Emerging ethical issues raised by highly portable MRI research in remote and resource-limited international settings
Francis X. Shen,
Susan M. Wolf,
Supriya Bhavnani,
Sean Deoni,
Jed T. Elison,
Damien Fair,
Michael Garwood,
Michael S. Gee,
Sairam Geethanath,
Kendrick Kay,
Kelvin O. Lim,
Georgia Lockwood Estrin,
Monica Luciana,
David Peloquin,
Karen Rommelfanger,
Nicoline Schiess,
Khan Siddiqui,
Efraín Torres,
J. Thomas Vaughan
Affiliations
Francis X. Shen
Professor of Law and Faculty Member, Graduate Program in Neuroscience, University of Minnesota; Instructor in Psychology, Harvard Medical School; Executive Director, MGH Center for Law, Brain & Behavior USA; Corresponding author.
Susan M. Wolf
McKnight Presidential Professor of Law, Medicine & Public Policy; Faegre Baker Daniels Professor of Law; Professor of Medicine; Chair, Consortium on Law and Values in Health, Environment & the Life Sciences, University of Minnesota USA
Supriya Bhavnani
Co-Principal Investigator, Child Development Group, Sangath, New Delhi, India
Sean Deoni
Associate Professor of Pediatrics (Research), Associate Professor of Diagnostic Imaging (Research), Brown University; Senior Program Officer, Maternal, Newborn & Child Health Discovery & Tools, Discovery & Translational Sciences, Bill & Melinda Gates Foundation USA
Jed T. Elison
Associate Professor, Institute of Child Development, Department of Pediatrics, University of Minnesota USA
Damien Fair
Redleaf Endowed Director, Masonic Institute for the Developing Brain; Professor, Institute of Child Development, College of Education and Human Development; Professor, Department of Pediatrics, Medical School, University of Minnesota USA
Michael Garwood
Malcolm B. Hanson Professor of Radiology, Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota USA
Michael S. Gee
Vice-Chair of Clinical Operations, Chief of Pediatric Radiology, Pediatric Imaging Research Center Director, Massachusetts General Hospital; Co-Director, Mass General Imaging Global Health Educational Programs USA
Sairam Geethanath
Associate Research Scientist, Columbia Magnetic Resonance Research Center, Columbia University USA
Kendrick Kay
Assistant Professor, Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota USA
Kelvin O. Lim
Professor, Vice-Chair of Research, Drs. T. J. and Ella M. Arneson Land-Grant Chair in Human Behavior, Department of Psychiatry and Behavioral Sciences, University of Minnesota USA
Georgia Lockwood Estrin
Sir Henry Wellcome Postdoctoral Research Fellow, Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck College, University of London UK
Monica Luciana
Professor, Department of Psychology; Adjunct Faculty Member, Institute of Child Development; Core Faculty Member, Center for Neurobehavioral Development, University of Minnesota USA
David Peloquin
Associate, Ropes & Gray LLP USA
Karen Rommelfanger
Director, Neuroethics Program, Center for Ethics; Associate Professor, Departments of Neurology and Psychiatry and Behavioral Sciences, School of Medicine, Emory University USA
Nicoline Schiess
Technical Officer, Brain Health Unit, World Health Organization Switzerland
Khan Siddiqui
Chief Medical Officer and Chief Strategy Officer, Hyperfine USA
Efraín Torres
PhD Candidate in the Department of Biomedical Engineering, NSF GRFP Fellow, University of Minnesota; Garwood Lab member USA
J. Thomas Vaughan
Professor in the Departments of Biomedical Engineering and Radiology, Director of the Columbia Magnetic Resonance Research Center; Principal and Investigator and MR Platform Director of the Zuckerman Institute, Columbia University; Director of the High Field Imaging Lab, Nathan Kline Institute USA
Smaller, more affordable, and more portable MRI brain scanners offer exciting opportunities to address unmet research needs and long-standing health inequities in remote and resource-limited international settings. Field-based neuroimaging research in low- and middle-income countries (LMICs) can improve local capacity to conduct both structural and functional neuroscience studies, expand knowledge of brain injury and neuropsychiatric and neurodevelopmental disorders, and ultimately improve the timeliness and quality of clinical diagnosis and treatment around the globe. Facilitating MRI research in remote settings can also diversify reference databases in neuroscience, improve understanding of brain development and degeneration across the lifespan in diverse populations, and help to create reliable measurements of infant and child development. These deeper understandings can lead to new strategies for collaborating with communities to mitigate and hopefully overcome challenges that negatively impact brain development and quality of life. Despite the potential importance of research using highly portable MRI in remote and resource-limited settings, there is little analysis of the attendant ethical, legal, and social issues (ELSI). To begin addressing this gap, this paper presents findings from the first phase of an envisioned multi-staged and iterative approach for creating ethical and legal guidance in a complex global landscape. Section 1 provides a brief introduction to the emerging technology for field-based MRI research. Section 2 presents our methodology for generating plausible use cases for MRI research in remote and resource-limited settings and identifying associated ELSI issues. Section 3 analyzes core ELSI issues in designing and conducting field-based MRI research in remote, resource-limited settings and offers recommendations. We argue that a guiding principle for field-based MRI research in these contexts should be including local communities and research participants throughout the research process in order to create sustained local value. Section 4 presents a recommended path for the next phase of work that could further adapt these use cases, address ethical and legal issues, and co-develop guidance in partnership with local communities.