Incidental findings on paediatric imaging harm patients and families when they are managed by rules written for adults. A pulmonary nodule, a small renal cyst, an adrenal lesion or a thyroid nodule carries a different prior probability of malignancy in a child, a different natural history, and a different cost to follow up — a decade of surveillance CT in a six-year-old is not the same proposition as three scans in a seventy-year-old. The literature specific to children is thin, and the adult guidelines fill the vacuum by default.
The ACR has set out how it plans to build paediatric-specific guidance, and — more useful in the meantime — a strategy for handling these findings while that guidance does not yet exist. The paper works through illustrated examples of how paediatric incidental findings differ from their adult equivalents, which is the part that transfers directly to a reporting session.
The change to make now is to stop citing adult follow-up intervals in paediatric reports without saying that is what you are doing. Where you recommend surveillance for an incidental finding in a child, name the source of the interval, state that it was derived in adults if it was, and weigh the cumulative radiation and the family's anxiety in the recommendation rather than leaving them out of it. Where a finding almost certainly needs nothing, say 'no follow-up imaging is required' in those words. An ambiguous recommendation in a child's report generates years of scans that no one ever decided to order.
- Do not quote adult follow-up intervals in a child's report without saying they were derived in adults.
- Write 'no follow-up imaging is required' explicitly when that is the answer.
- Weigh cumulative dose and family anxiety in the recommendation, not just the lesion.
- Agree a local approach for the common findings before the next one appears on a list.
- Expect ACR paediatric-specific guidance and check reporting templates against it when it lands.
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