71% of transgender and nonbinary patients have had a negative imaging encounter

Nearly 71% of transgender and nonbinary patients have had at least one negative imaging encounter, according to survey results released Tuesday.

About one-third of such patients had to instruct radiology staff about their gender to receive appropriate care, with ultrasound exams contributing the highest rate of unexpected emotional discomfort. The findings present an opportunity for leaders to modify their practices and provide more patient-centered care, experts reported in the American Journal of Roentgenology.

“Our data suggest that [transgender and gender nonbinary] patients have endured negative experiences during imaging encounters,” concluded Frances Grimstad, MD, an OB/GYN with Boston Children’s Hospital, and co-authors from two other institutions. “These data highlight opportunities for radiology professionals and professional organizations to improve care delivery for TGNB patients.”

Changes could include educating imaging personnel about cultural competency, redesigning facilities for transgender and nonbinary patients, and incorporating their feedback into the departmental policies, Grimstad et al. wrote Sept. 21.

To reach their conclusions the team surveyed 363 individuals who met the inclusion criteria, targeting them through social media, Listservs and events in 2018. The survey included 22 multiple-choice questions and explored all aspects of the imaging encounter. The majority had received gender-affirming hormones (84%), undergone at least one such surgery (63%), and were imaged at an outpatient center (75%).


One-quarter of those surveyed noted misgendering in their radiology reports, which can occur frequently across all medical settings, the authors noted. Exams such as ultrasound, mammography and image-guided procedures were most frequently associated with patient discomfort. Same for noninvasive modalities such as MRI, CT and radiography, with derogatory communication from staffers a possible cause, according to free-text responses.

“In extreme instances, the conduct was severe enough to potentially cause psychologic trauma,” Grimstad and colleagues wrote. “Imaging facility leadership should adopt strict policies for ensuring appropriate treatment of TGNB patients and for appropriate management of personnel who fail to comply with these standards.”

Practices can also better serve this patient population by offering gender-neutral restrooms, LGBTQ-affirming reading materials, and assisting with health insurance challenges. Nearly 10% of respondents reported denial of coverage for imaging services related to their gender identity.

You can read much more from the survey in AJR here.