Incidental finding on a research ultrasound
You are a sonographer participating in a research study recruiting healthy volunteers to validate a new ultrasound protocol. During a scan of a 41-year-old asymptomatic participant, you identify a 2.8 cm solid renal mass with internal vascularity. The participant was told at recruitment that scans were for research only and that findings would not be reported clinically. The study protocol states that incidental findings are 'not the responsibility of the research team'. The participant is waiting to leave and asks, 'Everything fine?'
1. What should you do about the incidental finding, and why?
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Report it through a proper clinical pathway.
Reasoning:
- A solid, vascular renal mass of ~2.8 cm is a potentially significant finding (possible renal cell carcinoma) that warrants clinical evaluation.
- A protocol clause disclaiming responsibility does not override the professional duty to act on a finding that could affect a person's health. Ignoring it would be indefensible.
- The participant consented to research, not to being placed at risk by non-disclosure of a clinically relevant result.
Actions:
- Do not say 'everything is fine'.
- Explain honestly that the scan showed something that needs a clinical check, without over-diagnosing on a research scan.
- Follow the study's incident/escalation route and inform the principal investigator and a responsible clinician.
- Arrange referral to the appropriate clinical team (e.g. urology/radiology) and document the discussion.
- Ensure the participant receives written information and a point of contact.
2. What communication approach would you use with the participant at this moment?
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Use a calm, honest, non-alarming approach:
- Acknowledge the question directly: 'I've seen something on the scan that I want a clinical team to look at properly.'
- Avoid premature diagnosis: Explain that research scans are not diagnostic and that further assessment is needed; do not speculate about cancer.
- Explain next steps: Who will contact them, roughly when, and what will happen (e.g. referral for a clinical scan).
- Check understanding and concerns: Allow questions, acknowledge anxiety, offer written information and a contact number.
- Confidentiality and documentation: Record what was said and to whom.
This balances honesty and duty of care with avoiding unnecessary alarm.