Incidental Findings at Chest CT

Rationale and Objectives

To assess practice patterns in evaluating incidental findings at chest computed tomography (CT) to determine the need for further education.

Materials and Methods

A survey was given to 1600 radiologists, presenting four clinical case questions regarding the evaluation/significance of the following incidental findings at chest CT: thyroid lesion; enlarged mediastinal lymph nodes; asymptomatic, small pulmonary embolus; and small lung nodule. The respondents’ answers were compared with “truth,” as defined by the best evidence available in the medical literature. Additional questions elicited the respondents’ demographics and comfort levels in addressing the findings. Analysis of variance models with a Tukey correction for post hoc comparisons and chi-square tests were used to determine if any demographic factors or comfort levels were predictive of higher correct response rates.

Results

The overall survey response rate was 28% (445/1600). Correct case response rates ranged from 26% (115/442) to 79% (343/445). Only 6% (28/438) of respondents chose the correct answers for all cases. Up to 80% (353/440) of respondents felt comfortable in addressing findings, and only 57% (252/443) of respondents felt that they needed more training in this area. Fellowship training in cardiothoracic radiology, working in a teaching practice, and subspecialization in abdominal or cardiothoracic radiology were predictive of higher correct response rates. Except for one case question, the comfort level was not predictive of correct response rate.

Conclusions

There was considerable variability among radiologists and substantial deviation from best medical practice with regard to the interpretation/evaluation of incidental findings at chest CT, signifying a significant need for further education.

Chest computed tomography (CT) scans have been employed with increasing frequency over the past two decades, both in patients with known diseases as well as in screening situations (eg, for lung cancer and coronary artery disease), leading to an explosion in the use of the modality. Approximately 3%–24% of chest CT exams show potentially significant incidental findings that require further evaluation or follow-up . The evaluation of such a large number of findings presents a huge potential burden on the health care system. The purpose of this survey-style study was to gain information about current practice patterns in the interpretation and evaluation of incidental chest CT findings, and to compare these patterns with the best available medical evidence, to assess the need for in-training and continuing medical education in this area.

Methods

An electronic survey was given to three groups of radiologists, as follows:

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Statistical Analysis

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Results

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Table 1

Demographic Data for 445 Survey Respondents

Variable Number of Responses (%) Job description ∗ Trainee (resident or fellow) 46 (10.4) General practice radiologist 227 (51.4) Abdominal radiology specialist 96 (21.7) Cardiothoracic radiology specialist 39 (8.8) Other 34 (7.7) Number of years in practice ∗ <1 51 (11.5) 1–5 69 (15.6) 6–10 65 (14.7) 11–15 58 (13.1) 16–20 62 (14.0) >20 137 (31.0) Type of practice † In training 46 (10.4) University/teaching 133 (30.2) Nonteaching 262 (59.4) Fellowship training in cardiothoracic radiology (nontrainees only) Yes (personal) ‡ 38 (9.6) Yes (member of group) § 161 (40.6)

Note: some respondents omitted certain responses regarding demographics, as follows:

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Discussion

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Conclusions

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Appendix

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Very Uncomfortable Uncomfortable Neutral Comfortable Very Comfortable Thyroid lesion ○ ○ ○ ○ ○ Enlarged lymph Nodes ○ ○ ○ ○ ○ Pulmonary embolus ○ ○ ○ ○ ○ Lung nodule ○ ○ ○ ○ ○

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References

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15. Gould M.K., Fletcher J., Iannettoni M.D., et. al.: Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132: pp. 108S-130S.
16. Casarella W.J.: A Patient’s Viewpoint on a Current Controversy. Radiology 2002; 224: pp. 927.
17. Berland L.L., Silverman S.G., Gore R.M., et. al.: Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol JACR 2010; 7: pp. 754-773.
18. Eisenberg R.L., Bankier A.A., Boiselle P.M.: Compliance with Fleischner Society guidelines for management of small lung nodules: a survey of 834 radiologists. Radiology 2010; 255: pp. 218-224.
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Incidental Findings at Chest CT

Rationale and Objectives

Materials and Methods

Results

Conclusions

Methods

Statistical Analysis

Results

Discussion

Conclusions

Appendix

References

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