An incidental finding reported without a next step generates a phone call, a repeat scan or nothing at all, and which of the three happens depends on who reads the report rather than on what it says. The finding is the radiologist's; the decision about it is being left to someone with less imaging information than the person who wrote the report.
Close every report that contains an unexpected finding with an explicit recommendation, using a form that can be acted on: the modality, the interval, and the condition under which it can stop. 'Six-millimetre solid pulmonary nodule; in a low-risk patient, CT at 12 months, and no further follow-up if unchanged' is actionable. 'Small pulmonary nodule noted; clinical correlation is advised' is not, and it moves the risk from the report to the clinic without moving any of the information.
Where a published framework applies — Lung-RADS, the Fleischner criteria, an appropriateness document — name it in the report. It makes the recommendation auditable, defensible and consistent between colleagues, which the phrase 'clinical correlation' never is.
- End every incidental finding with a modality, an interval and a stopping condition.
- Name the framework you applied rather than implying one.
- Avoid 'clinical correlation is advised' as a substitute for a recommendation.
- State the patient's risk category if the recommendation depends on it.
- Where the finding needs same-day action, telephone it and record that you did, in the report.
Why it matters
The decision about an incidental finding is currently made by whoever opens the report, using less information than the person who wrote it.
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