A systematic protocol to identify "clinical controls" for pediatric neuroimaging research from clinically acquired brain MRIs.

Progress at the intersection of artificial intelligence and pediatric neuroimaging necessitates large, heterogeneous datasets to generate robust and generalizable models. Retrospective analysis of clinical brain magnetic resonance imaging (MRI) scans offers a promising avenue to augment prospective research datasets, leveraging the extensive repositories of scans routinely acquired by hospital systems in the course of clinical care. Here, we present a systematic protocol for identifying "scans with limited imaging pathology" through machine-assisted manual review of radiology reports. The protocol employs a standardized grading scheme developed with expert neuroradiologists and implemented by non-clinician graders. Categorizing scans based on the presence or absence of significant pathology and image quality concerns, facilitates the repurposing of clinical brain MRI data for brain research. Such an approach has the potential to harness vast clinical imaging archives - exemplified by over 250,000 brain MRIs at the Children's Hospital of Philadelphia - to address demographic biases in research participation, to increase sample size, and to improve replicability in neurodevelopmental imaging research. Ultimately, this protocol aims to enable scalable, reliable identification of clinical control brain MRIs, supporting large-scale, generalizable neuroimaging studies of typical brain development and neurogenetic conditions.