The incidentaloma: a medicolegal dilemma.

Published on Mar 1, 2011in Radiologic Clinics of North America1.88
· DOI :10.1016/j.rcl.2010.11.002
Leonard Berlin25
Estimated H-index: 25
(Rush Medical College)
In October 2006, an 83-year-old, small, fraillooking woman, with a history of chronic obstructive pulmonary disease and smoking a pack of cigarettes daily for the previous 50 years, visited her family internist with complaints of cough and shortness of breath. Her physician referred her to the outpatient radiology department of a local hospital, where on October 19, 2006 she underwent posterior-anterior and lateral chest radiographies. A radiologist interpreted the examination as disclosing “evidence of chronic obstructive pulmonary disease with scattered fibrotic changes, but otherwise essentially normal study.” Ten months later the patient, now complaining of increasing cough and chest discomfort, again underwent chest radiography on the order of her family physician. A different radiologist interpreted the examination as disclosing a “2 cm mass in the right mid-lung field, suspicious for malignancy.” Computed tomography (CT) confirmed the finding, and a subsequent biopsy disclosed non–small cell carcinoma. Despite chemotherapy, the patient developed numerous metastases and died on July 17, 2008. A short time after the diagnosis was established, the patient’s physician informed the patient and her husband that in reviewing the earlier radiographs taken in October, 2006 with a radiologist, it was discovered that a small nodule had been present in the right midlung field, but no mention of it had been made in the radiographic report. Soon thereafter, the patient and her family filed a medical
  • References (34)
  • Citations (21)
Published on May 5, 2010in Journal of the National Cancer Institute10.21
H. Gilbert Welch61
Estimated H-index: 61
(Dartmouth College),
William C. Black25
Estimated H-index: 25
This article summarizes the phenomenon of cancer overdiagnosis—the diagnosis of a “cancer” that would otherwise not go on to cause symptoms or death. We describe the two prerequisites for cancer overdiagnosis to occur: the existence of a silent disease reservoir and activities leading to its detection (particularly cancer screening). We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected...
Published on May 5, 2010in Journal of the National Cancer Institute10.21
Laura Esserman64
Estimated H-index: 64
(UCSF: University of California, San Francisco),
Ian M. Thompson85
Estimated H-index: 85
In a review in this issue of the Journal (1), Welch and Black clearly document that surveillance routinely identifies lesions that many patients would not need to know about in their lifetimes. These lesions only become a problem because we feel compelled to diagnose and treat them. What motivates intervention is the opportunity to prevent disease progression, metastasis, and death and the philosophy that “early detection is always better.” The patient’s fear of cancer and clinician’s concern ab...
Published on Apr 20, 2010in Annals of Internal Medicine19.32
Jennifer Croswell9
Estimated H-index: 9
Stuart G. Baker31
Estimated H-index: 31
+ 2 AuthorsBarnett S. Kramer56
Estimated H-index: 56
Background: Direct-to-consumer promotion of lung cancer screening has increased, especially low-dose computed tomography (CT). However, screening exposes healthy persons to potential harms, and cumulative false-positive rates for low-dose CT have never been formally reported. Objective: To quantify the cumulative risk that a person who participated in a 1- or 2-year lung cancer screening examination would receive at least 1 false-positive result, as well as rates of unnecessary diagnostic proced...
Published on Mar 11, 2010in The New England Journal of Medicine70.67
David J Brenner D J81
Estimated H-index: 81
In the United States, the average radiation dose to which we are exposed has doubled in the past 30 years.1,2 The average dose from natural background sources has not changed, but what has changed is that there has been an increase by a factor of more than 6 in the average radiation dose from medical imaging.1–3 In 1980, medical imaging was responsible for only about 15% of the total radiation exposure to the U.S. population from all sources; now the proportion is about 50%. Up to 30% of the rad...
Published on Mar 1, 2010in Journal of Law Medicine & Ethics0.73
Erica K. Rangel3
Estimated H-index: 3
(SLU: Saint Louis University)
This paper addresses the question of how incidental findings (IFs) in clinical research should be managed by researchers, focusing in detail on IFs discovered in neuroimaging research. It begins by engaging the larger research ethics issue of whether researchers have any obligations of clinical care to participants, and assesses the content and merits of one particular framework for answering this question, Richardson and Belsky's ancillary care model. From here the paper develops an organizatio...
Published on Feb 4, 2010in The New England Journal of Medicine70.67
Ronald M. Epstein60
Estimated H-index: 60
David N. Korones23
Estimated H-index: 23
Timothy E. Quill44
Estimated H-index: 44
Drs. Ronald Epstein, David Korones, and Timothy Quill reflect on the circumstances in which physicians consciously (and sometimes unconsciously) withhold from patients information about their conditions, treatments, and outcomes. They write that the right to autonomy must be balanced with the ethical obligations to do good for patients and not to harm them.
Published on Feb 1, 2010in Radiology7.61
Lawrence E. Ginsberg33
Estimated H-index: 33
Amidst the discussion of reform and increasing health care costs, relatively little is being said about excessive imaging, but this issue needs to be addressed by radiologists before the matter is addressed by others.
Published on Dec 14, 2009in JAMA Internal Medicine20.77
Amy Berrington de Gonzalez42
Estimated H-index: 42
(NIH: National Institutes of Health),
Mahadevappa Mahesh31
Estimated H-index: 31
(Johns Hopkins University)
+ 4 AuthorsCharles E. Land17
Estimated H-index: 17
(NIH: National Institutes of Health)
Background The use of computed tomographic (CT) scans in the United States (US) has increased more than 3-fold since 1993 to approximately 70 million scans annually. Despite the great medical benefits, there is concern about the potential radiation-related cancer risk. We conducted detailed estimates of the future cancer risks from current CT scan use in the US according to age, sex, and scan type. Methods Risk models based on the National Research Council's “Biological Effects of Ionizing Radia...
Cited By21
Published on Mar 7, 2019in Genetics in Medicine8.68
Wayne W. Grody45
Estimated H-index: 45
(UCLA: University of California, Los Angeles)
There is no question that the advent of massively parallel (“next-generation”) DNA sequencing has thrust Medical Genetics and Molecular Diagnostics into a new era, availing practitioners and patients of a form of genetic testing unprecedented in its scope and comprehensiveness. It has produced impressive diagnostic yield, ended the “diagnostic odyssey” for many patients and families, expanded the known phenotypes of countless disorders, and led to almost weekly new disease gene discoveries. Neve...
Published on Jan 1, 2019
S. Weckbach19
Estimated H-index: 19
(University Hospital Heidelberg),
Oyunbileg von Stackelberg4
Estimated H-index: 4
(University Hospital Heidelberg)
Radiological incidental findings (IFs) occur in research and diagnostic imaging. They are findings whose discovery is not intended. Due to a strong increase in high-tech imaging modalities the prevalence of IFs has risen. IFs regularly evoke discussions about accompanying ethical challenges. General principles to be considered in the management of IFs are responsibility for the well-being of the patient/study participant and of the society. In order to avoid overdiagnosis and overtherapy and gen...
Published on Sep 1, 2018in Heliyon
Mogahid M. A. Zidan , Ikhlas A. Hassan (Sudan University of Science and Technology)+ 5 AuthorsSalah Ali (Sudan University of Science and Technology)
Abstract Purpose To calculate the frequencies of incidental extraspinal findings and incidentally detected congenital anomalies or anatomical differences in the lumbar spine on magnetic resonance imaging (MRI) scans of intervertebral discs. Materials and methods A total of 379 lumbar spine MRI cases were prospectively investigated in the period spanning from August 2016 to January 2018. Both 1.5 and 0.35 Tesla MRI units (Toshiba and Siemens Medical Systems) were used to examine patients with cli...
Published on Jan 1, 2018
Jie Yang1
Estimated H-index: 1
(TU: Temple University),
William C. Scarfe Bds Fracds29
Estimated H-index: 29
(University of Louisville),
Christos Angelopoulos8
Estimated H-index: 8
(A.U.Th.: Aristotle University of Thessaloniki)
An incidental finding is a generic term applied in radiology to describe an occult entity discovered unexpectedly on an imaging examination performed for an unrelated reason. Some incidental findings on cone beam computed tomography (CBCT) images are readily identifiable based on radiologic presentation and location (e.g., tonsilloliths) whereas others may be inconclusive and may present as a radiologic diagnostic dilemma. The purpose of this Chapter is to describe and illustrate various CBCT in...
Published on Sep 1, 2017in American Journal of Emergency Medicine1.65
Brit Long6
Estimated H-index: 6
(San Antonio Military Medical Center),
Michael D. April6
Estimated H-index: 6
(San Antonio Military Medical Center)
+ 1 AuthorsAlex Koyfman8
Estimated H-index: 8
(UTSW: University of Texas Southwestern Medical Center)
Abstract Background Trauma patients often present with injuries requiring resuscitation and further evaluation. Many providers advocate for whole body computed tomography (WBCT) for rapid and comprehensive diagnosis of life-threatening injuries. Objective Evaluate the literature concerning mortality effect, emergency department (ED) length of stay, radiation, and incidental findings associated with WBCT. Discussion Physicians have historically relied upon history and physical examination to diag...
Published on Jan 1, 2017
Jessica G. Zarzour7
Estimated H-index: 7
(UAB: University of Alabama at Birmingham),
Lincoln L. Berland31
Estimated H-index: 31
(UAB: University of Alabama at Birmingham)
A core principle of quality improvement for better outcomes is consistency. With the increased use of medical imaging, incidental findings are more commonly being discovered. There is significant variability in the reporting and follow-up regarding incidental findings. This can lead to confusion for the referring physician unless specific guidance is offered by the radiologist. Other guidelines have also been developed for specific conditions and to help guide the management of the patient. The ...
Published on Dec 1, 2016in Journal of The American College of Radiology3.79
Matthew E. Zygmont4
Estimated H-index: 4
(Emory University),
Haris Shekhani5
Estimated H-index: 5
(Emory University)
+ 2 AuthorsTarek N. Hanna8
Estimated H-index: 8
(Emory University)
Abstract Purpose The aim of this study was to assess the efficacy of an educational framework encouraging the systematic application of national societal recommendations regarding the imaging evaluation and follow-up of incidental findings (IFs) in the emergency department. Methods After institutional review board approval was received, consecutive CT and ultrasonographic examinations from the emergency department over a 2-month period were collected. Examination reports were categorized by stud...
Published on Apr 1, 2016in Emergency Radiology
Tarek N. Hanna8
Estimated H-index: 8
(Emory University),
Haris Shekhani5
Estimated H-index: 5
(Emory University)
+ 2 AuthorsJamlik-Omari Johnson7
Estimated H-index: 7
(Emory University)
The purpose of this study was to evaluate the frequency of incidental findings (IFs) in emergency department (ED) imaging reports and evaluate the adherence of imaging recommendations to consensus societal guidelines for IFs. A retrospective review of consecutive ED computed tomography (CT) and ultrasonography (US) reports from two university-affiliated EDs over a 2-month period was performed. Each imaging report was reviewed in its entirety, and incidental findings were documented along with re...
Published on Jan 1, 2016
Robert C. Bertheau3
Estimated H-index: 3
(University Hospital Heidelberg),
Oyunbileg von Stackelberg4
Estimated H-index: 4
(University Hospital Heidelberg)
+ 2 AuthorsChristopher L. Schlett26
Estimated H-index: 26
(University Hospital Heidelberg)
The German National Cohort is a long term, multicenter, population-based cohort study currently undertaken in Germany with the goal of investigating the development of common chronic diseases. As part of this investigation, 30.000 out of the total of 200.000 participants are being subjected to a whole-body 3-Tesla MR imaging without contrast agents. To help with the implementation of national and international ethical guidelines a system was developed to classify and report incidental findings t...