Incidental findings in clinical imaging: should patient consent be obtained before disclosure?

Seminal ethical guidelines regarding the management of incidental findings (IFs) in medicine recommend to obtain, in as far as practically possible, patients' informed consent regarding the disclosure of IFs arising from genetic tests or imaging procedures in clinical and research settings. In clinical genetics, genetics research and imaging research, patients' consent regarding the disclosure of IFs is standardly obtained. In clinical imaging, however, patients' consent regarding the disclosure of IFs is not systematically obtained. This raises the question whether there are theoretical and/or practical reasons for not obtaining patients' consent regarding the disclosure of IFs in clinical imaging. In this paper, I do two things. First, I offer a theoretical argument by analogy in favour of obtaining patients' informed consent regarding the disclosure of IFs in clinical imaging. Second, I develop a context-specific consent model, thereby mitigating important practical concerns regarding the feasibility of obtaining patients' consent in that context. However, the road towards implementation remains long and myriad practical difficulties remain. Therefore, my argument is not meant to show that obtaining patients' consent regarding the disclosure of IFs in clinical imaging is overall desirable, but that the burden of proof lies on those who wish to deny that obtaining patients' consent regarding the disclosure of IFs in clinical imaging is both theoretically desirable and practically feasible. I thereby strengthen previous calls for a more patient-centered radiology.