Toward a comprehensive management strategy for incidental findings in imaging.

Increased use of cross-sectional imaging along with improved image quality and increased spatial resolution has led to an increase in the number of incidental findings (IFs) in radiology reports. Incidental findings, defined as findings that are unrelated to the clinical indication for the imaging examination performed, might pose special challenges for family physicians and their patients upon identification in an imaging report. Debates have long raged about overmanagement of diagnostic findings; in 1972, Rang described “Ulysses syndrome,” in which patients make “a long journey through the investigative arts and experience a number of adventures before reaching their point of departure once again,”1 underscoring the fact that most IFs prove to be benign. Patients with IFs that have been unnecessarily investigated have been termed “victims of modern imaging technology (VOMIT),”2 while the term “brainless application of radiological findings (BARF)” has been used to describe management of IFs.3 However, the possibility of an IF representing a serendipitous discovery for which prudent management would have clear clinical benefit that outweighs the potential harm suggests that a robust strategy for IFs is required.