Tag: incidental findings

The Danger of Incidental Findings in CT Lung Screening

Posted on by Brian Casey

CT lung cancer screening is gaining momentum around the world, but one of the challenges providers face is how to manage incidental findings. It’s especially important given that a new study in JAMA Network Open suggests that incidental findings on screening exams are associated with a higher risk of cancer occurring outside the lung. 

Incidental findings are suspicious areas discovered outside the target region being imaged, and are especially a concern with cancer screening exams.

  • Incidental findings turn out to be normal most of the time, but pathology occurs often enough that most clinicians agree they’re worth investigating. 

The problem is that many providers don’t have a robust system in place for alerting referring physicians to incidental findings and ensuring that patients get the follow-up exams they need.

The new study addresses incidental findings within the context of CT lung cancer screening, specifically in the National Lung Screening Trial, the landmark study that established low-dose CT’s lifesaving benefit.

  • It’s an important question, because chasing down a large number of benign incidental findings would be a resource-intensive task that could alter the cost-benefit ratio of lung screening.

Researchers analyzed significant incidental findings unrelated to lung cancer in 26.4k people across three rounds of LDCT screening who were followed for a year, revealing…

  • Cancer findings outside the lung occurred in 6.8% of people, and 13% of them had multiple cancers. 
  • Patients with significant incidental findings had a higher absolute risk of being diagnosed with extrapulmonary cancer within a year (16 per 1k participants). 
  • Study participants with incidental findings tended to be slightly older (62 vs. 61 years) and more likely to have a history of smoking-related disease (69% vs. 66%).

The findings confirm that having a plan to manage incidental findings should be an important part of any CT lung cancer screening program, especially given previous research showing that 23% of deaths in NLST were due to cancers outside the lung. 

  • In fact, an effective incidental finding program could enhance LDCT screening’s value, especially given that people eligible for screening have heavy smoking histories.

The Takeaway

The new study shows that incidental findings on CT lung screening exams are common and serious enough to warrant further investigation. Screening programs that are able to do so effectively will deliver even more value to their patients than lung screening alone.

Managing Incidental Findings Isn’t Impossible

Posted on by Brian Casey

The number of incidental findings on medical imaging scans nearly quadrupled over nine years at a large academic medical center. That’s according to a new JACR analysis that fortunately offers strategies for following up on these unexpected imaging discoveries.

Incidental findings – defined as suspicious areas on medical images that aren’t related to a patient’s chief concern – comprise 15-30% of all medical imaging exams and are a growing challenge in radiology as imaging volume rises. 

  • Radiologists have a responsibility to include incidental findings in their reports, but who’s responsible for making sure patients know about them? 

Healthcare providers have adopted different methods for incidental follow-up, ranging from workflow changes to medical IT solutions.

In the current study, researchers from Northwestern University describe the incidental follow-up system they developed, which worked as follows…

  • An electronic button was embedded in the EMR for radiologists to click when an incidental finding was detected.
  • This relayed a note to the nursing team, which ensured that the patient’s care provider (or the patient themselves) knew about the finding.
  • The system required cases to be resolved when patients were notified of their findings and were told of the next steps to take.

In an analysis covering a total of 25.2k incidental findings from 2015 to 2023, researchers discovered… 

  • The number of findings grew at a compound annual growth rate of 21% with an average of 233 per month. 
  • Annual findings grew from 835 in 2015 to 4k in 2023 – a nearly 4X increase.
  • 99% of findings were resolved. 
  • Cases had to be resolved within seven months of the finding’s discovery.

One caveat is that Northwestern considered the loop closed once the patient was notified of the finding, rather than whether the patient complied with the recommendation.

  • A more robust protocol might involve additional longitudinal tracking to measure downstream effectiveness, which the authors note as a possibility for future research. 

The Takeaway

The new study underscores the stunning growth of incidental findings in radiology. But it also offers hope to imaging facilities through implementation of a simple IT fix and workforce changes that go a long way toward keeping patients notified of their imaging results.

Integrated Solutions for Managing Incidental CAC Findings

Posted on by Partner Content

The rising prominence of coronary artery calcium as a prognostic marker for heart disease has created an emerging challenge for radiologists: how should they manage incidental CAC findings discovered on routine CT exams? Fortunately, new industry collaborations are making it possible to deliver CAC reports to clinicians without disrupting workflow. 

Routine CT scans are revealing data beyond their original diagnostic intent.

  • AI solutions – such as AVIEW CAC from Coreline Soft – play a pivotal role in identifying risks for cardiovascular disease, osteoporosis, and metabolic disorders – all from a single scan.

AI allows one CT scan to assess lung, cardiovascular, and skeletal health, improving diagnosis and treatment planning.

One imaging services provider that has put AVIEW CAC into use is 3DR Labs, which has been actively integrating the solution into its nationwide clinical network.

  • The partnership enables 3DR Labs radiologists to generate consistent, high-quality CAC reports directly within PACS, while significantly reducing turnaround times.

3DR Labs is finding that AVIEW CAC optimizes workflow efficiency and significantly reduces the time required for CAC assessment. 

  • It also ensures that radiologic technologists can perform quick QA checks, enhancing consistency and reliability in the delivery of the report.

The latest generation of the FDA-cleared AVIEW CAC features an upgraded user interface and advanced batch-scoring functionality. 

  • 3DR Labs is now working to expand AI-driven insights into lung and neuroimaging through Coreline’s broader AVIEW platform (AVIEW ILA for interstitial lung abnormalities and AVIEW BAS for brain CT).

Beyond diagnostic imaging, this collaboration supports growing demands for cost-efficiency in healthcare. 

  • As U.S. insurers and government agencies recognize the ROI potential of early AI detection, platforms like AVIEW CAC offer scalable, high-performance solutions that lower costs and streamline care delivery.

3DR Labs has also highlighted Coreline Soft’s role as a founding partner in AI Labs, the company’s vendor-neutral platform to deliver the latest AI innovations to radiology workflows.

The Takeaway

New partnerships like the collaboration between Coreline Soft and 3DR Labs are advancing the future of AI in radiology – focusing on automation, early detection, and better patient outcomes through powerful, clinically validated technologies. Such partnerships not only reflect increasing adoption of AI in U.S. healthcare but set the stage for global transformation in diagnostic imaging.

Incidental Findings and Low-Value Care

Posted on by Jake Fishman

A whopping 15% to 30% of diagnostic imaging exams reveal at least one incidental finding. Each of those findings might seem like blessings to radiology outsiders, but a popular new AJR editorial argues that imaging incidentals are far more likely to drive low-value care.

Michigan Medicine’s Matthew Davenport, MD led-off his editorial by suggesting that early cancer detection “is not always an ideal outcome,” because most of those cancers won’t affect patient health, while incidental follow-ups always require resources and often negatively impact patients (physically, financially, and emotionally).

He identified numerous reasons for radiology’s incidental overdiagnosis challenges…

  • Screening low-risk patients inherently uncovers low-risk incidentals
  • There’s a lack of understanding of incidental risks (clinically and downstream)
  • Many early cancers don’t or shouldn’t require treatment
  • Radiologists face significant pressure to recommend follow-ups

Although many incidental findings significantly improve patient outcomes, and those positive examples have established incidentals as a “secondary benefit of imaging,” the editorial suggests that incidentals will have a negative overall impact on radiology’s value until current practices change. 

So, what should we do? Dr. Davenport encourages radiologists to…

  • Become more aware of the harms of incidental management
  • Advocate for guidelines that emphasize high-value care
  • Support research on incidental management practices
  • “Avoid being alarmist” about incidentals in radiology reporting
  • Adopt solutions to help rads assess incidental patients’ risk factors
  • Balance diagnostic sensitivity with minimizing follow-up risks 

The Takeaway

If you scroll through the Imaging Wire archives, you’ll find plenty of stories that depict incidentals as a net positive for patient care. In fact, most suggest that radiology’s research and business leaders are actively trying to find ways to detect more incidentals. However, efforts to better understand or to reduce incidentals’ negative impacts are far less common. 

That divide is pretty notable given how many radiologists agree with Dr. Davenport, and it suggests that the barriers to solving incidental findings’ value problems are quite high.

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