Incidental findings in ultrasound examinations: An exploratory study of the perspectives and experiences of sonographers in two Nordic countries

INTRODUCTION: In ultrasound scans, incidental findings (IFs) are unexpected findings of abnormalities with potential clinical impact. Sonographers face many challenges in clinical practice, including identifying and interpreting IFs. This study sought to explore sonographers' perceptions and experiences with IFs, and the strategies they use to handle them effectively. METHODS: We performed focus group discussions with nine trained sonographers in Denmark and five in Norway. The group discussions were conducted using a discussion guide with open-ended questions about the training and education of participating sonographers, how they handle and report on incidental findings, collaborate with colleagues to consult on IFs, other sources of information used in detecting and handling IFs, and how to communicate with patients on IFs, as well as the ethics involved in the process. Participants discussed their knowledge of, and experiences with handling IFs. Audio-recording of each discussion was, transcribed, and analysed following Braun & Clarke's thematic framework. RESULTS: Fourteen sonographers with 0.5-28 years of sonography experience participated. Analysis generated three overarching themes and six subthemes. The three themes described: 1) preparedness through education and training to identify and interpret IFs; 2) uncertainty and lack of confidence regarding reporting and follow-up procedures; and 3) challenges in communicating IFs to patients. Participants perceived these challenges as contributing to diagnostic delays, legal vulnerability, and emotional distress. CONCLUSION: Sonographers described uncertainty in the identification, interpretation, reporting, and communication of IFs, reflecting challenges in education and local practice in Denmark and Norway. IMPLICATION FOR PRACTICE: Clear clinical protocols for identifying and reporting IFs may support consistent practice, enhance patient safety, and improve communication in ultrasound services.