Radiology department adopts new incidental findings approach that’s closing cases at a 99% clip
A radiology department has adopted a new approach to addressing incidental imaging findings, which is closing nearly 100% of all cases.
Researchers with Northwestern University in Chicago detailed their novel system in an analysis published Wednesday in the Journal of the American College of Radiology. The protocol has radiologists submit findings via an electronic health record button, triggering a nurse-led follow-up that varies based on care setting (emergency, inpatient or outpatient) and finding (i.e., lung or kidney).
Medical student Rohan M. Shah and co-authors analyzed outcomes from the program dating to its initial implementation in 2015 through 2023. Across over 25,000 incidental findings reported, Northwestern consistently achieved resolution rates greater than 99%, with only two months falling below this threshold.
“We observed substantial utilization of the reporting system, with a rapid increase in cases over the initial years of the study period,” Shah and colleagues wrote Sept. 3. “Case resolution rates were consistently high, demonstrating the effectiveness of the program in increasing patient follow-up rates and awareness of their radiologic findings.”
Incidental findings are defined as unexpected imaging results unrelated to a patient’s chief concern for the exam. Such results are common, the authors noted, occurring in an estimated 15% to 30% of all diagnostic imaging, previous studies have found. Sometimes, these discoveries can slip through the cracks, potentially leading to worse patient outcomes and potential malpractice cases.
Northwestern’s intervention tasks the reading radiologist with clicking an electronic button, developed in-house, in the EHR after identifying a concerning incidental finding. The rad then writes the report as they would otherwise, dictating findings to the ordering provider. A nursing team is tasked with ensuring either the patient’s ordering physician, primary care doc or long-term specialist is made aware of the incidental finding. They also ensure the impacted physician communicates this concern to the patient. Next steps in the process vary based on setting, with ED visitors unaware of their incidentaloma, for instance, receiving a phone call, EHR message, and written letter if the first two attempts fail.
On average, the health system saw nearly 2,800 incidental findings reported per year and about 230 per month. This included an overall compounded annual growth rate of 21.44% as providers became more familiar with using the system. Across over 17,000 cases logged between 2019–2023, lung incidental findings were most common (19.3%), followed by brain (7.3%) and kidney (7.2%) concerns. Meanwhile, CT imaging was the most frequently involved modality at nearly 54%, followed by MRI (20.3%), X-ray (18.2%) and ultrasound (7.5%).
Shah and co-authors noted that the protocol achieved its success with minimal added staffing, “lending credence to the idea that provider-led systems that prioritize communication can be widely implemented.” They urged others to try similar interventions, ideally through electronic health records integration.
“At a minimum, this would require access to structured radiology reports, a systematic mechanism for identifying incidental findings (such as our in-house button built into the EHR), and a way to track resolution,” the authors concluded. “Our system was only successful due to the support of…everyone from the radiologists to the providers to the nursing staff. It is almost a given that other institutions would require some level of buy-in from institutional staff across the board. Ultimately, our study demonstrates that a well-designed, low-friction, and voluntary reporting system can achieve high case resolution and strong provider engagement—complementing the existing literature while offering a viable alternative to more resource-intensive models.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.