title: Differences in Perceptions Among Radiologists, Referring Physicians, and Patients Regarding Language for Incidental Findings Reporting.
abstract: OBJECTIVE
  The purpose of this article is to compare radiologists', referring physicians', and patients' interpretations of expressions within radiology reports to describe findings of likely low clinical significance.
  
  
  METHODS
  Surveys were completed by abdominal radiologists (n = 13), physicians referring patients for abdominal CT (n = 59), and outpatients awaiting imaging (n = 51) at a large urban academic medical center. Surveys presented 10 expressions for describing an incidental 5-mm liver lesion and asked respondents to select from a list of choices their perceived likelihood that the lesion represented malignancy. Radiologists and referrers were asked supplemental questions.
  
  
  RESULTS
  Compared with radiologists' concern, referrers' and patients' concerns were higher for four and seven of the 10 expressions. Only the expression "benign cyst" was associated with no concern in all groups; "most likely a cyst" and "too small to characterize" were associated with median levels of concern of 0% for radiologists, > 0% to 1% for referrers, and > 2% to 5% for patients. Expressions containing the phrase "not excluded" had the highest concern in all groups. Referrers' likelihood of ordering follow-up imaging varied widely for the expressions (e.g., "benign cyst," 2%; "cyst," 22%; "most likely a cyst," 46%; "most likely a cyst, although tumor not excluded," 75%). Overall, the preferred phrase for a 5-mm liver lesion with benign features in normal-risk patients was "cyst" among radiologists and "benign cyst" among referrers. Seventy-six percent of referring physicians thought that radiology reports should indicate whether follow-up imaging is recommended for such lesions.
  
  
  CONCLUSIONS
  Ambiguity in radiologists' language for incidental low-risk findings may contribute to increased patient anxiety and follow-up testing, warranting greater radiologist attention and potentially new practice or reporting strategies.
authors.affiliation: 1 Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Fl, New York, NY 10016.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D004282:Documentation / Q000379:methods; D057286:Electronic Health Records / Q000706:statistics & numerical data; D006801:Humans; D033162:Incidental Findings; D033181:Information Dissemination; D007802:Language; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000523:psychology*; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D011860:Radiography, Abdominal / Q000523:psychology* / Q000706:statistics & numerical data; D000072177:Radiologists / Q000523:psychology / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000517:prevention & control / Q000523:psychology*; D055815:Young Adult
keywords: incidental findings; radiologists; radiology report; standardized reporting; surveys