title: Imaging-based screening: maximizing benefits and minimizing harms.
abstract: Advanced imaging technologies play a central role in screening asymptomatic patients. However, the balance between imaging-based screening's potential benefits versus risks is sometimes unclear. Radiologists will have to address ongoing concerns, including high false-positive rates, incidental findings outside the organ of interest, overdiagnosis, and potential risks from radiation exposure. In this article, we provide a brief overview of these recurring controversies and suggest the following as areas that radiologists should focus on in order to tip the balance toward more benefits and less harms for patients undergoing imaging-based screening: interpretive variability, abnormal finding thresholds, and personalized, risk-based screening.
authors.affiliation: Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, G3-200, Seattle, WA, 98109-1023. Electronic address: germinoj@uw.edu.
authors.forename: Jessica C
authors.initials: JC
authors.lastname: Germino
authors.affiliation: Department of Medicine, University of Washington School of Medicine, 325 Ninth Avenue, Box 359780, Seattle, WA, 98104-2499; Department of Epidemiology, University of Washington School of Public Health, 325 Ninth Avenue, Box 359780, Seattle, WA, 98104-2499. Electronic address: jelmore@uw.edu.
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
authors.affiliation: Department of Radiology, University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI, 48109; University of Michigan Institute for Healthcare Policy and Innovation, 1500 East Medical Center Drive, Ann Arbor, MI, 48109. Electronic address: rcarlos@med.umich.edu.
authors.forename: Ruth C
authors.initials: RC
authors.lastname: Carlos
authors.affiliation: Department of Radiology, University of Washington School of Medicine, 825 Eastlake Avenue East, G3-200, Seattle, WA, 98109-1023; Department of Health Services, University of Washington School of Public Health, 825 Eastlake Avenue East, Seattle, WA, 98109; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, 825 Eastlake Avenue East, Seattle, WA, 98109. Electronic address: stophlee@uw.edu.
authors.forename: Christoph I
authors.initials: CI
authors.lastname: Lee
mesh_terms: D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D003952:Diagnostic Imaging / Q000379:methods*; D055088:Early Detection of Cancer / Q000379:methods*; D006801:Humans; D033162:Incidental Findings; D009369:Neoplasms / Q000175:diagnosis*
keywords: False-positives; Imaging-based screening; Incidental findings; Overdiagnosis; Screening harms