ObjectiveTo provide an overview of the evidence on prevalence and outcomes of incidental imaging findings. DeSiGNUmbrella review of systematic reviews. Data SOurceSSearches of MEDLINE, EMBASE up to August 2017; screening of references in included papers. eliGibility criteria Criteria included systematic reviews and meta-analyses of observational studies that gave a prevalence of incidental abnormalities ("incidentalomas"). An incidental imaging finding was defined as an imaging abnormality in a healthy, asymptomatic patient or an imaging abnormality in a symptomatic patient, where the abnormality was not apparently related to the patient's symptoms. Primary studies that measured the prevalence of incidentalomas in patients with a history of malignancy were also considered in sensitivity analyses. reSultS 20 systematic reviews (240 primary studies) were identified from 7098 references from the database search. Fifteen systematic reviews provided data to quantify the prevalence of incidentalomas, whereas 18 provided data to quantify the outcomes of incidentalomas (13 provided both). The prevalence of incidentalomas varied substantially between imaging tests; it was less than 5% for chest computed tomography for incidental pulmonary embolism in patients with and without cancer and whole body positron emission tomography (PET) or PET/computed tomography (for patients with and without cancer). Conversely, incidentalomas occurred in more than a third of images in cardiac magnetic resonance imaging (MRI), chest computed tomography (for incidentalomas of thorax, abdomen, spine, or heart), and computed tomography colonoscopy (for extracolonic incidentalomas). Intermediate rates occurred with MRI of the spine (22%) and brain (22%). The rate of malignancy in incidentalomas varied substantially between organs; the prevalence of malignancy was less than 5% in incidentalomas of the brain, parotid, and adrenal gland. Extra-colonic, prostatic, and colonic incidentalomas were malignant between 10% and 20% of the time, whereas renal, thyroid, and ovarian incidentalomas were malignant around a quarter of the time. Breast incidentalomas had the highest percentage of malignancy (42%, 95% confidence interval 31% to 54%). Many assessments had high between-study heterogeneity (15 of 20 metaanalyses with I 2 >50%).cONcluSiONS There is large variability across different imaging techniques both in the prevalence of incidentalomas and in the prevalence of malignancy for specific organs. This umbrella review will aid clinicians and patients weigh up the pros and cons of requesting imaging scans and will help with management decisions after an incidentaloma diagnosis. Our results can underpin the creation of guidelines to assist these decisions.

BACKGROUND: Medicines are increasingly purchased online, yet little is known regarding the ocular information-seeking behavior with medicine queries in search engines. A share of pharmacies found via search engines operate unlicensed and sell prescription-only medicines without a prescription. This study aimed to investigate how search engine users distinguish between genuine and falsified sources of information in terms of unlicensed and licensed online pharmacies in the case of medicine queries. METHODS: Eye-tracking of search tasks (transactional, navigational, informational and two limited results) in a Google search engine environment with retrospective gaze-cued think aloud protocol. Purposive sample of N=50 across three hospitals and one general practitioner. RESULTS: Discovery of a trichotomy of ocular search strategies based on the inclusion or exclusion of URLs in the information-seeking process. Finding of dissonance to existing studies related to fixation duration of search engine result page (SERP) elements. Discovery of an addition to information foraging theory: proximal cues are, in environments with non-credible information, used in both positive and negative ways.