The ethics of publishing medical imaging research.

lthough the editorial process is generally a placid activity, whereby the collective wisdom of the reviewers and editors provides a clear path, we are from time to time faced with issues that generate a lot of animated debate. This issue of iJACC contains a report that triggered an important discussion among the Editorial Board. Yin et al. (1) compared 2 different image acquisition and reconstruction protocols for coronary computed tomography (CT) angiography for their diagnostic accuracy in 60 patients who underwent invasive catheter-based coronary angiography for clinical reasons. The investigators provide valuable insight into radiation dose reduction that is possible using a new iterative reconstruction algorithm in combination with modified image acquisition protocols. Clearly, this was an important clinical question, and the study was nicely done. However, all patients underwent 2 separate coronary CT angiographic acquisitions for research purposes, which of course immediately caught our attention and generated questions about the ethical implications of subjecting patients to 2 separate CT acquisitions, with the associated contrast injections and radiation exposure, purely for research purposes. Although the average overall effective dose per patient was about 2.5 mSv (substantially lower than the dose of a single coronary CT angiographic exam in numerous previous research protocols), we remain intrigued. What would we have done if the radiation dose were higher?Would the information in such a study justify the higher risk to its participants? What range of radiation would be unacceptable given that we are unaware of a threshold dose below which radiation is not harmful? Should such research have even been allowed by the ethics committee in the first place?