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Editor's Correspondence
April 11, 2011

Another Point of View

Author Affiliations

Author Affiliation: Institute on Aging, School of Medicine, Temple University, Philadelphia, Pennsylvania.

Arch Intern Med. 2011;171(7):702-710. doi:10.1001/archinternmed.2011.119

Orme and associates,1 in their study titled “Incidental Findings in Imaging Research,” concluded that evaluation of incidental findings in imaging research resulted in medical benefits to a small number of patients. I offer another point of view, namely, no medical benefit but negative consequences.2 In many instances, expensive and occasionally dangerous investigations are pursued. Brain magnetic resonance imaging screening of asymptomatic patients regardless of age, health, or medical history is an example of an ineffective screening program that could produce many inconsequential findings. Valuable screening must either address a highly prevalent disease or are applied to high-risk individuals and must uncover a treatable disease. Chest computed tomographic angiograms ordered in the emergency department are more than twice as likely to find an incidental pulmonary nodule or adenopathy than a pulmonary embolism, suggesting that a systemic approach be developed to help primary care physicians contend with a growing number of new pulmonary nodules. In many instances this creates a Hobson's choice for physicians.

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