Practices in reporting incidental findings in lung cancer screening by low-dose CT: a European Survey of Radiologists by SOLACE

OBJECTIVE: Lung cancer screening (LCS) is complicated by a high prevalence of incidental findings (IFs), defined as abnormalities detected on low-dose computed tomography (LDCT) of the chest that are outside the scope of LCS. Although the detection of some abnormalities might lead to the diagnosis of conditions of clinical relevance, LDCT protocols are not adequate for the characterisation of most IFs and thus, further investigations are usually necessary. Thus, the detection of such findings is perceived as a double-edged sword, and radiologists still widely disagree on which IFs should be reported. MATERIALS AND METHODS: A survey was circulated amongst radiologists involved in LCS programmes across Europe to investigate their opinions regarding the reporting of IFs, based on their personal experiences and perspectives, as well as national regulations. The responses of 147 European radiologists were included in the final analysis. RESULTS: The survey revealed a lack of standardised regulations and limited awareness among European radiologists regarding IFs reporting in LCS. LDCT is perceived as unreliable for evaluating solid organs outside the mediastinum, and mandatory reporting is supported only for clinically relevant findings. CONCLUSION: With radiologists still partly disagreeing on which IFs should be reported, international evidence-based guidelines around IFs reporting and management are highly awaited but challenging. CRITICAL RELEVANCE STATEMENT: This study critically highlights the lack of standardised regulations and consensus on IFs reporting in European LCS, underscoring the urgent need for harmonised, evidence-based guidelines to advance consistency and quality in clinical radiology practice. KEY POINT: European radiologists report a lack of standardised regulations and awareness regarding IFs in LCS. LDCT is widely perceived as unreliable for assessing solid organs outside the mediastinum, limiting support for mandatory reporting of extra-thoracic findings. International, evidence-based guidelines are urgently needed to harmonise IFs reporting and management in LCS across Europe.

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Publication Details

Journal
Insights into Imaging
Published
2026-05-29
DOI
https://doi.org/10.1186/s13244-026-02257-w
Primary Topic
Lung Cancer Diagnosis and Treatment
Type
article
Field-Weighted Citation Impact
0.00

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article

Practices in reporting incidental findings in lung cancer screening by low-dose CT: a European Survey of Radiologists by SOLACE

Emily Nischwitz, Elizabeth Tong, Helmut Prosch, Kyriaki Tavernaraki et al.
Insights into Imaging
Lung Cancer Diagnosis and Treatment
article

Practices in reporting incidental findings in lung cancer screening by low-dose CT: a European Survey of Radiologists by SOLACE

Emily Nischwitz, Elizabeth Tong, Helmut Prosch, Kyriaki Tavernaraki, Monika Hierath, Viktoria Palm, Roberta Eufrasia Ledda, Iris Vlachantoni, Lucija Kovačević, Pilvi Ilves, T Blum, Steven Schalekamp, Ildikó Horváth, Katarzyna Błasińska, Eva Kočová, Anna Kerpel-Fronius, oyunaa von stackelberg, James Ryan, Coline Mathonier, István Levente Kui, J Vogel-Claussen, M K Koziar Vasakova, Joanna Chorostowska-Wynimko, Jens Vogel-Clausen, Mathis Konrad, Hans-Ulrich Kauczor, Marie-Pierre Revel, Maja Prutki, Guillermo Gallardo, Gianluca Milanese, SOLACE Collaborative Authors, Nuala Healy
article en

Abstract

OBJECTIVE: Lung cancer screening (LCS) is complicated by a high prevalence of incidental findings (IFs), defined as abnormalities detected on low-dose computed tomography (LDCT) of the chest that are outside the scope of LCS. Although the detection of some abnormalities might lead to the diagnosis of conditions of clinical relevance, LDCT protocols are not adequate for the characterisation of most IFs and thus, further investigations are usually necessary. Thus, the detection of such findings is perceived as a double-edged sword, and radiologists still widely disagree on which IFs should be reported. MATERIALS AND METHODS: A survey was circulated amongst radiologists involved in LCS programmes across Europe to investigate their opinions regarding the reporting of IFs, based on their personal experiences and perspectives, as well as national regulations. The responses of 147 European radiologists were included in the final analysis. RESULTS: The survey revealed a lack of standardised regulations and limited awareness among European radiologists regarding IFs reporting in LCS. LDCT is perceived as unreliable for evaluating solid organs outside the mediastinum, and mandatory reporting is supported only for clinically relevant findings. CONCLUSION: With radiologists still partly disagreeing on which IFs should be reported, international evidence-based guidelines around IFs reporting and management are highly awaited but challenging. CRITICAL RELEVANCE STATEMENT: This study critically highlights the lack of standardised regulations and consensus on IFs reporting in European LCS, underscoring the urgent need for harmonised, evidence-based guidelines to advance consistency and quality in clinical radiology practice. KEY POINT: European radiologists report a lack of standardised regulations and awareness regarding IFs in LCS. LDCT is widely perceived as unreliable for assessing solid organs outside the mediastinum, limiting support for mandatory reporting of extra-thoracic findings. International, evidence-based guidelines are urgently needed to harmonise IFs reporting and management in LCS across Europe.

Insights into ImagingVol. 17(1)
University of Parma (IT), Royal College of Surgeons in Ireland (IE), Radboud University Nijmegen (NL), Université Paris Cité (FR), Heidelberg University (DE), University Hospital Heidelberg (DE), Radboud University Medical Center (NL), Medizinische Hochschule Hannover (DE), MSB Medical School Berlin (DE), Hôpital Cochin (FR), Assistance Publique – Hôpitaux de Paris (FR), Helios Klinikum Emil von Behring (DE), Bioforschung Austria (AT), Sisters of Charity Hospital (HR), German Center for Lung Research (DE), European Institute for Biomedical Imaging Research (AT), Instytut Gruźlicy i Chorób Płuc (PL), Clinica Universidad de Navarra (ES), University of Nyíregyháza (HU), Thomayer University Hospital (CZ), Jósa András Múzeum (HU), Ministry of Health (GR), Fondazione IRCCS Istituto Nazionale dei Tumori (IT), Szuro Trade (Hungary) (HU), Országos Korányi Tbc és Pulmonológiai Intézet (HU), Chirurgische Universitätsklinik Heidelberg (DE), University of Tartu (EE), Medical University of Vienna (AT), Universidad de Navarra (ES)
European Commission
Openalex Percentile: Top 6%
Lung Cancer Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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