The Reading Room

How incidental findings management may have saved Justice Ginsburg's life—and what that means for your imaging department

by Matt Morrill and Emily Snow

Back in November, 85-year-old U.S. Supreme Court Justice Ruth Bader Ginsburg was hospitalized with three fractured ribs due to a fall. While a concerning injury, it may have actually been a blessing in disguise.

A CT performed by George Washington University Hospital revealed a potentially life-threatening incidental finding—two early-stage cancerous nodules in her left lung. In an article published by NBC, John Heymach, chair of thoracic, head, and neck Medical Oncology at the MD Anderson Cancer Center, explained that while lung cancer, in many cases, is detected at an advanced stage—and therefore with poor prognosis—Justice Ginsburg's early diagnosis through proper incidental findings management gave her much better odds of beating the disease. Justice Ginsburg, already a two-time cancer survivor, did have to miss her first oral argument since her appointment to the court, but she is otherwise expected to make a full recovery.

Incidental findings similar to that of Justice Ginsburg's are a common occurrence—31% of CT examinations have an incidental finding[1]. Appropriate management of incidental findings by imaging departments not only improves patient outcomes but can also generate additional revenue.

How to streamline and leverage incidental findings management

Incidental finding management can be difficult to regulate and track given that reporting is not always standardized and no one department owns follow-up. However, there are strategies that can improve the process. To better manage incidental findings:

  1. Standardize incidental findings documentation;
  2. Develop clear follow-up guidelines; and
  3. Assign ownership of follow-up responsibilities.

The University of Rochester found success using both manual and automated processes to achieve the management strategies for incidental finding follow-up listed above.

Learn more: Access the toolkit to support incidental findings management

In 2015, the University invested in a manual process, hiring a clinical navigator whose sole responsibility is to track patients due for a recommended exam as a result of an incidental finding. The clinical navigator enters patients for whom the radiologist recommends follow-up into a database before actively tracking their follow-up care for three months. This process, detailed in the graphic on the below, resulted in a final exam completion rate of 71% after 13 months, up from 46% previously. The 25% increase in final exam completion resulted in 107 new imaging studies, three-quarters of which were for CTs or MRIs. Overall, the newly realized exam revenue was greater than four times the cost of adding the additional staff member.[2]

The University also uses automated processes, two Natural Language Processing (NLP) products, to help their clinical navigators with follow-up. One of the NLPs gathers exam recommendations from patient reports, and a second uses the collected data to send follow-up reminders to the navigator. According to the GlobeNewswire, University of Rochester saw a 29% increase in exam-completion rate since implementing an automated process to support the navigator.

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[1] Adams SJ, et al., "Toward a Comprehensive Management Strategy for Incidental Findings in Imaging," Canadian Family Physician, 62 (2016): 541-543).

[2] Wandtke B, Gallagher S, "Reducing delay in diagnosis: multistage recommendation tracking," American Journal of Roentgenology, 209, no. 5 (2017), 970-975.