Commons medical diagnostic images under threat from unresolved ownership: Medical images have transformed many aspects of modern medicine. Over the past two decades the increasing sophistication of MRI, CT-scanning, and X-ray techniques has made these technologies the cornerstone of diagnosing a range of conditions, replacing what used to be largely guesswork by doctors. They can be the difference between life and death for a patient, and their importance is underlined by the tens of billions of dollars spent on them annually just in North America. For Wikimedia Foundation projects, advanced images are now a powerful tool for describing and explaining, and educating our worldwide readership of medical articles.
James Heilman edits as Jmh649 or "Doc James" on Wikipedia. In real life, he lives in Canada and works as an academic professor and emergency room doctor.
The views expressed in this op-ed are those of the author only; responses and critical commentary are invited in the comments section. The Signpost welcomes proposals for op-eds at our opinion desk.
The featured medical image that is up for deletion on Commons
Medical images have transformed many aspects of modern medicine. Over the past two decades the increasing sophistication of MRI, CT-scanning, and X-ray techniques has made these technologies the cornerstone of diagnosing a range of conditions, replacing what used to be largely guesswork by doctors. They can be the difference between life and death for a patient, and their importance is underlined by the tens of billions of dollars spent on them annually just in North America. For Wikimedia Foundation projects, advanced images are now a powerful tool for describing and explaining, and educating our worldwide readership of medical articles.
But somehow these images have fallen through the copyright crack because each image potentially involves a raft of stakeholders—both individuals and institutions ...
This legal fuzz was brought home with a thud on September 16 on Commons, when User:Eleassar nominated for deletion a featured image of the human brain, generated by a CT scanner. The image had been uploaded by a long-standing Wikipedian who is the subject of the image. Eleassar’s argument is that copyright for the scan belongs with the X-ray technician. If this position is upheld by Commons it may result in the deletion of the great majority of radiological imaging, which has been contributed by the patients or the physicians involved in their creation. To make matters worse, open-access publishers do not require release by the X-ray technologists, so we would likely lose those images as well.
This nomination for deletion has brought up a fundamental question: are diagnostic images copyrightable, and if so, who owns the copyright? Is it the patient, the technician, the radiologist (a medical specialist), the doctor who ordered the creation of the image, the hospital, the first person who publishes the image, or are such images by default in the public domain.
Wikimedians have put a number of arguments, including:
1) Diagnostic X-rays are the same as photos, and thus the person who presses the button owns the image.
2) Copyright requires "intellectual creativity". Radiological images are created on the basis of strict guidelines. No creativity is allowed. And thus they are not copyrightable.
3) Similar arguments used to support the deletion of X-rays can be made for ECGs—both types are created on the basis of electromagnetic waves at the press of a single button. Will we need to delete the thousands of ECGs on Commons?
4) What about the sculpture your plumber has created under your sink or your electrician within your walls? Are you allowed to take and upload a picture of that without his or her consent? Or do you need copyright release?
So what does the publishing world do? I have asked multiple publishers and academics from many countries. They all agree that copyright is not owned by the tech. Publishers state that they just assume that the author has "taken care of it". Authors state that they simply publish and do not feel they needed permission from either tech or hospital as long as the images were anonymized.
Is it country-dependent? Some are arguing that the laws pertaining to this in Sweden and Germany are different from those in the US and the UK; so while images might be allowed from some countries, they might not from others. The experts I asked from Sweden, however, viewed the laws the same as those from the US and UK. More opinions are being sought.
A number of radiological images have been deleted on the basis of the precautionary principle over the years.
With tens of thousands of images at stake, representing thousands of volunteer hours of time, the discussion has become heated, with a few insults beginning to fly. To solve the dilemma, I have started a request for comment on Commons to bring more voices to the table. Having asked at least a dozen lawyers and getting an even greater number of opinions, the question is: how do we resolve the unknown?
Discuss this story
In the U.S., patients have a clear right to physically possess their medical records including images. I've always assumed that these records are a work for hire, so if anybody owns the copyright, it is the patient. If the US copyright office say that the images are not copyrightable, then who on Commons has the standing to say they are wrong? In either case, it looks like the patient in the US has a clear right to upload them and claim that they are his or her "own work." Smallbones(smalltalk) 04:36, 6 October 2013 (UTC)[reply]
Thanks for bringing this to our attention. This article needs an illustration - preferably of one of the images proposed for deletion... they are still ok to use :) --Piotr Konieczny aka Prokonsul Piotrus| reply here 06:06, 6 October 2013 (UTC)[reply]
Somewhat off-topic, but re: "Will we need to delete the tens of thousands of ECGs on Commons?", why do we have tens of thousands of ECGs on Commons? Is there really that much variation among ECGs that a couple of hundred isn't enough? --Guy Macon (talk) 08:10, 6 October 2013 (UTC)[reply]
Does the Signpost have any guidelines they follow for providing balanced views on a subject, especially while it's the focus of an ongoing RFC? One-sided calls to arms like the above don't seem terribly helpful. --Avenue (talk) 08:33, 6 October 2013 (UTC)[reply]
This is a complex issue and one cannot invent a legal argument based on common sense and analogies with other laws. The law doesn't work that way. The medics (including those who have published such images in articles in journals) are generally surprised that such images may be copyright or have mixed opinions over who owns them. There are a number of "rights" involved. The rights requiring patient consent for publishing images are quite different to copyright (and anyway, most radiographic images don't require patient consent as they are anonymous). A common-sense argument about the artistic or originality of medical x-rays would seem to indicate they are not copyrightable. However, some countries (like the UK) have a ridiculously low threshold of originality. And other countries have "related rights" that provide similar protection for "photographs and images similar to photographs" even if purely mechanically generated (such as a passport photo machine, or CT scanner). Ownership of one's patient notes or the sense of ownership a physician (including a radiologist) may have over the images they have requested for their patients is irrelevant. The image is taken by a radiographer who is the equivalent of the photographer. In some circumstances and countries that may mean the radiographer is really the copyright owner. In most countries, however, work-for-hire rules mean copyright goes to the employer: the hospital. What is interesting is that we have as yet found nobody at a hospital who appreciates they own these assets or who has ever signed a document transferring such ownership to a medical journal for publication.
The publishers certainly believe these images are copyright and many of them believe they have the copyright for the images they have published. How they have achieved this is as yet unclear: they ask the authors of a medical paper for all relevant permissions, but these author's don't then appear to follow through and so sign as though they have the permission or own the rights themselves. This convenient situation has gone on happily and unchallenged for years without anyone minding. After all, if the owners of the images don't care, then they'll never sue. But now users at Commons have started to question it. Rather than come to some pragmatic solution, we have a situation where potentially thousands of images representing hundreds of hours of work by medical professionals could be deleted. Commons' "precautionary principle" is a hazard here because it tends towards deletion where there is any doubt.
I think the discussion on Commons could well do without more amateur lawyers piling on their opinions. Nor does it need people !voting. The WMF have said now that they are investigating this. That is essential IMO. But also Commons needs people to consider whether their policies are working for them or against them. Commons is in the same boat as Open Access publishers. We require images to have the same licence terms as them. I think there is a problem with their procedures just as there is with ours. I hope perhaps together Commons and the Open Access publishers can work out the legal situation and a practical solution to getting permissions where required. -- Colin°Talk 08:34, 6 October 2013 (UTC)[reply]
First off, if the images are copyrightable, they are decidedly not so for the technician who took them. Any copyright, at most, would devolve to the employer of the technician only, just as a movie cameraman does not have copyright to a film. That publishers assert copyright on their own suggests that the hospital did not assert copyright, so we have that as a pretty clear precedent. I would note that a publisher asserting copyright to a book does not mean the copyright properly applies to every image in such a book, so that argument is quite weak, and the fact that authors of a paper waive copyright does not mean they actually ever held a copyright on the material themselves. Thus - if a specific patient is in possession of the images, and waives their own copyright to such images, that should be more than sufficient. If Open Access attests that the authors of articles obtained such waivers from patients (providing the patient is alive) or their assigns, then that also is sufficient. Most of the rest is counting angels on a pin. The fact that the US law does not appear to treat the images as copyrightable may well be salient, as if they are not copyrightable, then they can not be subject to copyright provided they were obtained lawfully. Collect (talk) 12:31, 6 October 2013 (UTC)[reply]
The only rational position is to presume that X-rays are in the public domain unless and until someone wins a law-suit by claiming that he owns the rights. If that happens, then there would be a legal precedent which we could use to formulate a standard for licensing the images. JRSpriggs (talk) 13:53, 6 October 2013 (UTC)[reply]
The argument that the employer owns the copyright to these MRI photos cannot be correct, as the patient does not sign a waiver for his or her images to be used. Only a liability form explaining the procedure and any possible side effects or possible damage the patient may incur or sustain is signed by the patient. If a study is being conducted on patients that have a certain disease, a patient must first sign a waiver giving the study group permission to use his or her data, even when the data is used anonymously.
This is part of HIPPA, and is meant to keep a person's information within the control of that person. In the course of individually authoring a paper which uses patient data, the doctor must inform a patient that he/she is researching a subject, and must have the patient sign a release form in order to include that person's data even if the person's name is not used in the research paper. Also, if a doctor is shadowing another doctor to fulfill educational requirements, the patient must give verbal consent to both doctors before the student doctor is allowed to view patient background or observe the examination of said patient.
As the above are already covered by Federal law (which I have read), even though I am not a lawyer, I know that HIPPA guarantees that a patient's files belong to him or her, and may not be used for any purpose without explicit legal consent from said patient.
Again, even though I am not a lawyer, I would suggest that the person who gave those images to be used open-source is well within their right to do so. I would also suggest that the person sue the facility that has brought that copyright claim, asking that the consent form giving specific access to use their images (thereby waivering their copyright) to said facility be produced. If this specific form cannot be produced, I would further suggest that the facility be sued for attempted theft of copyright and for attempted violation of HIPPA.
Additionally, as an author, I know that in order to include images I myself have not produced in any article or book that I have written, I must first ask for explicit written permission to use these images, pictures, or photographs. If I fail to do so, I may be sued by the person or persons who first published these images, pictures, or photographs. Even if said items have not been registered with the Bureau of Copyrights and Patents, the ownership of said items lies with the individual(s) that produced these items, even if these items have not yet been published. The copyright mark [(c)] does not have to be used, as copyright law attaches copyright to the above referenced person(s), even without the mark being used, if that person or persons can provide proof of ownership prior to my usage.
This is why sealing a manuscript in an envelope and sending it to yourself via registered mail is referred to as "the poor man's copyright". As long as that envelope bears the "registered" form or stamp and remains unopened, the Court will allow that unopened envelope to be entered into the Court records as an exhibit of proof of copyright. Lakewolf Whitecrow (talk) 06:53, 10 October 2013 (UTC)[reply]