背景:以前在在线图像搜索结果中发现了在学术期刊上发表的医学病例报告的照片。这意味着患者的照片在原始期刊网站之外传播,并且可以在线自由访问。虽然这引起了道德和法律问题,没有系统的研究记录这种情况发生的频率。
目的:本横断面研究的目的是提供系统性证据,证明来自医学期刊上发表的病例报告的患者照片出现在GoogleImages搜索结果中。研究问题包括:(1)在GoogleImages搜索结果中发现了病例报告中发布的患者医疗照片的百分比是多少?(2)开放访问发布状态与图像可用性之间有什么关系?(3)在2020年和2022年进行的搜索之间,在第三方网站上找到患者照片的几率是否不同?次要结果变量包括图像源和图像在第三方网站上的可用性。使用汇总统计量描述医学图像的特征。使用逻辑回归测试了全文可用性来源与GoogleImages上图像可用性之间的关联。最后,我们使用广义估计方程研究了寻找患者照片的趋势.
结果:从PubMed索引的585例病例报告的随机样本中,186张患者照片,共598张不同的图像。对于186例病例报告中的142例(76.3%),在Google图片搜索结果中找到至少一张照片。共有18.3%(110/598)的照片包括眼睛,脸,或者全身,其中10.9%(65/598)可能识别患者。如果全文论文可在ResearchGate上获得,则从在线病例报告中找到图像的几率更高(优势比[OR]9.16,95%CI2.71-31.02),PubMedCentral(OR7.90,95%CI2.33-26.77),或Google学者(OR6.07,95%CI2.77-13.29),而全文仅通过开放获取期刊获得(OR5.33,95%CI2.31-12.28)。然而,所有因素都导致在线定位患者图像的风险增加.与2020年的搜索相比,根据2022年的搜索结果,在第三方网站上找到患者照片的可能性较小(OR0.61,95%Cl0.43-0.87)。
结论:在GoogleImages上发现了大量病例报告中的医学照片,提出伦理问题,涉及政策和实践。期刊出版商和谷歌等公司最有能力开发有效的补救措施。在那之前,至关重要的是,患者应充分了解同意临床医生在医学期刊上发表其图像的潜在风险和益处.
BACKGROUND: Photographs from medical case reports published in academic journals have previously been found in online image search results. This means that patient photographs circulate beyond the original journal website and can be freely accessed online. While this raises ethical and legal concerns, no systematic study has documented how often this occurs.
OBJECTIVE: The aim of this cross-sectional study was to provide systematic evidence that patient photographs from case reports published in medical journals appear in Google Images search results. Research questions included the following: (1) what percentage of patient medical photographs published in case reports were found in Google Images search results? (2) what was the relationship between open access publication status and image availability? and (3) did the odds of finding patient photographs on third-party websites differ between searches conducted in 2020 and 2022?
METHODS: The main outcome measure assessed whether at least 1 photograph from each case report was found on Google Images when using a structured search. Secondary outcome variables included the image source and the availability of images on third-party websites over time. The characteristics of medical images were described using summary statistics. The association between the source of full-text availability and image availability on Google Images was tested using logistic regressions. Finally, we examined the trend of finding patient photographs using generalized estimating equations.
RESULTS: From a random sample of 585 case reports indexed in PubMed, 186 contained patient photographs, for a total of 598 distinct images. For 142 (76.3%) out of 186 case reports, at least 1 photograph was found in Google Images search results. A total of 18.3% (110/598) of photographs included eye, face, or full body, including 10.9% (65/598) that could potentially identify the patient. The odds of finding an image from the case report online were higher if the full-text paper was available on ResearchGate (odds ratio [OR] 9.16, 95% CI 2.71-31.02), PubMed Central (OR 7.90, 95% CI 2.33-26.77), or Google Scholar (OR 6.07, 95% CI 2.77-13.29) than if the full-text was available solely through an open access journal (OR 5.33, 95% CI 2.31-12.28). However, all factors contributed to an increased risk of locating patient images online. Compared with the search in 2020, patient photographs were less likely to be found on third-party websites based on the 2022 search results (OR 0.61, 95% Cl 0.43-0.87).
CONCLUSIONS: A high proportion of medical photographs from case reports was found on Google Images, raising ethical concerns with policy and practice implications. Journal publishers and corporations such as Google are best positioned to develop an effective remedy. Until then, it is crucial that patients are adequately informed about the potential risks and benefits of providing consent for clinicians to publish their images in medical journals.