RSNA2023 Leading Through Change
Daily Bulletin

Health Equity in Radiology: Clinical Practice

Friday, Dec. 01, 2023

By Mary Henderson



Best practices for providing equitable care to diverse patient groups was the topic of a Thursday morning course featuring a panel of speakers from across the country.

Tackling Breast Cancer Screening Delays

Randy Miles, MD, MPH, described his team's efforts to leverage operational tools and local resources to improve health equity in breast screening at Denver Health.

The population at Denver Health consists of 50% Hispanic and 35% non-white patients, only 20% of whom have commercial insurance. Spanish is the primary language spoken by 30% of patients.

"Black women have the lowest 5-year survival rate compared to all other racial and ethnic groups and are 40 percent more likely to die from breast cancer compared to white women, despite having a lower incidence of disease," said Dr. Miles, chief of breast imaging at Denver Health.

According to research, a larger percentage of patients presented at stage 2 breast cancer and often experience delays in care at safety-net institutions.

"We've been able to reduce wait times for screening mammography from 75 days to 3 days or less," he said.

They tackled the wait problem by turning Fridays into all-day screening days and double-booking time slots for screening mammography to account for patient cancellations.

"We also significantly reduced our imaging exam report turnaround time to limit patient anxiety," he said.

By streamlining the process and organizing rotations, the center reduced report turnaround from 45 hours to less than one hour for all breast imaging reports.

"It's really easy to just settle in these settings, because patients are often grateful to receive care," he said. "Our team has put the onus on ourselves to advocate for these patients to ensure they receive the highest level of care possible."

Community events, partnerships with non-profit organizations, the use of patient navigators, a same-day biopsy program, and a mobile mammography van have all been part of Denver Health's efforts.



"Safety-net institutions represent an important target to reduce breast cancer disparities," he said.

Creating Awareness of Lung Cancer Screening

Ashley Elizabeth Prosper, MD, urged radiologists to take steps to increase the uptake of lung screening in historically underserved groups. Screening with LDCT has the potential to decrease lung cancer mortality by 20 percnet.

"Lung cancer is the leading cause of cancer-related death among all Americans of all races and ethnicities," said Dr. Prosper, section chief of cardiothoracic imaging and co-director of the Lung Screening Program at UCLA Health. "However, African Americans, particularly Black men, develop and die from lung cancer more than any other racial or ethnic group in the United States."

Only 4.4% of participants in the National Lung Screening Trial (NLST) included were African-American individuals. Using the NLST data and a statistical technique called transportability on a synthetically created population, Dr. Prosper predicted an even greater reduction in lung cancer mortality when more black individuals and current smokers are included.

"The initial USTFPS eligibility guidelines for lung cancer screening did not sufficiently include black individuals, who developed lung cancer before the age of eligibility and before they had smoked enough to qualify," she said.

With the updated 2021 guidelines, which lowered the age of eligibility from 55 to 50 and the pack-year requirement from 30 to 20, the gap between white and black individuals has improved but still exists, according to Dr. Prosper.

Identified barriers to lung screening include the inability to schedule time off from work and a concern about out-of-pocket costs. By spending time with African-American families in her community, Dr. Propser has also learned that awareness about lung screening is alarmingly low.

Achieving health equity in lung screening is a challenge, but Dr. Prosper remains optimistic.



"LDCT is an efficacious tool for the most vulnerable populations," she said. "If we can diagnose earlier, we have a better chance of impacting lung cancer mortality. However, we know that lung screening as it currently exists is not going to alleviate the disparity among those who participate. We have a lot of work to do through community partnerships and listening to the communities where we want to make a positive impact."

Boots On The Ground To Create Awareness

Efren Jesus Flores, MD, focused on the steps for creating an equitable health care system for Latino communities, from identifying needs and operationalizing interventions to personalizing care.

He said that since the pandemic, challenges, such as the digital divide, misinformation, and access to care, have all increased.

"One of the misperceptions that came out of the pandemic was that if you can delay the lung screening, it must not be that urgent," said the vice chair of diversity, equity, and inclusion and associate professor of radiology at Harvard Medical School. "This widened the already existing gap in screening uptake between patient groups."

Dr. Flores said health equity interventions should meet patients where they are and help them take control of their health. In addition to participating in a bi-weekly television show on Latin television, he regularly participates in community outreach events at local health centers serving a high proportion of Latino patients to better understand their health care needs.

"Nothing beats your presence out in the community," he said. "We must embrace multilingual community outreach to educate patients and establish trust."

When it comes to lung screening, he said patients want more information about their health beyond whether or not they have lung cancer.



"These grassroots efforts help us keep a finger on the pulse of the community and to identify the issues that matter most to patients," he said. "Only through these boots-on-the-ground efforts can we achieve meaningful change."

Opportunities For Radiology To Support Equity Efforts

Lucy B. Spalluto, MD, MPH closed the session by discussing how to move health equity in radiology from theory to action.

"We must work to achieve the highest level of health for all patients," she said. "I believe the road to health equity is in building a strong foundation of community engagement," said Dr. Spalluto, vice chair of health equity, Department of Radiology, Vanderbilt University Medical Center.

She noted that the theme of community resonated throughout RSNA2023, from meeting presentations by surgeons and medical oncologists to a new addition at this year's meeting, the RSNA Community Service Activity. So many meeting attendees showed up for this activity on Tuesday to pack hygiene and cold weather care kits that the task was quickly completed.

'Walk with a Doc' was another example of a successful community initiative she cited. During the five-month initiative, physicians volunteered to educate community members on a variety of health topics while exercising.

"These activities go a long way to building trust in the community," she said.

She encouraged institutions and radiology departments to seek grant and institutional funding for their own outreach efforts, and to consider research opportunities to build relationships with patients.

"We have an opportunity to maximize what we do in radiology by better understanding the patient journey," she said.