Medicolegal Aspects and Informed Consent

  • Leonard Berlin
Part of the Medical Radiology book series (MEDRAD)


With the advent of high resolution CT, MRI, and ultrasound scanning, the frequency of radiologists’ serendipitous discovery of incidental findings (colloquially referred to as “incidentalomas”) on radiological examinations is increasing. Incidentalomas account for approximately 20% of all findings, due to two reasons: (a) the number of hi-tech imaging exams (primarily CT) performed today, and (b) the increasing sophistication of the technology. In the early 1980s when CT scanning was in its infancy, 3 to 5 million scans were performed annually in the US. In the past few years, the annual number of CT scans performed in the US has increased exponentially to well over 80 million. In addition, the specificity of the equipment has advanced geometrically such that abnormalities and/or pseudo-abnormalities 1 mm or a fraction of 1 mm in size that were virtually “invisible” before can now be seen quite easily.

Statistically only 1% or less of these incidentalomas represent an early malignancy or other severe pathology. Thus, radiologists are faced with a dilemma: if they report every incidentaloma, many patients will be subjected to a cascade of costly testing, sometimes leading to biopsies or other invasive procedures, all of which on occasion may lead to complications and cause harm to the patient who was completely healthy and was never ill to begin with. On the other hand, should the radiologist decide not to report the presence of an incidentaloma, and it is later discovered that it was indeed an early malignancy and thus a fatal delay in diagnosis and treatment ensued, the patient could be permanently harmed or even die, and a medical malpractice lawsuit would almost certainly follow.

What, if anything, should the radiologist report to the patient or the referring physician, when faced with an incidentaloma? Should, or must, informed consent be required? This Chapter will focus on both the moral-ethical, and the medico-legal, aspects of the incidentaloma dilemma faced everyday by radiologists as well as treating physicians.


Down Syndrome Osteogenesis Imperfecta High Resolution Compute Tomography Medical Malpractice Compute Tomography Exam 
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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Radiology DepartmentSkokie HospitalSkokieUSA
  2. 2.Rush UniversityChicagoUSA
  3. 3.University of IllinoisChicagoUSA

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