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Long-Term Psychosocial Consequences of Whole-Body Magnetic Resonance Imaging and Reporting of Incidental Findings in a Population-Based Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12102356. [PMID: 36292045 PMCID: PMC9600583 DOI: 10.3390/diagnostics12102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/19/2022] [Accepted: 09/25/2022] [Indexed: 11/16/2022] Open
Abstract
Management of radiological incidental findings (IF) is of rising importance; however, psychosocial implications of IF reporting remain unclear. We compared long-term psychosocial effects between individuals who underwent whole-body magnetic resonance imaging (MRI) with and without reported IF, and individuals who did not undergo imaging. We used a longitudinal population-based cohort from Western Europe. Longitudinal analysis included three examinations (exam 1, 6 years prior to MRI; exam 2, MRI; exam 3, 4 years after MRI). Psychosocial outcomes included PHQ-9 (Patient Health Questionnaire), DEEX (Depression and Exhaustion Scale), PSS-10 (Perceived Stress Scale) and a Somatization Scale. Univariate analyses and adjusted linear mixed models were calculated. Among 855 included individuals, 25% (n = 212) underwent MRI and 6% (n = 50) had at least one reported IF. Compared to MRI participants, non-participants had a higher psychosocial burden indicated by PHQ-9 in exam 1 (3.3 ± 3.3 vs. 2.5 ± 2.3) and DEEX (8.6 ± 4.7 vs. 7.7 ± 4.4), Somatization Scale (5.9 ± 4.3 vs. 4.8 ± 3.8) and PSS-10 (14.7 ± 5.7 vs. 13.7 ± 5.3, all p < 0.05) in exam 3. MRI participation without IF reporting was significantly associated with lower values of DEEX, PHQ-9 and Somatization Scale. There were no significant differences at the three timepoints between MRI participants with and without IF. In conclusion, individuals who voluntarily participated in whole-body MRI had less psychosocial burden and imaging and IF reporting were not associated with adverse long-term psychosocial consequences. However, due to the study design we cannot conclude that the MRI exam itself represented a beneficial intervention causing improvement in mental health scores.
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Usher-Smith JA, Godoy A, Burge SW, Burbidge S, Cartledge J, Crosbie PAJ, Eckert C, Farquhar F, Hammond D, Hancock N, Iball GR, Kimuli M, Masson G, Neal RD, Rogerson S, Rossi SH, Sala E, Smith A, Sharp SJ, Simmonds I, Wallace T, Ward M, Callister MEJ, Stewart GD. The Yorkshire Kidney Screening Trial (YKST): protocol for a feasibility study of adding non-contrast abdominal CT scanning to screen for kidney cancer and other abdominal pathology within a trial of community-based CT screening for lung cancer. BMJ Open 2022; 12:e063018. [PMID: 36127097 PMCID: PMC9490622 DOI: 10.1136/bmjopen-2022-063018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Kidney cancer (renal cell cancer (RCC)) is the seventh most common cancer in the UK. As RCC is largely curable if detected at an early stage and most patients have no symptoms, there is international interest in evaluating a screening programme for RCC. The Yorkshire Kidney Screening Trial (YKST) will assess the feasibility of adding non-contrast abdominal CT scanning to screen for RCC and other abdominal pathology within the Yorkshire Lung Screening Trial (YLST), a randomised trial of community-based CT screening for lung cancer. METHODS AND ANALYSIS In YLST, ever-smokers aged 55-80 years registered with a general practice in Leeds have been randomised to a Lung Health Check assessment, including a thoracic low-dose CT (LDCT) for those at high risk of lung cancer, or routine care. YLST participants randomised to the Lung Health Check arm who attend for the second round of screening at 2 years without a history of RCC or abdominal CT scan within the previous 6 months will be invited to take part in YKST. We anticipate inviting 4700 participants. Those who consent will have an abdominal CT immediately following their YLST thoracic LDCT. A subset of participants and the healthcare workers involved will be invited to take part in a qualitative interview. Primary objectives are to quantify the uptake of the abdominal CT, assess the acceptability of the combined screening approach and pilot the majority of procedures for a subsequent randomised controlled trial of RCC screening within lung cancer screening. ETHICS AND DISSEMINATION YKST was approved by the North West-Preston Research Ethics Committee (21/NW/0021), and the Health Research Authority on 3 February 2021. Trial results will be disseminated at clinical meetings, in peer-reviewed journals and to policy-makers. Findings will be made available to participants via the study website (www.YKST.org). TRIAL REGISTRATION NUMBERS NCT05005195 and ISRCTN18055040.
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Affiliation(s)
- Juliet A Usher-Smith
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Angela Godoy
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Sarah W Burge
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Simon Burbidge
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK, Leeds, UK
| | - Jon Cartledge
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK, Leeds, UK
| | - Philip A J Crosbie
- Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Claire Eckert
- Leeds Institiute of Health Sciences, University of Leeds, Leeds, UK
| | - Fiona Farquhar
- Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - David Hammond
- Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Neil Hancock
- Leeds Diagnosis & Screening Unit, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Gareth R Iball
- Department of Medical Physics & Engineering, Leeds teaching hospitals NHS Trust, Leeds, UK
| | - Michael Kimuli
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK, Leeds, UK
| | - Golnessa Masson
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Pitcairn Practice, Balmullo Surgery, Fife, UK
| | - Richard D Neal
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Suzanne Rogerson
- Research and Innovation, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sabrina H Rossi
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Evis Sala
- Department of Radiology, University of Cambridge, Cambridge, UK
- Department of Radiology, Catholic University Sacro Cuore and Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Andrew Smith
- Upper Gastro-intestinal and Pancreas Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Irene Simmonds
- Leeds Institiute of Health Sciences, University of Leeds, Leeds, UK
| | - Tom Wallace
- Leeds Vascular Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthew Ward
- Leeds Institiute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Grant D Stewart
- Department of Surgery, University of Cambridge, Cambridge, UK
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Genomic health data generation in the UK: a 360 view. Eur J Hum Genet 2022; 30:782-789. [PMID: 34663916 PMCID: PMC8523282 DOI: 10.1038/s41431-021-00976-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/25/2021] [Accepted: 09/27/2021] [Indexed: 12/24/2022] Open
Abstract
In the UK, genomic health data is being generated in three major contexts: the healthcare system (based on clinical indication), in large scale research programmes, and for purchasers of direct-to-consumer genetic tests. The recently delivered hybrid clinical/research programme, 100,000 Genomes Project set the scene for a new Genomic Medicine Service, through which the National Health Service aims to deliver consistent and equitable care informed by genomics, while providing data to inform academic and industry research and development. In parallel, a large scale research study, Our Future Health, has UK Government and Industry investment and aims to recruit 5 million volunteers to support research intended to improve early detection, risk stratification, and early intervention for chronic diseases. To explore how current models of genomic health data generation intersect, and to understand clinical, ethical, legal, policy and social issues arising from this intersection, we conducted a series of five multidisciplinary panel discussions attended by 28 invited stakeholders. Meetings were recorded and transcribed. We present a summary of issues identified: genomic test attributes; reasons for generating genomic health data; individuals' motivation to seek genomic data; health service impacts; role of genetic counseling; equity; data uses and security; consent; governance and regulation. We conclude with some suggestions for policy consideration.
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Akyüz K, Chassang G, Goisauf M, Kozera Ł, Mezinska S, Tzortzatou O, Mayrhofer MT. Biobanking and risk assessment: a comprehensive typology of risks for an adaptive risk governance. LIFE SCIENCES, SOCIETY AND POLICY 2021; 17:10. [PMID: 34903285 PMCID: PMC8666836 DOI: 10.1186/s40504-021-00117-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/01/2021] [Indexed: 05/03/2023]
Abstract
Biobanks act as the custodians for the access to and responsible use of human biological samples and related data that have been generously donated by individuals to serve the public interest and scientific advances in the health research realm. Risk assessment has become a daily practice for biobanks and has been discussed from different perspectives. This paper aims to provide a literature review on risk assessment in order to put together a comprehensive typology of diverse risks biobanks could potentially face. Methodologically set as a typology, the conceptual approach used in this paper is based on the interdisciplinary analysis of scientific literature, the relevant ethical and legal instruments and practices in biobanking to identify how risks are assessed, considered and mitigated. Through an interdisciplinary mapping exercise, we have produced a typology of potential risks in biobanking, taking into consideration the perspectives of different stakeholders, such as institutional actors and publics, including participants and representative organizations. With this approach, we have identified the following risk types: economic, infrastructural, institutional, research community risks and participant's risks. The paper concludes by highlighting the necessity of an adaptive risk governance as an integral part of good governance in biobanking. In this regard, it contributes to sustainability in biobanking by assisting in the design of relevant risk management practices, where they are not already in place or require an update. The typology is intended to be useful from the early stages of establishing such a complex and multileveled biomedical infrastructure as well as to provide a catalogue of risks for improving the risk management practices already in place.
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Affiliation(s)
- Kaya Akyüz
- BBMRI-ERIC, Graz, Austria.
- Department of Science and Technology Studies, University of Vienna, Vienna, Austria.
| | - Gauthier Chassang
- BBMRI-ERIC, Graz, Austria
- CERPOP, Université de Toulouse, Inserm, Université Paul Sabatier, Toulouse, France
| | - Melanie Goisauf
- BBMRI-ERIC, Graz, Austria
- Department of Science and Technology Studies, University of Vienna, Vienna, Austria
| | | | - Signe Mezinska
- BBMRI-ERIC, Graz, Austria
- Institute of Clinical and Preventive Medicine, University of Latvia, Riga, Latvia
| | - Olga Tzortzatou
- BBMRI-ERIC, Graz, Austria
- Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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Luu JM, Sergeant AK, Anand SS, Desai D, Schulze K, Knoppers BM, Zawati MH, Smith EE, Moody AR, Black SE, Larose E, Marcotte F, Kleiderman E, Tardif JC, Lee DS, Friedrich MG. The impact of reporting magnetic resonance imaging incidental findings in the Canadian alliance for healthy hearts and minds cohort. BMC Med Ethics 2021; 22:145. [PMID: 34711210 PMCID: PMC8551943 DOI: 10.1186/s12910-021-00706-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 09/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies. METHODS Between 2013 and 2019, 8252 participants (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported. RESULTS Severe structural abnormalities occurred in 8.3% (95% confidence interval 7.7-8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy. CONCLUSION The management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT02220582 .
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Affiliation(s)
- Judy M Luu
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Anand K Sergeant
- Arts and Science Program, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada. .,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Dipika Desai
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada
| | - Karleen Schulze
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, 237 Barton St East, Hamilton, ON, L8L 2X2, Canada.,Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Bartha M Knoppers
- Centre of Genomics and Policy, McGill University, 740 Dr Penfield Ave, Suite 5200, Montréal, QC, H3A 0G1, Canada
| | - Ma'n H Zawati
- Centre of Genomics and Policy, McGill University, 740 Dr Penfield Ave, Suite 5200, Montréal, QC, H3A 0G1, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
| | - Alan R Moody
- Department of Medical Imaging, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - Sandra E Black
- Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Eric Larose
- Institut Universitaire de Cardiologie Et de Pneumologie de Québec - Université Laval, 2725 chemin Sainte-Foy, Québec, G1V 4G5, Canada
| | - Francois Marcotte
- School of Population and Public Health and Cancer Control Research, BC Cancer, University of British Columbia, 675 W 10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Erika Kleiderman
- Centre of Genomics and Policy, McGill University, 740 Dr Penfield Ave, Suite 5200, Montréal, QC, H3A 0G1, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada
| | - Douglas S Lee
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Matthias G Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
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Soumaré A, Beguedou N, Laurent A, Brochet B, Bordes C, Mournet S, Mellet E, Pereira E, Pollet C, Lachaize M, Mougin M, Tsuchida A, Loiseau H, Tourdias T, Tzourio C, Mazoyer B, Debette S. Prevalence, Severity, and Clinical Management of Brain Incidental Findings in Healthy Young Adults: MRi-Share Cross-Sectional Study. Front Neurol 2021; 12:675244. [PMID: 34093421 PMCID: PMC8173138 DOI: 10.3389/fneur.2021.675244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/19/2021] [Indexed: 01/17/2023] Open
Abstract
Background and Objectives: Young adults represent an increasingly large proportion of healthy volunteers in brain imaging research, but descriptions of incidental findings (IFs) in this age group are scarce. We aimed to assess the prevalence and severity of IFs on brain MRIs of healthy young research participants aged 18-35 years, and to describe the protocol implemented to handle them. Methods: The study population comprised 1,867 participants aged 22.1 ± 2.3 years (72% women) from MRi-Share, the cross-sectional brain MRI substudy of the i-Share student cohort. IFs were flagged during the MRI quality control. We estimated the proportion of participants with IFs [any, requiring medical referral, potentially serious (PSIFs) as defined in the UK biobank]: overall, by type and severity of the final diagnosis, as well as the number of IFs. Results: 78/1,867 participants had at least one IF [4.2%, 95% Confidence Interval (CI) 3.4-5.2%]. IFs requiring medical referral (n = 38) were observed in 36/1,867 participants (1.9%, 1.4-2.7%), and represented 47.5% of the 80 IFs initially flagged. Referred IFs were retrospectively classified as PSIFs in 25/1,867 participants (1.3%, 0.9-2.0%), accounting for 68.4% of anomalies referred (26/38). The most common final diagnosis was cysts or ventricular abnormalities in all participants (9/1,867; 0.5%, 0.2-0.9%) and in those with referred IFs (9/36; 25.0%, 13.6-41.3%), while it was multiple sclerosis or radiologically isolated syndrome in participants with PSIFs (5/19; 26.3%, 11.5-49.1%) who represented 0.1% (0.0-0.4%) and 0.2% (0.03-0.5%) of all participants, respectively. Final diagnoses were considered serious in 11/1,867 participants (0.6%, 0.3-1.1%). Among participants with referred IFs, 13.9% (5/36) required active intervention, while 50.0% (18/36) were put on clinical surveillance. Conclusions: In a large brain imaging study of young healthy adults participating in research we observed a non-negligible frequency of IFs. The etiological pattern differed from what has been described in older adults.
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Affiliation(s)
- Aïcha Soumaré
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Naka Beguedou
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Alexandre Laurent
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Bruno Brochet
- Department of Neurology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Constance Bordes
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Sandy Mournet
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Emmanuel Mellet
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Edwige Pereira
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
| | - Clothilde Pollet
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
| | - Morgane Lachaize
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
| | - Marie Mougin
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
| | - Ami Tsuchida
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
| | - Hugues Loiseau
- Department of Neurosurgery, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Thomas Tourdias
- Department of Diagnostic and Therapeutic Radiology and Neuroimaging, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
- Magendie Neurocenter INSERM-U1215, University of Bordeaux, Bordeaux, France
| | - Christophe Tzourio
- UMR1219 Bordeaux Population Health Center (Team HEALTHY), INSERM-University of Bordeaux, Bordeaux, France
- Department of Medical Information, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Bernard Mazoyer
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, University of Bordeaux, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CNRS, Bordeaux, France
- Neurofunctional Imaging Group, Institute of Neurodegenerative Disease-UMR5293, CEA, Bordeaux, France
- Department of Diagnostic and Therapeutic Radiology and Neuroimaging, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
| | - Stéphanie Debette
- UMR1219 Bordeaux Population Health Center (Team VINTAGE), INSERM-University of Bordeaux, Bordeaux, France
- Department of Neurology, University Hospital Centre Bordeaux Pellegrin Hospital Group, Bordeaux, France
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Graham M, Hallowell N, Savulescu J. A Just Standard: The Ethical Management of Incidental Findings in Brain Imaging Research. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2021; 49:269-281. [PMID: 34924060 PMCID: PMC8242825 DOI: 10.1017/jme.2021.38] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Neuroimaging research regularly yields "incidental findings": observations of potential clinical significance in healthy volunteers or patients, but which are unrelated to the purpose or variables of the study.
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Design and overview of the Origins of Alzheimer's Disease Across the Life course (ORACLE) study. Eur J Epidemiol 2020; 36:117-127. [PMID: 33324997 PMCID: PMC7847463 DOI: 10.1007/s10654-020-00696-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 11/07/2020] [Indexed: 12/15/2022]
Abstract
Brain development and deterioration across the lifespan are integral to the etiology of late-life neurodegenerative disease. Factors that influence the health of the adult brain remain to be elucidated and include risk factors, protective factors, and factors related to cognitive and brain reserve.
To address this knowledge gap we designed a life-course study on brain health, which received funding through the EU ERC Programme under the name Origins of Alzheimer’s Disease Across the Life course (ORACLE) Study. The ORACLE Study is embedded within Generation R, a prospective population-based cohort study of children and their parents, and links this with the Rotterdam Study, a population-based study in middle-aged and elderly persons. The studies are based in Rotterdam, the Netherlands. Generation R focuses on child health from fetal life until adolescence with repeated in-person examinations, but has also included data collection on the children’s parents. The ORACLE Study aims to extend the parental data collection in nearly 2000 parents with extensive measures on brain health, including neuroimaging, cognitive testing and motor testing. Additionally, questionnaires on migraine, depressive symptoms, sleep, and neurological family history were completed. These data allow for the investigation of longitudinal influences on adult brain health as well as intergenerational designs involving children and parents. As a secondary focus, the sampling is enriched by mothers (n = 356) that suffered from hypertensive disorders during pregnancy in order to study brain health in this high-risk population. This article provides an overview of the rationale and the design of the ORACLE Study.
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Arges K, Assimes T, Bajaj V, Balu S, Bashir MR, Beskow L, Blanco R, Califf R, Campbell P, Carin L, Christian V, Cousins S, Das M, Dockery M, Douglas PS, Dunham A, Eckstrand J, Fleischmann D, Ford E, Fraulo E, French J, Gambhir SS, Ginsburg GS, Green RC, Haddad F, Hernandez A, Hernandez J, Huang ES, Jaffe G, King D, Koweek LH, Langlotz C, Liao YJ, Mahaffey KW, Marcom K, Marks WJ, Maron D, McCabe R, McCall S, McCue R, Mega J, Miller D, Muhlbaier LH, Munshi R, Newby LK, Pak-Harvey E, Patrick-Lake B, Pencina M, Peterson ED, Rodriguez F, Shore S, Shah S, Shipes S, Sledge G, Spielman S, Spitler R, Schaack T, Swamy G, Willemink MJ, Wong CA. The Project Baseline Health Study: a step towards a broader mission to map human health. NPJ Digit Med 2020; 3:84. [PMID: 32550652 PMCID: PMC7275087 DOI: 10.1038/s41746-020-0290-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/19/2020] [Indexed: 12/27/2022] Open
Abstract
The Project Baseline Health Study (PBHS) was launched to map human health through a comprehensive understanding of both the health of an individual and how it relates to the broader population. The study will contribute to the creation of a biomedical information system that accounts for the highly complex interplay of biological, behavioral, environmental, and social systems. The PBHS is a prospective, multicenter, longitudinal cohort study that aims to enroll thousands of participants with diverse backgrounds who are representative of the entire health spectrum. Enrolled participants will be evaluated serially using clinical, molecular, imaging, sensor, self-reported, behavioral, psychological, environmental, and other health-related measurements. An initial deeply phenotyped cohort will inform the development of a large, expanded virtual cohort. The PBHS will contribute to precision health and medicine by integrating state of the art testing, longitudinal monitoring and participant engagement, and by contributing to the development of an improved platform for data sharing and analysis.
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Affiliation(s)
| | | | - Vikram Bajaj
- Stanford University, School of Medicine, Stanford, CA USA
| | - Suresh Balu
- Duke University, School of Medicine, Durham, NC USA
| | | | - Laura Beskow
- Vanderbilt University, School of Medicine, Nashville, TN USA
| | | | | | | | - Larry Carin
- Duke University, School of Medicine, Durham, NC USA
| | | | | | - Millie Das
- Stanford University, School of Medicine, Stanford, CA USA
| | | | | | | | | | | | - Emily Ford
- Duke University, School of Medicine, Durham, NC USA
| | | | - John French
- Duke University, School of Medicine, Durham, NC USA
| | | | | | | | | | | | | | | | - Glenn Jaffe
- Duke University, School of Medicine, Durham, NC USA
| | - Daniel King
- Duke University, School of Medicine, Durham, NC USA
| | | | | | - Yaping J. Liao
- Stanford University, School of Medicine, Stanford, CA USA
| | | | - Kelly Marcom
- Duke University, School of Medicine, Durham, NC USA
| | - William J. Marks
- Stanford University, School of Medicine, Stanford, CA USA
- Verily Inc., South San Francisco, CA USA
| | - David Maron
- Stanford University, School of Medicine, Stanford, CA USA
| | - Reid McCabe
- Duke University, School of Medicine, Durham, NC USA
| | | | - Rebecca McCue
- Stanford University, School of Medicine, Stanford, CA USA
| | | | | | | | - Rajan Munshi
- Stanford University, School of Medicine, Stanford, CA USA
| | | | | | | | | | | | | | | | - Svati Shah
- Duke University, School of Medicine, Durham, NC USA
| | | | - George Sledge
- Stanford University, School of Medicine, Stanford, CA USA
| | - Susie Spielman
- Stanford University, School of Medicine, Stanford, CA USA
| | - Ryan Spitler
- Stanford University, School of Medicine, Stanford, CA USA
| | - Terry Schaack
- California Health and Longevity Institute, Westlake Village, CA USA
| | - Geeta Swamy
- Duke University, School of Medicine, Durham, NC USA
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10
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Littlejohns TJ, Holliday J, Gibson LM, Garratt S, Oesingmann N, Alfaro-Almagro F, Bell JD, Boultwood C, Collins R, Conroy MC, Crabtree N, Doherty N, Frangi AF, Harvey NC, Leeson P, Miller KL, Neubauer S, Petersen SE, Sellors J, Sheard S, Smith SM, Sudlow CLM, Matthews PM, Allen NE. The UK Biobank imaging enhancement of 100,000 participants: rationale, data collection, management and future directions. Nat Commun 2020; 11:2624. [PMID: 32457287 PMCID: PMC7250878 DOI: 10.1038/s41467-020-15948-9] [Citation(s) in RCA: 236] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 04/03/2020] [Indexed: 01/18/2023] Open
Abstract
UK Biobank is a population-based cohort of half a million participants aged 40-69 years recruited between 2006 and 2010. In 2014, UK Biobank started the world's largest multi-modal imaging study, with the aim of re-inviting 100,000 participants to undergo brain, cardiac and abdominal magnetic resonance imaging, dual-energy X-ray absorptiometry and carotid ultrasound. The combination of large-scale multi-modal imaging with extensive phenotypic and genetic data offers an unprecedented resource for scientists to conduct health-related research. This article provides an in-depth overview of the imaging enhancement, including the data collected, how it is managed and processed, and future directions.
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Affiliation(s)
| | - Jo Holliday
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lorna M Gibson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Department of Clinical Radiology, New Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Fidel Alfaro-Almagro
- Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Jimmy D Bell
- Research Centre for Optimal Health, University of Westminster, London, UK
| | | | - Rory Collins
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Megan C Conroy
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nicola Crabtree
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | | | - Alejandro F Frangi
- Department of Cardiovascular Sciences and Electrical Engineering, KU Leuven, Leuven, Belgium
- CISTIB Centre for Computational Imaging and Simulation Technologies in Biomedicine, Schools of Computing and Medicine, University of Leeds, Leeds, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Paul Leeson
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Karla L Miller
- Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Stefan Neubauer
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University of Medicine, London, UK
| | - Jonathan Sellors
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- UK Biobank Coordinating Centre, Stockport, UK
| | | | - Stephen M Smith
- Centre for Functional MRI of the Brain, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Cathie L M Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Paul M Matthews
- Department of Brain Sciences, Imperial College London and UK Dementia Research Institute, London, UK
| | - Naomi E Allen
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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11
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Magiorkinis G, Matthews PC, Wallace SE, Jeffery K, Dunbar K, Tedder R, Mbisa JL, Hannigan B, Vayena E, Simmonds P, Brewer DS, Gihawi A, Rallapalli G, Lahnstein L, Fowler T, Patch C, Maleady-Crowe F, Lucassen A, Cooper C. Potential for diagnosis of infectious disease from the 100,000 Genomes Project Metagenomic Dataset: Recommendations for reporting results. Wellcome Open Res 2019; 4:155. [PMID: 32055707 PMCID: PMC6993825 DOI: 10.12688/wellcomeopenres.15499.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2019] [Indexed: 12/30/2022] Open
Abstract
The identification of microbiological infection is usually a diagnostic investigation, a complex process that is firstly initiated by clinical suspicion. With the emergence of high-throughput sequencing (HTS) technologies, metagenomic analysis has unveiled the power to identify microbial DNA/RNA from a diverse range of clinical samples (1). Metagenomic analysis of whole human genomes at the clinical/research interface bypasses the steps of clinical scrutiny and targeted testing and has the potential to generate unexpected findings relating to infectious and sometimes transmissible disease. There is no doubt that microbial findings that may have a significant impact on a patient’s treatment and their close contacts should be reported to those with clinical responsibility for the sample-donating patient. There are no clear recommendations on how such findings that are incidental, or outside the original investigation, should be handled. Here we aim to provide an informed protocol for the management of incidental microbial findings as part of the 100,000 Genomes Project
which may have broader application in this emerging field. As with any other clinical information, we aim to prioritise the reporting of data that are most likely to be of benefit to the patient and their close contacts. We also set out to minimize risks, costs and potential anxiety associated with the reporting of results that are unlikely to be of clinical significance. Our recommendations aim to support the practice of microbial metagenomics by providing a simplified pathway that can be applied to reporting the identification of potential pathogens from metagenomic datasets. Given that the ambition for UK sequenced human genomes over the next 5 years has been set to reach 5 million and the field of metagenomics is rapidly evolving, the guidance will be regularly reviewed and will likely adapt over time as experience develops.
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Affiliation(s)
- Gkikas Magiorkinis
- Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Philippa C Matthews
- University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | | | - Katie Jeffery
- University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | | | | | - Effy Vayena
- Swiss Federal Institute of Technology (ETH), Zurich, Switzerland
| | | | - Daniel S Brewer
- University of East Anglia, Norwich, UK.,Earlham Institute, Norwich, UK
| | | | | | | | | | | | | | - Anneke Lucassen
- Faculty of Medicine, University of Southampton, Southampton, UK
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12
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Keuss SE, Parker TD, Lane CA, Hoskote C, Shah S, Cash DM, Keshavan A, Buchanan SM, Murray-Smith H, Wong A, James SN, Lu K, Collins J, Beasley DG, Malone IB, Thomas DL, Barnes A, Richards M, Fox N, Schott JM. Incidental findings on brain imaging and blood tests: results from the first phase of Insight 46, a prospective observational substudy of the 1946 British birth cohort. BMJ Open 2019; 9:e029502. [PMID: 31371298 PMCID: PMC6678011 DOI: 10.1136/bmjopen-2019-029502] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To summarise the incidental findings detected on brain imaging and blood tests during the first wave of data collection for the Insight 46 study. DESIGN Prospective observational sub-study of a birth cohort. SETTING Single-day assessment at a research centre in London, UK. PARTICIPANTS 502 individuals were recruited from the MRC National Survey of Health and Development (NSHD), the 1946 British birth cohort, based on pre-specified eligibility criteria; mean age was 70.7 (SD: 0.7) and 49% were female. OUTCOME MEASURES Data regarding the number and types of incidental findings were summarised as counts and percentages, and 95% confidence intervals were calculated. RESULTS 93.8% of participants completed a brain scan (n=471); 4.5% of scanned participants had a pre-defined reportable abnormality on brain MRI (n=21); suspected vascular malformations and suspected intracranial mass lesions were present in 1.9% (n=9) and 1.5% (n=7) respectively; suspected cerebral aneurysms were the single most common vascular abnormality, affecting 1.1% of participants (n=5), and suspected meningiomas were the most common intracranial lesion, affecting 0.6% of participants (n=3); 34.6% of participants had at least one abnormality on clinical blood tests (n=169), but few reached the prespecified threshold for urgent action (n=11). CONCLUSIONS In older adults, aged 69-71 years, potentially serious brain MRI findings were detected in around 5% of participants, and clinical blood test abnormalities were present in around one third of participants. Knowledge of the expected prevalence of incidental findings in the general population at this age is useful in both research and clinical settings.
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Affiliation(s)
- Sarah E Keuss
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Thomas D Parker
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Christopher A Lane
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Chandrashekar Hoskote
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Sachit Shah
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - David M Cash
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Ashvini Keshavan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Sarah M Buchanan
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Heidi Murray-Smith
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Andrew Wong
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Sarah-Naomi James
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Kirsty Lu
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Jessica Collins
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Daniel G Beasley
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Ian B Malone
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - David L Thomas
- Leonard Wolfson Experimental Neurology Centre, UCL Queen Square Institute of Neurology, London, UK
- Department of Brain Repair and Neurorehabilitation, UCL Queen Square Institute of Neurology, London, UK
| | - Anna Barnes
- Institute of Nuclear Medicine, University College London Hospitals, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Nick Fox
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Jonathan M Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK
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13
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Gibson LM, Nolan J, Littlejohns TJ, Mathieu E, Garratt S, Doherty N, Petersen S, Harvey NCW, Sellors J, Allen NE, Wardlaw JM, Jackson CA, Sudlow CLM. Factors associated with potentially serious incidental findings and with serious final diagnoses on multi-modal imaging in the UK Biobank Imaging Study: A prospective cohort study. PLoS One 2019; 14:e0218267. [PMID: 31206530 PMCID: PMC6576786 DOI: 10.1371/journal.pone.0218267] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/29/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Feedback of potentially serious incidental findings (PSIFs) to imaging research participants generates clinical assessment in most cases. Understanding the factors associated with increased risks of PSIFs and of serious final diagnoses may influence individuals' decisions to participate in imaging research and will inform the design of PSIFs protocols for future research studies. We aimed to determine whether, and to what extent, socio-demographic, lifestyle, other health-related factors and PSIFs protocol are associated with detection of both a PSIF and a final diagnosis of serious disease. METHODS AND FINDINGS Our cohort consisted of all UK Biobank participants who underwent imaging up to December 2015 (n = 7334, median age 63, 51.9% women). Brain, cardiac and body magnetic resonance, and dual-energy x-ray absorptiometry images from the first 1000 participants were reviewed systematically by radiologists for PSIFs. Thereafter, radiographers flagged concerning images for radiologists' review. We classified final diagnoses as serious or not using data from participant surveys and clinical correspondence from GPs up to six months following imaging (either participant or GP correspondence, or both, were available for 93% of participants with PSIFs). We used binomial logistic regression models to investigate associations between age, sex, ethnicity, socio-economic deprivation, private healthcare use, alcohol intake, diet, physical activity, smoking, body mass index and morbidity, with both PSIFs and serious final diagnoses. Systematic radiologist review generated 13 times more PSIFs than radiographer flagging (179/1000 [17.9%] versus 104/6334 [1.6%]; age- and sex-adjusted OR 13.3 [95% confidence interval (CI) 10.3-17.1] p<0.001) and proportionally fewer serious final diagnoses (21/179 [11.7%]; 33/104 [31.7%]). Risks of both PSIFs and of serious final diagnoses increased with age (sex-adjusted ORs [95% CI] for oldest [67-79 years] versus youngest [44-58 years] participants for PSIFs and serious final diagnoses respectively: 1.59 [1.07-2.38] and 2.79 [0.86 to 9.0] for systematic radiologist review; 1.88 [1.14-3.09] and 2.99 [1.09-8.19] for radiographer flagging). No other factor was significantly associated with either PSIFs or serious final diagnoses. Our study is the largest so far to investigate the factors associated with PSIFs and serious final diagnoses, but despite this, we still may have missed some associations due to sparsity of these outcomes within our cohort and small numbers within some exposure categories. CONCLUSION Risks of PSIFs and serious final diagnosis are substantially influenced by PSIFs protocol and to a lesser extent by age. As only 1/5 PSIFs represent serious disease, evidence-based PSIFs protocols are paramount to minimise over-investigation of healthy research participants and diversion of limited health services away from patients in need.
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Affiliation(s)
- Lorna M. Gibson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - John Nolan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas J. Littlejohns
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom
| | - Edouard Mathieu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Steve Garratt
- UK Biobank Co-ordinating Centre, UK Biobank, Stockport, United Kingdom
| | - Nicola Doherty
- UK Biobank Co-ordinating Centre, UK Biobank, Stockport, United Kingdom
| | - Steffen Petersen
- William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Nicholas C. W. Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Jonathan Sellors
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom
- UK Biobank Co-ordinating Centre, UK Biobank, Stockport, United Kingdom
| | - Naomi E. Allen
- Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, United Kingdom
| | - Joanna M. Wardlaw
- UK Dementia Research Institute, University of Edinburgh, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Caroline A. Jackson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - Cathie L. M. Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
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14
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Feng F, Thompson MP, Thomas BE, Duffy ER, Kim J, Kurosawa S, Tashjian JY, Wei Y, Andry C, Stearns-Kurosawa DJ. A computational solution to improve biomarker reproducibility during long-term projects. PLoS One 2019; 14:e0209060. [PMID: 30995241 PMCID: PMC6469750 DOI: 10.1371/journal.pone.0209060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/16/2019] [Indexed: 12/13/2022] Open
Abstract
Biomarkers are fundamental to basic and clinical research outcomes by reporting host responses and providing insight into disease pathophysiology. Measuring biomarkers with research-use ELISA kits is universal, yet lack of kit standardization and unexpected lot-to-lot variability presents analytic challenges for long-term projects. During an ongoing two-year project measuring plasma biomarkers in cancer patients, control concentrations for one biomarker (PF) decreased significantly after changes in ELISA kit lots. A comprehensive operations review pointed to standard curve shifts with the new kits, an analytic variable that jeopardized data already collected on hundreds of patient samples. After excluding other reasonable contributors to data variability, a computational solution was developed to provide a uniform platform for data analysis across multiple ELISA kit lots. The solution (ELISAtools) was developed within open-access R software in which variability between kits is treated as a batch effect. A defined best-fit Reference standard curve is modelled, a unique Shift factor “S” is calculated for every standard curve and data adjusted accordingly. The averaged S factors for PF ELISA kit lots #1–5 ranged from -0.086 to 0.735, and reduced control inter-assay variability from 62.4% to <9%, within quality control limits. S factors calculated for four other biomarkers provided a quantitative metric to monitor ELISAs over the 10 month study period for quality control purposes. Reproducible biomarker measurements are essential, particularly for long-term projects with valuable patient samples. Use of research-use ELISA kits is ubiquitous and judicious use of this computational solution maximizes biomarker reproducibility.
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Affiliation(s)
- Feng Feng
- Department of Microbiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Morgan P Thompson
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Beena E Thomas
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts, United States of America
| | - Elizabeth R Duffy
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Jiyoun Kim
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Shinichiro Kurosawa
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Joseph Y Tashjian
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts, United States of America.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Yibing Wei
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts, United States of America.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Chris Andry
- Department of Pathology and Laboratory Medicine, Boston Medical Center, Boston, Massachusetts, United States of America.,Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - D J Stearns-Kurosawa
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts, United States of America
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15
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Gibson LM, Paul L, Chappell FM, Macleod M, Whiteley WN, Al-Shahi Salman R, Wardlaw JM, Sudlow CLM. Potentially serious incidental findings on brain and body magnetic resonance imaging of apparently asymptomatic adults: systematic review and meta-analysis. BMJ 2018; 363:k4577. [PMID: 30467245 PMCID: PMC6249611 DOI: 10.1136/bmj.k4577] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To determine prevalence and types of potentially serious incidental findings on magnetic resonance imaging (MRI) in apparently asymptomatic adults, describe factors associated with potentially serious incidental findings, and summarise information on follow-up and final diagnoses. DESIGN Systematic review and meta-analyses. DATA SOURCES Citation searches of relevant articles and authors' files in Medline and Embase (from inception to 25 April 2017). REVIEW METHODS Eligible studies included prevalence and types of incidental findings detected among apparently asymptomatic adults undergoing MRI of the brain, thorax, abdomen, or brain and body. Data on study population and methods, prevalence and types of incidental findings, and final diagnoses were extracted. Pooled prevalence was estimated by random effects meta-analysis, and heterogeneity by τ2 statistics. MAIN OUTCOME MEASURES Prevalence of potentially serious incidental findings on MRI of the brain, thorax, abdomen, and brain and body. RESULTS Of 5905 retrieved studies, 32 (0.5%) met the inclusion criteria (n=27 643 participants). Pooled prevalence of potentially serious incidental findings was 3.9% (95% confidence interval 0.4% to 27.1%) on brain and body MRI, 1.4% (1.0% to 2.1%) on brain MRI, 1.3% (0.2% to 8.1%) on thoracic MRI, and 1.9% (0.3% to 12.0%) on abdominal MRI. Pooled prevalence rose after including incidental findings of uncertain potential seriousness (12.8% (3.9% to 34.3%), 1.7% (1.1% to 2.6%), 3.0% (0.8% to 11.3%), and 4.5% (1.5% to 12.9%), respectively). There was generally substantial heterogeneity among included studies. About half the potentially serious incidental findings were suspected malignancies (brain, 0.6% (95% confidence interval 0.4% to 0.9%); thorax, 0.6% (0.1% to 3.1%); abdomen, 1.3% (0.2% to 9.3%); brain and body, 2.3% (0.3% to 15.4%)). There were few informative data on potential sources of between-study variation or factors associated with potentially serious incidental findings. Limited data suggested that relatively few potentially serious incidental findings had serious final diagnoses (48/234, 20.5%). CONCLUSIONS A substantial proportion of apparently asymptomatic adults will have potentially serious incidental findings on MRI, but little is known of their health consequences. Systematic, long term follow-up studies are needed to better inform on these consequences and the implications for policies on feedback of potentially serious incidental findings. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42016029472.
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Affiliation(s)
- Lorna M Gibson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh BioQuarter, Edinburgh EH16 4UX, UK
| | - Laura Paul
- Department of Clinical Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Malcolm Macleod
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - William N Whiteley
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Joanna M Wardlaw
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Cathie L M Sudlow
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh BioQuarter, Edinburgh EH16 4UX, UK
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