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Physician involvement varies across EEG, MRI, TCD, TMS, and FUS based on real-time interpretation needsDoctors and technicians play different roles in brain imaging tests

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Key Takeaway
Note that TCD, TMS, and FUS typically require physician involvement due to real-time interpretation requirements.

This systematic review examines the roles of health professionals in performing and interpreting various neuroimaging and neuromodulation modalities, including EEG, MRI, TCD, TMS, and FUS, across 26 countries. The review synthesizes current local practices to determine the level of physician involvement required for each specific technology.

Findings indicate that EEG and brain MRI are typically performed by technicians and interpreted by physicians, such as neurologists or radiologists. In contrast, TCD is performed and interpreted predominantly by physicians due to the requirement for real-time evaluation. For single-pulse TMS, the procedure is performed by physicians or requires a physician's presence if a technician performs it, with interpretation always performed by physicians. Therapeutic applications of rTMS and FUS are performed by physicians, including neurologists, psychiatrists, or surgeons.

A significant limitation noted is the absence of local guidelines regarding the specific responsibilities for performing and interpreting TMS and FUS. Consequently, the authors suggest that standardized national protocols are necessary to ensure patient safety and diagnostic accuracy for these specific modalities. Clinical practice may currently vary significantly depending on regional guidelines.

When you undergo a brain scan or a specialized treatment, a team of experts works behind the scenes. A review of practices across 26 countries looked at how these teams are organized for different types of tests, including EEG, MRI, and others like TMS and FUS.

For common tests like EEG and MRI, technicians usually perform the scan while doctors, such as neurologists or radiologists, interpret the results. However, for tests like TCD, physicians often perform and interpret the results in real time. For other procedures like single-pulse TMS, a physician must be present if a technician is performing the task.

While these roles are established for many tests, the review found a lack of local guidelines for specific treatments like TMS and FUS. Because these procedures are complex, experts suggest that standardized national protocols are needed to ensure everything stays accurate and safe for every patient.

What this means for you:
Different brain tests require different levels of physician involvement during the procedure and interpretation.

Common questions

Who performs and interprets common brain scans like MRI?

For tests like EEG and brain MRI, the work is typically split. Technicians perform the actual scan, while physicians, such as neurologists or radiologists, are responsible for interpreting the results to help with your diagnosis.

Do doctors have to perform every type of brain test?

Not every test requires a doctor to perform it. While some are done by technicians, others like TCD are performed and interpreted by physicians because they require real-time evaluation. For single-pulse TMS, a physician must be present if a technician is doing the work.

What are the current challenges with some brain treatments?

The review found a significant lack of local guidelines for the specific responsibilities involved in performing and interpreting TMS and FUS. Experts suggest that standardized national protocols are needed to ensure accuracy and safety for these specific procedures.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
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). We systematically searched scientific literature, national health organizations websites, and contacted local health authorities from 26 countries. 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). The development of standardized national protocols is needed to ensure patients' safety and diagnostic accuracy in clinical settings for TMS and FUS.
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