Imaging Services a Negative Experience for Most Transgender, Non-Binary Patients

Close to three-quarters of transgender and non-binary (TGNB) patients report having at least one negative encounter associated with imaging services, according to the results of a newly released survey.

The results published in the American Journal of Roentgenology, reveal that there are many aspects to imaging encounters that can create uncomfortable and negative situations for patients. But, these incidents can help facilties improve their performance.

“Our data suggest that TGNB patients have endured negative experiences during imaging encounters,” said a team of investigators led by Frances Grimstad, M.D., an obstetrician-gynecologist with Boston Children’s Hospital. “These data highlight opportunities for radiology professionals and professional organizations to improve care delivery for TGNB patients.”

Particularly, she said, these experiences can be a launching point for improvements in cultural competency and sensitivity, such as re-designing facilities to be more accommodating of TGNB patients’ needs and incorporating their feedback into departmental policy developments.

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To assess the impact of imaging encounters on TGNB patients, Grimstad and her colleagues surveyed 363 individuals through social media and listservs between January 2018 and December 2018. Of the group, 84 percent had received gender-affirming hormones, 63 percent had undergone at least one surgery, and 75 percent were imaged in outpatient centers. Within 22 questions, respondents were asked about the type of imaging completed, facility locations, and any emotional, psychological, or physical discomfort they felt during the encounter. 

According to the survey results, more than 70 percent of TGNB patients reported having at least one negative experience with imaging, and of those individuals, roughly 25 percent revealed they had had at least six negative encounters. Transgender women were 4.15 times more likely than transgender men to experience emotion discomfort, the team said, and 5.01 times more likely than gender non-binary individuals and all other genders combined.

Courtesy: American Journal of Roentgenology

Negative experiences included not being asked about personal pronouns or a chosen name, and many respondents said they felt imaging staff showed little regard for their comfort. In nearly one-third of instances, the team said, respondents had to instruct staff about TGNB patients in order to receive appropriate care, and nearly 25 percent said their gender was listed incorrectly on their radiology report.

Courtesy: American Journal of Roentgenology

In a balance to the negative experiences, though, approximately 70 percent of respondents also said they had positive encounters when undergoing imaging services, the team explained. Many reported feeling safe, welcomed, and respected by imaging staff who showed concern for their comfort and privacy.

In addition, respondents reported that the type of imaging service they received affected them in different ways. Image-guided procedures, ultrasounds, and mammograms created the most unexpected physical and emotional discomfort, they said. In addition, X-ray, CT, and MRI also caused unexpected emotional distress with 40 percent saying they did not receive adequate explanations prior to procedures.

Grimstad’s team encouraged imaging facilities to use these results to improve their performance with and accommodations for TGNB patients and the LGBTQ community overall. To make beneficial changes, they offered these suggestions:

• Train and educate radiology personnel in cultural sensitivity and gender-affirming care standards.
• Consider no longer routinely including gender in the radiology report because misgendering occurs frequently.
• Develop approaches and examination techniques that accommodate the needs and comfort of transgender men undergoing pelvic ultrasounds.
• Create policies and appropriate management protocols for staff who fail to comply with the appropriate treatment of these patients.
• Provide gender-neutral restrooms, and provide LGBTQ-affirming reading material in the facility.

Given the impact such steps can have on patient experience, outcomes, and retention, the team also suggested leadership organizations, such as the American College of Radiology, consider such factors when issuing standards for facility accreditation.

“Our results may be practice-changing for referring clinicians who wish to refer TGNB patients for imaging services,” the team said. “These data can assist clinicians in providing anticipatory guidance to their patients about uncomfortable experiences they may have during imaging encounters, selectively referring patients to imaging facilities that have shown sensitivity toward TGNB patients, or electing to limit referrals altogether for fear of subjecting their patients to untoward discomfort or even trauma.”