Medical imaging has become a cornerstone of modern healthcare, enabling early diagnosis, treatment planning, and disease monitoring across a wide spectrum of conditions. From the first X-ray images in the late 19th century to contemporary applications of artificial intelligence (AI) in radiology, imaging technologies have transformed clinical practice. However, these advances raise profound ethical concerns. Patient autonomy, data privacy, diagnostic accuracy, and equitable access must be balanced against rapid technological innovation. Emerging issues such as algorithmic bias, ground truth inconsistencies, and the “black box” nature of AI deepen the ethical complexity. This paper provides a comprehensive review of ethical considerations in medical imaging, analyzing historical foundations, patient rights, data governance, diagnostic integrity, and technological transparency. The goal is to demonstrate how ethical frameworks and professional responsibility can safeguard patients while ensuring that innovation enhances rather than undermines healthcare delivery.