In 2006, we created and implemented an informal weekly departmental ethics roundtable designed to: (1) Identify core ethical challenges in contemporary imaging practice; (2) Identify those ethical challenges that are distinctive to imaging practice; (3) Learn to distinguish medical legal issues from ethical issues in imaging; (4) Create, through group discussion, an annotated core of articles and other materials on imaging ethics that will be available to current and future trainees on the departmental Web site; (5) Provide a forum for the informal and anonymized discussion of ethical challenges experienced by participants; (6) Provide resources for and discussions about appropriate responses to ethical dilemmas; and (7) Work toward the creation of a specific imaging ethics curriculum.

In 2008, we incorporated an imaging informatics aspect into the roundtable structure by focusing the discussion content, at least once each month, on specific informatics-related ethics topics and by making participation in the roundtable a requisite part of our informatics fellowship program.

We will describe the format of the roundtable; the results of discussions identifying central ethical problems, and proposed solutions, in imaging informatics; the participant perceptions of the practical and professional utility of these sessions; and the suggestions for the incorporation of ethics training and feedback into other imaging informatics curricula.

The initiation of a regular ethics roundtable was initially received well, both within the department and by medical school administration. The roundtable process has spurred informal discussions by faculty and trainees and produced an annotated core of resources on these topics. The addition of imaging informatics as a focus has created new areas of discussion, including significant observations on whether and how the practicing radiologist at the workstation can affect or participate in the core identified medical ethical principles of respect for persons, beneficence, and justice. In addition to positing and discussing numerous hypothetical situations for debate, these discussions have also focused on ways in which a specific “ethics of radiology practice” might differ from and expand upon those ethical guidelines that have been based on direct physical patient contact. Example hypothetical situations will be given in this presentation, along with the varying perspectives of those involved in the roundtable. Roundtable leaders are using these results to assess the feasibility of a formal imaging ethics curriculum. Specific research efforts that have come out of the roundtable discussions will also be highlighted.

The rapid acceptance of novel imaging technologies, advances in information technology for communicating large amounts of data, and changing political and economic realities are contributing to a shifting bioethical landscape in which many physicians work in increasing isolation from the patients for whom they provide care.[1-7] The high degree of personal disengagement and “professional remove” these same technologies facilitate may strain the ability to analyze or even recognize new moral or ethical conflicts. Moreover, the more isolated a discipline is from direct patient contact, the less likely it is to have invested significantly in an educational infrastructure to address such issues.[8-11] In fact, it is precisely the “objectivity” conveyed by high technology that insulates some disciplines from considering ethical foci in either graduate training or professional discourse. Conversations about ethics in radiology, for example, have focused, for the most part, on medicolegal issues that, although significant, have more to do with financial and professional self-preservation than true moral dilemmas.

At the same time, radiology has been challenged to identify and explore ethical issues by new training requirements from the ACGME and by the recognition that novel issues may arise at the interface between the diagnostician and the digital screen.

The paradox of imaging informatics and radiology ethics is this: the very tools that automate, accelerate, and enhance the imaging interpretation process tend to isolate the radiologist from those elements of patient contact and responsiveness that are usually associated with basic medical ethics. At the same time, innovations in these same tools may be used to provide a new focus on ethics in imaging practice and on more careful consideration of ethical behavior. Examples include tools that facilitate and document timely delivery of findings, follow-up, and patient outcomes; automated tools that provide beneficial decision making in optimal study choices for each patient and situation; teleradiology innovations that serve to more equitably distribute imaging expertise to previously unserved populations; etc.