The Economic Burden of Incidentally Detected Findings

Radiologic Clinics of North America

Volumn 49, Issue 2, 2011, Pages 257-265

  Ding, Alexander ^a   Eisenberg, Jonathan D ^a   Pandharipande, Pari V ^a,b  

^a MASSACHUSETTS GENERAL HOSPITAL   (United States)

^b HARVARD MEDICAL SCHOOL   (United States)

Author keywords

CT colonography; Economic burden; Imaging; Incidental findings

Indexed keywords

CANCER SCREENING; COLORECTAL CANCER; COMPUTED TOMOGRAPHIC COLONOGRAPHY; COMPUTER ASSISTED TOMOGRAPHY; COST EFFECTIVENESS ANALYSIS; HEALTH CARE COST; HEALTH CARE POLICY; HEALTH CARE SYSTEM; HUMAN; INCIDENTAL FINDING; LIFE EXPECTANCY; LUNG CANCER; LUNG NODULE; PATIENT REFERRAL; PRIORITY JOURNAL; QUALITY OF LIFE; REIMBURSEMENT; REVIEW; STATISTICAL MODEL; UNITED STATES;

COST-BENEFIT ANALYSIS; DIAGNOSTIC IMAGING; HUMANS; INCIDENTAL FINDINGS; MODELS, ECONOMIC;

EID: 79951559918     PISSN: 00338389     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.rcl.2010.11.004     Document Type: Review

References (42)

1. Chin M., Mendelson R., Edwards J., et al. Computed tomographic colonography: prevalence, nature, and clinical significance of extracolonic findings in a community screening program. Am J Gastroenterol 2005, 100(12):2771-2776.
2. Flicker M.S., Tsoukas A.T., Hazra A., et al. Economic impact of extracolonic findings at computed tomographic colonography. J Comput Assist Tomogr 2008, 32(4):497-503.
3. Gluecker T.M., Johnson C.D., Wilson L.A., et al. Extracolonic findings at CT colonography: evaluation of prevalence and cost in a screening population. Gastroenterology 2003, 124(4):911-916.
4. Veerappan G.R., Ally M.R., Choi J.H., et al. Extracolonic findings on CT colonography increases yield of colorectal cancer screening. AJR Am J Roentgenol 2010, 195(3):677-686.
5. Hara A.K., Johnson C.D., MacCarty R.L., et al. Incidental extracolonic findings at CT colonography. Radiology 2000, 215(2):353-357.
6. Kimberly J.R., Phillips K.C., Santago P., et al. Extracolonic findings at virtual colonoscopy: an important consideration in asymptomatic colorectal cancer screening. J Gen Intern Med 2009, 24(1):69-73.
7. Pickhardt P.J., Hanson M.E., Vanness D.J., et al. Unsuspected extracolonic findings at screening CT colonography: clinical and economic impact. Radiology 2008, 249(1):151-159.
8. Tolan D.J., Armstrong E.M., Chapman A.H. Replacing barium enema with CT colonography in patients older than 70 years: the importance of detecting extracolonic abnormalities. AJR Am J Roentgenol 2007, 189(5):1104-1111.
9. Xiong T., McEvoy K., Morton D.G., et al. Resources and costs associated with incidental extracolonic findings from CT colonography: a study in a symptomatic population. Br J Radiol 2006, 79(948):948-961.
10. Yee J., Kumar N.N., Godara S., et al. Extracolonic abnormalities discovered incidentally at CT colonography in a male population. Radiology 2005, 236(2):519-526.
11. Liu W., Mortele K.J., Silverman S.G. Incidental extraurinary findings at MDCT urography in patients with hematuria: prevalence and impact on imaging costs. AJR Am J Roentgenol 2005, 185(4):1051-1056.
12. Maizlin Z.V., Barnard S.A., Gourlay W.A., et al. Economic and ethical impact of extrarenal findings on potential living kidney donor assessment with computed tomography angiography. Transpl Int 2007, 20(4):338-342.
13. Yousem D.M., Huang T., Loevner L.A., et al. Clinical and economic impact of incidental thyroid lesions found with CT and MR. AJNR Am J Neuroradiol 1997, 18(8):1423-1428.
14. Kucharczyk M.J., Menezes R.J., McGregor A., et al. Assessing the impact of incidental findings in a lung cancer screening study by using low-dose computed tomography. Can Assoc Radiol J 2010, [Epub ahead of print].
15. Machaalany J., Yam Y., Ruddy T.D., et al. Potential clinical and economic consequences of noncardiac incidental findings on cardiac computed tomography. J Am Coll Cardiol 2009, 54(16):1533-1541.
16. Lee C.I., Tsai E.B., Sigal B.M., et al. Incidental extracardiac findings at coronary CT: clinical and economic impact. AJR Am J Roentgenol 2010, 194(6):1531-1538.
17. Baker L.C., Atlas S.W., Afendulis C.C. Expanded use of imaging technology and the challenge of measuring value. Health Aff (Millwood) 2008, 27(6):1467-1478.
18. Smith-Bindman R., Miglioretti D.L., Larson E.B. Rising use of diagnostic medical imaging in a large integrated health system. Health Aff (Millwood) 2008, 27(6):1491-1502.
19. Orme N.M., Fletcher J.G., Siddiki H.A., et al. Incidental findings in imaging research: evaluating incidence, benefit, and burden. Arch Intern Med 2010, 170(17):1525-1532.
20. Pearson S.D., Knudsen A.B., Scherer R.W., et al. Assessing the comparative effectiveness of a diagnostic technology: CT colonography. Health Aff (Millwood) 2008, 27(6):1503-1514.
21. Zauber AG, Knudsen AB, Rutter CM, et al. Cost-effectiveness of CT colonography to screen for colorectal cancer: technology assessment report. Published 2009. Available at: Accessed December 6, 2010. http://www.cms.gov/determinationprocess/downloads/id58TA.pdf.
22. U.S.Preventive Services Task Force Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008, 149(9):627-637.
23. Decision memo for screening computed tomography (CTC) for colorectal cancer (CAG-00396N) Available at:, Accessed October 20, 2010. http://www.cms.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=220&.
24. Zalis M.E., Barish M.A., Choi J.R., et al. CT colonography reporting and data system: a consensus proposal. Radiology 2005, 236(1):3-9.
25. Central Intelligence Agency. The World Factbook Available at:, Accessed October 20, 2010. https://www.cia.gov/library/publications/the-world-factbook/fields/2076.html.
26. Messersmith W.A., Brown D.F., Barry M.J. The prevalence and implications of incidental findings on ED abdominal CT scans. Am J Emerg Med 2001, 19(6):479-481.
27. MacRedmond R., Logan P.M., Lee M., et al. Screening for lung cancer using low dose CT scanning. Thorax 2004, 59(3):237-241.
28. Black C., Bagust A., Boland A., et al. The clinical effectiveness and cost-effectiveness of computed tomography screening for lung cancer: systematic reviews. Health Technol Assess 2006, 10(3):iii-iiv. ix-x, 1-90.
29. McMahon P.M., Kong C.Y., Johnson B.E., et al. Estimating long-term effectiveness of lung cancer screening in the Mayo CT screening study. Radiology 2008, 248(1):278-287.
30. Mortensen J.D., Woolner L.B., Bennett W.A. Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab 1955, 15(10):1270-1280.
31. Sosnouski D., Bonsall R.P., Mayer F.B., et al. Extracardiac findings at cardiac CT: a practical approach. J Thorac Imaging 2007, 22(1):77-85.
32. Knudsen A.B., Lansdorp-Vogelaar I., Rutter C.M., et al. Cost-effectiveness of computed tomographic colonography screening for colorectal cancer in the medicare population. J Natl Cancer Inst 2010, 102(16):1238-1252.
33. Lee J.M., McMahon P.M., Kong C.Y., et al. Cost-effectiveness of breast MR imaging and screen-film mammography for screening BRCA1 gene mutation carriers. Radiology 2010, 254(3):793-800.
34. Pandharipande P.V., Gervais D.A., Hartman R.I., et al. Renal mass biopsy to guide treatment decisions for small incidental renal tumors: a cost-effectiveness analysis. Radiology 2010, 256(3):836-846.
35. Weinstein M.C., Siegel J.E., Gold M.R., et al. Recommendations of the panel on cost-effectiveness in health and medicine. JAMA 1996, 276(15):1253-1258.
36. Berland L.L., Silverman S.G., Gore R.M., et al. Managing incidental findings on abdominal CT: white paper of the ACR incidental findings committee. J Am Coll Radiol 2010, 7(10):754-773.
37. Lee J.M., Kopans D.B., McMahon P.M., et al. Breast cancer screening in BRCA1 mutation carriers: effectiveness of MR imaging-Markov Monte Carlo decision analysis. Radiology 2008, 246(3):763-771.
38. Hrung J.M., Langlotz C.P., Orel S.G., et al. Cost-effectiveness of MR imaging and core-needle biopsy in the preoperative work-up of suspicious breast lesions. Radiology 1999, 213(1):39-49.
39. Swan J.S., Fryback D.G., Lawrence W.F., et al. MR and conventional angiography: work in progress toward assessing utility in radiology. Acad Radiol 1997, 4(7):475-482.
40. Swan J.S., Sainfort F., Lawrence W.F., et al. Process utility for imaging in cerebrovascular disease. Acad Radiol 2003, 10(3):266-274.
41. Swan J.S., Ying J., Stahl J., et al. Initial development of the temporary utilities index: a multiattribute system for classifying the functional health impact of diagnostic testing. Qual Life Res 2010, 19(3):401-412.
42. U.S.Preventive Services Task Force Screening for colorectal cancer: recommendation and rationale. Ann Intern Med 2002, 137(2):129-131.