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Incidental Imaging Findings

“We believe we may have found something. But it’s nothing to worry about.”

The very words that no patient wants to hear. With the increase of incidental findings after medical imaging, more and more doctors and patients have to find the balance between precautionary prevention and unnecessary alarmism.

Can this balance exist? How do we weigh the increasing costs of healthcare against the costs of lives?

Health screenings are an integral part of our medical system, and have helped to save hundreds if not thousands of lives. Many of these screenings are planned, routine tests to help detect diseases such as cancer and brain tumors in their earliest stages. Incidental findings are generally those that arise out of unplanned detections, usually with individuals participating in clinical trials and research studies. A small and almost irrelevant matter that could possibly be a concern or it could be nothing to worry about at all.

It would be similar to a building inspector searching for a structural problem and while doing so finds a small and seemingly insignificant loose nail in a non-load bearing wood post; something that may pose a problem in the future but it is still highly unlikely. Should the loose nail be addressed, or even acknowledged, as part of the bigger picture? Does the building owner take action or hope that the issue just goes away on its own? Does the inspector even bother to disclose this matter to the owner or just shrug the nail off as unimportant?

Do we treat every medical problem as a nail and attack it with a hammer?
Increasing numbers of doctors and radiologists must face these dilemmas as the number of incidental findings escalates. More screenings means more findings. Between 1995 and 2005, Medicare reports two times the use of computed tomography. While this means better and earlier detection for some, for others it causes more confusion and anxiety.

Is there such a thing as over-diagnosis after years of under-diagnosis?
The next step then is to request even more testing to verify or disprove the findings of the first screening. Doctors refer their patients to radiologists who will perform the advanced imaging screenings. Are the direct and indirect costs doing more harm than good for patients?

(CT) scans and three times the use of magnetic resonance imaging (MRI) scans. A quick scan of CT and MRI prices range from $300 to upwards of $3000 depending on where you live. One way of putting this into perspective is even after all costs across the board are averaged out to approximately $74 per patient undergoing an abdominal CT scan, Medicare will spend some $226 million in radiology costs in just one year.

In the second part of this series, we look will look at the issues facing doctors and patients when dealing with incidental findings and deciding whether that loose nail is worth a second or even third look.

This piece draws on the information presented in ‘Incidental Imaging Findings: Strategies to Minimize Their Impact’ Alec J. Megibow, MD, MPH, FACH, New York University – Langone Medical Center, New York, NY as part of the Presidential Symposium “Incidental Findings on Imaging: Friend or Foe?” NAMS 22nd Annual Meeting Washington D.C. 2011.

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