Table 1

SUMMIT protocolised incidental findings management protocol

Incidental finding and assessment criteriaOnward clinical action
Incidental findings of the pulmonary parenchyma:
Emphysema
Qualitative grading by visual assessment of extent of lung affectedMild (>5%–25%)Research purposes only
Moderate (>25%–50%)
Severe (>50%–75%)
Very severe (>75%)
Bronchiectasis
Visual grading based on luminal diameter relative to the accompanying artery diameterMild (1.5–2×larger)Research purposes only
Moderate (2–3×larger)
Severe (>3×larger)PCP to assess patient and consider referral to secondary care
Interstitial lung abnormality
Visual assessment of extent of interstitial reticulation and presence or absence of fibrotic featuresMild (<10% reticulation)Research purposes only
Moderate (>10% reticulation with no fibrosis)
Severe (>10% reticulation with fibrotic features present)PCP to assess patient and consider referral to secondary care
Cardiovascular incidental findings
Coronary artery calcification (CAC)
Each territory (the circumflex, the right coronary artery and the left main plus left anterior descending artery) was assigned a score based on its CAC level: none (0 points), mild (1 point), moderate (2 points) or severe (3 points). Combining the score per territory gave a total overall score out of nine for CAC44 45Mild (1–3)Research purposes only
Moderate (4–6)
Severe (7–9)
Thoracic aortic aneurysm
Calliper measurement of the widest diameter of the ascending thoracic aorta20 46 defined as diameter ≥5.0 cm of the ascending aorta or ≥4.0 cm of the descending aorta464.0–5.5 cmPCP to refer to secondary care
>5.5 cmDirect referral to vascular surgery
Abdominal aortic aneurysm
Measurement of widest diameter of the abdominal aorta47≥3–5 cmPCP to refer non-urgently to vascular surgery
≥ 5 cmDirect referral to vascular surgery
Aortic valve calcification
Radiologist assessment of whether the central or peripheral half of valve commissures had calcification present48CentralResearch purposes only
Peripheral
Both
Other incidental findings
Osteoporotic wedge fracture
Visual assessment of extent of loss of vertebral height>50%PCP to refer for bone density assessment
<50%Research purposes only
Pleural findings
Pleural plaques recorded as present or absent
Diffuse pleural thickening refers to a diffuse process with no radiological suspicion of malignancy and was recorded as present or absent
(unilateral pleural effusions and unilateral or focal pleural thickening were referred to lung MDT for immediate workup as potential cancer)
Bilateral Pleural Effusions49PCP review
Diffuse pleural thickeningAnnual SUMMIT LDCT
Pleural plaquesResearch purposes only
Hiatus hernia
PresentResearch purposes only
  • LDCT, low-dose CT; MDT, multi-disciplinary team; PCP, primary care provider.