ARRS 2022 Abstracts


1448. Incidental Radiology Findings: A Retrospective Review of Resident Preliminary Reports and Patient Follow-up
Authors * Denotes Presenting Author
  1. Grace Wang *; The University of Texas Health Science Center at Houston
  2. Susan John; The University of Texas Health Science Center at Houston
  3. Eduardo Matta; The University of Texas Health Science Center at Houston
  4. Susanna Spence; The University of Texas Health Science Center at Houston
  5. Mindy Wang; The University of Texas Health Science Center at Houston
Communication and management of incidental findings in radiology studies is an essential component of high quality patient care. Although there are several studies exploring improved communication and management of incidental findings, there is no literature exploring specific findings missed or overcalled in resident preliminary reports. The purpose of this retrospective analysis is to report and categorize incidental findings found in preliminary radiology resident reports and to assess the follow-up rate at our institution in the emergency and inpatient setting.

Materials and Methods:
There were 41,289 preliminary resident reports generated in the 2019-2020 academic year (July 2019-June 2020) at our institution, one of the busiest Level 1 trauma centers in the United States. Attending radiologists provide feedback after overreading resident preliminary reports. Our discrepancy review committee, consisting of residents and attending radiologists continually monitors discrepancy data collected through our Picture Archiving and Communication System (PACS)-integrated feedback software. For this retrospective analysis, all discrepant preliminary reports with incidental findings overread by radiology attendings for the 2019-2020 academic year were evaluated. Exclusion criteria included studies without a recorded discrepant finding and duplicate reports. Assessment of patient follow-up was conducted through review of medical records.

There were 854 resident preliminary reports categorized as discrepant over the review period, and 69 reports (8%) were categorized with incidental findings. Individual discrepancy topics were evaluated from these studies, and 83 incidental finding topics were identified. The most common incidental finding discrepancies were pulmonary masses/nodules, bony findings, and thyroid nodules. Other discrepant topics included hepatic lesions, lymphadenopathy, soft tissue lesions, and other. Follow-up imaging was recommended for the majority of patients (n = 54), with 18 patients obtaining imaging follow-up. Other patients were successfully notified of the finding (n = 21) or unsuccessfully notified of the finding (n = 3). There were 19 patients for whom follow-up was not documented.

Identifying the most common types of incidental findings that residents misread is highly informative when working to improve resident report accuracy and follow-up patient management. The opportunity to inform patients of their incidental findings requiring follow-up may be lost if the findings are not included in the preliminary report. Therefore, educating residents on the most common types of missed incidental findings will allow more patients to be informed of both their findings and the need for follow-up.