The Current Impact of Incidental Findings Found during Neuroimaging on Neurologists’ Workloads

Abstract

ObjectiveNeuroimaging is an important diagnostic tool in the assessment of neurological disease, but often unmasks Incidental Findings (IFs). The negative impacts of IFs, such as ‘patient’ anxiety, present neurologists with management dilemmas, largely due to the limited knowledge base surrounding the medical significance of these IFs. In particular, the lack of evidence-based clinical trials investigating the efficacy of treatments for subclinical IFs makes management protocols challenging. The objective was to determine the impact IFs may have on neurologists’ workloads and healthcare budgets and to examine neurologists’ concerns regarding the clinical management of these ‘patients’.MethodsQualitative research based on constructivist grounded theory. Data was collected through semi-structured interviews of purposively sampled neurologists, coded, and concurrent comparative analysis performed. A substantive theory of the ‘IF impacts’ was developed after concept saturation.ResultsNeurologists managed the escalating workload caused by an increased number of referrals of ‘patients’ with IFs found during neuroimaging; however it was unclear whether this was sustainable in the future. Neurologists experienced IF management dilemmas and spent more time with ‘patients’ affected by anxiety. The lack of information provided to those undergoing neuroimaging by the referring clinician regarding the possibility of discovering IFs was highlighted.ConclusionThe impact of IFs upon the neurologist, ‘patient’ and the health institution appeared considerable. Further research determining the natural history of subclinical IFs and the efficacy of intervention will help to alleviate these issues.

Primary care management of headaches and how direct-access MRI fits: a qualitative study of UK general practitioners’ views

“…A recent study interviewed senior neurologists in Edinburgh about the impact of IFs on their workload. 39 Neurologists reported that patient anxiety often needed addressing before treatment options could be discussed. If such distress could be effectively managed in primary care, this could reduce workload and wait times for specialists, although this remains to be investigated.…”

The effects of incidental findings from whole-body MRI on the frequency of biopsies and detected malignancies or benign conditions in a general population cohort study

“…There exists uncertainty as to which IFs warrant disclosure and further investigation. Management guidelines are lacking [3,10,11]. Research participants with disclosed IFs may present to their physicians and invasive diagnostic actions such as biopsies may result to rule out serious pathology.…”

Incidental findings discovered during imaging: implications for general practice

“…Certain communities have explored the impact of managing IFs in more depth: in the UK, imaging researchers have convened to produce a minimum set of guidelines; 2 special interest radiology and surgical groups have developed follow-up protocols; and neurologists have described the challenges they face as a result of advances in neuroimaging. 4 Nonetheless, there seems to be no consensus among radiologists 6 when it comes to reporting or recommending IF follow-up, or among imaging researchers about how to handle IFs, 3 and this lack of unity and clarity is mirrored amongst other clinicians -GPs included.…”