By Katherine Anderson
American Indian and Alaska Native (AI/AN) communities–roughly 9.7 million people–continue to face persistent barriers to health care.
Rooted in the historical and ongoing impacts of colonization, forced relocation and cultural erasure, these disparities manifest differently across regions and tribes, with notable variation between urban and rural communities and between areas such as Alaska and the Southwest.
In a Thursday morning session, experts examined imaging disparities in AI/AN communities, shared successful case studies and outlined strategies to improve access and equity.
Although Native Hawaiians are not classified under the AI/AN designation, they also experience significant health care disparities, particularly regarding access to cancer screening and specialty imaging services.
“Access is a challenge for all patients living in rural areas far from health centers and particularly for those needing state-of-the-art care,” said Marilyn A. Roubidoux, MD, professor at the University of Michigan and session moderator who also presented during the session. “Many AI/AN live on reservations, which are rural and lacking in good health care facilities. Seldom do they have access to transportation to imaging facilities.”
This lack of access is especially critical for cancer screening, according to Rodney C. Haring, PhD, MSW, chair of the Department of Indigenous Cancer Health at Roswell Park Comprehensive Cancer Center in Buffalo, New York, and a member of the Seneca Nation/Beaver Clan, who also presented during the session.
“One barrier, exemplified in the cancer screening field, is limited access points along with overall conversations about screening,” Dr. Haring said. “Thus, the need for more mobile screening imaging and technology is imperative for the Indigenous-rural partnership to save lives through early detection.”
Mobile screening units—vans or buses equipped with advanced imaging technology and staffed with health educators and patient navigators—offer a practical solution.
“The Mobile Unit of the Great Plains Indian Health Service that operated from 2005 to 2017, largely among South Dakota and North Dakota Indian reservations, brought screening mammography to thousands of women who were not receiving this opportunity for breast cancer detection,” Dr. Roubidoux said.
Dr. Haring added that Roswell has a growing fleet of mobile technologies, including the first mobile lung cancer screening bus in New York and the first dual-purpose mammography and prostate cancer screening unit in the country, which is scheduled to visit tribes and areas across the state later this year and into 2026.“It is important to establish Nation-to-Nation partnerships with academic and treatment-serving institutions to advance collaborative science, care and imaging innovation. These efforts must be evidence-based and developed with Native Nations, coordinated through their health systems and Indian Health Services–not just adapted from U.S. population norms.”
Rodney C. Haring, PhD, MSW
Strengthening relationships with tribal leadership is essential for fostering confidence and mutual understanding.
“Radiologists and health researchers can build trust by encouraging bi-directional conversations that produce beneficial outlooks and outcomes towards community partnerships with sovereign Native Nations,” Dr. Haring said. “This includes being cognizant of community-led ideas, health initiatives and areas of translational research interests.”
Speakers emphasized that community-driven research models are critical to ensuring imaging initiatives reflect tribal priorities and sovereignty. Sharing imaging technology with tribal leaders and Indian Health Service (IHS) units can increase understanding of available health care options, particularly cancer screening programs.
Greater transparency in how imaging data is used can also help overcome generational mistrust. “If clinical data and/or other collected data is intended for research, work with tribal leadership to create data user agreements, tribal council approvals and seek tribal government inclusion in all data and research conversations,” Dr. Haring stressed.
Recruiting more AI/AN students into medical schools and radiology residencies will help improve representation, build trust in care and cultivate the next generation of cancer scientists and radiologists.
“Radiologists could include medical students in local outreach programs,” Dr. Roubidoux said. “These efforts will increase the trust AI/AN have in their medical care which will result in better compliance.”
A central point of the session was that health care access for AI/AN communities cannot be separated from treaty obligations. Dr. Haring emphasized that AI/AN are not just a racial or ethnic category but a political classification as Native Nations as defined by treaties with the U.S. government. These treaties, dating all the way back to 1777, established the U.S. government’s responsibility to provide health care and education in exchange for land.
These agreements, upheld in over 1,000 court cases, form the legal basis for the IHS and continue to shape how cancer centers, universities and research institutions must engage with tribes today. Establishing formal partnerships, he noted, is not merely good practice but a fulfillment of these treaty commitments.
“It is important to establish Nation-to-Nation partnerships with academic and treatment-serving institutions to advance collaborative science, care and imaging innovation. These efforts must be evidence-based and developed with Native Nations, coordinated through their health systems and IHS—not just adapted from U.S. population norms,” Dr. Haring concluded.
Access the presentation, “Addressing Imaging Disparities in American Indian and Alaska Native Communities: Opportunities and Solutions,” (R4-CNPM13) on demand at RSNA.org/MeetingCentral.
© 2025 RSNA.
The RSNA 2025 Daily Bulletin is the official publication of the 110th Scientific Assembly and Annual Meeting of the Radiological Society of North America. Published online Sunday, November 30 — Thursday, December 4.
The RSNA 2025 Daily Bulletin is owned and published by the Radiological Society of North America, Inc., 820 Jorie Blvd., Suite 200, Oak Brook, IL 60523.
