With the rapid advances in neurosciences in the last three decades, there has been an exponential increase in the use of neuroimaging both in basic sciences and clinical research involving human subjects. During routine neuroimaging, incidental findings that are not part of the protocol or scope of research agenda can occur and they often pose a challenge as to how they should be handled to abide by the medicolegal principles of research ethics. This paper reviews the issue from various ethical (do no harm, general duty to rescue, and mutual benefits and owing) and medicolegal perspectives (legal liability, fiduciary duties, Law of Tort, and Law of Contract) with a suggested protocol of approach. 1. Introduction Modern scientific research often involves recruitment of human participants, and in the field of neuroimaging research employing various methods based on nuclear magnetic resonance, it is often a routine to obtain high-resolution structural scans of the brain and spinal cord as a template for subsequent interpolation of data. During such routine scans, it is not unusual to discover incidental abnormalities which are pure incidental findings not relevant to the actual research but can be life endangering to the participants if they are not pursued further. The question arises as to whether these otherwise healthy participants need to be informed, and if so, in what way, and finally, what needs to be done in the best interests of the participants to abide by the legal and ethical principles in research and medicine. Despite the prevalence of incidental findings of up to 10% in neuroimaging research, there is as yet a clear and unambiguous set of guidelines for dealing with incidental findings, and most researchers may not know how to deal with them [1]. A recent survey also showed that actual knowledge of the issue and logistics of management differ widely [2]. 2. Case Scenario FE, a 65-year-old lady who volunteered for an fMRI study for osteoarthritic knee pain, was incidentally found to have ischemic changes in the left temporal lobe during a base-line structural brain scan. She did not develop any neurological deficit, nor did she complain of any discomfort during the process of scanning. As the Principal Investigator of the study is a qualified clinician, he decided to withdraw FE from the study in her best interests. In view of her preexisting comorbidity of cardiac arrhythmias and diabetes, the PI decided to disclose the incidental findings to the participant in anticipation of further investigations and management. With the participant’s
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