ACR white paper encouraging appropriate imaging of incidental findings

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A large number of radiologists who read the American College of Radiology (ACR) Incidental Findings Committee white paper utilize it in clinical practice, apply its recommendations, and advise imaging for incidental findings (IFs) less often than those who did not read it, according to a study published online Oct. 16 in the Journal of the American College of Radiology.

In October 2010, a white paper was published encapsulating the consensus of the ACR Incidental Findings Committee. This white paper provides radiologists with guidance for characterizing, reporting, and managing IFs in the liver, kidneys, adrenal glands, and pancreas. To determine how widely the paper has been read, how its information is being used, and how management of its findings can be improved, Lincoln Berland, MD, of the University of Alabama at Birmingham, and colleagues created a survey for ACR physician members.

Comprised of 14 multiple-choice questions and five free-text responses, the SurveyMonkey survey was sent out by email to 14,336 ACR members from June to July 2012. Twenty percent, or 2,892 of the members completed the survey, with 38 percent indicating that they read the white paper. Fifty-seven percent said they always or usually use the white paper’s recommendations and 51 percent recommended additional imaging less often. Tort reform was cited by 76 percent of the radiologists as a means to decrease the likelihood of their recommendations for additional imaging.

Free-text responses were reviewed by the study’s authors and illustrated a need for simplification of the white paper’s content, enhanced clarity, and easier access.

“The 2010 JACR white paper on incidental abdominal CT findings has been read by a substantial number of radiologists, and among those who read it, the recommendations are being largely followed and are leading to a reduction in imaging recommendations,” wrote Berland and colleagues. “Future similar consensus-based white papers could lead to more consistent and effective management of incidental imaging findings and likely reduce the overall number of patients for whom additional imaging is recommended.”