Incidental findings in neuroimaging research: a framework for anticipating the next frontier

While strategies for handling unusual and possibly clinically significant anatomical findings on brain scans of research volunteers have been developed and implemented across neuroimaging laboratories worldwide, few concrete steps have been taken to consider the next frontier: functional anomalies. Drawing on the genetics literature, early work in neuroimaging considered actionability to be a driving force for determining if and when findings should be disclosed to individuals in whom they are detected, as inherent uncertainty raises potential ethical dilemmas of misdiagnosing and mislabelling people as patients. Here we consider the possibility of incidental findings in brain function during the resting state. Our approach does not anchor the resting state as the sine qua non of functional incidental findings, but as a path to thinking about where they may emerge in the future and how our professional communities need to think about thinking about them. We suggest that considering the issues proactively today, within a framework that is maximally flexible and open to modification, is better than responding reactively after the fact and with no framework at all. We argue that there is a duty to consider possible incidental findings despite the ambiguities of data interpretation, while working hard to prevent unnecessary alarm.