Roles in brain stimulation, recording and interpreting neuroimaging data: a systematic survey of 26 countries on current practices in EEG, MRI, TCD, TMS and FUS.

Introduction: Clear role definitions in performing and interpreting neurophysiological and neuroimaging procedures are essential for patient safety and diagnostic accuracy. There is currently no comprehensive overview of the international landscape of health professionals responsible for these tasks. In the present review, we aimed to summarize local practices for electroencephalography (EEG), brain magnetic resonance imaging (MRI), transcranial magnetic stimulation (TMS), transcranial Doppler (TCD), and focused ultrasound stimulation (FUS). Methods: We systematically searched scientific literature, national health organizations websites, and contacted local health authorities from 26 countries. Results: EEG and brain MRI are typically performed by technicians and interpreted by physicians (neurologists or radiologists). TCD is performed and interpreted predominantly by physicians, since it requires real-time evaluation. Single-pulse TMS is either performed by physicians or requires the presence of physicians when the procedure is performed by a technician. The interpretation is done by physicians. Despite existing international recommendations, there is a significant absence of local guidelines for responsibilities in performing and interpreting TMS and FUS. In countries with information available, therapeutic use of rTMS, and FUS is performed by physicians (neurologists, psychiatrists, or surgeons). Discussion: The development of standardized national protocols is needed to ensure patients' safety and diagnostic accuracy in clinical settings for TMS and FUS.