Background:
Patients who are admitted to the hospital often get various diagnostic radiological studies. These tests reveal incidental radiological findings unrelated to their current illness.
Purpose:
This study was to evaluate the prevalence of these incidental radiological findings among hospitalized general medicine patients that would require further imaging to rule out malignancy. We also assessed the cost associated with this process and evaluate its impact on the health care system.
Description:
Incidental findings were defined as those on CT imaging report that were not a part of the acute illness but were required to be follwed up as an outpatient. This retrospective study included 720 patients — 371 males, mean age 61 ± 19.8 years, and 349 females, mean age 63.0 ± 20.7 years. Of these 720 patients, 330 (45.8%) had CT scans. Among them, 116 (35.2%) had an incidental finding that required outpatient follow‐up imaging. Similar prevalence was noted among males 69 (18.6%) and females 64 (18.3%). Of the 116 patients, pulmonary nodules had the highest in incidence at 69 (50.4%). Thyroid and adrenal nodules came in second with a frequency of 14.0%, seen in 18 palients each. Patients with incidental findings on CT were older (69.6 ± 15.7 years) than patients without findings (61.4 ± 21.0 years), with a P value < 0.001. According to Fleischner recommendations, the patients with incidental pulmonary nodules were classified based on size as ≤ 4 mm (26.08%), > 4–6 mm (27.54%), > 6–8 mm (7.25%), and > 8 mm (39.13%). Each group was then further divided as high versus low risk based on their age and smoking history. Cost of a chest CT scan ranged between $260 and $1600, with a national average of $550. The follow‐up imaging for the 69 patients who were found to have incidental pulmonary nodules, would result in a cost of $60,500‐$83,600 over a 2‐year period. Patients with thyroid nodules would require FNAC for further evaluation in ruling out malignancy, which would cost about $1000 per patient. Total expense would be $18,000. For an incidental adrenal nodule, minimal workup would include checking blood hormone levels to determine if the nodule was functional, whose cost might range from $500 to $1000, averaging an estimated total of $20,000.
Conclusions:
Incidental radiological findings are commonly identified in a third of all CT scans in hospitalized general medicine patients. This correlates with increasing age and positive history of smoking. For our 105 patients with lung, adrenal, or thyroid nodules, near‐complete evaluation would cost an estimated $100,000. As such, these incidental radiological findings have a huge impact on health care costs.
Author Disclosure:
B. Prakash, none; S. Gavi, none; A. Kataya, none; V. Ranpura, none.