Incidental findings in imaging research: Evaluating incidence, benefit, and burden

Nicholas M. Orme, Joel Garland Fletcher, Hassan A. Siddiki, W. Scott Harmsen, Megan M. O'Byrne, John D Port, William J. Tremaine, Henry Clement Pitot, Elizabeth G. McFarland, Marguerite E. Robinson, Barbara A. Koenig, Bernard Francis King, Susan M. Wolf

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Background: Little information exists concerning the frequency and medical significance of incidental findings (IFs) in imaging research. Methods: Medical records of research participants undergoing a research imaging examination interpreted by a radiologist during January through March 2004 were reviewed, with 3-year clinical follow-up. An expert panel reviewed all IFs generating clinical action to determine medical benefit/burden on the basis of predefined criteria. The frequency of IFs that generated further clinical action was estimated by modality, body part, age, and sex, along with net medical benefit or burden. Results: Of 1426 research imaging examinations, 567 (39.8%) had at least 1 IF (1055 total). Risk of an IF increased significantly by age (odds ratio [OR], 1.5; 95% confidence interval, 1.4-1.7 per decade increase). Abdominopelvic computed tomography generated more IFs than other examinations (OR, 18.9 vs ultrasonography; 9.2% with subsequent clinical action), with computed tomography of the thorax and magnetic resonance imaging of the head next (OR, 11.9 and 5.9; 2.8% and 2.2% with action, respectively). Of the 567 examinations with an IF, 35 (6.2%) generated clinical action, resulting in clear medical benefit in 1.1% (6 of 567) and clear medical burden in 0.5% (3 of 567). Medical benefit/burden was usually unclear (26 of 567 [4.6%]). Conclusions: Frequency of IFs in imaging research examinations varies significantly by imaging modality, body region, and age. Research imaging studies at high risk for generating IFs can be identified. Routine evaluation of research images by radiologists may result in identification of IFs in a high number of cases and subsequent clinical action to address them in a small but significant minority. Such clinical action can result in medical benefit to a small number of patients.

Original languageEnglish (US)
Pages (from-to)1525-1532
Number of pages8
JournalArchives of Internal Medicine
Volume170
Issue number17
DOIs
StatePublished - Sep 27 2010

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Incidental Findings
Incidence
Research
Odds Ratio
Tomography
Body Regions
Human Body
Medical Records
Biomedical Research
Ultrasonography
Thorax
Head
Magnetic Resonance Imaging
Confidence Intervals

ASJC Scopus subject areas

  • Internal Medicine
  • Medicine(all)

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Incidental findings in imaging research : Evaluating incidence, benefit, and burden. / Orme, Nicholas M.; Fletcher, Joel Garland; Siddiki, Hassan A.; Harmsen, W. Scott; O'Byrne, Megan M.; Port, John D; Tremaine, William J.; Pitot, Henry Clement; McFarland, Elizabeth G.; Robinson, Marguerite E.; Koenig, Barbara A.; King, Bernard Francis; Wolf, Susan M.

In: Archives of Internal Medicine, Vol. 170, No. 17, 27.09.2010, p. 1525-1532.

Research output: Contribution to journalArticle

Orme, NM, Fletcher, JG, Siddiki, HA, Harmsen, WS, O'Byrne, MM, Port, JD, Tremaine, WJ, Pitot, HC, McFarland, EG, Robinson, ME, Koenig, BA, King, BF & Wolf, SM 2010, 'Incidental findings in imaging research: Evaluating incidence, benefit, and burden', Archives of Internal Medicine, vol. 170, no. 17, pp. 1525-1532. https://doi.org/10.1001/archinternmed.2010.317
Orme, Nicholas M. ; Fletcher, Joel Garland ; Siddiki, Hassan A. ; Harmsen, W. Scott ; O'Byrne, Megan M. ; Port, John D ; Tremaine, William J. ; Pitot, Henry Clement ; McFarland, Elizabeth G. ; Robinson, Marguerite E. ; Koenig, Barbara A. ; King, Bernard Francis ; Wolf, Susan M. / Incidental findings in imaging research : Evaluating incidence, benefit, and burden. In: Archives of Internal Medicine. 2010 ; Vol. 170, No. 17. pp. 1525-1532.
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abstract = "Background: Little information exists concerning the frequency and medical significance of incidental findings (IFs) in imaging research. Methods: Medical records of research participants undergoing a research imaging examination interpreted by a radiologist during January through March 2004 were reviewed, with 3-year clinical follow-up. An expert panel reviewed all IFs generating clinical action to determine medical benefit/burden on the basis of predefined criteria. The frequency of IFs that generated further clinical action was estimated by modality, body part, age, and sex, along with net medical benefit or burden. Results: Of 1426 research imaging examinations, 567 (39.8{\%}) had at least 1 IF (1055 total). Risk of an IF increased significantly by age (odds ratio [OR], 1.5; 95{\%} confidence interval, 1.4-1.7 per decade increase). Abdominopelvic computed tomography generated more IFs than other examinations (OR, 18.9 vs ultrasonography; 9.2{\%} with subsequent clinical action), with computed tomography of the thorax and magnetic resonance imaging of the head next (OR, 11.9 and 5.9; 2.8{\%} and 2.2{\%} with action, respectively). Of the 567 examinations with an IF, 35 (6.2{\%}) generated clinical action, resulting in clear medical benefit in 1.1{\%} (6 of 567) and clear medical burden in 0.5{\%} (3 of 567). Medical benefit/burden was usually unclear (26 of 567 [4.6{\%}]). Conclusions: Frequency of IFs in imaging research examinations varies significantly by imaging modality, body region, and age. Research imaging studies at high risk for generating IFs can be identified. Routine evaluation of research images by radiologists may result in identification of IFs in a high number of cases and subsequent clinical action to address them in a small but significant minority. Such clinical action can result in medical benefit to a small number of patients.",
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AU - Fletcher, Joel Garland

AU - Siddiki, Hassan A.

AU - Harmsen, W. Scott

AU - O'Byrne, Megan M.

AU - Port, John D

AU - Tremaine, William J.

AU - Pitot, Henry Clement

AU - McFarland, Elizabeth G.

AU - Robinson, Marguerite E.

AU - Koenig, Barbara A.

AU - King, Bernard Francis

AU - Wolf, Susan M.

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N2 - Background: Little information exists concerning the frequency and medical significance of incidental findings (IFs) in imaging research. Methods: Medical records of research participants undergoing a research imaging examination interpreted by a radiologist during January through March 2004 were reviewed, with 3-year clinical follow-up. An expert panel reviewed all IFs generating clinical action to determine medical benefit/burden on the basis of predefined criteria. The frequency of IFs that generated further clinical action was estimated by modality, body part, age, and sex, along with net medical benefit or burden. Results: Of 1426 research imaging examinations, 567 (39.8%) had at least 1 IF (1055 total). Risk of an IF increased significantly by age (odds ratio [OR], 1.5; 95% confidence interval, 1.4-1.7 per decade increase). Abdominopelvic computed tomography generated more IFs than other examinations (OR, 18.9 vs ultrasonography; 9.2% with subsequent clinical action), with computed tomography of the thorax and magnetic resonance imaging of the head next (OR, 11.9 and 5.9; 2.8% and 2.2% with action, respectively). Of the 567 examinations with an IF, 35 (6.2%) generated clinical action, resulting in clear medical benefit in 1.1% (6 of 567) and clear medical burden in 0.5% (3 of 567). Medical benefit/burden was usually unclear (26 of 567 [4.6%]). Conclusions: Frequency of IFs in imaging research examinations varies significantly by imaging modality, body region, and age. Research imaging studies at high risk for generating IFs can be identified. Routine evaluation of research images by radiologists may result in identification of IFs in a high number of cases and subsequent clinical action to address them in a small but significant minority. Such clinical action can result in medical benefit to a small number of patients.

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