This young adult female (22 years age) had no significant complaints and was referred for a routine ultrasound scan of the abdomen to rule out any pathology. Tune in to a DAS SMACC talk by James Rippey on the Ethics of Incidental Findings.įor more like this, head to our podcast page. Incidental Finding on Routine Ultrasound Imaging of the Pelvis. Rely on the help of other experts to guide interpretation of incidental findings where appropriate. For those clinicians with advanced ultrasound education, James encourages you to identify and consider any incidental findings you come across while performing an ultrasound. It causes us to consider Ethics in Healthcare and the value of procedures that can be unnecessary.įor those practicing POCUS, James suggests not to be distracted by incidental findings.Ĭommunication regarding the limitations of your scan is far more important. This extends not only to the likelihood of the finding being serious but also to consider the financial and emotional costs of incidental findings. Luckily James’s son survived, however it raises questions as to the risk-benefit ratio in the discovery of an incidental finding. James shares a personal story about how using a handheld ultrasound machine on his son, incidentally found a retroperitoneal tumour. However, the ethics of incidental findings is scrutinised. Given that there is evidence that ultrasound is an accurate modality for assessing the size of renal masses, and that subcentimetre angiomyolipomas are not an uncommon finding, hyperechoic masses 1 cm can be followed with ultrasound unless morphologic change is encountered on subsequent imaging 23,24. The advancement of high quality, handheld ultrasound machines means that we will all have imaging available at our fingertips. Then, there are the ultrasound experts, who look beyond the specific questions and embrace ultrasound as a valuable diagnostic tool. According to James Rippey, there are two main groups of clinicians who use ultrasound.įirst, there are the POCUS providers, who have a specific, focused question and use the ultrasound machines accordingly. Accessory anatomical structures in the ankle and foot usually represent incidental imaging findings however, they may also eventually represent a source of pathology, such as painful syndromes, degenerative changes, be the subject of overuse and trauma, or appear as masses and cause compression syndromes or impingement. Ultrasound is an incredibly useful tool for clinicians. The ethics of incidental findings: James Rippey
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