VOMIT and “BOMIT”

VOMIT stands for “victim of modern imaging technology.” This term was first introduced in 2003.[1] It refers to patients who have undergone medical imaging for a specific indication and a new incidental finding discovered on imaging may necessitate further evaluation or management. This situation typically pertains to nonsinister but still noteworthy findings that can lead to additional investigations and sometimes invasive procedures. For instance, a small arachnoid cyst may be identified in a patient who has had a magnetic resonance imaging of the brain for headache. This may not explain the patient's symptoms. But being aware of this abnormality may cause the patient significant anxiety and may in turn worsen their perceived symptom. In essence, this leads to “over-diagnosis” and sometimes “overtreatment,” adding to further distress for the patient and increasing workload for an already overstretched radiology department. The meaning of the acronym seems to resonate with the overall negative sentiment associated with it.

The abbreviation VOMIT has been extensively used in the medical literature. If we reflect for a moment, the determination of whether something is “good or bad” is more influenced by the decision to request a specific test rather than the technology itself. Conversely, we lack a term for the opposite end of the spectrum, which could be termed “beneficiary of modern imaging technology”; an appropriate acronym for this might be BOMIT. Although this word lacks a specific meaning, it serves as a reminder of the valuable information we gain from modern technology, which contributes positively to patient care. The benefits sought by both patients and doctors are often taken for granted. In reality, incidental findings can significantly alter management in a favorable manner. For example, decades ago, the most common presentation of renal cell carcinoma was hematuria, whereas today, it is often detected through modern imaging as an incidental finding. Carcinoma of the lung is also being detected more often in the early stage. Like early cancer detection, finding unexpected aneurysms also could be life-saving by allowing appropriate treatment. Incidental findings discovered during imaging could have implications for general practice too.[2] Early follow-ups may be required to monitor the early detected abnormality before it turns out to be dangerous.

Similar circumstances may arise in other contemporary medical technologies as well, such as laboratory tests and endoscopic examinations. Nevertheless, we do not encounter any catchy acronyms.

As radiologists, we consistently identify numerous incidental findings in our daily practice. It is crucial to document our observations meticulously and also mention its significance and the need for further evaluation. They could be elaborated within the body of the report and carefully presented in the final impression so that they are actioned or left alone accordingly.

Overlooking these findings can result in adverse outcomes where patients may present with symptoms, for example, an incidental nerve sheath tumor in the carotid space of the neck may grow over time and the patient may present with a lump or vagal nerve paralysis. Review of previous imaging may suggest that the lesion was present on previous imaging when it was smaller and possibly would have warranted further follow-up, which could subsequently have resulted in earlier surgery.

We must consider all potential repercussions that an individual might face due to an incidental finding. Our experience should guide us to assign the appropriate significance to these observations so that they are accurately managed and patients are given appropriate advice or reassurance.

 

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Conflict of Interest

None declared.

• References

• 1 Hayward R. VOMIT (victims of modern imaging technology)—an acronym for our times. BMJ 2003; 326 (7401): 1273
• 2 Booth TC, Najim R, Petkova H. Incidental findings discovered during imaging: implications for general practice. Br J Gen Pract 2016; 66 (648): 346-347

Publication History

Article published online:
16 September 2025