Incidentalomas in chest CT

Advances in imaging technology have dramatically increased the resolution of CT and improved detection of disease; these advances also have led to an increase in incidentalomas or incidental findings that often do not represent significant disease. Incidental findings on thoracic CT are common and can be problematic and expensive to evaluate. Thoracic imagers often are having to make recommendations for appropriate management which adds to the burden. Thoracic CT incidental findings are broad and include those of the lungs, heart, mediastinum, pleura, chest wall, thoracic soft tissues as well as the lower neck and upper abdomen. Of these, incidental pulmonary nodules have garnered the most interest over the years, but all incidentals may be proven to represent significant disease. In the USA, the American College of Radiology has generated white papers on incidentals that have proven useful. Currently, a number of investigations to utilize artificial intelligence for qualification and management of incidentals are ongoing. Likewise, the radiology/imaging community must support efforts to collaboratively address incidental findings and management concerns. As such, continued efforts to establish guidelines for appropriate identification, classification and management of incidentals is important to improve patient care and assure fiscally responsible assessment.