The high incidence and bioethics of findings on magnetic resonance brain imaging of normal volunteers for neuroscience research

• Published in: Journal of medical ethics Vol. 35; no. 3; pp. 194 - 199
• Main Authors: Hoggard, N, Darwent, G, Capener, D, Wilkinson, I D, Griffiths, P D
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Institute of Medical Ethics 01.03.2009; Institute of Medical Ethics and BMJ Publishing Group; BMJ Publishing Group Ltd; BMJ Publishing Group LTD
• Subjects: Adult; Aged; Aged, 80 and over; Aneurysms; Bioethical Issues; Bioethics; Brain; Brain Diseases - diagnosis; Brain research; Family physicians; Female; Health aspects; Human Experimentation; Humans; Imaging; Incidental Findings; Magnetic resonance imaging; Magnetic Resonance Imaging - ethics; Male; Medical examination; Medical imaging; Medical referrals; Medical research; Medical research volunteers; Middle Aged; Neuroimaging; Neurosciences; Pathology; Physicians; Physiological aspects; Primary health care; Research Ethics; Research studies; Scanners; Truth Disclosure - ethics; Tumors; Volunteerism; Volunteers; Young Adult
• ISSN: 0306-6800; 1473-4257
• DOI: 10.1136/jme.2008.025502

Background: We were finding volunteers for functional magnetic resonance imaging studies with abnormalities requiring referral surprisingly frequently. The bioethics surrounding the incidental findings are not straightforward and every imaging institution will encounter this situation in their normal volunteers. Yet the implications for the individuals involved may be profound. Should all participants have review of their imaging by an expert and who should be informed? Methods: The normal volunteers that were imaged with magnetic resonance (MR) which were reviewed by a consultant neuroradiologist. All participants completed a volunteer consent form in addition to a standard departmental MR safety screening form. The volunteer screening form requires the general practitioner details to be completed and asks the participant to consider closely the possibility and implications of finding an unexpected but potentially serious abnormality before signing. Results: 525 different individuals were scanned as normal volunteers, the mean age was 35-years and 330 were males. Of these 525, 46 had definite significant abnormalities (8.8%), mean age 50-years. Conclusion: We have found a high rate of incidental abnormalities amongst individuals participating in imaging studies at our institution. It is our current practice to inform the research study participant of the findings, counsel them and inform their primary care physician. We think that it is advisable for researchers utilising MR imaging of the brain to have access to trained neuroradiologists, a protocol in place to deal with this problem and take consent in a way that allows the participant to realise the possibility of an abnormal finding.