Common incidental findings on MDCT: survey of radiologist recommendations for patient management

J Am Coll Radiol. 2011 Nov;8(11):762-7. doi: 10.1016/j.jacr.2011.05.012.


Purpose: The aim of this study was to evaluate for agreement with respect to how radiologists report incidental findings encountered on CT.

Methods: A multiple-choice survey was designed to query radiologists about how they handle 12 incidental findings on body CT, assuming the patient is a 45-year-old woman with no history of malignancy. Included were a 1-cm thyroid nodule, a 5-mm noncalcified lung nodule, coronary artery calcification, a 2-cm adrenal nodule, a 2-cm pancreatic cyst, a 1-cm enhancing liver lesion, a 2-cm high-density renal cyst, short-segment small bowel intussusception, a 1-cm splenic cyst, focal gallbladder wall calcification, and a 3-cm ovarian cyst in both a premenopausal woman and a postmenopausal woman. Choices ranged from "do not report" to advising interventional procedures tailored to the organ. Surveys were administered to body CT attending radiologists at 3 academic institutions.

Results: Twenty-seven radiologists completed the survey. The mean experience level was 15.7 years after training. Seventy percent or greater agreement on interpretation was identified for only 6 findings: recommend ultrasound for a 1-cm thyroid nodule, recommend ultrasound for a 3-cm cyst in postmenopausal woman, follow Fleischner Society recommendations for a 5-mm lung nodule, describe only coronary calcification, and describe as likely benign both short-segment small bowel intussusception and a 1-cm splenic cyst.

Conclusions: Agreement is lacking, both across institutions and within departments, for the management of 6 commonly encountered incidental findings on body CT. Individual departments should develop internal guidelines to ensure consistent recommendations based on existing evidence.

Publication types

  • Comparative Study

MeSH terms

  • Academic Medical Centers
  • Attitude of Health Personnel*
  • Case Management
  • Cross-Sectional Studies
  • Female
  • Guideline Adherence
  • Humans
  • Incidental Findings*
  • Male
  • Medical Records
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Quality Improvement
  • Radiology / standards*
  • Radiology / trends
  • Statistics as Topic
  • Surveys and Questionnaires*
  • United States