Ethical Concerns with Portable MRIs in Research

By Stacey Kusterbeck

New portable magnetic resonance imaging (MRI) technologies are being developed, allowing study investigators to conduct field-based research in remote settings. “Rather than participants traveling to the scanner, now the scanner will travel to them,” says Francis Shen, PhD, a professor of law at University of Minnesota and member of Harvard Medical School’s Center for Bioethics. Shen and colleagues saw a need to provide ethical and legal guidance for research with these new types of MRI machines.

“We were especially concerned about portable MRI research in community settings, outside the hospital,” says Shen. The group developed recommendations for portable MRI technology, including ethical concerns, and identified 15 core issues to be addressed.¹ These include:

• Technology quality control.

The introduction of portable MRI technologies means that new users, some with less experience with MRI research, are using MRI in new locations. There also is increased variation in image resolution. All those factors raise concerns about researchers’ ability to maintain quality control. “Ensuring quality control is important to ensure the quality of the acquired brain data,” explains Shen.

• Safety of research participants and others in the scanning environment.

Traditional MRI is fixed in place behind locked doors. In contrast, portable MRI machines may be placed in school gymnasiums or parking lots. “It is important to ensure that the scanner is safely set up and also that the scanning environment is controlled to provide participants with sufficient privacy,” says Shen.

• Engagement of diverse participants.

Portable MRI research will reach communities and participants who have not previously participated in MRI research studies. In this way, portable MRI machines facilitate the inclusion of rural and economically disadvantaged study participants. For example, the working group examined the possibility of portable MRI for research with indigenous communities, and for research with participants who live far from hospitals with MRI facilities.

“This has great potential to improve the representativeness of MRI research. But at the same time, it will require researchers to develop strong relationships with the new communities in which they are conducting MRI research,” says Shen.

• Therapeutic misconception.

Study participants might mistakenly view neuroimaging research as clinical care. “While this could be the case with traditional MRI as well, the therapeutic misconception might be of particular concern when MRI research is being conducted with participants in a community that has not previously had adequate access to clinical MRI,” says Shen. Researchers should directly confront this issue by explaining the difference between research and clinical neuroimaging and by clearly identifying their MRI use as research, assert the authors.

• Return of results and managing incidental findings.

A portable MRI research study could reveal a concerning brain finding. The research team needs to prepare for the possibility that research participants who are geographically remote and far from a hospital might then need a pathway to follow-up evaluation based on the incidental finding. “We argue that researchers should ensure pathways to timely care in the event of concerning research results, regardless of the participant’s geographic location, insurance status, and ability to pay for care,” says Shen.

• Research participant data access and control.

“Researchers should alert participants that they are entitled to request their data and scans,” says Shen. Providing individuals with access to their data displays respect for individuals’ autonomy and their rights of agency and control over their data, according to the working group.

• Concerns about “helicopter research.”

This refers to research teams coming to rural locations, collecting data, and then just moving on. “We emphasize the importance of deep community engagement before, during, and after the portable MRI research study,” says Shen.

Before a study, researchers can visit the community to establish relationships with community leaders. During the scanning, researchers can obtain feedback from community partners and address any concerns that arise. “After the study concludes, researchers can maintain communications with the community by sharing research results,” says Shen.

REFERENCE

1. Shen FX, Wolf SM, Lawrenz F, et al. Ethical, legal, and policy challenges in field-based neuroimaging research using emerging portable MRI technologies: Guidance for investigators and for oversight. J Law Biosci 2024;11:lsae008.