Beyond the Binary: How Imaging Leaders Can Foster a Gender-Inclusive Culture

Patient encounters in imaging are often brief and body-focused, yet they deeply affect dignity and trust. Imaging leaders have an important responsibility to assess how policies, staff practices, and workplace culture support patients of all backgrounds and gender expression.

One area that can be especially challenging for imaging administrators and staff is discussing transgender status and preference with patients. Even the most well-intentioned healthcare professionals can make the mistake of misgendering a patient or making an assumption around birth gender.

To create a truly inclusive culture and welcome all patients, there are a few ways to approach this sensitive topic with care.

Start With a Clear Purpose: Patient Care

Discussions around gender expression can be deeply personal and emotional. When approaching the topic with your team, it's important to focus on clinical excellence and respectful care, regardless of whether the patient is transgender, nonbinary, or cisgender. While certain efforts may be made to create a more inclusive environment for transgender and nonbinary patients, the level and quality of care they receive should not waver.

Perspectives to Center

When approaching transgender and nonbinary care, your team can focus on these three perspectives and their unique needs.

• Nonbinary: Requests for gender-neutral intake options, consistent they/them pronoun use, avoidance of assumptions about anatomy, and private, neutral changing areas.
• Transgender woman (male-to-female): Need for respectful discussion about prior surgeries or anatomy relevant to imaging interpretation without misgendering or unnecessary exposure.
• Transgender man (female-to-male): Need for privacy, correct documentation of chosen name/pronouns, and sensitivity during exams involving chest, pelvic, or reproductive anatomy. Here is an example of a common practice for radiology techs. Some exams will require a pregnancy test. Instead of assuming a transgender male should have a pregnancy test, try this approach, “For safety reasons, we routinely check whether a pregnancy test is needed before this procedure. Are you able to become pregnant, or have you had surgeries that mean pregnancy isn’t possible?”

Key Themes Recommended by Experts

While inclusive care looks different in every organization, experts agree on several core themes that matter most. These are some areas where leaders can have the greatest impact.

• Active Allyship: Allyship is a verb, and this requires action (correcting misgendering, intervening in discriminatory behavior, advocating system changes), not just passive support.
• Visible Modeling: Leaders should model inclusive behaviors (e.g., introduce name and pronouns), so staff adopt these practices.
• Specific Policies: Implement tangible changes such as gender-neutral bathrooms, inclusive health benefits (covering transition-related care when appropriate), and clear use of chosen name/pronouns in records and scheduling systems.
• The Platinum Rule: Treat employees how they want to be treated, not how leaders assume they should be treated; ask and honor preferences.

Practical Steps for Leaders

Building a gender-inclusive imaging environment requires clear intent and operational follow-through. These practical steps translate inclusive principles into everyday workflows, policies, and staff behaviors.

• Update intake and electronic medical record fields: Separate legal name from chosen name, include pronouns and gender identity fields, record sex assigned at birth only when clinically relevant and limit access.
• Standardize scripts and workflows: Teach staff to ask, “What name and pronouns do you use?” and use short clinical scripts for anatomy-related questions. For example, when performing imaging, here’s an example of what a technologist can say, “To ensure accurate imaging, can you tell me if you’ve had any chest or pelvic surgery?”
• Offer specific training: Require scenario-based training for technologists, schedulers, radiologists, and managers on inclusive language, de-escalation, and correction protocols when mistakes occur.
• Make environmental and privacy changes: Provide single-occupancy changing rooms, clear signage about nondiscrimination, and scheduling options that respect privacy.
• Review policies and benefits: Ensure nondiscrimination policies explicitly include gender identity and expression; update benefits to be inclusive of transition-related care where applicable.
• Hold staff accountable and offer feedback: Incorporate inclusive-care metrics into staff evaluations, collect patient experience data by gender identity, and maintain a confidential reporting mechanism for incidents.

By centering dignity, as well as using correct names and pronouns, limiting invasive questions to clinical necessity, and building systems that respect identity, imaging leaders can create safer, higher-quality care for transgender and nonbinary patients and a more inclusive workplace. The key to success is to never assume and always ask for their preference.

References

Thoroughgood, C. N., Sawyer, K., & Webster, J. R. (2020, March–April). Creating a trans-inclusive workplace. Harvard Business Review. https://hbr.org/2020/03/creating-a-trans-inclusive-workplace

Jecke, L., & Zepf, F. D. (2024). Delivering transgender-specific knowledge and skills into health and allied health studies and training: a systematic review. European child & adolescent psychiatry, 33(5), 1327–1354. https://doi.org/10.1007/s00787-023-02195-8