Monday, 11 June 2018

Radiologists and incidental imaging findings

A group of radiologists from several American university hospitals (Massachusetts General, Cleveland, Brigham and Women's, etc.) started a debate in the Journal of the American College of Radiology about the eventuality that radiologists would stop reporting the incidental imaging findings lacking clinical significance. "The traditional role of the radiologist," they say, "is to warn of everything they see, leaving the interpretation of the findings’ relevance to the referring physician”. However, we now open the opportunity to go further, and not just intervene by saying, for example, that an observed abnormality is benign, but also taking the decision not to report the milder ones, given the possibility that our opinion generates confusion and ends up causing excessive medical actions".

Regarding level I renal cysts of the Bosnian classification

The radiologists who authored the article used the findings of renal cysts, which are very frequent with a prevalence of 36% in patients over 80 years of age, in order not to inform of renal cysts of level I of the Bosnian classification in their reports, in accordance with the following criteria: a) the cyst is not the reason for the examination, b) doesn’t generate local problems, c) has no malignant potential, and d) is not likely to generate a polycystic kidney disease.

Legal precautions

The authors acknowledge that the proposal not to inform opens up new legal risks for radiologists, and for this reason they believe that the professional debate should be reinforced with the deployment of analysis that contrast the benefits and risks of both reporting and not reporting. We must create – they say - a doctrinal body regarding this as today’s scanners, with improved functional and perfusion techniques, have an impressive ability to visualize all kinds of findings that were unthinkable until recently and as an example, they recall that the American College of Medical Genetics and Genomics has developed a consensus that geneticists should only report genetic variants that have been shown to be related to pathologies, therefore advising against diagnosing genetic abnormalities that are not known to have pathogenic associations.

The emergence of diagnostic imaging techniques and the awe that these arouse in doctors and patients, is opening a debate on the role that radiologists must play within this new medicine with its strong tendency to exacerbate. The authors of this article, under the aegis of the American College of Radiology, believe that radiologists should abandon their role of registrars and become more involved in the value of clinical practice. Welcome to the club.

Jordi Varela

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