Radiologists now regularly report findings such as masses or lesions that are "incidental" to the reason an imaging study was ordered in the first place. Such a finding is referred to as an actionable incidental finding (AIF), which is frequently conveyed in a radiologist's report along with recommendations for follow up diagnostic testing or other actions such as specialty referrals, or invasive procedures. Too often, these findings and recommendations can be overlooked, with no clinical follow up. This is particularly the case with imaging performed for patients in hospital emergency departments.

The emergency department creates challenges in AIF communication and follow-up for obvious reasons. In such settings, the focus is on the sign or symptom for which imaging study was ordered, and because the emergency physician does not have an ongoing relationship with the patient, follow up is next to impossible.

To address these challenges, the American College of Radiology and the American College of Emergency Physicians convened a panel of radiologists, emergency physicians, patients, and others involved in health care systems and quality "to seek consensus regarding best practices in the reporting, communication, and follow-up of AIFs on ED imaging tests." The panel has just published a new white paper in the Journal of the American College of Radiology. 

The panel identified four "consensus areas" upon which to focus its recommendations:

• Report structure (elements to be included and where). "There was strong consensus that the report summary section should include the presence of an AIF, recommended follow-up modality and time frame, evidence supporting recommendations if available, and documentation of any notification or communication."

• Communication of findings with patients. "One notable area of consensus that was that 'patient-facing language' should be included in the report."

• Communication of findings with clinicians. "Perhaps the most important area in which agreement was strong was that the communication of incidental findings is ultimately a systems responsibility as opposed to the responsibility of individual clinicians."

• Follow-up and tracking systems. "There was consensus that best practice in this area includes a follow-up system that assigns a dedicated individual to contact the patient at a later date and track follow-up.

The ultimate takeaway for me is that the panel, despite some recent commentary that some incidental findings not be reported by radiologists, did not discourage the reporting of incidental findings. But there are admittedly challenges for addressing these findings in the ED setting. It is a positive, I believe, that the panel recommends that AIFs should be clearly identified in the radiology report and also communicated clearly to the patient in addition to the emergency physician. Most importantly, the panelists believe the follow up on incidental findings is a "systems" issue, where informatics and tracking systems need to be employed. 

So who will take ownership of incidental findings for ED patients? Certainly, technology is vital in tracking the follow up on these important incidental findings. One must hope that the systems approach the panel describes will create the incentives and accountability to assure the necessary follow up actions for the betterment of patient care.