Incidental Findings in Neuroimaging Research: Ethical Considerations

Neuroimaging-especially functional MR imaging (fMRI)-opens the door to non-invasively map cortical processing and to understand how our brain works. fMRI evolved from basic (Ogawa et al., Proc Natl Acad Sci U S A 87: 9868-9872, 1990; Ogawa et al., Biophys J 64: 803-812, 1993; Kwong et al., Proc Natl Acad Sci U S A 89: 5675-5679, 1992) and clinical applications in the 1990s (Yousry et al., Radiology 195: 23-29, 1995) to become a powerful and ubiquitous tool in neurocognitive research. Because fMRI can be used to answer clinical questions, the more the research conducted, the greater the potential for clinical translation and subsequent patient benefit. This book focuses on the clinical applications of fMRI; however, prior to any routine clinical use, there is a need to test its reliability in healthy controls. The focus of this chapter is on ethical questions raised by incidental findings (IF) in fMRI in healthy volunteers and the conclusions to be drawn. Considering ethical issues is important in patient care but should be taken even more serious in healthy volunteers. Ethical issues relevant to fMRI concern how the requirements of voluntary participation and privacy are handled by the researchers (Carli et al., J Med Ethics 38: 127-129, 2012), how harm is prevented and whether appropriate information and decisional aids are offered to the subjects or patients before obtaining informed consent (Reiter-Theil and Stingelin Giles, Screening and preventive diagnosis with radiological imaging, Springer, Berlin 2007). Because an IF can have a major impact on the subject’s life, the management pertaining to such a discovery should be analysed thoroughly (Ulmer et al., AJNR Am J Neuroradiol 30: E55, 2009).