Imaging Disparities in Radiology

Patients who undergo radiologic imaging procedures for diagnostic testing may have more to consider depending on their racial background. Imaging procedures often serve as critical screening for diagnosis of various types of cancer and other crucial medical diagnoses. Even though radiologists who analyze radiologic imaging seldom see or talk to patients, other factors are at play in imaging disparities. But what are the factors that impact imaging disparities, and how can these imaging disparities be overcome for better health outcomes?

Disparities in Radiologic Diagnostic Testing

Medical professionals at SUNY Downstate Medical Center and Weill Cornell Medical College speculated about imaging disparities in radiology and decided to analyze patient data on the issue. Their analysis of imaging disparities culminated in three main categories of causes of imaging disparities: patient-related factors, system-related factors, and provider-related factors.

For patient-related factors, a wide range of issues may place an impact on disparities. Some potential issues originating from the patient side might include communication or language barriers, medical mistrust, health literacy, limited or lack of health insurance, lack of awareness of screening recommendations, and non-compliance with screening recommendations, among other issues.

For system-related factors, imaging type may impact the rate of disparities. Diagnostic testing in radiologic imaging can range from CAT scans or CT scans, fluoroscopies, MRIs, PET scans or PET/CT scans, ultrasounds, and X-rays. Yet not all of these imaging types are created equal. MRIs and PET/CT scans are considered a couple of the most advanced imaging types, but MRIs and PET/CT scans have lower availability rates in medical facilities where BIPOC patients turn to for their care. Black patients are more likely to receive care at healthcare facilities that serve low-income and BIPOC communities, which have been shown to rank lower on quality processes and health outcomes. Additional barriers for patients of color include longer wait times and travel times for access to more advanced imaging types.

For provider-related factors, there are multiple factors at play in disparities. Imaging quality and interpretations of lower quality imaging are two additional factors working against quality diagnostic testing and patient care. The medical professionals analyzing the imaging disparities also have an impact. For example, Black patients are more likely to receive care from a Black physician. And, in turn, Black physicians have a higher likelihood of providing care in low-income communities, serving charity care, and are less frequently board-certified in comparison to white physicians. Some studies have also shown that imaging ordering practices of healthcare professionals vary based on the patient socioeconomic status, thus putting lower income patients at higher risk of poor health outcomes.

Solutions Toward Equity in Radiologic Imaging

The medical professionals at SUNY Downstate Medical Center and Weill Cornell Medical College analyzed the data on imaging disparities and created a list of proposed solutions toward bridging the equity gap.

For patient-related interventions, healthcare professionals and facilities can work to raise awareness. Developing outreach and educational programs in partnership with local and state organizations would be an excellent model to help improve health literacy of disadvantaged communities. Raising awareness could be highly beneficial for cancer types like lung cancer that have higher incidence rates in disadvantaged communities. Solutions for patient-related factors could also include interventions like increasing healthcare staff diversity and providing transportation services for those with transportation barriers to appointments.

For system-related interventions, the medical professionals proposed a multitude of potential solutions. Instituting standardized race-neutral evaluation algorithms for diagnostic imaging could help reduce racial disparities, as was shown in the CHALICE algorithm for children’s head injuries. They also propose the U.S. Preventative Services Task Force revise current guidelines to lower the eligibility requirement for the number of pack years for Black smokers from the current guideline of 30 packs to 20 packs.

For provider-related interventions, the most effective solution noted is for academic institutions and healthcare facilities to more recruitment, training, and retention of BIPOC and Black radiologists. The medical professionals involved in the radiology disparities analysis also recommend that radiology departments include as part of their mission statement to stay informed about updates in technology and techniques and be prepared to work interdepartmentally to confirm that these updates are available to providers. In addition, they also recommend that radiologists work to contain health care costs by actively introducing interdepartmental efforts to curb inappropriate imaging use and improve efficiency through performance enhancement efforts.

Though there are disparities in diagnostic imaging, medical professionals at SUNY Downstate Medical Center and Weill Cornell Medical College spearheaded an effort to analyze disparities and solutions toward bridging the gaps. Patients and patient advocates can help raise awareness for improved diagnostic imaging and patient care toward the future.

What can you do next?

• Advocate for yourself and others. Be sure to share your concerns and opinions. Write to your congressperson to ask for federal funding to support diverse representation in diagnostic testing with radiology.

• Build community and support toward equity in diagnostic testing. Look for online forums discussing equity in diagnostics for radiologic imaging for all. Ask your healthcare provider for other ways to find people working to close the gap in imaging diagnostic testing disparities.

• Lead. If you are a healthcare provider, examine how you currently engage with your patients. Consider joining our Pro Hub to connect with other experts committed to removing barriers to health equity.

Sources

Stephen Waite, Jinel Scott, Daria Colombo. Narrowing the Gap: Imaging Disparities in Radiology. Radiology Society of North America website. Accessed November 5, 2024. https://pubs.rsna.org/radiographics/doi/10.1148/radiol.2021203742

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