A system for addressing incidental findings in neuroimaging research

Abstract

When healthy subjects undergo brain imaging, incidental findings are not rare. The optimal response to such findings has been the focus of considerable discussion. The current report describes the operations and results of a system that provides review of incidental findings by an appropriate medical professional. A web-based system was created whereby investigators performing brain MRI scans on healthy subjects could refer images with suspected concerns to a board certified radiologist who had a Certificate of Added Qualification in Neuroradiology. The specific details of this system are described. Among 27 scans suspected by an investigator of having a significant finding, all but one were referred by a researcher with a PhD. The most common concerns described by these investigators were for the possible presence of a cyst or of enlarged ventricles. The most common findings reported by the radiologist were Virchow-Robin spaces and cysts. Findings were generally of low clinical significance, with 1 major exception. Identifying the optimal response to incidental findings in neuroimaging research remains a challenge. The current report describes a system for providing expert assistance and so addresses these issues in the setting of suspected incidental findings. To our knowledge the current system is the first to provide a specific means for evaluation of incidental findings in neuroimaging research.

Acting on incidental findings in research imaging

“…7 Remote review of images via a network of trained individuals who provide quick advice on findings has worked in some places but needs organisation and incurs cost. 52 No alternatives are in widespread use. [53][54][55][56] Perhaps non-expert researchers could benefit from a list of common incidental findings with their health implications.…”

Incidental Chest Radiographic Findings in Healthy Indian Research Subjects

“…The continued development of protocols for managing IFs in research and the establishment of guidelines are needed to ensure that research procedures reflect the best interest of participants. 9,25,26 Such clinical action may provide medical benefit, although, to a small number of research participants.…”

Discovery and informing research participants of incidental findings detected in brain magnetic resonance imaging studies: Review and multi‐institutional study

“…Thus, the greatest benefit of discovering IFs and providing the information to participants is that it can lead to an early detection of serious diseases (Borgelt, Anderson, & Illes, 2013; Hilgenberg, 2006; Illes et al., 2002, 2006; Underwood, 2012). On the other hand, researchers are not necessarily capable of clinically evaluating images, and the imaging methods and performance of the equipment employed in studies might not be sufficient for clinical evaluation, even though it is adequate for the purpose of the study (Booth, Waldman, Wardlaw, Taylor, & Jackson, 2012; Cramer et al., 2011; Grossman & Bernat, 2004; Illes et al., 2002; Illes, Kirschen, et al., 2004; Mamourian, 2004; Wolf, Paradise, & Caga‐anan, 2008). Thus, the risks of offering information about IFs have been reported, such as the possibility of causing fear in participants, posing time, physical, and financial burden on participants for detailed examinations (Anonymous, 2005; Grossman & Bernat, 2004; Illes et al., 2006; Kumra, Ashtari, Anderson, Cervellione, & Kan, 2006; Warlow, 2011), possibility of false‐negative and false‐positive results (Illes et al., 2006; Kumra et al., 2006; Royal & Peterson, 2008), existence of a “therapeutic misconception” (Kirschen, Jaworska, & Illes, 2006; Meltzer, 2006; Miller, Mello, & Joffe, 2008; Parker, 2008; Shaw, Senior, Peel, Cooke, & Donnelly, 2008), and issues related to insurability (Apold & Downie, 2011; Check, 2005).…”

“…Thus, the risks of offering information about IFs have been reported, such as the possibility of causing fear in participants, posing time, physical, and financial burden on participants for detailed examinations (Anonymous, 2005; Grossman & Bernat, 2004; Illes et al., 2006; Kumra, Ashtari, Anderson, Cervellione, & Kan, 2006; Warlow, 2011), possibility of false‐negative and false‐positive results (Illes et al., 2006; Kumra et al., 2006; Royal & Peterson, 2008), existence of a “therapeutic misconception” (Kirschen, Jaworska, & Illes, 2006; Meltzer, 2006; Miller, Mello, & Joffe, 2008; Parker, 2008; Shaw, Senior, Peel, Cooke, & Donnelly, 2008), and issues related to insurability (Apold & Downie, 2011; Check, 2005). Thus far, experts have reached a consensus that researchers are obliged to respond to IFs in some way (Wardlaw et al., 2015; Wolf, Lawrenz, et al., 2008) and proposed some models for handling IFs (Illes et al., 2008; Wolf, Lawrenz, et al., 2008; Cramer et al., 2011; NINDS (National Institute of Neurological Disorders and Stroke), 2005; Shoemaker et al., 2016). However, there is no global consensus on the concrete handling procedures (Borgelt et al., 2013; Underwood, 2012; Wardlaw et al., 2015).…”