Potentially relevant incidental findings on research whole-body MRI in the general adult population: frequencies and management

Hegenscheid, Katrin; Seipel, Rebecca; Schmidt, Carsten Oliver; Völzke, Henry; Kühn, Jens‐Peter; Biffar, Reiner; Kroemer, Heyo K.; Hosten, Norbert; Puls, Ralf

doi:10.1007/s00330-012-2636-6

Cited by 128 publications

(168 citation statements)

References 42 publications

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“…The prevalence in other whole-body MRI studies of healthy populations ranged from 12.8% to 57.6% [15][16][17][18] . Since those studies used similar MRI sequences applied to similar tissue volumes, variations in prevalence are most likely to have arisen from differences in the definition of IFs, or in the age and other characteristics of the imaged populations.…”

Section: Discussionmentioning

confidence: 99%

Impact of detecting potentially serious incidental findings during multi-modal imaging

Gibson¹,

Littlejohns²,

Adamska³

et al. 2017

Wellcome Open Res

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There are limited data on the impact of feedback of incidental Background findings (IFs) from research imaging. We evaluated the impact of UK Biobank's protocol for handling potentially serious IFs in a multi-modal imaging study of 100,000 participants (radiographer 'flagging' with radiologist confirmation of potentially serious IFs) compared with systematic radiologist review of all images.: Brain, cardiac and body magnetic resonance, and dual-energy x-ray Methods absorptiometry scans from the first 1000 imaged UK Biobank participants were independently assessed for potentially serious IFs using both protocols. We surveyed participants with potentially serious IFs and their GPs up to six months after imaging to determine subsequent clinical assessments, final diagnoses, emotional, financial and work or activity impacts.: : Compared with systematic radiologist review, radiographer Conclusions flagging missed some serious diagnoses, but avoided adverse impacts for many participants with non-serious diagnoses. While systematic radiologist review may benefit some participants, UK Biobank's responsibility to avoid both unnecessary harm to larger numbers of participants and burdening of publicly-funded health services suggests that radiographer flagging is a justifiable approach in the UK Biobank imaging study. The potential scale of non-serious final diagnoses raises questions relating to handling IFs in other settings, such as commercial and public health screening.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of detecting potentially serious incidental findings during multi-modal imaging

Gibson¹,

Littlejohns²,

Adamska³

et al. 2017

Wellcome Open Res

View full text Add to dashboard Cite

show abstract

“…The prevalence in other whole-body MRI studies of healthy populations ranged from 12.8% to 57.6% 15– 18 . Since those studies used similar MRI sequences applied to similar tissue volumes, variations in prevalence are most likely to have arisen from differences in the definition of IFs, or in the age and other characteristics of the imaged populations.…”

Section: Discussionmentioning

confidence: 97%

Impact of detecting potentially serious incidental findings during multi-modal imaging

Gibson¹,

Littlejohns²,

Adamska³

et al. 2018

Wellcome Open Res

View full text Add to dashboard Cite

Background: There are limited data on the impact of feedback of incidental findings (IFs) from research imaging. We evaluated the impact of UK Biobank’s protocol for handling potentially serious IFs in a multi-modal imaging study of 100,000 participants (radiographer ‘flagging’ with radiologist confirmation of potentially serious IFs) compared with systematic radiologist review of all images. Methods: Brain, cardiac and body magnetic resonance, and dual-energy x-ray absorptiometry scans from the first 1000 imaged UK Biobank participants were independently assessed for potentially serious IFs using both protocols. We surveyed participants with potentially serious IFs and their GPs up to six months after imaging to determine subsequent clinical assessments, final diagnoses, emotional, financial and work or activity impacts. Results: Compared to systematic radiologist review, radiographer flagging resulted in substantially fewer participants with potentially serious IFs (179/1000 [17.9%] versus 18/1000 [1.8%]) and a higher proportion with serious final diagnoses (21/179 [11.7%] versus 5/18 [27.8%]). Radiographer flagging missed 16/21 serious final diagnoses (i.e., false negatives), while systematic radiologist review generated large numbers of non-serious final diagnoses (158/179) (i.e., false positives). Almost all (90%) participants had further clinical assessment (including invasive procedures in similar numbers with serious and non-serious final diagnoses [11 and 12 respectively]), with additional impact on emotional wellbeing (16.9%), finances (8.9%), and work or activities (5.6%). Conclusions: Compared with systematic radiologist review, radiographer flagging missed some serious diagnoses, but avoided adverse impacts for many participants with non-serious diagnoses. While systematic radiologist review may benefit some participants, UK Biobank’s responsibility to avoid both unnecessary harm to larger numbers of participants and burdening of publicly-funded health services suggests that radiographer flagging is a justifiable approach in the UK Biobank imaging study. The potential scale of non-serious final diagnoses raises questions relating to handling IFs in other settings, such as commercial and public health screening.

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“…Preventive health checks enjoy rising popularity among healthy people, although the health benefits have never been demonstrated [7]. Particularly, a fullbody scan by magnetic resonance imaging (MRI) is commercially exploited and is advertised as a screening test to detect cancer early: ''Better safe than sorry'' [8]. The Se and Sp of MRI for the screening of cancer have never been assessed, and the nearest comparable imaging technique we found was 18F-fluorodeoxyglucose-positron emission tomography combined with computerized axial tomography (FDG-PET/CT) for the detection of unknown primary cancers.…”

Section: ''Low Risk''dearly Cancer Detection By Full-body Scansmentioning

confidence: 99%

The indication area of a diagnostic test. Part I—discounting gain and loss in diagnostic certainty

Stalpers¹,

Nelemans²,

Geurts³

et al. 2015

Journal of Clinical Epidemiology

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Potentially relevant incidental findings on research whole-body MRI in the general adult population: frequencies and management

Abstract: Potentially relevant incidental findings are very common in wb-MRI research but the nature of these findings remains unclear in most cases. This requires dedicated management to protect subjects' welfare and research integrity.

Cited by 128 publications

References 42 publications

Impact of detecting potentially serious incidental findings during multi-modal imaging

Impact of detecting potentially serious incidental findings during multi-modal imaging

Impact of detecting potentially serious incidental findings during multi-modal imaging

The indication area of a diagnostic test. Part I—discounting gain and loss in diagnostic certainty

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