Virtual Mentor. November 2007

This month in Virtual Mentor

Ethical Issues in Diagnostic Radiology

X-rays have been used in clinical diagnosis for about a hundred years. But the field of diagnostic imaging has expanded rapidly in the last three decades—as rapidly as any other sector of clinical medicine. CT and MRI were introduced in the '70s, the PET scan in the '80s, and the MR angiogram and virtual colonoscopy are products of the new millennium. The November Virtual Mentor examines some ethical and educational challenges brought about by the transformation and widespread use of imaging technology and asks some lingering questions about the accuracy of the centenarian X-ray itself.

Taking Full Measure of Today's Radiologist Lina Nayak The expansion of diagnostic radiology has affected all aspects of clinical medicine. As its role in patient care increases, the physician-specialists who work in and lead the field are reassessing their professional responsibilities.

Disclosure and the Retrospectoscope Commentary by Thomas H. Gallagher, MD,
and R. James Brenner, MD This challenging case represents a potential error on the part of the radiologist who interpreted a previous film—not the doctor who is currently treating the patient. While standards are being developed to help doctors disclose their own errors, guidelines for discussing other doctors' errors with patients are lacking.

Radiologists' Ethical and Professional Obligations Kay Denise Spong Lozano, MD Each time an imaging study is ordered, radiologists must ask whether exposure to radiation is warranted. Imaging should not be performed to avoid litigation, for financial gain, to reach a quota, when the outcome clearly will not affect the treatment plan, or because the patient's family demands it.

The Magic of X-ray Vision Gretchen Case, PhD When Hans Castorp, the protagonist in Thomas Mann's Magic Mountain, receives a miniature X-ray print, he acquires a passport to what Susan Sontag describes as the "kingdom of the ill." Hans knows he is ill because the X-ray declares it so, and his doctor merely shows him how to see the proof in the picture.

Upcoming Issues

• December: Public Health and Physicians as Agents of the State
• January: Ethical Issues in Diagnosing and Treating Addiction
• February: Caring for the Incarcerated Patient
• March: Medicine and Personhood