Thinking outside the box: clinical and economic implications of extracardiac findings on cardiac computed tomography angiography

Kelion et 1 report a cross- sectional study of the incidence of non- cardiac incidental findings on 4340 clinically indicated coronary CT angiography (CCTA). The first and most significant finding is that 15.8% of CCTA examinations contained an incidental finding, although 23.6% were previously known (12.1% newly recognised incidental findings). A large proportion of these findings, 43%, were pulmonary nodules or cysts of unclear clinical significance. While these incidentals would not otherwise have been diag-nosed by screening criteria, their identification often does impose a burden on patients and medical systems without prognostic benefit. Second, most incidentals, but not all, could be identified on a cardiac field of view (FOV) image, without a need for a wide FOV reconstruction as per routine at many centres. The authors suggest this finding could support a rationale to more expeditiously evaluate only the cardiac FOV dataset in resource- limited settings, given the added time and cost burden of requiring a radiologist to review the full FOV scan for incidentals. Currently, as Kelion et al have noted, the minimum recommendation evaluate the cardiac Society Cardiovascular 1 4 could be detected on limited cardiac FOV vs on wide FOV