The focus of equity, diversity, and inclusivity (EDI) initiatives in imaging should not only include staff but also patients, according to a statement paper published by the ESR's EDI Subcommittee.
The group's paper, published in Insights into Imaging on 27 November, examined issues reflecting inequity in the provision of services to patients. The group offered recommendations on how radiologists and radiology departments can remain mindful of disparities in how radiology services are provided and educated on interacting with different groups.
Additionally, Dr. Anagha Parkar, Prof. Amaka Offiah, Dr. Mihai-Alexandru Ene, and Prof. Ioana-Andreea Gheonea wrote that radiologists should be “sensibly critical” and aware of how guidelines often reflect a lack of evidence-based knowledge and data on female and nonwhite populations.
Such gaps are attributable to a lack of diversity in research populations, a phenomenon the points out has been well-documented. Lack of consideration of factors and issues specific to minority populations can lead to important questions not being asked in research. For healthcare to be equitable, the authors wrote, not only must research teams themselves be diverse, but research populations must as well: “A diverse research workforce positively impacts patient outcomes through collaboration, innovation, and decreased implicit bias.”
Occurrence of keywords in papers regarding radiology and EDI, from a PubMed search. Publications in which the keywords occur date from 2014 (dark blue) to 2022 (yellow).Dr. Anagha Parkar et al; Insights into Imaging
Related to the lack of data and the implications of biases in research is the presence of and potential for bias in the use of AI, the authors wrote, adding that radiology has adopted AI more widely than other medical fields. They caution that such biases -- which may be introduced at any point in an algorithm’s development -- may be considered to violate bioethical principles, a compelling reason for radiologists to be mindful of the possibility of inequity in treatment when such AI is used.
In radiology, implicit and systemic biases may result in incorrect diagnosis or a medical condition being overlooked. For example, systematic review findings show that patients who belong to ethnic-minority groups receive fewer appropriate imaging studies than others.
A similar gap in care, with similar potential consequences of delayed or missed diagnoses, has been shown with women. The authors cite a Spanish study that found that women with a solitary lung nodule were more likely than men to be recommended for follow-up rather than intervention, possibly leading to delayed diagnoses.
Biases concerning age and disability also lead to inequity in imaging services: The elderly may receive fewer imaging referrals due to a perception that they will derive less benefit from some procedures; in surveys, up to 20% of older patients have reported encountering this prejudice during medical interactions. Patients who are disabled are more likely to face barriers to care due to lack of support, accessibility, and accommodation for disabilities, the authors wrote, obstacles which may also affect older patients.
Issues affecting inequity in imaging services.Dr. Anagha Parkar et al; Insights into Imaging
Inequity is also a significant obstacle to care for patients who are gender nonbinary or transgender, the authors stated. Survey findings show that 25% of transgender and nonbinary patients have had negative encounters with radiology staff, often marked by a lack of privacy protection and disregard for the patient’s comfort. Another survey showed that 28% of transgender patients have delayed seeking medical care for fear of discrimination; 50% of the patients reported having to educate their healthcare providers on transgender care. The particular needs of these patients are often overlooked in guidelines, with data lacking -- for example, in breast cancer screening guidelines.
Parkar and colleagues recommend that radiology staff “strive to be active bystanders” in being aware of how inequities in imaging affect patients in minority groups. Initiatives such as educating staff on how to interact with diverse populations and maintaining equipment and tools that serve patients with disabilities are necessary to level the path to access for these patients.
Read the statement paper here.
