In subsequent exams, the initial review of cardiac scans was performed at the Los Angeles Biomedical Research Center by a physician, with experience in CT imaging. If the review was negative for a significant noncardiac finding, the process ended, and a report documenting this was sent to the coordinating center. If on initial review, there was a significant or potentially significant finding, the report was then reviewed by a radiologist, experienced in the application of appropriate diagnostic criteria for an asymptomatic screening population. This second interpretation reviewed all initial clinical readings that were positive for any findings. This systematic approach allowed us to have timely reporting, while maintaining a consistent and evidence-based approach to the clinical reviews of the CT exams.

The reporting center provided the clinic and participant with a report on letterhead documenting the potential issue in clear language with a recommended next action. In addition to the reports, the CT reading center helped participants obtain copies of their images upon request if it proved difficult from the primary source, the site where the CT exam is performed. In addition, if requested by local physicians, cases were discussed and consulted. We did not collect data from follow-up and results of the workup of the incidental findings.