1
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Ahrendt H, Sun H, Mishra K, Gupta S, Bukavina L. Multidisciplinary management of sexual and gender minorities with bladder cancer. Urol Oncol 2024:S1078-1439(24)00496-4. [PMID: 38880704 DOI: 10.1016/j.urolonc.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/19/2024] [Accepted: 05/24/2024] [Indexed: 06/18/2024]
Abstract
Bladder cancer, a common urologic malignancy, has poor morbidity and mortality in sexual and gender minority (SGM) individuals, stemming from higher risk, poor access to care and lack of quality cancer care. To begin addressing this disparity, this review offers key considerations for evaluation, diagnosis and treatment of SGM individuals with bladder cancer. In addition to thorough medical and surgical history, initial evaluation should include discussion of patient goals for sexual function and organ preservation, as well as an evaluation of sexual function. Prior gender affirming surgery and patient specific sexual function goals will impact diagnosis and treatment approaches, including surgical and radiation therapy. Throughout care for SGM individuals with bladder cancer, it is critical to acknowledge the systemic discrimination that may be experienced by these individuals and approach conversations with sensitivity and humility and incorporate mental and social support as appropriate.
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Affiliation(s)
- Hannah Ahrendt
- Case Western Reserve University, School of Medicine, Cleveland, OH
| | - Helen Sun
- Case Western Reserve University, School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Kirtishri Mishra
- Case Western Reserve University, School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Shubham Gupta
- Case Western Reserve University, School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH
| | - Laura Bukavina
- Case Western Reserve University, School of Medicine, Cleveland, OH; Urology Institute, University Hospitals of Cleveland, Cleveland, OH.
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2
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Jacobson AR, Blaszczak J, Ahn J, Viglianti BL. DEXA Screening for Transgender and Gender Diverse Patients: An Overview of Current Guidance and Call for Improved Protocols. Acad Radiol 2024; 31:2159-2163. [PMID: 37977892 DOI: 10.1016/j.acra.2023.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023]
Affiliation(s)
| | - Julie Blaszczak
- Department of Family Medicine, University of Michigan, Ann Arbor, MI (J.B.).
| | - Jaimo Ahn
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor MI (J.A.).
| | - Benjamin L Viglianti
- Department of Radiology, Division of Nuclear Medicine, University of Michigan, Ann Arbor, MI (B.L.V.).
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3
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Dutruel SP, Hentel KD, Hecht EM, Kadom N. Patient-Centered Radiology Communications: Engaging Patients as Partners. J Am Coll Radiol 2024; 21:7-18. [PMID: 37863150 DOI: 10.1016/j.jacr.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/22/2023]
Abstract
Patient-centered care is a model in which, by bringing the patient's perspective to the design and delivery of health care, we can better meet patients' needs, enhancing the quality of care. Patient-centered care requires finding ways to communicate effectively with a diverse patient population that has various levels of health literacy, cultural backgrounds, and unique needs and preferences. Moreover, multimedia resources have the potential to inform and educate patients promoting greater independence. In this review, we discuss the fundamentals of communication with the different modes used in radiology and the key elements of effective communication. Then, we highlight five opportunities along the continuum of care in the radiology practice in which we can improve communications to empower our patients and families and strengthen this partnership. Lastly, we discuss the importance on communication training of the workforce, optimizing and seamlessly integrating technology solutions into our workflows, and the need for patient feedback in the design and delivery of care.
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Affiliation(s)
- Silvina P Dutruel
- Department of Radiology, Weill Cornell Medical Center, New York, New York.
| | - Keith D Hentel
- Professor, Clinical Radiology, Executive Vice Chairman, Department of Radiology; Vice President, Weill Cornell Imaging at New York-Presbyterian, New York, New York
| | - Elizabeth M Hecht
- Vice Chair for Academic Affairs, Department of Radiology, Weill Cornell Medical Center, New York, New York. https://twitter.com/ehecht_md
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Director of Quality, Department of Radiology, Children's Healthcare of Atlanta, Georgia; Interim Director of Quality, Department of Radiology, Emory Healthcare, Atlanta, Georgia; Chair, Practice and Performance Improvement Committee, ARRS; and Chair, Metrics Committee, ACR
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4
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Sozio SJ, Soliman A, Shah K, Schonfeld S, Kempf J. Educating Radiology Stakeholders on Relevant Health Issues and Terminology Regarding LGBTQIA+ Patients in 2023. Acad Radiol 2023; 30:2422-2428. [PMID: 37311679 DOI: 10.1016/j.acra.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 06/15/2023]
Abstract
RATIONALE AND OBJECTIVES Over 20% of the Lesbian, Gay, Bisexual, Queer or Questioning, Intersex, Asexual or Ally, and more (LGBTQIA+) community reports experiencing discrimination upon accessing health care, causing many to defer access to care and resulting in poorer outcomes. While members of this community routinely undergo imaging studies, little formal education exists within the field of radiology to review the unique health care needs of this population and the specific relevance to imaging, in addition to actionable methods to promote inclusion. MATERIALS AND METHODS A 1-hour educational conference was held for a cohort of radiology resident physicians at our institution, in which topics including LGBTQIA+ health care disparities, clinical nuances relevant to the field of radiology, and actionable suggestions that both academic and private-practice centers can adopt to foster inclusion were presented. All attendees were required to complete a 12-question, multiple-choice preconference and postconference examination. RESULTS Median prelecture and postlecture quiz scores for four first-year radiology residents were 29% and 75%, for two second-year radiology residents were 29% and 63%, for two third-year radiology residents were 17% and 71%, and for three fourth-year radiology residents were 42% and 80%. CONCLUSION Multiple areas of opportunity to foster LGBTQIA+ inclusion at the provider and administration levels currently exist throughout the field of radiology. A radiology-focused education module regarding clinical nuances, health care inequities, and ways to foster an inclusive environment with the LGBTQIA+ community is an effective way to promote learner knowledge.
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Affiliation(s)
- Stephen J Sozio
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.
| | - Andrew Soliman
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Kush Shah
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Steven Schonfeld
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jeffrey Kempf
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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5
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McGowan A, Dowley A, Ryan ML. An assessment of radiation safety practices for transgender and gender non-binary patients in Irish radiology departments. Radiography (Lond) 2023; 29:1021-1028. [PMID: 37677848 DOI: 10.1016/j.radi.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 07/12/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Studies indicate there may be inadequate care given to transgender and non-binary (TGNB) patients in healthcare environments, with radiology departments not being equipped to cater for this group. There is currently a deficit in research concerning the use of radiation safety measures for TGNB patients. The purpose of this research was to examine opinions of Irish Radiation Safety Experts (RSE) on current status of radiation safety protocols and techniques in place for TGNB patients and consider any changes necessary. METHODOLOGY Ten semi-structured interviews were conducted with RSEs from eight Irish hospitals, including five radiation protection officers (RPO) and five medical physicists. Question included: current radiation safety protocols for TGNB patients, potential issues and challenges with current practice, and recommendations of new measures. Coding was used to facilitate content analysis for interpretation of findings. RESULTS No reference to TGNB patients in local policies or guidelines was evident. Interviews established key radiation safety risks including inadvertent exposure of the foetus and insensitive patient care. Prominent categories identified included additional education, gender identification at patient registration and consideration of current policies and guidelines. The extent to which RSEs promoted the implementation of further measures to radiology departments varied. CONCLUSIONS A clear lack of guidance and instruction for radiation safety for TGNB patients is evident. Whilst there are few TGNB patients in Irish hospitals, participants believed that inclusive changes should be made concurrent with Ireland's evolving culture and in the interest of equality of patient safety. IMPLICATIONS FOR PRACTICE Inclusive changes should be made to radiology departments concurrent with Ireland's evolving culture. However, barriers to implementing such measures include a lack of available resources, investment, and instruction from authoritative bodies.
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Affiliation(s)
- A McGowan
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - A Dowley
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
| | - M-L Ryan
- Radiography and Diagnostic Imaging, School of Medicine, University College Dublin, Ireland.
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6
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Constantinou N, Marshall C, Marshall H. Discussion and Optimization of the Male Breast Cancer Patient Experience. JOURNAL OF BREAST IMAGING 2023; 5:339-345. [PMID: 38416881 DOI: 10.1093/jbi/wbac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Indexed: 03/01/2024]
Abstract
Breast cancer in men is rare and often overlooked as there is a misconception that it is a gendered disease that affects women only. The feminization, or "pinkification," of the disease has been socially constructed to raise awareness, improve screening, and empower women but has not addressed the occurrence of the illness in men. Men may therefore experience unique psychosocial difficulties when faced with a disease that predominantly affects women, including feelings of disbelief and embarrassment that impact their sense of self and challenge their masculinity. The lack of mammographic screening in men, lack of public awareness, and the shame that develops during the time of diagnosis can result in treatment avoidant behaviors, a delayed presentation, and worse prognosis in men. Although male breast cancer (MBC) is uncommon, the incidence is increasing; therefore, efforts should be made to enhance education for health care professionals and the general public in order to lessen the stigma, with the goal of improving outcomes. Furthermore, special attention to the unique medical needs and hurdles encountered by transgender males can break down health care barriers in this marginalized patient population. This article offers male perceptions on breast cancer, the psychosocial implications of being diagnosed with a gendered disease, and suggestions on how to improve the MBC experience.
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Affiliation(s)
- Niki Constantinou
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
| | - Colin Marshall
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
| | - Holly Marshall
- Case Western Reserve University, Department of Radiology, Cleveland, OH, USA
- University Hospitals Cleveland Medical Center, Department of Radiology, Cleveland, OH, USA
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7
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Practical Approaches to Advancing Health Equity in Radiology, From the AJR Special Series on DEI. AJR Am J Roentgenol 2023:1-10. [PMID: 36629307 DOI: 10.2214/ajr.22.28783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Despite significant advances in healthcare, many patients from medically underserved populations are impacted by existing healthcare disparities. Radiologists are uniquely positioned to decrease health disparities and advance health equity efforts in their practices. However, literature on practical tools for advancing radiology health equity efforts applicable to a wide variety of patient populations and care settings is lacking. Therefore, this article seeks to equip radiologists with an evidence-based and practical knowledge toolkit of health equity strategies, presented in terms of four pillars of research, clinical care, education, and innovation. For each pillar, equity efforts across diverse patient populations and radiology practice settings are examined through the lens of existing barriers, current best practices, and future directions, incorporating practical examples relevant to a spectrum of patient populations. Health equity efforts provide an opportune window to transform radiology through personalized care delivery that is responsive to diverse patient needs. Guided by compassion and empathy as core principles of health equity, leveraging the four pillars provides a helpful framework to advance health equity efforts as a step towards social justice in health.
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8
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Promoting Progress and Learning from Mistakes: Results of a Radiology Department LGBTQ Inclusion Audit. Acad Radiol 2022; 29:1833-1839. [PMID: 35466052 DOI: 10.1016/j.acra.2022.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 01/26/2023]
Abstract
RATIONALE AND OBJECTIVES As radiology programs seek to recruit and retain diverse and competitive applicants, it is important to critically review existing department policies to ensure they meet the needs of their residents. To evaluate a radiology program's inclusivity measures, an interdepartmental committee developed an "LGBTQ inclusion index" and performed an LGBTQ inclusion audit to identify gaps in policy and to craft proposals for administrative review. MATERIALS AND METHODS An LGBTQ inclusion index was compiled through the collaboration of an interdisciplinary committee of residents, faculty, institutional and community representatives. Five inclusion milestones were identified relating to department policy, department facilities, institutional culture, department culture, and community engagement. Milestones were scored as 0, for milestone not at all met, 1, for milestone partially met, and 2, for milestone completely met, with a total score of 10. Program scores were calculated for the 2018-2021 academic years. RESULTS The radiology program LGBTQ inclusion index score increased over the course of the study period. The program LGBTQ inclusion index score was 4 of 10 in 2018 and 2019, but after formation of an LGBTQ inclusion task force by the diversity and inclusion committee, increased to 7 of 10 in 2020. The LGBTQ inclusion audit identified several areas that required improvement and the committee drafted proposals to address these gaps. By 2021, the program scored 9 of 10 on the inclusion index. CONCLUSION Promoting an inclusive and affirming radiology department is an important step to providing culturally competent healthcare and mitigating health disparities. An LGBTQ inclusion audit and a robust department diversity committee can help to identify and address gaps in policy, facilities, and culture.
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9
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Gupta S, Choe AI, Hardy PA, Ganeshan D, Hobbs SK, Probyn L, Awan OA, Straus CM. Proposed Multilevel measures to Support Diversity, Equity and Inclusion (DEI) Efforts in Radiology. Acad Radiol 2022; 30:952-958. [PMID: 36155167 DOI: 10.1016/j.acra.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 11/19/2022]
Abstract
Integrating diversity into healthcare systems has its challenges and advantages. Academic medicine strives to expand the diversity of the healthcare workforce. The Association of University Radiologists (AUR) put together a task force to review the concept of Diversity, Equity and Inclusion (DEI) as it pertains to Radiology and to propose strategies for better integrating DEI in Radiology. We present several measures aimed at the trainee, leadership, management and professional society levels to empower DEI in Radiology.
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Affiliation(s)
- Supriya Gupta
- Department of Radiology and Imaging, Amita St. Mary's Hospital, Western Springs, IL.
| | - Angela I Choe
- Penn State Health Milton S. Hershey Medical Cente, Hershey, PA
| | | | - Dhakshina Ganeshan
- Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan K Hobbs
- Department of Imaging Sciences, Education Department of Imaging Sciences, Diagnostic Radiology Residency Program, Integrated Diagnostic Radiology/Interventional Radiology Residency Program, University of Rochester Medical Center, Rochester, NY
| | - Linda Probyn
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Department of Medical Imaging, University of Toronto, Toronto, ON
| | - Omer A Awan
- University of Maryland School of Medicine, Baltimore, MD
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10
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Sharma S, Sharma B. Gender Affirmative Care Clinic: An Overview. Indian J Plast Surg 2022; 55:144-148. [PMID: 36017414 PMCID: PMC9398518 DOI: 10.1055/s-0042-1749103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
AbstractTransgender healthcare is an evolving multispecialty field including medical and social domains catering to the needs of a specific subset of population presenting with gender incongruence, differences in sexual development/orientation, requiring care rather than cure. Delivery of transgender healthcare is done through gender friendly healthcare facilities, which are designated as “gender affirmative care clinics (GACC).” The primary purpose of the gender affirmative care clinic is to be the “one stop solution” for a person seeking affirmative care. The main objective is to facilitate care with compassion and prevent/mitigate dysphoria. The components of the GACC should include reception cum front office; affirmative mental healthcare department; affirmative medical, surgical, and sexual healthcare department; diagnostics, legal, and ethics department, as well as inpatient care. The GACC should be preferably located in a place that is easily accessible to the community members and has an “open plan.”
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Affiliation(s)
- Sanjay Sharma
- ATHI, Association for Transgender Health in India, Board Member WPATH (World Professional Association for Transgender Health), WPATH GEI SOC7 Certified Member, Gurgaon, Haryana, India
| | - Bela Sharma
- Department of Internal Medicine, FMRI, Gurgaon, Haryana, India
- Medical Director IPATH (Indian Professional Association for Transgender Health), Member WPATH (World Professional Association for Transgender Health), Gurgaon, Haryana, India
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11
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Transgender health and medicine – Are radiological devices prepared? Eur J Radiol 2022; 151:110320. [DOI: 10.1016/j.ejrad.2022.110320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 04/03/2022] [Accepted: 04/11/2022] [Indexed: 11/22/2022]
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12
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DeBenedectis CM, Spalluto LB, Americo L, Bishop C, Mian A, Sarkany D, Kagetsu NJ, Slanetz PJ. Health Care Disparities in Radiology-A Review of the Current Literature. J Am Coll Radiol 2022; 19:101-111. [PMID: 35033297 DOI: 10.1016/j.jacr.2021.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/31/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of radiology's efforts to mitigate disparities. Our primary objective is to perform a comprehensive review of the last 10 years of literature pertaining to disparities in radiology care. Our secondary objective is to raise awareness of disparities in radiology. METHODS We reviewed English-language medicine and health services literature from the past 10 years (2010-2020) for research that described disparities in any aspect of radiologic imaging using radiology search terms and key words for disparities in OVID. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS The search yielded a total 1,890 articles. We reviewed the citations and abstracts with the initial search yielding 1,890 articles (without duplicates). Of these, 1,776 were excluded based on the criteria set forth in the methods. The remaining unique 114 articles were included for qualitative synthesis. DISCUSSION We hope this article increases awareness and inspires action to address disparities and encourages research that further investigates previously identified disparities and explores not-yet-identified disparities.
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Affiliation(s)
- Carolynn M DeBenedectis
- Vice-Chair, Education; Director, Radiology Residency Program; Department of Radiology, President-elect, New England Roentgen Ray Society; and Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Lucy B Spalluto
- Vice-Chair, Health Equity; Director, Women in Radiology; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research; and Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Lisa Americo
- Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | - Casey Bishop
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Asim Mian
- Director, Radiology Residency Program; Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - David Sarkany
- Director, Radiology Residency Program; Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | - Nolan J Kagetsu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Priscilla J Slanetz
- Vice-Chair, Academic Affairs; Associate Program Director, Radiology Residency Program, Boston Medical Center; President-elect Massachusetts Radiologic Society; Secretary, Association of University Radiologists; Chair, Breast Imaging Panel 2, ACR Appropriateness Guidelines Committee; and Department of Radiology, Boston Medical Center, Boston, Massachusetts
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13
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Callen AL. Invited Commentary: Advancing the Field of Transgender Radiology. Radiographics 2022; 42:E23-E24. [PMID: 34990333 DOI: 10.1148/rg.210188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Andrew L Callen
- From the Neuroradiology Section, Department of Radiology, University of Colorado Anschutz Medical Campus, 12401 E 17th Ave, Mail Stop L954, Aurora, CO 80045
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14
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Hiles P, Gilligan P, Damilakis J, Briers E, Candela-Juan C, Faj D, Foley S, Frija G, Granata C, de Las Heras Gala H, Pauwels R, Sans Merce M, Simantirakis G, Vano E. European consensus on patient contact shielding. Insights Imaging 2021; 12:194. [PMID: 34939154 PMCID: PMC8695402 DOI: 10.1186/s13244-021-01085-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 08/19/2021] [Indexed: 12/25/2022] Open
Abstract
Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.
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Affiliation(s)
- Peter Hiles
- Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK.
| | - Patrick Gilligan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands.,Mater Private Hospital, Eccles St., Dublin, Ireland
| | - John Damilakis
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria.,University of Crete, Iraklion, Crete, Greece
| | - Eric Briers
- Member ESR-Patient Advisory Group, Patient Advocate, Hasselt, Belgium
| | - Cristian Candela-Juan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands.,Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain
| | - Dario Faj
- European Radiation Dosimetry Group, Neuherberg, Germany.,Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Shane Foley
- European Federation of Radiographer Societies, Utrecht, Belgium.,Radiography and Diagnostic Imaging, University College Dublin, Dublin, Ireland
| | - Guy Frija
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria.,Université de Paris, Paris, France
| | - Claudio Granata
- European Society of Paediatric Radiology, Le Kremlin-Bicêtre, France.,Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Hugo de Las Heras Gala
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands.,Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - Ruben Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Marta Sans Merce
- European Radiation Dosimetry Group, Neuherberg, Germany.,Geneva University Hospitals, Geneva, Switzerland
| | - Georgios Simantirakis
- European Radiation Dosimetry Group, Neuherberg, Germany.,Greek Atomic Energy Commission, Agia Paraskevi, Athens, Greece
| | - Eliseo Vano
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria.,Radiology Department, Complutense University, Madrid, Spain
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15
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Hiles P, Gilligan P, Damilakis J, Briers E, Candela-Juan C, Faj D, Foley S, Frija G, Granata C, de Las Heras Gala H, Pauwels R, Sans Merce M, Simantirakis G, Vano E. European consensus on patient contact shielding. Radiography (Lond) 2021; 28:353-359. [PMID: 34953726 DOI: 10.1016/j.radi.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.
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Affiliation(s)
- P Hiles
- Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK.
| | - P Gilligan
- European Federation of Organizations for Medical Physics, Utrecht, the Netherlands; Mater Private Hospital, Eccles St., Dublin 7, Ireland
| | - J Damilakis
- European Society of Radiology, EuroSafe Imaging, Vienna, Austria; University of Crete, Iraklion, Crete, Greece
| | - E Briers
- Member ESR-Patient Advisory Group, Patient Advocate, Hasselt, Belgium
| | - C Candela-Juan
- European Federation of Organizations for Medical Physics, Utrecht, the Netherlands; Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain
| | - D Faj
- European Radiation Dosimetry Group, Neuherberg, Germany; Faculty of Dental Medicine and Health, Osijek, Croatia
| | - S Foley
- European Federation of Radiographer Societies, Utrecht, the Netherlands; Radiography & Diagnostic Imaging, University College Dublin, Ireland
| | - G Frija
- European Society of Radiology, EuroSafe Imaging, Vienna, Austria; Université de Paris, France
| | - C Granata
- European Society of Paediatric Radiology, Le Kremlin-Bicêtre, France; Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - H de Las Heras Gala
- European Federation of Organizations for Medical Physics, Utrecht, the Netherlands; Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - R Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Denmark
| | - M Sans Merce
- European Radiation Dosimetry Group, Neuherberg, Germany; Geneva University Hospitals, Geneva, Switzerland
| | - G Simantirakis
- European Radiation Dosimetry Group, Neuherberg, Germany; Greek Atomic Energy Commission, Agia Paraskevi, Athens, Greece
| | - E Vano
- European Society of Radiology, EuroSafe Imaging, Vienna, Austria; Radiology Department, Complutense University, Spain
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Hiles P, Gilligan P, Damilakis J, Briers E, Candela-Juan C, Faj D, Foley S, Frija G, Granata C, de Las Heras Gala H, Pauwels R, Sans Merce M, Simantirakis G, Vano E. European consensus on patient contact shielding. Phys Med 2021; 96:198-203. [PMID: 34955383 DOI: 10.1016/j.ejmp.2021.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patient contact shielding has been in use for many years in radiology departments in order to reduce the effects and risks of ionising radiation on certain organs. New technologies in projection imaging and CT scanning such as digital receptors and automatic exposure control (AEC) systems have reduced doses and improved image consistency. These changes and a greater understanding of both the benefits and the risks from the use of shielding have led to a review of shielding use in radiology. A number of professional bodies have already issued guidance in this regard. This paper represents the current consensus view of the main bodies involved in radiation safety and imaging in Europe: European Federation of Organisations for Medical Physics, European Federation of Radiographer Societies, European Society of Radiology, European Society of Paediatric Radiology, EuroSafe Imaging, European Radiation Dosimetry Group (EURADOS), and European Academy of DentoMaxilloFacial Radiology (EADMFR). It is based on the expert recommendations of the Gonad and Patient Shielding (GAPS) Group formed with the purpose of developing consensus in this area. The recommendations are intended to be clear and easy to use. They are intended as guidance, and they are developed using a multidisciplinary team approach. It is recognised that regulations, custom and practice vary widely on the use of patient shielding in Europe and it is hoped that these recommendations will inform a change management program that will benefit patients and staff.
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Affiliation(s)
- Peter Hiles
- Glan Clwyd Hospital, Bodelwyddan, Denbighshire, UK.
| | - Patrick Gilligan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands; Mater Private Hospital, Eccles St., Dublin 7, Ireland
| | - John Damilakis
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria; University of Crete, Iraklion, Crete, Greece
| | - Eric Briers
- Member ESR-Patient Advisory Group, Patient Advocate, Hasselt, Belgium
| | - Cristian Candela-Juan
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands; Centro Nacional de Dosimetría (CND), Instituto Nacional de Gestión Sanitaria, Valencia, Spain
| | - Dario Faj
- European Radiation Dosimetry Group, Neuherberg, Germany; Faculty of Dental Medicine and Health, Osijek, Croatia
| | - Shane Foley
- European Federation of Radiographer Societies, Utrecht, The Netherlands; Radiography & Diagnostic Imaging, University College Dublin, Ireland
| | - Guy Frija
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria; Université de Paris, France
| | - Claudio Granata
- European Society of Paediatric Radiology, Le Kremlin-Bicêtre, France; Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Hugo de Las Heras Gala
- European Federation of Organizations for Medical Physics, Utrecht, The Netherlands; Federal Office for Radiation Protection, Oberschleißheim, Germany
| | - Ruben Pauwels
- Aarhus Institute of Advanced Studies, Aarhus University, Denmark
| | - Marta Sans Merce
- European Radiation Dosimetry Group, Neuherberg, Germany; Geneva University Hospitals, Geneva, Switzerland
| | - Georgios Simantirakis
- European Radiation Dosimetry Group, Neuherberg, Germany; Greek Atomic Energy Commission, Agia Paraskevi, Athens, Greece
| | - Eliseo Vano
- European Society of Radiology - EuroSafe Imaging, Vienna, Austria; Radiology Department, Complutense University, Spain
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Pedersen S, Corcoran L. Implementation of transgender and gender diverse curriculum in medical imaging programs: A review of the literature. J Med Imaging Radiat Sci 2021; 52:S110-S116. [PMID: 34303645 DOI: 10.1016/j.jmir.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/10/2021] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Sexual and gender minority patients experience significant inequities when accessing health care. Transgender and non-binary patients are at an even greater risk of experiencing health disparities due to their specialized health care needs. In the discipline of medical imaging, limited cultural competence, social stigma, and cis-heteronormative environments are barriers for these patients. There is an urgent need to improve medical imaging care for transgender and non-binary people; inclusion of sexual and gender minority content in medical imaging curriculum is one strategy to begin to address this need. METHOD A review of the literature was undertaken to explore implementation of sexual and gender minority content in the curricula of medical imaging programs. RESULTS/DISCUSSION Three main themes were identified: 1) educators' acknowledgement of the importance and value of adding sexual and gender minority content to healthcare curriculum; 2) educators' lack of a sense of preparedness, experience, and knowledge to adequately teach this content: and 3) lack of resources and institutional support to help develop curriculum. CONCLUSION Including content in the curriculum related to the needs of transgender and non-binary patients will help ensure entry-to-practice Medical Radiation Technologists are better prepared to provide inclusive care.
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Affiliation(s)
- Sidsel Pedersen
- Faculty of Health Disciplines, Athabasca University, Alberta, Canada.
| | - Lynn Corcoran
- Faculty of Health Disciplines, Athabasca University, Alberta, Canada
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18
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Wandy T, Gray S, Durand DJ, Kadom N. Improving Awareness of LGBTQ Patient Preferences Among Radiology Staff Members. Curr Probl Diagn Radiol 2021; 50:768-771. [PMID: 33827769 DOI: 10.1067/j.cpradiol.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/03/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Our health system set out to improve services to patients from the LGBTQ community as a step towards decreasing disparities in care. MATERIALS AND METHODS A pilot education intervention targeting staff knowledge and skills regarding terminology with regards to gender fluidity and sexual orientation was designed and implemented. RESULTS 81 staff members participated and we found improvements in knowledge but there remain uncertainties that can be addressed in future training sessions. CONCLUSIONS LGBTQ staff education in radiology is feasible and effective. Additional education interventions may be necessary to address persistent knowledge gaps. Effects on patient acre are yet unknown.
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Affiliation(s)
- Tiffany Wandy
- Julian O. Salik Department of Radiology, LifeBridge Health System, Baltimore, MD
| | - Sommer Gray
- Julian O. Salik Department of Radiology, LifeBridge Health System, Baltimore, MD
| | - Daniel J Durand
- Julian O. Salik Department of Radiology, LifeBridge Health System, Baltimore, MD
| | - Nadja Kadom
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA; Department of Radiology, Children's Healthcare of Atlanta, Atlanta, GA.
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19
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Hassan O, Sun D, Jha P. Imaging in Gender Affirmation Surgery. Curr Urol Rep 2021; 22:14. [PMID: 33515366 PMCID: PMC7847456 DOI: 10.1007/s11934-020-01029-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 11/29/2022]
Abstract
Purpose of Review This review summarizes recent developments in gender affirmation surgery, imaging findings in patients undergoing these surgeries, focusing on common postoperative radiologic appearances, complications, and pitfalls in interpretation. Recent Findings The imaging workup of masculinizing and feminizing genitourinary surgeries uses multiple modalities in presurgical planning and within the immediate and long-term postoperative period. CT and MRI can help identify immediate and remote postoperative complications. Fluoroscopic examinations can diagnose postoperative urethral complications after gender affirmation surgeries. Lastly, the patients can undergo imaging for unrelated acute and chronic pathology, and knowledge of these imaging findings can be very helpful. Summary Imaging plays a significant role in the care of transgender patients and, particularly, in those pursuing gender affirmation surgery. As insurance coverage expands for these surgical procedures, radiologists should be prepared to encounter, understand, and interpret pre and postoperative findings.
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Affiliation(s)
- Omar Hassan
- Department of Radiology, Abdominal Imaging and Ultrasound Section, University of California, San Francisco, 505 Parnassus Ave, box 0628, San Francisco, CA, 94143-0628, USA.
| | - Derek Sun
- Department of Radiology, Abdominal Imaging and Ultrasound Section, University of California, San Francisco, 505 Parnassus Ave, box 0628, San Francisco, CA, 94143-0628, USA
| | - Priyanka Jha
- Department of Radiology, Abdominal Imaging and Ultrasound Section, University of California, San Francisco, 505 Parnassus Ave, box 0628, San Francisco, CA, 94143-0628, USA
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20
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Gentle Touch: Noninvasive Approaches to Improve Patient Comfort and Cooperation for Pediatric Imaging. Top Magn Reson Imaging 2021; 29:187-195. [PMID: 32541256 DOI: 10.1097/rmr.0000000000000245] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pediatric imaging presents unique challenges related to patient anxiety, cooperation, and safety. Techniques to reduce anxiety and patient motion in adults must often be augmented in pediatrics, because it is always mentioned in the field of pediatrics, children are not miniature adults. This article will review methods that can be considered to improve patient experience and cooperation in imaging studies. Such techniques can range from modifications to the scanner suite, different ways of preparing and interacting with children, collaborating with parents for improved patient care, and technical advances such as accelerated acquisition and motion correction to reduce artifact. Special considerations for specific populations including transgender patients, neonates, and pregnant women undergoing fetal imaging will be described. The unique risks of sedation in children will also be briefly reviewed.
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21
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Facial Feminization Surgery: Key CT Findings for Preoperative Planning and Postoperative Evaluation. AJR Am J Roentgenol 2020; 217:709-717. [PMID: 33377802 DOI: 10.2214/ajr.20.25228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Facial feminization surgery is an increasingly performed component of gender affirmation surgery for transgender women. Preoperative facial CT is performed to plan the adjustment of the patient's masculine characteristics to feminine and to plan operative navigation around specific readily identifiable anatomic structures. In the upper face, surgery is performed to reduce the prominence of the brow and increase the nasofrontal angle; the radiology report should indicate the frontal sinus and supraorbital foramen anatomy. In the midface, rhinoplasty is performed to increase the nasofrontal and nasolabial angles; the radiology report should indicate the presence of a dorsal hump and septal deviation or spurring. In the lower face, the prominence of the chin and squareness of the jaw are adjusted via genioplasty and mandible contouring, respectively; the radiology report should describe the location and potential anatomic variations of the inferior alveolar nerve and mental foramina as well as the presence of dental abnormalities that directly inform the surgical approach. CT may also be performed if there is clinical suspicion for postoperative complications such as hardware fracture or osteotomy through the supraorbital or mental foramen. Familiarity with these findings will facilitate improved communication between radiologists and surgeons, thereby contributing to the care of transgender women.
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22
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Callen AL, Badiee RK, Phelps A, Potigailo V, Wang E, Lee S, Talbott J, Glastonbury C, Pomerantz JH, Narvid J. Facial Feminization Surgery: Key CT Findings for Preoperative Planning and Postoperative Evaluation. AJR Am J Roentgenol 2020:AJR.20.25528. [PMID: 33377414 DOI: 10.2214/ajr.20.25528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Facial feminization surgery (FFS) is an increasingly performed component of gender affirmation surgery for transgender women. Preoperative facial CT is performed to plan the adjustment of the patient's masculine characteristics to feminine, and to plan operative navigation around specific readily identifiable anatomic structures. In the upper face, surgery is performed to reduce the prominence of the brow and increase the nasofrontal angle; the radiology report should indicate the frontal sinus and supraorbital foramen anatomy. In the midface, rhinoplasty is performed to increase the nasofrontal and nasolabial angles; the radiology report should indicate presence of a dorsal hump and septal deviation or spurring. In the lower face, prominence of the chin and squareness of the jaw are adjusted via genioplasty and mandible contouring, respectively; the radiology report should describe the location and potential anatomic variations of the inferior alveolar nerve and mental foramina, as well as presence of dental abnormalities that directly inform the surgical approach. CT may also be performed if there is clinical suspicion for postoperative complications such as hardware fraction or osteotomy through the supraorbital or mental foramen. Familiarity with these findings will facilitate improved communication between radiologists and surgeons, thereby contributing to the care of transgender women.
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Affiliation(s)
- Andrew Lawrence Callen
- University of Colorado Anschutz Medical Campus, Department of Radiology, 1201 Larimer St, Denver, CO 80204, Phone: 720-848-1130
| | - Ryan K Badiee
- University of California San Francisco Division of Plastic and Reconstructive Surgery, 505 Parnassus Ave, San Francisco, CA 94143, Phone: 415-353-3526
| | - Andrew Phelps
- Oregon Health Sciences University Department of Radiology, 3181 SW Sam Jackson Park Rd, Portland OR 97239, Phone: 503-418-0990
| | - Valeria Potigailo
- University of Colorado Anschutz Medical Campus, Department of Radiology, 1201 Larimer St, Denver, CO 80204, Phone: 720-848-1130
| | - Eric Wang
- University of California San Francisco Division of Plastic and Reconstructive Surgery, 505 Parnassus Ave, San Francisco, CA 94143, Phone: 415-353-3526
| | - Solomon Lee
- University of California San Francisco Division of Plastic and Reconstructive Surgery, 505 Parnassus Ave, San Francisco, CA 94143, Phone: 415-353-3526
| | - Jason Talbott
- University of California San Francisco Department of Radiology and Biomedical Imaging, 505 Parnassus Ave, San Francisco, CA 94143, Phone: 415-353-2573
| | - Christine Glastonbury
- University of California San Francisco Department of Radiology and Biomedical Imaging, 505 Parnassus Ave, San Francisco, CA 94143, Phone: 415-353-2573
| | - Jason H Pomerantz
- University of California San Francisco Division of Plastic and Reconstructive Surgery, 505 Parnassus Ave, San Francisco, CA 94143, Phone: 415-353-3526
| | - Jared Narvid
- University of California San Francisco Department of Radiology and Biomedical Imaging, 505 Parnassus Ave, San Francisco, CA 94143, Phone: 415-353-2573
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23
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Survey of Experiences of Transgender and Gender Nonbinary Patients During Imaging Encounters and Opportunities for Improvement. AJR Am J Roentgenol 2020; 215:1136-1142. [DOI: 10.2214/ajr.19.22558] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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24
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Kennedy J, Perchik JD, Porter KK. Systematic Review of Transgender-Related Research in Radiology Over a Decade: There Is Work to Be Done. J Am Coll Radiol 2020; 18:93-102. [PMID: 33007310 DOI: 10.1016/j.jacr.2020.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE The ACR has established that diversity and inclusion are central to its mission of excellence in the radiologic professions; therefore, radiologists have a responsibility to serve the imaging needs of the transgender community. To understand radiologists' current knowledge of transgender topics, the authors performed a systematic review of publications from radiology journals. METHODS A lexicon of 14 transgender-related terms was created and expanded through a PubMed keyword search. From the 129 journals from the radiology, nuclear medicine, and medical imaging category of Journal Citation Reports, 106 journals met the inclusion criteria, including English translation and Scopus data for the study period. Using the Scopus advanced search feature, articles with titles, abstracts, Medical Subject Headings terms, or key words including 1 of 14 transgender terms were identified and analyzed. RESULTS Of the more than 200,000 articles published by the 106 journals from January 2008 to July 2019, 29 relevant articles were identified. Only 14 of the 106 journals published any transgender-related topics. The volume of articles has increased over time. The largest proportion of articles was published under the "general radiology" subsection, with the majority of these being editorials (6 of 10). Most of the original research was published under "neuroradiology" (7 of 13). Use of nonpreferred language, such as "transsexual" and "natal sex" was present through 2019. CONCLUSIONS Publication on transgender-related topics was uncommon among radiology journals. It is important to encourage further research and publication on transgender topics, as well as use of respectful, accepted language in radiology journals.
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Affiliation(s)
- Jasper Kennedy
- University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
| | - Jordan D Perchik
- Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kristin K Porter
- Chief of MRI, Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama; President-Elect, American Association for Women in Radiology, Reston, Virginia.
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25
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Dabela-Biketi A, Mawad K, Li H, Tan-Kim J, Morrill MY, Rosenstein D, Salim AM. Urethrographic Evaluation of Anatomic Findings and Complications after Perineal Masculinization and Phalloplasty in Transgender Patients. Radiographics 2020; 40:393-402. [PMID: 32004117 DOI: 10.1148/rg.2020190143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transgender patients seeking gender-affirming surgery are a growing population with unique health care needs. The radiologist must understand the challenges these patients face to facilitate a positive patient-physician interaction during the series of postoperative fluoroscopic evaluations. The authors present a standard two-stage surgical approach and common postoperative fluoroscopic findings after perineal masculinization and phalloplasty procedures. Perineal masculinization including urethral lengthening is performed first, followed by skin-flap-based phalloplasty. Patients undergo voiding cystourethrography (VCUG) after intravesical administration of contrast media by way of an indwelling suprapubic catheter after each stage. Retrograde urethrography plays a complementary role to supplement the limitations of VCUG after the second stage. The article reviews the expected postoperative anatomy and explains standardized terminology developed at the authors' institution. Imaging features of common and rare complications are discussed, including contained leak, stenosis, occlusion, and fistula. The successful postoperative imaging study in a transmasculine patient relies on open communication among the interdisciplinary team of specialized surgeons, radiologists, and medical providers, as well as special modifications to existing imaging techniques. ©RSNA, 2020.
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Affiliation(s)
- Amsalu Dabela-Biketi
- From the Departments of Radiology (A.D.B., K.M., H.L.), Gynecology (M.Y.M.), and Surgery (A.M.S.), Kaiser Permanente San Francisco Medical Center, 2425 Geary Blvd, San Francisco, CA 94115; Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, Calif (J.T.K.); and Department of Urology, Kaiser Permanente San Jose Medical Center, San Jose, Calif (D.R.)
| | - Kareem Mawad
- From the Departments of Radiology (A.D.B., K.M., H.L.), Gynecology (M.Y.M.), and Surgery (A.M.S.), Kaiser Permanente San Francisco Medical Center, 2425 Geary Blvd, San Francisco, CA 94115; Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, Calif (J.T.K.); and Department of Urology, Kaiser Permanente San Jose Medical Center, San Jose, Calif (D.R.)
| | - Hongtai Li
- From the Departments of Radiology (A.D.B., K.M., H.L.), Gynecology (M.Y.M.), and Surgery (A.M.S.), Kaiser Permanente San Francisco Medical Center, 2425 Geary Blvd, San Francisco, CA 94115; Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, Calif (J.T.K.); and Department of Urology, Kaiser Permanente San Jose Medical Center, San Jose, Calif (D.R.)
| | - Jasmine Tan-Kim
- From the Departments of Radiology (A.D.B., K.M., H.L.), Gynecology (M.Y.M.), and Surgery (A.M.S.), Kaiser Permanente San Francisco Medical Center, 2425 Geary Blvd, San Francisco, CA 94115; Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, Calif (J.T.K.); and Department of Urology, Kaiser Permanente San Jose Medical Center, San Jose, Calif (D.R.)
| | - Michelle Y Morrill
- From the Departments of Radiology (A.D.B., K.M., H.L.), Gynecology (M.Y.M.), and Surgery (A.M.S.), Kaiser Permanente San Francisco Medical Center, 2425 Geary Blvd, San Francisco, CA 94115; Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, Calif (J.T.K.); and Department of Urology, Kaiser Permanente San Jose Medical Center, San Jose, Calif (D.R.)
| | - Daniel Rosenstein
- From the Departments of Radiology (A.D.B., K.M., H.L.), Gynecology (M.Y.M.), and Surgery (A.M.S.), Kaiser Permanente San Francisco Medical Center, 2425 Geary Blvd, San Francisco, CA 94115; Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, Calif (J.T.K.); and Department of Urology, Kaiser Permanente San Jose Medical Center, San Jose, Calif (D.R.)
| | - Ali M Salim
- From the Departments of Radiology (A.D.B., K.M., H.L.), Gynecology (M.Y.M.), and Surgery (A.M.S.), Kaiser Permanente San Francisco Medical Center, 2425 Geary Blvd, San Francisco, CA 94115; Department of Obstetrics and Gynecology, Kaiser Permanente San Diego Medical Center, San Diego, Calif (J.T.K.); and Department of Urology, Kaiser Permanente San Jose Medical Center, San Jose, Calif (D.R.)
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26
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Goldberg JE, Moy L, Rosenkrantz AB. Assessing Transgender Patient Care and Gender Inclusivity of Breast Imaging Facilities Across the United States. J Am Coll Radiol 2018; 15:1164-1172. [PMID: 29933975 DOI: 10.1016/j.jacr.2018.05.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate transgender patient care, gender inclusivity, and transgender health-related policies at breast imaging facilities across the United States. METHODS A survey on breast imaging facilities' policies and practices regarding transgender care was distributed to the membership of the Society of Breast Imaging, consisting of approximately 2,500 breast radiologists across the United States. The survey was conducted by e-mail in January 2018. RESULTS There were 144 survey respondents. Responses showed that 78.5% of facilities have gender-neutral patient bathrooms, 9.0% have a separate waiting area for transgender patients, and 76.4% do not have dominant pink hues in their facilities, although 54.2% have displays with female gender content. Also, 58.0% of intake forms do not ask patients to provide their gender identity, although 25.9% automatically populate with female phrases. Within the electronic health record, 32.9% lack a distinct place to record patients' preferred names and 54.9% lack a distinct place to record patients' gender pronouns. The majority (73.4%) do not have explicit policies related to the care of transgender patients. Only 14.7% of facilities offer lesbian, gay, bisexual, and transgender training. CONCLUSION Our national survey demonstrates that many breast imaging facilities do not have structures in place to consistently use patients' preferred names and pronouns, nor provide inclusive environments for transgender patients. All breast imaging facilities should recognize the ways in which their practices may intensify discrimination, exclusivity, and stigma for transgender patients and should seek to improve their transgender health competencies and foster more inclusive environments.
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Affiliation(s)
- Julia E Goldberg
- Department of Radiology, NYU Langone Medical Center, New York, New York.
| | - Linda Moy
- Department of Radiology, NYU Langone Medical Center, New York, New York
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