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A practical approach to incidental findings in neuroimaging research
J M Shoemaker1, M T Holdsworth, C Aine
1Mind Research Network, Albuquerque, NM, USA. jroberts@mrn.org
Objective:
We describe the systematic approach to incidental findings (IFs) used at the Mind Research Network (MRN) where all MRI scans receive neuroradiologist interpretation and participants are provided results.
Methods:
From 2004 to 2011, 8,545 MRI scans were acquired by 45 researchers. As mandated by MRN's external institutional review board, all structural sequences were evaluated by a clinical neuroradiologist who generated a report that included recommendations for referral if indicated. Investigators received a copy of their participants' reports, which were also mailed to participants unless they specifically declined. To better understand the impact of the radiology review process, a financial analysis was completed in addition to a follow-up phone survey to characterize participant perceptions regarding receiving their MRI scan results.
Results:
The radiologist identified IFs in 34% of the 4,447 participants. Of those with IFs (n = 1,518), the radiologist recommended urgent or immediate referral for 2.5% and routine referral for 17%. For 80.5%, no referral was recommended. Estimated annual cost for this approach including support for the neuroradiologist, medical director, and ancillary staff is approximately $60,000 or $24/scan. The results of the retrospective phone survey showed that 92% of participants appreciated receiving their MRI report, and the majority stated it increased their likelihood of volunteering for future studies.
Conclusions:
Addressing IFs in a cost-effective and consistent manner is possible by adopting a policy that provides neuroradiology interpretation and offers participant assistance with clinical follow-up when necessary. Our experience suggests that an ethical, institution-wide approach to IFs can be implemented with minimal investigator burden.
Insights
A systematic approach to incidental findings (IFs) on MRI scans, including neuroradiologist interpretation and participant results, is cost-effective. This method ensures ethical care and enhances participant trust, encouraging future research involvement.
Area of Science:
- Neuroimaging
- Radiology
- Medical Ethics
Background:
- Incidental findings (IFs) are common in neuroimaging research.
- A consistent approach to managing IFs is crucial for participant welfare and ethical research conduct.
Purpose of the Study:
- To describe and evaluate a systematic approach to incidental findings (IFs) in MRI scans at the Mind Research Network (MRN).
- To assess the cost-effectiveness and participant perceptions of providing neuroradiologist interpretation and results for IFs.
Main Methods:
- Systematic review of 8,545 MRI scans acquired between 2004-2011.
- Neuroradiologist interpretation of all structural MRI sequences.
- Financial analysis and participant phone survey to assess cost and perceptions.
Main Results:
- Incidental findings were identified in 34% of participants.
- 2.5% of IFs required urgent referral, 17% routine referral, and 80.5% no referral.
- The annual cost was approximately $60,000 ($24/scan), with 92% of participants appreciating receiving their results.
Conclusions:
- A policy providing neuroradiology interpretation and facilitating clinical follow-up for IFs is cost-effective and consistent.
- An ethical, institution-wide approach to IFs can be implemented with minimal investigator burden.
- Providing MRI results enhances participant trust and willingness to participate in future research.
