Incidental findings on imaging

As O’Sullivan and colleagues show in a linked article (doi:10.1136/bmj.k2387),1 unexpected anomalies discovered during imaging are common. However, they are also problematic.234 Even though most unexpected anomalies are unlikely to be clinically relevant, often the clinician and patient want to evaluate them further as both are unwilling to accept the uncertainty that often surrounds the diagnosis and subsequent clinical course of the anomaly.5

Occasionally such a discovery can be beneficial and even life saving,6 but it can also be harmful. A suspicious lesion can lead to lifelong follow-up, further imaging and appointments, unwarranted treatment, and even radical surgery, only for the finding to be ultimately innocuous.7 Furthermore, unexpected anomalies can cause anxiety (for patients and clinicians) and incur financial penalties, including implications about future medical and life insurance.4 Such costs to individuals led …