Managing Incidental Findings

Valeria Makeeva, MD; Kirsten Schofield, MS; Melissa Davis, MBA, MD; Nadja Kadom, MD


Appl Radiol. 2021;50(6):22-26. 

In This Article

Effectiveness of Follow-up Recommendations

The wording and placement of follow-up recommendations in the radiology report can affect how likely they are to be completed and to engage patients in the process.

Follow-up recommendation language should be clear and concise. Statements like, "If clinically indicated, follow-up CT could be performed in 4–6 weeks to document resolution," limit clinicians' ability to judge the necessity of follow-up and lead to low follow-up rates.[12,13] On the other hand, recommendations that precisely identify the lesion in question, the recommended modality, and time interval can result in higher completion rates.[12,13] Detailed recommendations should be placed in the Impression section of the radiology report, where they can be easily seen and noted by clinicians. [14,15] For example, a section in the radiology report reading, "Recommendation: Right upper lobe pulmonary nodule follow-up with a CT in 3–6 months to assess stability," is more useful than "follow-up to assess stability."[13,15]

Patient engagement plays an important role in ensuring that follow-up is completed. With passage of the 21st Century Cures Act, patient access to test results and clinical notes no longer poses a barrier, but their highly technical language is inaccessible to most patients.[16] In the emergency room and some radiology settings, results may be discussed directly with patients.[14,17] This helps ensure that patients fully understand the findings and their next steps.[14] Similarly, placing Info-RADS messages in radiology reports is an effective way to convey the nature of imaging results and whether any further steps are necessary.[18] These messages indicate to patients either that the results are normal and no additional steps need to be taken, or that there was a non-emergent finding for which the patient should contact their provider to discuss next steps.[18] Sending radiology results to patients, as is mandated in states such as Pennsylvania for AIFs, without providing an opportunity to ask for clarification, can risk increased patient distress that could in turn decrease patient willingness to pursue follow-up.[18,19]