This is a problem that has plagued medical providers over the years, with varying responses but no definitive solutions. Who is responsible for reporting incidental radiology findings?

An example is a case we handled: our client came to a hospital in the middle of the night with extreme abdominal pain. The “night” ER doctor appropriately ordered a CT scan, with the preliminary results reported by the “night” radiologist who was off-site. That report was received by the ER doctor who had ordered the imaging. 

The source of the pain was identified as an intestinal blockage that likely would require emergency surgery. So the ER doctor contacted the surgery service, with the surgeon on duty that night agreeing to accept the patient for admission. The transfer of the patient to the surgery service took place, and the night ER doctor went home in the morning.

The preliminary report, however, included an “incidental finding” of a kidney mass that could be a tumor. Although the night ER doctor was aware that this finding could be serious in terms of long-term risks for the patient, he did not inform the patient or the surgeon admitting the patient. His reason:  he was charged with dealing with the immediate emergency – the bowel obstruction – and he assumed the surgeon or other hospital personal would review the report and advise the patient that he needed to be referred to a urologist. 

That never happened. Four years later, the patient went to the hospital for another reason, and he was told about the kidney mass. By then, it had grown and the kidney now needed to be completely removed, and the patient needed long-term monitoring for possible recurrence of kidney cancer. Another wrinkle in the case: the original day radiologist reviewed the film and issued a “final” report which was sent to the ER and placed in the computer file. It also included the incidental finding of the kidney mass, and specifically stated it was suspicious for cancer.

So, who is responsible for reporting incidental radiology findings? Check in later this week to see how one state in particular has addressed this issue.