The October 2021 issue of The Journal of the American College of Radiology (JACR) here and here contains a fascinating and crucial exchange on the importance of communication and follow-up on "incidental findings" in radiology studies. Incidental findings occur when a mass or lesion is detected by an imaging examination performed for an unrelated reason. Approximately a quarter of imaging tests reveal incidental findings, with nearly a third of CT scans revealing incidental findings.
In 2019, the American College of Radiology (ACR) received a grant from the Gordon and Betty Moore Foundation entitled “Closing the Results Loop on Incidental Findings,” which aims to improve quality relating to incidental findings communication and follow-up. That work has been carried out through the ACR's Incidental Findings Committee. An article in the June issue of JACR explored – via a survey of radiologists, referring clinicians, support staff, and patients – the challenges of follow-up, and adherence to recommendations for follow-up tests, after such incidental findings.
A pair of radiologists submitted a letter to the JACR editor on the clinical importance of determining whether the ordering clinician or the patient's primary care provider should be responsible for arranging further management of incidental findings in radiology studies. The reporting radiologist, they write—particularly for emergency department studies — could ultimately be tasked with organizing these follow-up tests. Consequently, they believe the recommendations for follow-up testing must be provided clearly in the final written interpretive report because if the advice is given verbally or via an internal hospital-based system, that recommendation may not be communicated to the patient's primary care physician and may not be acted on. Thus, they ask what measures would the authors from the ACR committee suggest to facilitate and support this handover of care and responsibility?
The response was encouraging. The ACR authors cited nine draft-quality measures on this topic that are currently in the testing, public comment, or revision phases. Further, several of the authors are developing a white paper entitled “Best Practices for the Communication and Management of Incidental Findings in Emergency Department Imaging.” This initiative is supported by the ACR and the American College of Emergency Physicians. But challenges remain. Ultimately, the authors believe it may be more effective for the system where the imaging study was performed to employ systemwide informatics-based processes to facilitate this vital communication and follow-up rather than putting that responsibility on individual providers.