Incidental findings discovered during imaging: implications for general practice

Abstract

Whether they are called incidentalomas, unexpected findings, or VOMIT (‘victims of modern imaging technology’),1 the issue surrounding incidental findings (IFs) discovered during radiological imaging will affect the future of medical practice and needs to be addressed. IFs are those findings that are discovered by chance in the context of radiological diagnostics which can potentially affect the health of an individual (if not already a patient, they may now have become one). IFs can of course be life-saving but they can also be harmful to the ‘patient.’ It is not uncommon for a minor developmental anomaly, normal variant, or physiological feature to be identified as pathology on imaging.2 A seemingly harmful lesion can lead to lifelong follow-up, further imaging and appointments, unwarranted treatment, and even radical surgery, only for the pathology to turn out to be benign. Furthermore, IFs can incur unnecessary financial costs, waste time, provoke anxiety (for patients and clinicians), and can have serious implications for the ‘patient’ regarding future medical and life insurance.3 While it can be argued that the harmful discovery of an IF is unintentional, the prevalence of IFs and their potential for harm is known a priori. If we are to first do no harm, should we change our mindset and start thinking of IFs as possible side effects of a medical procedure? Indeed, some even propose that consent should be obtained from ‘patients’ prior to imaging.4 From 1980 to 2010 the numbers of CT scans performed increased from 80 million per year in the …