When X-Rays Play Music: Lessons in Ethics, Etched in Time

Erin Saechin, BS, fourth-year medical student at Virginia Tech Carilion School of Medicine, contributed this article.

During the Cold War of the mid-20th century, music was forbidden in the Soviet Union. Reality told people to hunker down, watch their backs. But their souls clung onto something more, a yearning for expressions of the purest kind. And in the shadows, an unexpected hero emerged: bone music.

Smugglers and underground artists discovered that discarded X-ray films, pulled from hospital trash bins, could be cut into circles, burned with a cigarette to mark the center hole and pressed with grooves to carry music. This illegal art form was ghostly and strange to be sure — faint outlines of ribs, skulls and clavicles mingled with the voices of banned artists such as Elvis or Duke Ellington.

The result was haunting: The human skeleton literally carried forbidden sound, soothing the ache of a burdensome time. With that spirit in mind, bone music becomes not only a story from the past but a reminder of radiology’s evolving role today.

Radiology has always extended beyond the images on a screen. Just as bone music repurposed X-rays to preserve expression, today we face the challenge of using modern technology responsibly and creatively.  We know images are shaped by the institutions and cultures that use them. In the Soviet underground, an X-ray meant for diagnoses became a vessel for defiance and connection. Today, as images are increasingly created and analyzed with technology, the responsibility to safeguard their meaning has never been greater.

How we choose to use technology in our profession reflects not only our technical skill but our ethical compass. The ACR^® continues to guide this effort, especially through initiatives from the ACR Data Science Institute^® (DSI) helping radiologists understand, develop and ethically implement AI tools. One such initiative is ACR Assess-AI, the nation’s premier quality registry that continuously monitors clinical AI in practice, ensuring AI performance, safety and reliability — at scale.

Also through the ACR DSI, the ACR Recognized Center for Healthcare-AI is the first national AI quality assurance program designed to recognize adherence to best practices for use of AI in imaging interpretation, ensuring that radiology facilities are using AI safely and effectively. Another ACR DSI program, AI Central, empowers practices to access more transparent AI product information and make better AI purchases, enabling them to select algorithms that can improve care for their patients.

In an era where AI is reshaping diagnostic imaging, the ACR focus on safety, transparency and patient-first innovation echoes the message of bone music as it whispers across time. For example, ACR patient- and family-centered care resources such as patient-friendly animations and resources to reduce anxiety improve patient experiences and enhance health outcomes. ACR members can also access tools within their ACR Practice Toolkit to provide patients with additional educational, informational and safety materials.

The lesson for modern radiologists is clear: Never underestimate the cultural weight of images. Radiology is not only about identifying pathology; it is so much more. Every day, our profession reminds us to be resourceful and ethical, and to remember the human stories etched into every image.

And when the clavicle coos to us from another era, bone music reminds us of the power of radiology’s past and the promise of ingenuity to come. Medical imaging can carry voices, preserve freedoms and, when we choose wisely — create harmony between technology and humanity.