Understanding Marginalization in Radiology: What It Means and Why It Matters

By Dr. Nicole Dhanraj

Marginalization in health care – especially in radiology – goes beyond statistics; it’s a real challenge affecting patients’ access to essential imaging services.

Imagine a patient in pain, needing an MRI to diagnose a chronic condition but facing barriers based on geography, finances or cultural background.

For radiology leaders, addressing these barriers isn’t just about making patients feel welcome – it’s about saving lives by ensuring fair, timely access to imaging.

What Does Marginalization Look Like in Radiology?
Marginalization in radiology occurs when patients encounter obstacles that others don’t: longer wait times, fewer referrals or lack of nearby imaging centers. These challenges can delay diagnoses, affecting outcomes for conditions where early detection is crucial, like cancer and cardiovascular disease.

As Dr. Martin Luther King Jr. once said, “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” In radiology, this truth is clear – a lack of access to imaging can mean the difference between life and death.

The Real Impacts of Marginalization in Radiology

Take, for instance, a Black patient with persistent symptoms who is less likely to be referred for advanced imaging than a white patient with similar complaints.

Research suggests that biases – whether in clinical decision-making, financial resources or logistical challenges – can prevent these patients from receiving the imaging they need.

In rural areas, patients may face hours of travel to the nearest imaging center, a major hurdle for those with limited transportation or work flexibility. By addressing these gaps, radiology managers can help ensure that quality care is accessible to all.

Effective Strategies Radiology Leaders Can Implement Today

Creating a truly inclusive radiology department requires more than good intentions. The following steps offer practical and impactful ways for managers to make a difference:

• Data-Driven Equity: Using Analytics to Close Gaps
  Radiology leaders can use data to uncover disparities in their department. Regularly reviewing referral rates, wait times, and follow-up appointments across demographics can highlight gaps in access and treatment. For instance, if Black or rural patients consistently have longer wait times, consider adjusting scheduling priorities or adding additional appointment slots for high-risk communities.

• Community Advisory Panels: Hearing from Those We Serve
  Understanding patient experiences is vital. Establish a community advisory panel made up of patients and community leaders from marginalized backgrounds. Quarterly meetings with the panel can cover topics like accessibility, communication, and comfort during procedures, allowing for feedback that informs policies and improves outreach efforts.

• Collaborate with Public Health Organizations for Preventive Imaging
  By partnering with public health organizations and local nonprofits, radiology leaders can extend their reach into underserved communities. Organizing “Radiology Days” at community centers, offering low-cost or free imaging like mobile mammograms or lung screenings, builds trust within communities and promotes preventive health.

• Leveraging AI Tools to Minimize Diagnostic Bias
  Artificial intelligence (AI) can reduce diagnostic bias by analyzing patient data without preconceived notions, ensuring fair access to advanced imaging. Piloting AI-powered tools for referrals and diagnostics, and collaborating with IT to ensure they work effectively for diverse populations, can help maintain consistency across all groups.

• Introducing Sliding Scale or Subsidized Imaging Programs
  Financial barriers prevent many patients from accessing necessary imaging. Establishing a sliding scale fee structure for high-cost services like MRIs or CT scans, with funding options through grants or community health initiatives, can make services more accessible for patients facing financial constraints.

• Diversity Mentorship Programs: Building a More Inclusive Workforce
  A diverse radiology team fosters trust and understanding with patients from marginalized backgrounds. Developing a mentorship program for young professionals from underrepresented communities, in partnership with local universities, can enhance team diversity and cultural competence.

• Patient Navigation Programs for Supportive Follow-Up Care
  After a scan, patients often need clear guidance on their results and next steps. Establishing a patient navigation program that assists with scheduling follow-ups, explaining imaging results in simple terms, and helping patients access additional resources can improve outcomes, especially for those with limited health literacy.

• Form a Health Equity Quality Improvement (QI) Committee
  A QI committee focused on health equity provides oversight of equity goals in the radiology department. Setting metrics specifically for health equity – like access to imaging types and diagnostic accuracy – alongside quarterly audits, allows for ongoing assessment and adjustments to improve fairness and accessibility.

Building a Radiology Department That Works for Everyone

Addressing marginalization in radiology is a gradual but essential journey. By implementing data analytics, AI tools and community partnerships, radiology departments can make strides toward a more inclusive environment.

Every small improvement, from patient navigation to affordable imaging, adds up to a big impact on patient care.

This isn’t just about individual patients – it’s about fostering a health care system where everyone has the opportunity to access timely, quality imaging. With dedicated effort, we can ensure that diagnostic imaging becomes a bridge to better health outcomes for all, not just a select few.

Nicole Dhanraj, Ph.D., SHRM-SCP, PMP, GPHR, CPSS, CRA, R.T(R)(CT)(MR), is an experienced imaging director.