Closing the loop: nine-year outcomes of an electronic medical record-based protocol for reporting incidental imaging findings.

Introduction: Incidental findings in radiology are common, especially with rising imaging volumes. Early disease recognition can greatly improve clinical outcomes, but in low-risk cases, incidental findings often lead to overdiagnosis and overtreatment, causing harm. Robust systems are critical to promote early identification without overburdening patients or healthcare systems.

Methods: We conducted a retrospective analysis of incidental findings reported through a novel electronic notification system from January 1, 2015, to December 31, 2023. Adults undergoing CT, MRI, radiographs, or ultrasound were included. The protocol involved radiologists submitting findings via an EMR button, triggering a nursing-led follow-up algorithm that varied based on clinical setting (ED, inpatient, outpatient) and finding type (e.g., lung, kidney). Primary outcomes were utilization (total cases, compounded growth) and case resolution. Secondary outcomes included stratification by imaging modality and type of incidental finding. Descriptive statistics were used for analysis.

Results: A total 25,175 incidental findings were reported, averaging 2,797 cases per year and 233 per month, with an overall compounded annual growth rate of 21.44%. Resolution rates remained consistently >99% after initial tracking began, with only two months below this threshold. From 2019-2023, among 17,205 available cases, lung findings were the most common (19.31%), followed by brain (7.29%) and kidney (7.17%). CT imaging was the most frequent modality (53.99%), followed by MRI (20.34%), radiographs (18.17%), and ultrasound (7.49%).

Conclusions: We successfully implemented an incidental findings reporting protocol with strong provider uptake and case resolution. As imaging volumes continue to rise, structured follow-up systems are increasingly critical for hospitals.