title: Canadian perspectives on the clinical actionability of neuroimaging in disorders of consciousness.
abstract: BACKGROUND
  Acquired brain injury is a critical public health and socioeconomic problem in Canada, leaving many patients in vegetative, minimally conscious, or locked-in states, unresponsive and unable to communicate. Recent advances in neuroimaging research have demonstrated residual consciousness in a few exemplary patients with acquired brain injury, suggesting potential misdiagnosis and changes in prognosis. Such progress, in parallel with research using multimodal brain imaging technologies in recent years, has promising implications for clinical translation, notwithstanding the many challenges that impact health care and policy development. This study explored the perspectives of Canadian professionals with expertise either in neuroimaging research, disorders of consciousness, or both, on the potential clinical applications and implications of imaging technology.
  
  
  METHODS
  Twenty-two professionals from designated communities of neuroimaging researchers, ethicists, lawyers, and practitioners participated in semistructured interviews. Data were analyzed for emergent themes.
  
  
  RESULTS
  The five most dominant themes were: (1) validation and calibration of the methods; (2) informed consent; (3) burdens on the health care system; (4) implications for the Canadian health care system; and (5) possibilities for improved prognosis.
  
  
  CONCLUSIONS
  Movement of neuroimaging from research into clinical care for acquired brain injury will require careful consideration of legal and ethical issues alongside research reliability, responsible distribution of health care resources, and the interaction of technological capabilities with patient outcome.
authors: 1National Core for Neuroethics,Division of Neurology,Department of Medicine,University of British Columbia,Vancouver,Canada.
authors: Grace
authors: G
authors: Lee
authors: 1National Core for Neuroethics,Division of Neurology,Department of Medicine,University of British Columbia,Vancouver,Canada.
authors: Adrian C
authors: AC
authors: Byram
authors: 2The Brain and Mind Institute,University of Western Ontario,London,Canada.
authors: Adrian M
authors: AM
authors: Owen
authors: 3Behavioural and Cognitive Neuroscience Institute,Simon Fraser University,Burnaby,Canada.
authors: Urs
authors: U
authors: Ribary
authors: 1National Core for Neuroethics,Division of Neurology,Department of Medicine,University of British Columbia,Vancouver,Canada.
authors: A Jon
authors: AJ
authors: Stoessl
authors: 5Division of Physical Medicine and Rehabilitation,Department of Medicine, Faculty of Medicine,University of British Columbia,Vancouver,Canada.
authors: Andrea
authors: A
authors: Townson
authors: 4Pacific Parkinson's Research Centre and National Parkinson Foundation Centre of Excellence,Vancouver,Canada.
authors: Christine
authors: C
authors: Stables
authors: 1National Core for Neuroethics,Division of Neurology,Department of Medicine,University of British Columbia,Vancouver,Canada.
authors: Judy
authors: J
authors: Illes
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D001921:Brain / Q000473:pathology; D002138:Calibration; D002170:Canada; D003244:Consciousness Disorders / Q000175:diagnosis* / Q000473:pathology; D017281:Cost of Illness; D003695:Delivery of Health Care; D003951:Diagnostic Errors; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007258:Informed Consent; D008297:Male; D059906:Neuroimaging / Q000379:methods*; D018458:Persistent Vegetative State / Q000175:diagnosis; D010820:Physicians; D011379:Prognosis; D015203:Reproducibility of Results; D016896:Treatment Outcome
keywords: qualitative methods