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'Pandora's box' of incidental findings in brain imaging research

Nature Clinical Practice Neurology volume 2, pages 60–61 (2006)Cite this article

The title of Grossman and Bernat's editorial1 'Incidental research imaging findings: Pandora's costly box' captures perfectly the discussion, and sometimes heated debate, about the complexity of handling such findings in research. The debate centers on a scenario involving an imaging protocol and a research subject who has a brain anomaly. If the subject is a healthy control, the anomaly is unexpected. If the subject is a patient, the anomaly is unrelated to the purpose of the imaging study.

The important choices about what to do with such a finding are indeed all potentially costly. The choices can be appreciated in relation to axes of an imagined 3-dimensional problem space: incidence and significance (x-axis), disclosure (y-axis), and duty of care (z-axis). I will discuss these dimensions in terms of ongoing work and the state of the current discussions and argue that, although the scientific community must vigorously continue its solution-seeking efforts, there will ultimately be no single approach to the problem space defined by these dimensions. A minimum set of practice standards are needed to enable investigators to protect their participants, to insure that participants understand the limitations of those protections, and to promote trust and reciprocity in the research process.

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References

  1. Grossman RI and Bernat JL (2004) Incidental research imaging findings: Pandora's costly box. Neurology 62: 849–850

    Article  Google Scholar 

  2. Kim BS et al. (2002) Incidental findings on pediatric MR images of the brain. AJNR Am J Neuroradiol 23: 1674–1677

    PubMed  Google Scholar 

  3. Katzman GL et al. (1999) Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 281: 36–39

    Article  Google Scholar 

  4. Illes J et al. (2004) Ethical consideration of incidental findings on adult brain MRI in research. Neurology 62: 888–890

    Article  CAS  Google Scholar 

  5. CBTRUS (2004) Statistical report: primary brain tumors in the United States, 1997–2001. [http://www.cbtrus.org/reports//2004-2005/2005report.pdf] (accessed 28 November 2005)

  6. Weber F and Knopf H (2005) Incidental findings in magnetic resonance imaging of the brains of healthy young men. J Neurol Sci [10.1016/j.jns.2005.09.008]

  7. Illes J et al. (2004) Discovery and disclosure of incidental findings in neuroimaging research. J Magn Reson Imaging 20: 743–747

    Article  Google Scholar 

  8. Kirschen MP et al.: Subjects' expectations in neuroimaging research. J Magn Reson Imaging, in press

  9. Wachbroit R (1998) The question not asked: the challenge of pleiotropic genetic tests. Kennedy Inst Ethics J 8: 131–144

    Article  Google Scholar 

Download references

Acknowledgements

The ongoing work of the Planning and Working Groups on Incidental Findings, Dr E Edwards, Co-chair, is gratefully acknowledged. The author also acknowledges Dr D Magnus for helpful discussions. Supported by NIH NS 045831.

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  1. Program in Neuroethics, Lecturer, and Senior Research Scholar at Stanford University, Stanford, CA, USA

    Judy Illes

  2. Center for Biomedical Ethics and the Department of Radiology,

    Judy Illes

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  1. Judy Illes
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The author declares no competing financial interests.

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Illes, J. 'Pandora's box' of incidental findings in brain imaging research. Nat Rev Neurol 2, 60–61 (2006). https://doi.org/10.1038/ncpneuro0119

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