Recent years have witnessed intensive efforts to specify which requirements ethical artificial intelligence (AI) must meet. General guidelines for ethical AI consider a varying number of principles important. A frequent novel element in these guidelines, that we have bundled together under the term explicability, aims to reduce the black-box character of machine learning algorithms. The centrality of this element invites reflection on the conceptual relation between explicability and the four bioethical principles. This is important because the application of general ethical (...) frameworks to clinical decision-making entails conceptual questions: Is explicability a free-standing principle? Is it already covered by the well-established four bioethical principles? Or is it an independent value that needs to be recognized as such in medical practice? We discuss these questions in a conceptual-ethical analysis, which builds upon the findings of an empirical document analysis. On the example of the medical specialty of radiology, we analyze the position of radiological associations on the ethical use of medical AI. We address three questions: Are there references to explicability or a similar concept? What are the reasons for such inclusion? Which ethical concepts are referred to? (shrink)

In this paper I argue that radiological attempts to elucidate the properties of self -- an endeavor currently popular in the social neurosciences -- are fraught with conceptual difficulties. I first discuss several philosophical criteria that increase the chances we are posing the “right” questions to nature. I then discuss whether these criteria are met when empirical efforts are directed at one of the central constructs in the social sciences – the human self. In particular, I consider whether recent attempts (...) to map the neural correlates of self and its assumed properties using brain scanning technology satisfy the conceptual conditions minimally required to ask well-formed, theoretically satisfying questions of nature. I conclude that much theoretical work remains to be done. (shrink)

There has been a significant increase in the use of radiological services in the past 30 years. There are many reasons for this, but one has received little attention: the increased role of patient autonomy in healthcare. Patients demand x rays, CT scans, MRI, and positron emission tomography scans. The key question in this article is how a moral principle, such as respect for patient autonomy, can influence the extension of radiological services. A literature review reveals how patient autonomy is (...) acknowledged in radiology, and how it is used both to explain and to justify the increase in radiological examinations. Furthermore, it also shows how the premises favouring patients’ exercise of their autonomy are not always present, which makes patient autonomy subject to adverse side effects and even abuse. Patient autonomy can be used to reduce the professionals’ responsibility for radiological examinations , to increase the popularity of the profession , to increase the income of the professionals or their institutions, and to promote professional activity. Patient autonomy intended to reduce paternalism, to legitimise otherwise morally unjustifiable actions , and to protect patients, can easily be used as a moral means for opposite ends. These adverse effects are not peculiar to radiology. However, they emerge particularly clearly in explanations and justifications of the substantial increase in radiological services, as well as in debates on overuse of radiological services. (shrink)

Definition of the problem The umbrella term “explicability” refers to the reduction of opacity of artificial intelligence (AI) systems. These efforts are challenging for medical AI applications because higher accuracy often comes at the cost of increased opacity. This entails ethical tensions because physicians and patients desire to trace how results are produced without compromising the performance of AI systems. The centrality of explicability within the informed consent process for medical AI systems compels an ethical reflection on the trade-offs. Which (...) levels of explicability are needed to obtain informed consent when utilizing medical AI? Arguments We proceed in five steps: First, we map the terms commonly associated with explicability as described in the ethics and computer science literature, i.e., disclosure, intelligibility, interpretability, and explainability. Second, we conduct a conceptual analysis of the ethical requirements for explicability when it comes to informed consent. Third, we distinguish hurdles for explicability in terms of epistemic and explanatory opacity. Fourth, this then allows to conclude the level of explicability physicians must reach and what patients can expect. In a final step, we show how the identified levels of explicability can technically be met from the perspective of computer science. Throughout our work, we take diagnostic AI systems in radiology as an example. Conclusion We determined four levels of explicability that need to be distinguished for ethically defensible informed consent processes and showed how developers of medical AI can technically meet these requirements. (shrink)

Studies in the psychology of visual expertise have tended to focus on a limited set of expert domains, such as radiology and athletics. Conclusions drawn from these data indicate that experts use parafoveal vision to process images holistically. In this study, we examined a novel, as-of-yet-unstudied class of visual experts—architects—expecting similar results. However, the results indicate that architects, though visual experts, may not employ the holistic processing strategy observed in their previously studied counterparts. Participants (n = 48, 24 architects, (...) 24 naïve) were asked to find targets in chest radiographs and perspective images. All images were presented in both gaze-contingent and normal viewing conditions. Consistent with a holistic processing model, we expected two results: (1) architects would display a greater difference in saccadic amplitude between the gaze- contingent and normal conditions, and (2) architects would spend less time per search than an undergraduate control group. We found that the architects were more accurate in the perspectival task, but they took more time and displayed a lower difference in saccadic amplitude than the controls. Our research indicates a disjunctive conclusion. Either architects are simply different kinds of visual experts than those previously studied, or we have generated a task that employs visual expertise without holistic processing. Our data suggest a healthy skepticism for across-the-board inferences collected from a single domain of expertise to the nature of visual expertise generally. More work is needed to determine whether holism is a feature of all visual expertise. (shrink)

Objective: In this study, it is aimed to examine the characteristics and publication rates of oral presentations presented in national congresses. Methods: The data about the oral presentations in national anatomy congresses (from 2016 to 2021), including the number of contributing institutions, the institutions that contributed the most oral presentations each year, and the publication rates of the oral presentations in the journals scanned in different indexes. In the study, the titles and the keywords were scanned using Google Scholar and (...) Web of Science, and journal index details were noted. Results: Of the national congresses we examined in our study, the most oral presentations (193) were the congress in 2019 and the least oral presentations (47) were the congress in 2017. The publication rate of oral presentations was highest in the papers of the congress in 2016 (42%) and at least in the papers of the congress in 2019 (13%). None of the oral presentations in the last congress held in 2021 were published until the time of our study. Large proportions (34%) of the papers that are accepted as oral presentations and published are radiological studies. 70% of the publications were published in journals indexed in Web of Science. Conclusion: For both new and senior academics, congresses offer a useful and distinctive setting. Congress papers showcase the scientific opportunities and interests of various universities while also providing opportunities for collaboration. Attendance at a conference is significantly influenced by its location, timing, and financial situation. (shrink)

Individual health assessments (IHAs) for asymptomatic individuals provide a challenge to traditional distinctions between patient care and non-medical practice. They may involve undue radiation exposure, lead to false positives, and involve high out-of-pocket costs for recipients. A recent paper (Journal of the American College of Radiology 13(12): 1447–1457.e1, 2016) has criticised the use of IHAs and argued that recipients should be classified as ‘presenters’, not ‘patients’, to distinguish it from regular medical care. I critique this classificatory move, on two (...) grounds: one, it is conceptually suspect. Two, it obviates the medical ethics framework for IHAs, potentially exposing recipients of IHAs to lower standards of oversight and protection. Responsible regulation of IHAs will be easier to ethically justify if those seeking IHAs are considered patients and not merely presenters. (shrink)

Informed consent has become the most obvious instantiation of patient autonomy in contemporary medicine, though as a practice it does not encompass all spheres of medicine. While diagnostic radiological procedures carry some risk due to the use of radiation, there is no standardized practice of informed consent in the United States. The authors describe the ethical justification of informed consent, the legal background surrounding it, and a brief history of radiology and radiological protection. They ultimately argue that informed consent (...) should become a common practice in computed tomography given the risks involved due to radiation exposure, especially considering the overuse of this technology, since it respects patient autonomy. (shrink)

There is uncertainty and disagreement about the question which preventive actions are rationally justified with regard to moderately elevated levels of nuclear radiation. This may have at least four causes: ignorance, insufficient information, inconclusiveness and indeterminability. After the nuclear disaster with the Fukushima nuclear power plant the advice, given by some authorities, to leave Tokyo was largely based on the former two factors: ignorance and insufficient information. By contrast, the uncertainty and disagreement amongst experts about the size of the area (...) to be evacuated was mainly caused by the latter two factors: inconclusiveness and indeterminability. Inconclusiveness concerns the question whether moderately elevated radiation levels cause real and significant health risks that require drastic measures. Indeterminability concerns the problem of rationally weighing disparate benefits and costs of the preventive measures, to wit, expected health benefits versus the costs and burdens of mass evacuation. The International Commission on Radiological Protection (ICRP) recommends that no measures should be taken unless they produce a positive net benefit. Exposure to moderately increased levels of radiation may increase the risk of fatal cancer in the future, while mass evacuation has burdensome and disruptive consequences for the society and for the persons who have to leave their residential and/or working area for a long time. Ordering of mass evacuation seems rationally and ethically justified only if the expected future benefits outweigh the present and future burdens. Small or uncertain future health benefit may be outweighed by large costs and burdens of mass evacuation. Because we have to take into consideration not only public but also individual costs and benefits, it is important to take into account the personal absolute increase in health risk of elevated radiation in addition to relative risk. Unlike relative risk, absolute risk reveals the individual chance of getting a radiation-based disease. The increase in absolute risk – that is, the difference between the chances of getting the disease with and without the exposure to the increased level of radiation – is a useful measure to reveal the personal chance of health benefit from evacuation. This personal benefit must be balanced against the personal costs and burdens. The key question is which levels of radiation absorption and health risks outweigh the burdens of mass evacuation. There seems consensus amongst experts about the justification of mass evacuation in cases of expected individual radiation absorption > 500 mSv over a year. Similarly, experts agree that expected extra radiation absorption < 10 mSv does not justify mass evacuation. But between these two extremes there is a wide range of 50-fold increasing radiation levels in which it is not clear whether the personal and public benefits from mass evacuation outweigh the personal and public costs. This may partly explain why experts and authorities gave conflicting advice about the radius of the area around the Fukushima nuclear power plant within which people had to be evacuated. The uncertainty about the right thing to do with respect to a wide range of moderately elevated levels of radiation seems to be caused not only by inconclusiveness but also by indeterminability, that is, impossibility of determinately weighing disparate costs and benefits. (shrink)

Objective: To determine the prevalence of the accessory sacroiliac joint (ASIJ) on both computed tomography (CT) images and dry bones and ultimately, to contribute to the literature. -/- Materials and Methods: CT images archived in the Radiology department of Gaziantep University Medical Faculty obtained from 145 individuals (104 males and 41 females) as well as 92 sacral bones were examined. -/- Results: The prevalence of ASIJ among 92 sacral bones was 15.2%. The ASIJ was more commonly (52%) located at (...) the posterior portion of the SIJ at the level of the second dorsal sacral foramen. In 48% of the bones, ASIJ was identified just above the first dorsal sacral foramen. Unilateral ASIJ was observed in 10.8% and bilateral ASIJ in 4.4% of the sacral bones. On CT images, ASIJ was found in 7.8% of the males and 7.2% of the females. The total prevalence of sacroiliac joint variations was 28.9%, and 6.8% of them were ASIJs. -/- Conclusion: It should be kept in mind that ASIJ may be a source of arthritis and chronic hip pain. The presence of ASIJ should be sought through imaging studies for early diagnosis of ASIJ. (shrink)

Objective: The coronoid fossa and the olecranon fossa located on the distal end of the humerus are separated by a thin bone septum. This septum may be translucent or opaque. In some cases, this septum may become perforated, and it is called supratrochlear foramen. The aim of the present study was to describe the morphology of the supratrochlear foramen of the humerus. Methods: This study was conducted on 108 dry humeri (right (R): 56, left (L): 52) belonging to adults whose (...) age, gender, and racial properties are unknown. They were examined to determine the presence of the supratrochlear foramen. The shapes of the supratrochlear foramen were determined, and their diameters were measured. Results: The supratrochlear foramen was observed in 11 cases on the right side and 11 cases on the left side. On the right side, 5 foramens were detected to be round-shaped, 3 oval-shaped, and 3 kidney-shaped, whereas on the left side, 6 foramens were detected to be oval-shaped and 5 round-shaped. Of the 86 dry humeri with no supratrochlear foramen, 57 (R: 30, L: 27) had a translucent septum, and 29 (R: 15, L: 14) had an opaque septum. Conclusion: It is apparent that the supratrochlear foramen has been evaluated on bones generally in the literature, and there are differences in incidence rates. Owing to the clinical significance of this formation, it is thought that studying on a wider population of living individuals using radiologic imaging methods will contribute to the literature. In addition, although there are different terms used to express this formation in the literature, it is thought that adopting the name, which is commonly used as supratrochlear foramen, is most appropriate. (shrink)

Objective: The measurement of international publication activities is one of the essential indicators used to evaluate the scientific development level of countries. Although many studies are using the bibliometric method in the literature, it is seen that there are very few bibliometric studies in the field of anatomy. This study aimed to analyze the articles bibliometrically which conducted by researchers at institutions from Turkey and indexed in Science Citation Index Expanded (SCI-E) of the Web of Science database in the category (...) of Anatomy and Morphology. Materials and Methods: According to 2019 data, journals in the Anatomy and Morphology category and indexed in the SCI-E were determined. Publications from Turkey that were published in these journals was determined. The full-texts of these articles were examined, and study types were defined. Also, VOSviewer software was used to create a collaboration and word co-occurrence network. Results: It was determined that there were 48,002 publications in 21 journals. It was found that 1,461 publications (3.04%) have at least one author from Turkey. The total number of citations was 11,728 for these publications. The average number of citations was 8.02±11.95. The radiological studies have increased statistically more than both experimental animal and cadaveric studies by years. In addition, it has been determined that the total number of articles, especially the radiological studies, has increased significantly over the years. Conclusion: The increase in the number of scientific studies in the field of anatomy is important in terms of the contribution of Turkey to literature in this area. (shrink)

Psoriatic arthritis is a chronic, systemic inflammatory disorder. It has been classified in spondyloarthropathies group which shares clinical, radiologic, serologic features, familial and genetic relationship. Up to 5-30% of patients with psoriasis may go on to develop psoriatic arthritis, usually within 5-10 years. Adalimumab (ADA) is the first human monoclonal antibody against TNF-α. ADA is a biologic agent effective in both skin lesions and joint signs. Anti-TNF agents are powerful immunmodulating drugs with potentially side effects. Our case is 38 years (...) old woman complaining about swelling and pain in hand joints. In physical examination she has asymmetrical arthritis in wrist, proximal (PIP) and distal interphalangeal (DIP) hand joints and right knee joint. In laboratory; sedimentation rate: 80 mm/h, C-reactive protein: 17 mg/l, rheumatoid factor (RF): 8.7 IU/ml and HLA B27 was positive. Radiologically, erosions and narrowing were determined in PIP and DIP hand joints and grade 3 sacroiliitis bilaterally. In clinical monitoring, psoriaform lesions progressed in her scalp, so we diagnosed psoriatic artritis. We started ADA therapy 40 mg subcutaneously every two weeks. She developed periorbital infection in left-sided in tertiary month following. Streptococcal proliferation was seen in lesion culture, so we began amoxicillin-clavulanate therapy. She benefit antibiotic therapy, infectious signs regressed. ADA therapy discontinued, instead of it, etanercept 50 mg twice weekly subcutaneous and methylprednisolone 12 mg/daily oral therapy is started. We purposed to declare our case with literature selection. (shrink)

Advanced medical imaging, such as CT, fMRI and PET, has undergone enormous progress in recent years, both in accuracy and utilization. Such techniques often bring with them an illusion of immediacy, the idea that the body and its diseases can be directly inspected. In this paper we target this illusion and address the issue of the reliability of advanced imaging tests as knowledge procedures, taking positron emission tomography in oncology as paradigmatic case study. After individuating a suitable notion of reliability, (...) we argue that PET is a highly theory-laden and non-immediate knowledge procedure, in spite of the photographic-like quality of the images it delivers; the diagnostic conclusions based on the interpretation of PET images are population-dependent; PET images require interpretation, which is inherently observer-dependent and therefore variable. We conclude with a three-step methodological proposal for enhancing the reliability of advanced medical imaging. (shrink)