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To determine imaging utilization and expenditures among an underserved population at a student-run free clinic. This was a retrospective review of billing records for all radiology studies performed over a 4-year period at a student-run free clinic supervised by physician faculty. All imaging services were outsourced through either direct payment by the clinic to a local imaging group or through in-kind donations. Radiology studies were grouped by modality and diagnostic category. Data were analyzed to determine overall and average imaging utilization and expenditures. Across the 4-year study period, 413 radiology studies were performed with a yearly average of 103 (SD = 16). During this time, 192 (46%) ultrasounds, 123 (30%) radiographic studies, 40 (10%) MRIs, 37 (9%) CTs, 8 (2%) interventional procedures, and 5 (1%) nuclear imaging studies were obtained. Overall, expenditures were $157,888 with a yearly average of $39,472 (SD = $1982). In-kind donations accounted for $138,508 (88%) of expenditures. Across the 4-year study period, utilization increased by 15% with less than 1% increase in expenditures. Ultrasound was the most common imaging modality used. Overall imaging utilization was considerably less than that of published data in an ambulatory setting. [ABSTRACT FROM AUTHOR]

Political momentum for antiracist policies grew out of the collective trauma highlighted during the COVID pandemic. This prompted discussions of root cause analyses for differences in health outcomes among historically underserved populations, including racial and ethnic minorities. Dismantling structural racism in medicine is an ambitious goal that requires widespread buy-in and transdisciplinary collaborations across institutions to establish systematic, rigorous approaches that enable sustainable change. Radiology is at the center of medical care and renewed focus on equity, diversity, and inclusion (EDI) provides an opportune window for radiologists to facilitate an open forum to address racialized medicine to catalyze real and lasting change. The framework of change management can help radiology practices create and maintain this change while minimizing disruption. This article discusses how change management principles can be leveraged by radiology to lead EDI interventions that will encourage honest dialogue, serve as a platform to support institutional EDI efforts, and lead to systemic change. [ABSTRACT FROM AUTHOR]

Many radiologists are interested in providing affordable care to underserved populations but are unsure how to accomplish it. We present a model for providing imaging services to the underserved with an emphasis on the challenges we encountered and strategies we used to overcome them. In partnership with our medical school's student-run free clinic, we developed a community-based ultrasound service that provides diagnostic ultrasound examinations to an uninsured urban population to address the need of timely access to care and integrated follow-up care. Image storage and reporting were fully integrated with our existing imaging informatics and electronic medical record systems. Radiology residents play a central role in the operation of the service while gaining hands-on ultrasound experience, in partnership with volunteer sonographers, radiology attendings, and medical students. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, the disproportionate morbidity and mortality borne by racial minorities, patients of lower socioeconomic status, and patients lacking health insurance reflect the critical role of social determinants of health, which are manifestations of entrenched structural inequities. In radiology, social determinants of health lead to disparate use of imaging services through multiple intersecting contributors, on both the provider and patient side, affecting diagnosis and treatment. Disparities on the provider side include ordering of initial or follow-up imaging studies and providing standard-of-care interventional procedures, while patient factors include differences in awareness of screening exams and confidence in the healthcare system. Disparate utilization of mammography and lung cancer screening lead to delayed diagnosis, while differential provision of minimally invasive interventional procedures contributes to differential outcomes related to treatment. Interventions designed to mitigate social determinants of health could help to equalize the healthcare system. Here we review disparities in access and health outcomes in radiology. We investigate underlying contributing factors in order to identify potential policy changes that could promote more equitable health in radiology. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, the disproportionate morbidity and mortality borne by racial minorities, patients of lower socioeconomic status, and patients lacking health insurance reflect pre-existing structural inequities. Structural racism is racial discrimination rooted in history, perpetuated through policies, and manifested in disparities in healthcare, housing, education, employment, and wealth. Although these disparities exert greater impacts on health outcomes than do genetics or behavior, scientists, and policy makers are only beginning to name structural racism as a key determinant of population health and take the necessary steps to dismantle it. In radiology, structural racism impacts how imaging services are utilized. Here we review the history and policies that contribute to structural racism and predispose minority and disadvantaged communities to inferior outcomes during the COVID-19 pandemic in order to identify policy changes that could promote more equitable access to radiologic services. [ABSTRACT FROM AUTHOR]