Quality Improvement and Reimbursements: An Opportunity to Address Health Disparities in Radiology

Social Determinants of Health Framework to Identify and Reduce Barriers to Imaging in Marginalized Communities

Social determinants of health (SDOH) are conditions influencing individuals' health based on their environment of birth, living, working, and aging. Addressing SDOH is crucial for promoting health equity and reducing health outcome disparities. For conditions such as stroke and cancer screening where imaging is central to diagnosis and management, access to high-quality medical imaging is necessary. This article applies a previously described structural framework characterizing the impact of SDOH on patients who require imaging for their clinical indications. SDOH factors can be broadly categorized into five sectors: economic stability, education access and quality, neighborhood and built environment, social and community context, and health care access and quality. As patients navigate the health care system, they experience barriers at each step, which are significantly influenced by SDOH factors. Marginalized communities are prone to disparities due to the inability to complete the required diagnostic or screening imaging work-up. This article highlights SDOH that disproportionately affect marginalized communities, using stroke and cancer as examples of disease processes where imaging is needed for care. Potential strategies to mitigate these disparities include dedicating resources for clinical care coordinators, transportation, language assistance, and financial hardship subsidies. Last, various national and international health initiatives are tackling SDOH and fostering health equity.

How We Got Here: The Legacy of Anti-Black Discrimination in Radiology

Current disparities in the access to diagnostic imaging for Black patients and the underrepresentation of Black physicians in radiology, relative to their representation in the general U.S. population, reflect contemporary consequences of historical anti-Black discrimination. These disparities have existed within the field of radiology and professional medical organizations since their inception. Explicit and implicit racism against Black patients and physicians was institutional policy in the early 20th century when radiology was being developed as a clinical medical field. Early radiology organizations also embraced this structural discrimination, creating strong barriers to professional Black radiologist involvement. Nevertheless, there were numerous pioneering Black radiologists who advanced scholarship, patient care, and diversity within medicine and radiology during the early 20th century. This work remains important in the present day, as race-based health care disparities persist and continue to decrease the quality of radiology-delivered patient care. There are also structural barriers within radiology affecting workforce diversity that negatively impact marginalized groups. Multiple opportunities exist today for antiracism work to improve quality of care and to apply standards of social justice and health equity to the field of radiology. An initial step is to expand education on the disparities in access to imaging and health care among Black patients. Institutional interventions include implementing community-based outreach and applying antibias methodology in artificial intelligence algorithms, while systemic interventions include identifying national race-based quality measures and ensuring imaging guidelines properly address the unique cancer risks in the Black patient population. These approaches reflect some of the strategies that may mutually serve to address health care disparities in radiology. ^© RSNA, 2023 See the invited commentary by Scott in this issue. Quiz questions for this article are available in the supplemental material.

Analysis of Literature Regarding Health Care Disparities in Radiology: Is Radiology Falling Behind?

PURPOSE

To quantify the gap between radiology and other specialties regarding the amount of literature on healthcare disparities (HCD).

METHODS

Four different searches were conducted to evaluate the amount of literature on HCD in radiology as compared to internal medicine and surgery. Initially, the Journal Citation Report was utilized to search for the five highest ranking journals in each field and a second search used impact factor. A combination of search terms "health" AND "disparities" was used. Two additional searches were performed with PubMed using the terms "health" AND "disparities AND "radiology" with the final term changed for each specialty. The second PubMed search added the term "medical education" for each specialty. Articles were limited to years 2017 to 2020.

RESULTS

The initial search found 1817 articles discussing "health" and "disparities". 14.6% of these were radiology, 65.7% internal medicine, and 19.7% surgery. The subsequent search controlling for impact factor found 2176 articles. 12.2% were for radiology, 66.1% were for internal medicine, and 21.7% for surgery. The initial PubMed search found 6543 articles. 9.9% were for radiology, 32.4% for internal medicine, and 57.7% were for surgery. The addition of "medical education" decreased the articles to 807. Radiology had 9.9%, internal medicine was 44.2%, and surgery was 45.9 %.

CONCLUSION

A gap in HCD literature exists for radiology as compared to surgery and internal medicine. However, radiology has demonstrated a recent significant push towards understanding HCD.  Radiology should continue to capitalize on its momentum and develop HCD curricula and research.

Is Empowerment of Female Radiologists Still Needed? Findings of a Systematic Review

Considering that radiology is still a male-dominated specialty in which men make up more than two thirds of the workforce, this systematic review aimed to provide a comprehensive overview of the current role of women in radiological imaging, focusing on the main aspects such as career progression, leadership, academic practice, and perceived discrimination. Three electronic databases were searched up to 21 October 2020. To identify additional records, weekly automatic email alerts were set up on PubMed until December 2020 and reference lists of key studies and included papers were screened. Two reviewers independently performed the search, study selection, quality appraisal, data extraction, and formal narrative synthesis. In case of disagreement, a third reviewer was involved. Across the 61 included articles, women worked more often part-time and held fewer positions of power in hospitals, on editorial boards, and at the academic level (associate and full professors). Women were less often in relevant positions in scientific articles, had fewer publications, and had a lower H-index. Discrimination and sexual harassment were experienced by up to 40% and 47% of female radiologists, respectively. Our study highlights that women in radiology are still underrepresented and play a marginal role in the field, struggling to reach top and leading positions.