Managing incidental findings in total body PET/CT studies: balancing ethical considerations and resource constraints

Total body positron emission tomography (TB-PET) represents a major advancement in molecular imaging. While this technology expands the capabilities of PET imaging for both research and clinical applications, it also introduces significant ethical and operational challenges, particularly in the management of incidental findings. Current ethical and regulatory guidance acknowledge the need to address incidental findings that arise during research studies, but often provides ambiguous or insufficient direction. This leaves institutions to independently balance participant safety, ethical responsibilities, and resource constraints. Using the Australian National Total Body PET Facility as a case study, this article explores strategies for managing incidental findings in PET/CT research. By comparing research workflows with clinical practices, we highlight critical differences and propose a practical framework to help institutions establish ethically sound and feasible protocols. This framework aims to balance the duty of care to the participant with the logistical demands of PET research, contributing to the ongoing discourse on ethical imaging practices and offering guidance for managers of TB-PET research facilities.