February is Black History Month, a time to not only celebrate the culture and contributions of Black people throughout history, but also to recognize the work that still needs to be done to address systemic racism in our communities. Some believe that radiology does not perpetuate disparities in healthcare, because of the field’s limited patient interaction, however imaging plays a role in propagating health disparities [Waite et al. 2021]. Imaging is essential at almost every step of a patient’s care, from diagnosis, assessment of interventions to follow-up. Eliminating disparities at this fundamental stage will improve patient care at all levels.

In this article, we will be outlining some health disparities that Black patients face in radiology and reviewing some solutions that aim to address these disparities.

Dr. Rebecca Lee Crumpler was the first African American woman to obtain an M.D. degree.

A study on the influence of patient race on the use of diagnostic imaging found that Black patients were 21% less likely to receive imaging – the widest disparity among all groups [Ross et al. 2020]. Moreover, the uninsured rate among Blacks is substantially higher than their White counterparts [Buchmueller et al. 2020], adding another barrier to access imaging. Black patients also disproportionally receive care at lower-quality facilities [Kronebusch et al. 2014], unequipped with newer high-end imaging technology and modalities [Brinjikji et al. 2014].

Interventional radiology also contains health disparities when it comes to the procedures being. For example, the prevalence of peripheral arterial disease (PAD) is highest in Black Americans compared to other ethnic groups, and they are less likely to be diagnosed and promptly treated [Hackler III et al. 2021]. They are less likely to receive endovascular procedures and are more likely to undergo amputation regardless of insurance status and disease stage. Meaning that with the same insurance and disease stage, a black patient is more likely to be amputated then a their white counterparts even though amputation is associated with increased mortality (50% at 2 years).  [Hackler III et al. 2021]. Multiple studies have shown Black patients with chronic liver disease have decreased access to liver transplantation compared to White patients [Reid et al. 2004]. They are also less likely to be offered locoregional therapies for their primary liver cancer and have higher probability of receiving less effective and more toxic tyrosine kinase inhibitors according to Medicare database study.

Actions must be taken at the individual and systemic levels to combat these health disparities in imaging. Antibias and diversity training have been implemented in several universities and hospitals to combat individual bias [Allen & Garg 2016] but more can be done systemically by radiology departments to curb health disparities. Radiology departments can and should work interdepartmentally to educate other providers on screening recommendations, especially for underrepresented groups. Furthermore, there is evident underrepresentation of minorities in diagnostic radiology, with only 1.3% of radiologists identifying as Black in a 2017 survey [Peckham C. Medscape Lifestyle Report 2017]. Training, recruiting, and retaining Black radiologists and technologists may help mitigate disparities [Lightfoote et al. 2014]. Access is a major issue. Lack of transportation has been identified for example as a reason why PAD is diagnosed at later stage in black patients. Mobile screening vans are ways to go to the patients rather than expect them to come to the facilities. There is a mistrust that also must be addressed.

The Diversity, Equity, and Inclusion (DEI) committee in our Department of Radiology at UCI aims to combat the health inequities faced by the patients we serve through the pillars of Education, Recruitment/Retention, and Research. Our Education efforts include hosting a workshop series to combat implicit and explicit bias in radiology. In Recruitment/Retention, we are more mindful about the residents we choose and the physicians we hire to ensure we have a diverse team to care for patients. Our department continues to conduct and contribute to Research that highlights health disparities and social determinants of health. Together, we can uplift Black voices and ensure the highest quality of care and imaging for Black patients.

Learn more about our Diversity work here: https://radiology.uci.edu/about-us/diversity/

Members of the UCI School of Medicine held a peaceful demonstration of solidarity, kneeling together in honor of George Floyd and countless other victims of racial injustice on June 5, 2020.