Homegrown tracking boosts follow-up imaging for incidental findings of uncertain gravity
A structured program to track incidental findings on body CT has significantly boosted rates of clinician follow-up as well as timely patient adherence to radiologist recommendations for next exams.
The designers and testers of the program’s concept and software suggest the results demonstrate their system’s usefulness for early detection of progressively harmful diseases.
The work was conducted by Kaitlin Zaki-Metias, MD, and colleagues at Wayne State University-affiliated Trinity Health Oakland Hospital in Pontiac, Mich., and published Feb. 9 in the Journal of Digital Imaging [1].
Calling the effort FIND for Radiology Finding Incidental Disease program, the authors trialed the method by reviewing cases of 1,000 patients who received cross-sectional CT before FIND inception and 1,000 who were scanned up to one year after.
The researchers concentrated on body imaging studies, which they designated as any CT of the chest, abdomen or pelvis, including CT angiography, coronary calcium score CT and low-dose chest CT for lung cancer screening.
Comparing key outcomes, the team found the post-intervention group had follow-up imaging at a 51% clip, breezing past the 31% rate recorded for the pre-program group.
Other key findings:
- Incidental findings noted on studies for emergency department patients more frequently recommended follow-up imaging in the post-intervention group (97.7%, 42 of 43) compared to 81.8% (27 of 33) of studies in the pre-intervention group.
- Emergency patients with incidental findings for which imaging follow-up was recommended had a higher rate of adherence to follow-up recommendations in the post-implementation group (22 of 40, 55.0%) compared to the pre-implementation group (5 of 26, 19.2%).
- There was no significant difference in the clinical outcomes of incidental findings follow-up between the pre-implementation and post-implementation groups: In the pre-implementation group, 7 of 21 incidental findings (33.3%) were determined to be malignant, concerning for malignancy, or otherwise clinically significant, compared to 35.3% (12 of 34) in the post-implementation group.
Commenting on the latter research finding, the authors note the FIND program brought “no direct translation to increased detection of malignant or potentially malignant incidental findings.”
However, given the study’s relatively small sample size, this doesn’t detract from FIND’s demonstrated success in helping improve follow-up rates for incidental imaging findings, they suggest.
At the very least, they point out, FIND and similar programs supply potentially consequential follow-up reminders to physicians and patients:
This can lead to earlier detection of disease and should be communicated to the patient clearly and with regard for how this may affect a patient’s overall well-being. … Determination of follow-up of incidental findings ultimately depends on the type and location of finding, the evidence-based guidelines regarding follow-up recommendations and individual patient preferences.”
The study includes a summary overview of Trinity Health’s FIND program, and the journal is offering the full study report as open-access content.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.