. Emerg Radiol 21(4):373–379. doi:10.​1007/​s10140-014-1209-1 CrossRefPubMed
33.
go back to reference Brook OR, Beddy P, Pahade J, Couto C, Brennan I, Patel P et al (2015) Delayed growth in incidental pancreatic cysts: are the current American College of Radiology Recommendations for follow-up appropriate? Radiology 140972. doi: 10.1148/radiol.2015140972 Brook OR, Beddy P, Pahade J, Couto C, Brennan I, Patel P et al (2015) Delayed growth in incidental pancreatic cysts: are the current American College of Radiology Recommendations for follow-up appropriate? Radiology 140972. doi: 10.​1148/​radiol.​2015140972
36.
go back to reference Xiong T, McEvoy K, Morton DG, Halligan S, Lilford RJ (2006) Resources and costs associated with incidental extracolonic findings from CT colonography: a study in a symptomatic population. Br J Radiol 79(948):948–961. doi:10.1259/bjr/58438178 CrossRefPubMed Xiong T, McEvoy K, Morton DG, Halligan S, Lilford RJ (2006) Resources and costs associated with incidental extracolonic findings from CT colonography: a study in a symptomatic population. Br J Radiol 79(948):948–961. doi:10.​1259/​bjr/​58438178 CrossRefPubMed
37.
go back to reference Gluecker TM, Johnson CD, Wilson LA, Maccarty RL, Welch TJ, Vanness DJ et al (2003) Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology 124(4):911–916. doi:10.1053/gast.2003.50158 CrossRefPubMed Gluecker TM, Johnson CD, Wilson LA, Maccarty RL, Welch TJ, Vanness DJ et al (2003) Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology 124(4):911–916. doi:10.​1053/​gast.​2003.​50158 CrossRefPubMed
40.
go back to reference Veerappan GR, Ally MR, Choi JH, Pak JS, Maydonovitch C, Wong RK (2010) Extracolonic findings on CT colonography increases yield of colorectal cancer screening. AJR American Journal of Roentgenology 195(3):677–686. doi:10.2214/AJR.09.3779 CrossRefPubMed Veerappan GR, Ally MR, Choi JH, Pak JS, Maydonovitch C, Wong RK (2010) Extracolonic findings on CT colonography increases yield of colorectal cancer screening. AJR American Journal of Roentgenology 195(3):677–686. doi:10.​2214/​AJR.​09.​3779 CrossRefPubMed
Metadata
Title
Incidental findings in emergency imaging: frequency, recommendations, and compliance with consensus guidelines
Authors
Tarek N. Hanna
Haris Shekhani
Matthew E. Zygmont
James Matthew Kerchberger
Jamlik-Omari Johnson
Publication date
01-04-2016
Publisher
Springer Berlin Heidelberg
Published in
Emergency Radiology / Issue 2/2016
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI
https://doi.org/10.1007/s10140-016-1378-1

Other articles of this Issue 2/2016

Emergency Radiology 2/2016 Go to the issue