Incidental findings in emergency imaging: frequency, recommendations, and compliance with consensus guidelines

The effectiveness of emergency medicine follow-up in attaining closed loop communication and downstream follow-up

BACKGROUND

Utilization of different Electronic Health Records (EHR) impedes communication between Emergency Medicine (EM) and Primary Care Provider (PCP) necessitating study on EM's effectiveness in enabling continuity of care following patient discharge. This study's objective was to evaluate the effectiveness of an EM-based follow-up program using secure email for closed-loop communication and follow-up of incidental findings (IF) after EM discharge.

METHODS

Retrospective study of IFs from two Emergency Departments (ED) and one urgent care between 9/1/20-8/30/21. Preceding day IFs were identified by an EM Quality Assurance (QA) team who then notified the patient's PCP via email. Automated rules-based natural language processing (NLP) of emails linking data to EHRs. Chart reviewing of outcomes included whether closed loop communication was established (via a PCP reply acknowledging IF receipt) and whether follow-up care occurred within 12 months. Multivariate logistic regression models examined factors associated with each outcome.

RESULTS

Of 1781 IF notifications, 62 % were female, 77 % white, and 91 % English speaking. PCP replied to 39.1 %; 64.9 % were ultimately followed-up. Patient and IF characteristics were not associated with PCP reply. PCP tenure and EM/PCP EHR system concordance were associated with higher adjusted Odds Ratio (aOR) of PCP reply (aOR 1.05 [1.04-1.07] vs 2.6 [2.0-3.3]). Laboratory IFs were followed-up more than imaging IFs (aOR 1.94 [1.46-2.6]). EM/PCP Use of same EHR was associated with higher odds of some form of follow-up (aOR: 2.1 [1.7-2.7]).

CONCLUSIONS

While email notifications and using the same EHR improve continuity of care, they are insufficient on their own. More comprehensive solutions are needed to enable EM-PCP communication and patient follow-up.

Automated Incidental Findings Notification Through the Electronic Health Record Utilizing Dictation Macros

The objective of this study is to implement an actionable incidental findings (AIFs) communication workflow integrated into the electronic health record (EHR) using dictation macros to improve the quality of radiology reports and facilitate delivery of findings to clinicians. The workflow was implemented across an academic multi-hospital health system and used by over 100 radiologists from 12 divisions. Standardized macros were created for different organ systems including the thyroid, lungs, liver, pancreas, spleen, kidney, female reproductive, and others, designed based on the ACR Novel Quality Measure Set. All macros contained special codes enabling automated notification of clinicians in Epic EHR and unique codes to allow for tracking. When notified, clinicians can fast track ordering of follow-up imaging exams. All alerts were monitored by radiology operations who ensured messages were acknowledged within 73 h. From September 2023 to March 2024, 12,919 AIFs alerts were filed for 10,766 patients. Median age was 65 years, and 63.6% were female and 36.4% were male. Most alerts were submitted for outpatients (73.5%), and a majority originated from CT exams (57.3%) followed by radiographs (12.2%) and ultrasound (11.5%). Number of submissions per radiologist ranged from 0 to 930 with a median of 62. Median time to alert acknowledgment was 8.1 h, and 93.9% were acknowledged within 73 h. Follow-up orders were placed for 62.3% of patients. A standardized AIFs communication workflow utilizing dictation macros can help facilitate delivery of findings and follow-up recommendations to clinicians.

Trauma and 'Whole' Body Computed Tomography: Role, Protocols, Appropriateness, and Evidence to Support its Use and When

Imaging plays a crucial role in the immediate evaluation of the trauma patient, particularly using multi-detector computed tomography (CT), and especially in moderately to severely injured trauma patients. There are specific areas of relative consensus, while other aspects of whole-body computed tomography (WB-CT) use remain controversial and are subject to opinion/debate based on the current literature. Even a few hours of a delayed diagnosis may result in a detrimental outcome for the patient. One must utilize all the tools available to enhance the interpretation of images. It is also important to recognize imaging pitfalls and artifacts to avoid unnecessary intervention.

Types of Evidence Needed to Assess the Clinical Value of Diagnostic Imaging

AbstractThe evidence underlying the use of advanced diagnostic imaging is based mainly on diagnostic accuracy studies and not on well-designed trials demonstrating improved patient outcomes. This has led to an expansion of low-value and potentially harmful patient care and raises ethical issues around the widespread implementation of tests with incompletely known benefits and harms. Randomized clinical trials are needed to support the safety and effectiveness of imaging tests and should be required for clearance of most new technologies. Large, diverse cohort studies are needed to quantify disease risk associated with many imaging findings, especially incidental findings, to enable evidence-based management. The responsibility to minimize the use of tests with unknown or low value requires engagement of clinicians, medical societies, and the public.

Mass Effect of Large Pelvic Lipoma Resulting in Femoral Hernia

A 73-year-old lady presented with a three-day history of constipation, vomiting, and abdominal pain. On examination, a right femoral hernia was identified, and this was confirmed on computed tomography imaging with evidence of mechanical small bowel obstruction. There was an incidental finding of a large pelvic lipoma causing a mass effect. This lady underwent open repair of the femoral hernia. Intra-abdominal lipomatosis is a rare finding and can present itself in a variety of manifestations, or it can be identified as an incidental finding on cross-sectional imaging. Bowel obstructions, abdominal pain, lipoma, and abdominopelvic hernias are some examples of symptomatic presentations of intra-abdominal lipomas.

Incidental Computed Tomography Findings Among Traumatized Adults: A One-Year Analysis at a Trauma Center

Background Computed tomography (CT) for patients with trauma represents a widely accepted diagnostic method. Non-trauma-related incidentalomas or incidental findings are commonly depicted based on CT examination. Our study aimed to assess the frequency of incidental findings on CT scans among traumatized adult patients during one year at a trauma center. Methods We performed a retrospective case review of all adult patients triaged at the King Abdullah Medical Complex trauma service in Jeddah, Saudi Arabia, between 31 May 2022 and 30 May 2023. Patients under the age of 18 were excluded from the study. Patients who could not complete radiographic studies due to deterioration in condition, patients with missing CT scan reports, and transfer patients who had CT scans done at outside facilities were excluded. Demographic data, including age, sex, type of trauma, and type of CT, were recorded. All CT studies were reviewed for incidental findings. Results A total of 106 incidental findings were discovered in 99 patients. The rate of incidental findings for one year was 1.87%. The average age was 41.19 ± 17.90 years, with 73 (73.7%) male and 26 (26.3%) female patients. In trauma classifications, road traffic accidents were the most common (59.60%), followed by falls (33.33%), penetrating trauma (3.03%), and others. A high number of scans for the whole body (56.57%); face, brain, and cervix (13.13%); chest and abdomen/pelvis (11%); and spine (5.05%) had incidental findings. Genitourinary-related incidental findings were observed in 27.36% of patients, followed by craniospinal (16.98%), pulmonary (12.26%), hepatobiliary (9.43%), endocrine (9.43%), and musculoskeletal (5.66%). Conclusion In trauma centers, incidental findings are frequently discovered during CT imaging. In contrast, our center has a lower incidental finding rate. A whole-body CT scan yielded more incident findings than a selective one. The incidental findings are prevalent in the genitourinary system and higher in young male patients. It is important to properly document, communicate, and follow up on these incidental discoveries.

The Value of Using a Quality Assurance Follow-Up Team to Address Incidental Findings After Emergency Department or Urgent Care Discharge: A Cost Analysis

BACKGROUND

Incidental finding (IF) follow-up is of critical importance for patient safety and is a source of malpractice risk. Laboratory, imaging, or other types of IFs are often uncovered incidentally and are missed, not addressed, or only result after hospital discharge. Despite a growing IF notification literature, a need remains to study cost-effective non-electronic health record (EHR)-specific solutions that can be used across different types of IFs and EHRs.

OBJECTIVE

The objective of this study was to evaluate the utility and cost-effectiveness of an EHR-independent emergency medicine-based quality assurance (QA) follow-up program in which an experienced nurse reviewed laboratory and imaging studies and ensured appropriate follow-up of results.

METHODS

A QA nurse reviewed preceding-day abnormal studies from a tertiary care hospital, a community hospital, and an urgent care center. Laboratory values outside preset parameters or radiology over-reads resulting in clinically actionable changes triggered contact with an on-call emergency physician to determine an appropriate intervention and its implementation.

RESULTS

Of 104,125 visits with 1,351,212 laboratory studies and 95,000 imaging studies, 6530 visits had IFs, including 2659 laboratory and 4004 imaging results. The most common intervention was contacting a primary care physician (5783 cases [88.6%]). Twenty-one cases resulted in a patient returning to the ED, at an average cost of $28,000 per potential life-/limb-saving intervention.

CONCLUSIONS

Although abnormalities in laboratory results and imaging are often incidental to patient care, a dedicated emergency department QA follow-up program resulted in the identification and communication of numerous laboratory and imaging abnormalities and may result in changes to patients' subsequent clinical course, potentially increasing patient safety.

[Geriatric ultrasound : Prospective evaluation of ultrasound as extended screening in acute geriatric patients]

BACKGROUND

The aim of this study was to evaluate ultrasound as a routinely used procedure and extended physical examination in geriatric patients in acute care.

METHODS

Prospective study of 86 patients using ultrasound as a screening examination (abdomen, basal sections of the thorax, thyroid glands) under comparative use of a hand-held ultrasound device (HHUSD) and a high-end ultrasound (HEUS = gold standard).

RESULTS

In 20/86 (23.2%) clinically relevant findings with therapeutic consequences were found (pleural effusion, urinary retention, choledocholithiasis metatases, colon tumor). In 22/86 (25.6%) patients, additional questions existed besides the screening indication: tumor search (9.3%), anemia (5.8%), liver value elevation (5.8%), dyspnea (5.8%), splenic pathologies (2.3%), weight loss (1.2%), infectious focus (1.2%), diarrhea (1.2%), intra-abdominal hematoma (1.1%), abdominal aortic aneurysm (1.2%). The most common sonographic findings included: cholecystolithiasis (32.6%); right pleural effusion (31.4%), thyroid nodules (30.2%), renal cysts (27.9%), and fatty liver (26.7%). There were significant differences in sizing between HHUSD and HEUS (kidneys, pancreatic corpus and pancreatic caudal diameters, portal vein, left hepatic vein) without diagnostic relevance.

CONCLUSION

The extended screening by ultrasound provided important answers to classical questions in geriatrics (e.g. urinary retention, volume deficiency/pleural effusion) in many cases. The new findings had therapeutic consequences in one fifth of the patients. The HHUSD can be used in screening.

Standardized Follow-Up Recommendations Improve Reporting of Incidental Renal Lesions in a Community Setting

Introduction The objective of this quality improvement study was to assess radiology report follow-up recommendation trends upon detection of incidental renal lesions before and after instituting standardized follow-up macros.  Materials and methods A retrospective review was performed in 2019 of multiphase imaging workups on renal lesions (n = 396), including the following imaging modalities: ultrasound, CT with and without contrast, and spine MRI. Utilizing the same collection methods, a similar retrospective set of cases was collected in 2021, 12 months following the creation of the renal follow-up macros (n = 501). After exclusions, the second set was left with 98 cases of newly characterized incidental renal lesions. For both sets, we assessed the reports of the exams that initially detected the incidental renal lesion. We evaluated the incident reports for the presence of a follow-up recommendation, recommendation completeness, and alignment with the American College of Radiology (ACR) white paper suggestions for renal lesion follow-up. Results Before the implementation of the standardized renal follow-up macros, initial follow-up recommendations were in concordance with the ACR white paper recommendations in 33 of 98 cases (33.7%), incomplete or discordant in 49 of 98 (50.0%), and absent in 16 of 98 cases (16.3%). Following the institution of our macros, there was an improvement in concordant follow-up recommendations (51/98; 52.0%) (p = 0.009), a decrease in the number of incomplete or discordant recommendations (37/98; 37.8%), and a decrease in the number of reports lacking a follow-up recommendation (10/98; 10.2%).  Conclusion Utilization of standard language renal lesion follow-up macros improves the rate of appropriate follow-up recommendations in radiology reports when encountering a previously unknown incidental renal lesion.

Implementing a Streamlined Radiology Workflow to Close the Loop on Incidental Imaging Findings in the Emergency Department

Actionable incidental findings (AIFs) are common imaging findings unrelated to the clinical indication for the imaging test for which follow-up is recommended. Increasing utilization of imaging in the emergency department (ED) in recent years has resulted in more patients with AIFs. When these findings are not properly communicated and followed up upon, there is harm to the patient's health outcome as well as possible increased financial costs for the patient, the health system, and potential litigation. Tracking these findings can be difficult, especially so in a large health system. In this report, we detail our experience implementing a closed-loop AIF program within the ED of 11 satellite hospitals of a large academic health system. Our new workflow streamlined radiologist reporting of AIFs through system macros and by using a standardized form integrated into the dictation software. Upon completion of the form, an automatic email is sent to a dedicated nurse navigator who documented the findings and closed the loop by coordinating follow-up imaging or clinic visits with patients, primary care providers, and specialists. Through the new workflow, a total of 1207 incidental finding reports have been submitted from July 2021 to May 2022. The vast majority of AIFs were identified on CT, and the most common categories included lung nodules, pancreas lesions, liver lesions, and other potentially cancerous lesions. At least 10 new cancers have been detected. We hope this report can help guide other health systems in the design of a closed-loop incidental findings program.

Implementation of Incidental Liver Lesion Clinically Integrated Workflow Increases Compliance With ACR Follow-Up Guidelines, Closing Care Gaps

OBJECTIVE

Follow established management guidelines from the ACR and improve adherence to follow-up recommendations for incidental liver lesions (ILLs) for all patients undergoing CT abdomen and pelvis with contrast (CTAPw) examinations, with advocacy from a multidisciplinary care team.

METHODS

A mandatory structured radiology reporting module was developed for use in CTAPw reports for ILL recommendations. Data from the electronic medical record describing patients with radiology-reported ILLs and their clinical risk diagnosis categories were tabulated in a queryable electronic database. A nurse co-ordinator initiated workflow to communicate the need for ILL follow-up MRI to ordering physicians and primary care providers. MRIs were ordered by the ILL team. An interactive process was undertaken with continuous review to improve identification of eligible patients and adherence to recommendations.

RESULTS

During the initial launch phase from December 2020 to March 2021, 1,577 ILLs were detected on 20,667 CTAPw examinations, and for those with the characterize now recommendation, 36 of 114 (31.6%) received follow-up in 30 days. Between January 2021 and June 2022, 117,520 CTAPws were performed and 4,371 ILLs were detected. Using the ILL workflow, in the MRI now cohort, follow-up occurred within 30 days in 202 of 542 (36.2%) patients, and a total of 368 of 542 (67.9%) patients have completed their follow-up to date.

DISCUSSION

Using a focused effort to close a gap in ILL care, adherence to follow-up recommendations improved over the long term, although there remains a gap in adherence to short-term interventions. A multidisciplinary approach, radiology reporting, and software solutions were leveraged to improve a complex process.

System-driven longitudinal follow-up of incidental imaging findings

Increasing utilization of cross-sectional imaging has resulted in more clinically significant incidental findings being discovered. However, the current approach for handling these findings is commonly inconsistent and relies greatly on the efforts of individual clinicians. Making sure every actionable incidental finding is handled in a consistent and reliable manner can be difficult, especially for a large health system. We propose an approach to handling incidental findings aimed at improving patient follow-up rates, which involves implementing system-level processes that standardize the reporting of incidental findings, notification of clinicians and the patient, and centralized monitoring of longitudinal patient follow-up. We will lay out a general framework for standardized reporting of incidental findings by the radiologist using software integrated into the daily workflow. This should enable simultaneous notification of the ordering clinician, the patient's primary-care provider, and an incidental findings navigator. The navigator will "close the loop" by working with clinicians to notify the patient of the finding, coordinate patient follow-up, and document the finding and long-term follow-up. We hope this can serve as a basic framework to help large health systems design an incidental findings workflow to improve follow-up rates and reduce patient harm.

Catching Those Who Fall Through the Cracks: Integrating a Follow-Up Process for Emergency Department Patients with Incidental Radiologic Findings

STUDY OBJECTIVE

Abnormal findings unrelated to the indication for testing are identified on emergency department (ED) imaging studies. We report the design and implementation of an electronic health record-based interdisciplinary referral system and our experience from the first 13 months of ensuring that patients with incidental radiology findings were connected with the appropriate outpatient surveillance.

METHODS

Our informatics team standardized the contemporaneous reporting of critical radiology alerts using our ED trackboard and created a companion follow-up request form for the treating ED clinicians to complete. The forms were routed to nurse case managers, who arranged follow-ups based on the findings and clinical significance. The primary outcome was the proportion of ED patient visits with identified incidental findings that had documented communication of the incidental findings and surveillance plans.

RESULTS

Over the first 13 months after implementation, 932 ED patient visits had critical radiology alert referrals, for a total of 982 incidental findings. The primary outcome (confirmed post-ED communication and documented follow-up plan) was attained in 888 (95.3%, 95% confidence interval [CI] 93.9% to 96.6%) ED patient visits with confirmed post-ED communication and documented follow-up plans. The team was unable to contact or confirm follow-up with 44 (4.7%, 95% CI 3.4 to 6.1) patients by telephone or through the health care system's electronic communication tools.

CONCLUSION

We report the implementation of a standardized notification and referral system for ED patients with incidental radiology findings. The development of a reliable notification and follow-up system is an important patient safety intervention given the opportunity to potentially identify undiagnosed malignancies.

Incidental Radiology Findings on Computed Tomography Studies in Emergency Department Patients: A Systematic Review and Meta-Analysis

STUDY OBJECTIVE

An incidental finding is defined as a newly discovered mass or lesion detected on imaging performed for an unrelated reason. The identification of an incidental finding may be an opportunity for the early detection of a serious medical condition, including a malignancy. However, little is known about the prevalence of incidental findings in the emergency department (ED) setting and the strategies that can be used to mitigate the risk associated with them in the ED. This study aimed to estimate the overall prevalence of incidental findings and to summarize the currently described measures to mitigate the risks associated with incidental findings.

METHODS

On November 22, 2020, a systematic literature search of PubMed, EMBASE, and Scopus was performed for studies that were published in peer-reviewed journals and reported the prevalence of incidental findings in computed tomography (CT) scans in patients in the ED. Patients who received CT scans that included the head, neck, chest, or abdomen/pelvis were included. The study characteristics, overall prevalence of incidental findings, prevalence of incidental findings by body region, and prespecified subgroups were extracted. The criteria used for risk stratification within individual studies were also extracted. Pooled estimates were calculated using a random-effects meta-analysis.

RESULTS

A total of 1,385 studies were identified, and 69 studies met the inclusion criteria. The included studies represented 147,763 ED encounters or radiology reports across 16 countries, and 83% of studies were observational, cross-sectional studies. A total of 35 studies (50.7%) were in trauma patients. A large degree of heterogeneity was observed across the included studies. The overall pooled prevalence estimate for any incidental finding was 31.3% (95% confidence interval 24.4% to 39.1%). We found great variation in the methods described to mitigate the risk associated with incidental findings, including a lack of standardized risk stratification, inconsistent documentation practices, and only a small subset of studies describing prospective interventions aimed at improving the recognition and management of incidental findings from the ED.

CONCLUSION

In patients in the ED receiving CT scans, incidental findings are commonly encountered across a broad range of ED chief complaints. This review highlights the existence of great heterogeneity in the definitions used to classify incidental findings. Future studies are needed to determine a clinically feasible categorization standard or terminology for commonly encountered incidental findings in the ED setting to standardize classification and documentation.

Whole-body computed tomography: a new point of view in a hospital check-up unit? Our experience in 6516 patients

BACKGROUND

There is a growing awareness that prevention and early diagnosis may reduce the high mortality associated with cancer, cardiovascular and other diseases. The role of whole-body computed tomography (WB-CT) in self-referred and asymptomatic patients has been debated.

AIM

To determine frequency and spectrum of WB-CT findings in average-risk subjects derived from a Medical-Check-Up-Unit, to evaluate recommendations reported and distribution according to sex and age-groups.

MATERIALS AND METHODS

We retrospectively reviewed 6516 subjects who underwent WB-CT (June 2004/February 2015). All were > 40 years and referred by Medical-Check-Up-Unit of our hospital. The main findings were categorized and classified as normal or not. Its distribution according to sex and age-groups was evaluated using Chi-square test and linear-by-linear association test, respectively. Number of recommendations, type and interval of follow-up were recorded. Descriptive statistics were used.

RESULTS

WB-CT performed in 6516 patients (69% men, 31% women, mean age = 58.4 years) revealed chest (81.4%), abdominal (93.06%) and spine (65.39%) abnormalities. Only 1.60% had completely normal exploration. Abnormal WB-CT in men was significantly higher than women (98.64% vs. 97.87%; p = 0.021), with significant increase as age was higher (40-49 years: 95.65%; 50-59 years: 98.33%; 60-69 years: 99.47%; > 69 years: 99.89%) (p < 0.001). Although most findings were benign, we detected 1.47% primary tumors (96, mainly 35 kidneys and 15 lungs). 17.39% of patients received at least one recommendation predominantly in chest (78.19%) and follow-up imaging (69.89%).

CONCLUSION

The most common WB-CT findings in asymptomatic subjects are benign. However, this examination allows identifying an important number of relevant and precocious findings that significantly increase with age, involving changes in lifestyle and precocious treatment.

Incidental findings on whole-body computed tomography in trauma patients: the current state of incidental findings and the effect of implementation of a feedback system

Aim

Whole‐body computed tomography (CT) for trauma occasionally reveals significant incidental findings not related to trauma, which require an adequate response. In this study, we examined the current state of incidental findings in trauma patients on whole‐body CT and the effects of the feedback system.

Methods

The subject sample included trauma patients who underwent whole‐body CT while being examined for trauma during the 2‐year period, with the interpretation of the CT reported by a radiologist. The frequency and recognition of incidental findings and the involved body region were investigated. The state of incidental findings before and after implementation of a radiography report feedback system was also examined.

Results

During the study period, whole‐body CT revealed incidental findings in 79 of 199 trauma patients (40.1%). The mean age of the 79 patients with incidental findings was 62.8 ± 19.5 years, and the mean injury severity score was 16.6 ± 10.0. No difference was observed in the severity of trauma, age, or length of hospital stay. The incidental findings were related to the liver/gallbladder in 22 patients, kidneys in 17, lungs in 14, and the intracranial area in 13. The recognition rate of incidental findings after the implementation of the feedback system increased from 23.3% to 32.6%.

Conclusions

Considering that not all incidental findings are accurately recognized, a proper feedback system is required. A feedback system is beneficial and a need to ensure improvement in the recognition of incidental findings.

Detection of unexpected emergency diseases using FDG-PET/CT in oncology patients

PURPOSE

To evaluate the frequency of emergency diseases that were detected unexpectedly using FDG-PET/CT.

MATERIALS AND METHODS

Interpretation reports for 11,663 FDG-PET/CT studies in our hospital were retrospectively reviewed. Patients with major emergency diseases were extracted according to the following exclusion criteria: (1) relevant findings had been recognized prior to the PET/CT; (2) an intervention or operation that may have been relevant to the present findings was performed within 1 month prior to the PET/CT; and (3) the clinical course could not be investigated sufficiently (e.g., in cases where the patients were introduced from other hospitals).

RESULTS

Forty-one patients (0.35%) with unexpected emergency diseases were identified. The most frequent disease was pneumothorax (8 patients), followed by chronic subdural hematoma (CSH) (7 patients), ureteral stone (7 patients), and abdominal aortic aneurysm (AAA) with a dirty fat sign or a high-attenuation crescent sign visualized on CT (4 patients). Nine patients (2 pneumothorax, 3 CSH, 1 cerebral hemorrhage, 1 acute cholecystitis, 1 acute pancreatitis, and 1 acute appendicitis) were hospitalized and/or underwent therapeutic intervention within 1 week after the PET/CT.

CONCLUSION

Although rare, an unexpected emergency disease requiring urgent management can be detected using FDG-PET/CT in oncology patients.

"Incidentalomas" on abdominal and pelvic CT in emergency radiology: literature review and current management recommendations

The purpose of this article is to familiarize radiologists and clinicians with a subset of common and uncommon incidental findings on abdominal and pelvic computed tomography examinations, including hepatic, splenic, renal, adrenal, pancreatic, aortic/iliac arterial, gynecological, and a few other miscellaneous findings, with an emphasis on "incidentalomas" discovered in the emergency setting. In addition, we will review the complex problem of diagnosing such entities, and provide current management recommendations. Representative case examples, which we have encountered in our clinical practices, will be demonstrated.

Big Data and Machine Learning-Strategies for Driving This Bus: A Summary of the 2016 Intersociety Summer Conference

The 38th radiology Intersociety Committee reviewed the current state and future direction of clinical data science and its application to radiology practice. The assembled participants discussed the need to use current technology to better generate and demonstrate radiologists' value for our patients and referring providers. The attendants grappled with the potentially disruptive applications of machine learning to image analysis. Although the prospect of algorithms' interpreting images automatically initially shakes the core of the radiology profession, the group emerged with tremendous optimism about the future of radiology. Emerging technologies will provide enormous opportunities for radiologists to augment and improve the quality of care they provide to their patients. Radiologists must maintain an active role in guiding the development of these technologies. The conference ended with a call to action to develop educational strategies for future leaders, communicate optimism for our profession's future, and engage with industry to ensure the ethics and clinical relevance of developing technologies.

[Clinically relevant incidental cardiovascular findings in CT examinations]

BACKGROUND AND METHOD

Incidental cardiovascular findings are a frequent phenomenon in computed tomography (CT) examinations. As the result of a dedicated PubMed search this article gives a systemic overview of the current literature on the most important incidental cardiovascular findings, their prevalence and clinical relevance.

RESULTS

The majority of incidental cardiovascular findings are of only low clinical relevance; however, highly relevant incidental findings, such as aortic aneurysms, thromboses and thromboembolic events can also occasionally be found, especially in oncology patients.

CONCLUSION

The scans from every CT examination should also be investigated for incidental findings as they can be of decisive importance for the further clinical management of patients, depending on their clinical relevance.