Survey of Experiences of Transgender and Gender Nonbinary Patients During Imaging Encounters and Opportunities for Improvement

OBJECTIVE. The purpose of this study was to assess the inclusivity of imaging centers for transgender and gender nonbinary (TGNB) patients and those patients' level of comfort during imaging center visits. MATERIALS AND METHODS. A survey of TGNB persons was developed to explore their experiences during imaging encounters. The survey was distributed via purposive snow-ball sampling with link sharing on social media and listservs as well as at TGNB community events and conferences during the period from January to December 2018. RESULTS. Of the 555 respondents who initiated the survey, 363 (65.4%) completed it and satisfied inclusion criteria. Of the 363, 257 (70.8%) reported having had at least one negative imaging encounter. Nearly one-third (32.4%, 116/358) had to instruct imaging facility staff about TGNB persons to receive appropriate care. Ultrasound examinations and image-guided procedures contributed to the highest rates of unexpected emotional discomfort (49.1% [109/222] and 38.1% [16/42], respectively). Noninvasive modalities also contributed to unexpected emotional discomfort, with the highest percentage of patients (23.5%) reporting emotional discomfort during MRI. Many imaging environments were considered unwelcoming toward TGNB patients, with 45.2% (164/363) of respondents noting no visible reading materials or other postings that could be considered to be affirming to lesbian, gay, bisexual, transgender, or queer patients and 39.1% (142/363) noting a lack of all-gender or gender-neutral restrooms. CONCLUSION. To our knowledge, our data provide the largest documentation and first quantification of the experiences of TGNB patients during imaging encounters. The data show several aspects of imaging encounters that may contribute toward negative experiences for TGNB patients, which may be improved through education of imaging personnel in TGNB cultural competency, redesign of facilities with sensitivity toward TGNB persons, and incorporation of TGNB patient feedback in the adoption of departmental policies.