Matthew Davenport, MD, on the unintended consequences of incidental findings management.

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Radiology Reporting

Incidental Findings and Low-Value Care

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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