REACH for BRAIN: Improving Recruitment, Engagement, and Access for Community Health Equity for Human Neuroimaging Research

Gary Boas

In September 2023, the MGH Martinos Center for Biomedical Imaging saw installation of “Connectome 2.0,” a state-of-the-art MRI scanner for imaging of structural connections within the human brain—in fact, the most advanced such scanner in the world. 

Led by Susie Huang, MD, PhD, a neuroradiologist at Massachusetts General Hospital and a faculty member in the Martinos Center, the Connectome 2.0 system will provide unprecedented insights into the workings of the brain. But the impact of the project will extend even beyond these vastly improved understandings of neural connectivity. 

With the launch of the scanner, researchers have also set their sights on a longstanding challenge in neuroscience research: how to increase diversity in the recruitment and enrollment of human participants, a critical step in improving the robustness of neuroscience research findings, and in ensuring that the benefits of new medical technology are shared equitably across the communities the technology is meant to serve. 

To this end, Huang is partnering with colleagues at the Harvard Medical School Center for Bioethics, MGH Center for Law, Brain & Behavior (CLBB), and the Community Access, Recruitment and Engagement (CARE) Center at Massachusetts General Hospital in a new project: Recruitment, Engagement, and Access for Community Health Equity for BRAIN Next-Generation Human Neuroimaging Research and Beyond (REACH for BRAIN). 

Recently funded by the NIH BRAIN Neuroethics program, REACH for BRAIN will strive to improve engagement with and recruitment of research participants in studies using the Connectome 2.0 scanner. 

“Neuroimaging technologies have improved dramatically over the years, but engagement and recruitment efforts have not,” says Francis X. Shen, JD, PhD, a faculty member in the Harvard Medical School Center for Bioethics, Chief Innovation Officer at CLBB, and one of the PIs of the REACH for BRAIN project. “The main thrust of the project is to challenge and reimagine the ways neuroimaging research is conducted by grounding it in the local community,” 

The project will introduce two major innovations. The first will be the creation of an engagement and recruitment infrastructure employing a “Theory of Change” framework. 

Pioneered by Helen Hemley, MPA, administrative director with the MGH CARE Research Center, the community-owned framework encourages the development of concrete, patient-centered mechanisms to advance clinical research engagement and recruitment activities. With REACH for BRAIN, the CARE Center will achieve this goal by developing a long-term stakeholder network—beginning with convening twelve Black and Latinx community leaders from the greater Boston area—and integrating the network directly into research design processes. 

Using this framework will enable the team to develop “community-entrenched pathways” for individuals from underrepresented minority (URM) populations to engage and participate in Connectome 2.0 studies, ultimately allowing diverse non-researchers to contribute to procedures and technologies devised in the wake of the studies, beyond merely serving as research participants. 

“We are excited to bring historically marginalized and minoritized community voices—and ownership—to cutting-edge neuroimaging through the Connectome 2.0 project,” Hemley says. “In REACH for BRAIN, we will partner with patients, caregivers, clinicians, and community members to co-lead neuroimaging research design—leading to bidirectional relationships that elegantly bring diversity and inclusion to the most advanced neuroimaging studies.” 

The second major innovation in the REACH for BRAIN project will be the development of neuroethical guidance covering measurement, reporting and sharing of neuroimaging data with race and ethnicity identifiers. To help develop this guidance, the project will establish a national expert working group with diverse expertise in neuroscience and ethics.

Jonathan Jackson, PhD, executive director of the CARE Research Center at Mass General, and a co-PI of REACH for BRAIN, describes the impetus for this part of the project. “When it comes to cutting-edge practices and emerging technologies in medical science, historically marginalized populations are often left out or, worse, exploited,” he says. On the one hand, widespread reliance on “convenience sampling” often results in broadly disproportionate representation in biomedical research—and thus inequitable distribution of benefits, as well as weakened research quality more generally. On the other, scientists have historically taken advantage of patients from URM populations, using their bodies for research without their knowledge or consent. 

Jackson also points to a long history of racialized neuroscience, in which the scientific process is co-opted in attempts to assert the superiority of one group over another. Dating back to the early 19th century and the application of phrenology to the ranking of races, this history also extends into the present. A resurgence of racialized neuroscience continues to harm URM communities, stemming in part from the availability of large collections of neuroscience data that can be manipulated to prop up dangerous unfounded claims about specific groups. 

“With the REACH for BRAIN project, we will learn from centuries of mistakes in brain research and invite marginalized groups to co-design—and co-own—research processes from the very beginning,” Jackson says. “Our hope is to find ways to limit or prevent racialized or essentialized questions from coming to the fore.” 

The innovations introduced by REACH for BRAIN are long overdue in neuroscience and, moving forward, will play a critical role in neuroimaging studies, especially as those studies delve deeper into the brain while expanding into new areas of research. Huang, the Martinos-based co-PI of the project and leader of the Connectome 2.0 effort, explains. 

“The initial data we have obtained on Connectome 2.0 show that we can now detect tissue microstructural features within a single individual that would require dozens of measurements on standard clinical MRI scanners,” she says. “These results suggest that Connectome 2.0 and other technologies supported by the NIH BRAIN Initiative will pave the way toward precision human neuroscience and thus underscore the importance of having greater representation and inclusion of participants as we make new discoveries using these cool new tools. 

“This is exactly what REACH for BRAIN hopes to accomplish. I am very excited about partnering with our community stakeholders to ensure that this next-generation technology benefits all participants and increases the richness and diversity of insights afforded by Connectome 2.0 and other next-generation technologies developed at the Martinos Center and elsewhere.” 

In the images above (clockwise from left): Susie Huang and Francis X. Shen with the Connectome 2.0 scanner; Jonathan Jackson engaging members of the local community about clinical research at Massachusetts General Hospital; Helen Hemley (right) also engaging members of the local community.