Gender‐inclusive practice in pregnancy determination for transgender, gender diverse and non‐binary patients in medical imaging

In recent years, there has been an increased awareness and understanding of the varying gender identities within our society. Consequently, there has also been a need for healthcare providers to be cognizant of the unique needs of a gender‐diverse population. Determining the pregnancy status of transgender, gender‐diverse and non‐binary patients in medical imaging settings has been poorly handled, and there is a lack of standardisation in the Australian and Aotearoa New Zealand setting. The potential risk of exposing a gender‐diverse pregnant patient to ionising radiation increases the need for guidance to ensure potentially pregnant persons are not missed during screening questionnaires. This review article explores various approaches to pregnancy status determination for gender‐diverse patients, recognising the complexities involved and emphasising the need for future work to establish a widely accepted solution.


Introduction
This review was initiated in response to an incident in the medical imaging department at a large public hospital in Melbourne, Victoria, Australia.The incident involved a trans man who presented for an abdominal CT.Only afterwards, staff realised he had a uterus, so safety checks were not adequately conducted.Subsequently, there has recently been considerable controversy in Australia about a trial of using gender-inclusive language such as 'birthing parent' in a pregnancy setting. 1 The federal government services minister terminated the trial after one person complained.However, trans men giving birth have called for inclusive language.
Current methods of pregnancy status determination in medical imaging may miss pregnancies in transgender, gender-diverse and non-binary (TGDNB) individuals, inadvertently exposing them to radiation.We use TGDNB to refer to the wide spectrum of people whose gender identity differs from that usually associated with their sex assigned at birth.These include many relevant identity terms for TGDNB assigned female at birth people who may be pregnant among indigenous cultures globally, such as Brotherboy in Australia and Takat apui in New Zealand. 2,3Many more people are seen in medical imaging departments who present with a gender identity different from the sex assigned at birth and different to their reproductive organs.Matoori et al. 4 found that out of 116,525 imaging sessions per year in a large hospital, 350 sessions were conducted on transgender patients.A recent study shows that 0.5% of US adults and 1.2-1.7% of US secondary school students identify as trans or gender diverse. 5The rise of people identifying as nonbinary is even more significant.A recent Brazilian study 6 found that transgender individuals represented 0.69% of the sample, whereas non-binary persons were 1.19% (CI 95% = 0.92-1.47).Solanki et al. 7 found that at two Melbourne gender affirmation clinics, 19% (Monash Health Gender Clinic (MHGC)) and 27% (Equinox) of clients were non-binary.Annual referrals to gender clinics in Melbourne increased between 2011 and 2021 from 90 to 450 for adults (MHGC) and 8 to 470 for children and adolescents (Royal Children's Hospital Gender Service), indicating a rapid increase in people socially or medically affirming their gender identity.In this review, we use the term sex to mean the physiological and biological characteristics that are observed and assigned at birth based on external genitalia.Conversely, we use gender to mean the social characteristics and behaviours that are internalised and are related to the sense of self of an individual.Often, these terms are conflated, but there is increasing social and structural acceptance of their difference in various health settings.
Current guidelines recommend that the pregnancy status of all persons capable of childbearing is confirmed before any medical imaging that utilises ionising radiation. 8,9Evidence suggests that the foetus is more radiosensitive than an adult, which increases the risk of developing future cancers. 10A recent meta-analysis supported that in utero exposure of the foetus to low doses of radiation, such as those found in medical imaging, may increase the risk of future adult cancers. 11For higher radiation doses, such as absorbed doses above 100 mGy, there could be significant impairment to mental development and growth, and increased risk of foetal death, depending on the foetal age and radiation dose. 12owever, it is important to note that these higher foetal doses are unlikely to be delivered during standard imaging procedures, providing some reassurance that even in cases where errors in screening for pregnancy occur, the risk of harm is still relatively low. 13he Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) recommend that procedures likely to expose the uterus of a patient of childbearing age to more than 1 mSv equivalent dose require the establishment of pregnancy status before the procedure, with written consent if possible. 8This pregnancy status information can then be used to balance the risk of radiation to the foetus versus the benefits of the exam to the parent, which may ultimately benefit the foetus.Additionally, understanding the pregnancy status allows Medical Imaging Technologists to optimise the radiation dose to help minimise the risk to the foetus.Any person capable of becoming pregnant must be screened for pregnancy before they are exposed to radiation through imaging procedures, regardless of their gender presentation.Practices for identifying sex and gender need to acknowledge gender diversity and may need to be altered to avoid the accidental scanning of people who may be pregnant and may not be aware of the radiation risks associated with imaging.
Inclusive medical imaging services are essential as the TGDNB community is less likely to seek services due to a fear of prejudice and transphobia in healthcare services. 14Patients have reported discrimination from radiology staff and having to disclose or explain to staff their transgender identity or history, previous gender confirmation surgeries, or why their anatomy may be incongruent with or unexpected for their gender presentation. 15Additionally, TGDNB individuals have higher rates of mental health conditions and suicidality, 16 and a lack of safe access to healthcare is likely to exacerbate these risks.Meanwhile, using chosen names, pronouns, titles and affirmed gender helps create a more accommodating environment that encourages TGDNB people to seek healthcare. 15,17,18Therefore, methods of pregnancy status determination within medical imaging settings need to become inclusive of TGDNB patients.
This review article aims to summarise the challenges and various approaches to determining pregnancy status for gender-diverse patients.

Current methods of pregnancy status determination
A key recommendation of The 2018 Australian Trans and Gender Diverse Sexual Health Survey 19 was that healthcare providers should not make assumptions about their patients genders, bodies, sexual orientations or sexual partners as gender identities and gender-affirming practices are diverse.However, information regarding sex assigned at birth is routinely collected at Victorian health services during intake to comply with the standardisation of patient identification as specified by the National Safety and Quality Health Service Standards. 20ne of the practices for collecting gender information identified by the authors of this paper entails a combination of major structural mechanisms regarding Medicare (Australia's universal health insurance scheme) and data reporting/collecting mechanisms at the national and state level.Australian states allow people to change the sex identifier on their birth certificates with different degrees of difficulty and costs involved, making this option financially inaccessible to TGDNB people of low socio-economic status.In contrast, updating one's gender with Services Australia (the Federal department in charge of Medicare) is less onerous and less costly (it may require documentation from their General Practitioner).A client can change their legal identification documents independently of their Medicare identity.However, as it stands, the Information Technology (IT) systems at many hospital networks do not currently differentiate between gender and sex, capturing either a patient's sex as stated in identification documents or gender as stated in their Medicare card; in both scenarios, the IT systems record this information as sex.As well as differences between hospital networks, there are often differences within a single hospital network, where departments have separate databases so that TGDNB people may be addressed by different names across departments.This results in a confusing scenario where state institutions acknowledge that gender is independent of sex, while IT systems do not.The Australian Bureau of Statistics (ABS) and The Australian Institute of Health and Welfare's Metadata Online Registry 21,22 have updated their gender and sex categories to be more inclusive of TGDNB people.For sex, the ABS proposes either 'Male', 'Female', 'Another Term' or 'Non-binary sex'.For gender, the categories are 'Man or Male', 'Woman or Female', 'Non-binary' and 'Different Term'.This differentiation by the ABS is a step towards more inclusive data collection and interpretation.
Healthcare IT systems that record only a patient's sex are accurate for cisgendered patients as their sex and gender are congruent.However, they will not always be accurate for sex and/or gender for transgender, gender diverse and non-binary people.In addition to the clinical risks that this may cause, it also means that the data managing and collecting practices are not reflecting the difference between gender identity and sex assigned at birth.This means that (among other systems) the current IT health systems in Victoria, where the incident mentioned in the introduction of this review occurred, can misgender people with unnecessarily gendered titles based on the sex variable in the patient's medical records.There is also the potential to unintentionally reject a data service entry for a trans person if they have changed their sex identifier on official documents; the system can report errors when there is a discrepancy between a service that is traditionally gendered (e.g.pregnancy) because the patient does not have 'female' in their record.This type of system error can occur in hospitals, and in Victoria is due to current validation rules of the Victorian Integrated Non-Admitted Health Minimum Data Set (VINAH MDS) manual 2022-23. 23imited information relating to the approaches taken by Australian and Aotearoa New Zealand medical imaging practices in establishing pregnancy status is reported in the literature.Although there is guidance from the ARPANSA Code for Radiation Protection in Medical Exposure (2019), 8 each medical imaging service may implement the recommendations differently.For example, is the question asked for all medical imaging procedures or only those with a risk of the foetus receiving more than 1 mSv?Do different sites use printed material to provide information on the risks of imaging during pregnancy, or is this done verbally by the practice staff?An effort to collate the different approaches used in the Australian and Aotearoa New Zealand setting may provide further insight to help tailor approaches that may work for different settings, such as a large hospital network versus a small private practice.
Various pregnancy determination methods have been reported in both peer-reviewed and grey literature.However, these methods are not regularly implemented yet and may have limitations that need to be explored.A 2019 article by the UK Society and College of Radiographers proposed a straightforward solution 'to routinely ask every patient of childbearing age the same question' about pregnancy. 24Although this would simplify the process and remove any assumptions made based on appearance or perceived gender, the acceptability of this method to the broader patient cohort has not been studied.Pedersen & Sanders created a form that asks the patient to note their name, their pronouns and where their reproductive organs are located. 25Additional questions related to the menstrual cycle would be asked if the patient indicated that their reproductive organs are internal.This form was piloted, and the results showed that patients understood the need for the information being asked and were willing to complete it before imaging. 26The article, however, provides limited information on how acceptable and understood the form was in the participating patient cohort.Girling describes a patient who noted that the language used to describe the anatomy in this form was 'harsh' and suggested asking the patient, 'If you have internal reproductive organs (uterus and ovaries), is there a possibility of pregnancy?'. 27he Society and College of Radiographers built on this form using a similar tiered approach and created the Inclusive Pregnancy Status (IPS) form.This form asks about the sex registered at birth rather than reproductive organs. 28If the patient answered female, they then get asked if they had any surgeries, treatments or medical conditions that resulted in them being unable to become pregnant; if the answer is no, they would then be asked about their menstrual cycle.The form was piloted in the UK, and phase one noted that radiographers lack understanding and confidence surrounding the inclusive pregnancy status issue. 29They also stated that patients lack understanding of the rationale behind the questions and potential fear or embarrassment relating to answering questions aimed at gender identity.A negative patient experience related to miscommunication and knowledge by the staff was described.Phase two assessed both the staff and patient feedback on the form.It was noted that radiographers understood the form and rationale behind the change of practice, and some staff reported concerns that they might have confrontational situations with cisgender males.However, the study notes that 80% of cismale patient respondents stated they were 'okay' with the form.
A third idea yet to be explored in the literature is to provide patients with a list of organs and ask them to choose which organs relate to them.This will allow the patient to select if they have a uterus.This may avoid sensitive questions to a patient who does not have a uterus, such as a cisgender female, trans-masculine or non-binary person who has undergone a hysterectomy or a trans-feminine person.However, consideration needs to be given to what organs the list may contain and the relevance of each organ in changing patient care.For example, if the list includes testes, this alone would unlikely alter patient management in medical imaging.However, suppose the list only contained female internal reproductive organs, which are relevant in this context.In that case, it may be similar to asking all patients if there is any chance they could be pregnant.
Patients and staff need to easily understand all methods of establishing pregnancy status.The questions will be asked to a diverse range of patients, who may have varying knowledge about the procedure to be performed, risks during pregnancy and proficiency in the English language.It is also important to consider the communication needs of TGDNB individuals with disabilities, such as blindness, deafness or intellectual disabilities, as their intersecting identities may further complicate communication and access to healthcare services. 30Thus, an approach like that of the IPS form, which asks the patient their gender, their sex assigned at birth, if they have had any procedures that could result in them being unable to become pregnant, and information surrounding their menstrual cycle will require a high level of staff engagement and understanding, as well as consideration to how this information will be portrayed in languages other than English and adapted for patients with different communication needs, such as those with disabilities, to ensure effective communication with diverse patient populations.

Recording sex and gender information on electronic medical records
Using chosen names, pronouns and titles/honorifics is crucial for safe gender-affirming care within medical imaging.However, most electronic medical record (EMR) platforms do not currently allow these to be accurately recorded. 31According to the Healthcare Equality Index, only 13% of the 500 healthcare facilities evaluated in the US in 2014 had methods to record if gender identity differs from the sex on the birth certificate, and 45% included this information in free-form notes. 32The field for sex on the EMR often provides only binary options and does not acknowledge the difference between gender identity and sex assigned at birth.While some healthcare professionals will use the field to record the patient's gender identity, others may record legal sex or sex assigned at birth, leading to variation and inconsistent use. 33Another critical challenge is the development of data input signifiers for gender identity that is clinically helpful, as terms such as 'transgender' may be too general and heterogeneous. 34shley 17 highlights the importance of addressing privacy and institutional practices when recording the gender and sex information of TGDNB people.Safeguarding vulnerable patients must go beyond simply being mindful of their concerns.Some considerations include not wanting their gender or sex assigned at birth recorded for fear of involuntary disclosure, the possibility that reporting gender might reveal their TGDNB identity and apprehension about the extensive access that healthcare staff have to this information.Implementing privacy measures and policies prioritising the safety and confidentiality of TGDNB patients is crucial in fostering a more inclusive healthcare environment.
Sex assigned at birth is also collected to inform clinical practice.Best practices should follow what Kronk et al. 35 refer to as a two-step process, in which the questions of gender/sex assigned at birth are separated and asked at different steps during patient intake and care.To protect the patient's privacy, these two-step processes should be mindful of any situation in which they might unintentionally out a TGDNB person.

TGDNB patient experiences
Limited literature explores the lived experience of TGDNB patients regarding screening for pregnancy status in medical imaging settings.An extensive survey of TGDNB patients demonstrated that more than 70% of survey respondents had negative experiences within radiology compared to the 33% rate in other medical settings.Respondents described negative experiences ranging from insensitivity among staff members with little regard for chosen names, pronouns and titles to unwelcoming facilities that did not provide sensitive reading material or gender-neutral toilets. 36Findings from a survey of transgender and non-binary experiences of maternity services in the UK indicated that TGDNB birth parents reported poorer experiences of care compared to cisgender women in the Care Quality Commission Maternity Services Survey. 37ndividuals reported low healthcare provider knowledge about TGDNB pregnancies, as pregnancy was seen as something only women could experience. 38oncerning TGDNB patient experiences of determining pregnancy status, patients were asked questions about their last menstrual period 27 or testosterone use, 39 which do not adequately screen an individual's pregnancy status.
Participants in Floyd's qualitative study 15 provide solutions for improving the TGDNB patient's experience in medical imaging.They prioritise the need for staff education and training to increase their cultural awareness and the need for this education to begin in undergraduate training.This type of training in medical school is also highlighted for endocrinologists to serve TGDNB individuals better. 32Respondents also suggested the provision of welcoming facilities, signalled through cues, of which some are listed as recommendations outlined in Table 2. Across the literature, more emphasis was observed on inclusive waiting rooms and facilities when participants discussed more gendered environments such as mammogram screenings or antenatal imaging.Some patients suggested separate screening sessions for trans men or gender-diverse people due to the dysphoric experience of being in a waiting room surrounded by cisgender women. 40esearch highlights the need for increased investment in training healthcare staff in TGDNB health. 41This entails training in respectful interaction with TGDNB people 42,43 and providing safety and validation to patients. 41,42,44

Recommendations
Several practices have been put forward to potentially foster a more gender-inclusive environment for establishing pregnancy status prior to radiation exposure.Each of these methods, with its strengths and limitations, can have varied effectiveness contingent on specific patient and staff circumstances.Two of these practices have been previously explored in the literature, while the third is being introduced for consideration within the medical imaging setting in this review.Table 1 offers a concise summary of these three methods.
In addition to determining and recording a patient's pregnancy status, fostering an inclusive and safe environment is paramount.Such an environment encourages patients to share pertinent information that can enhance their care. 43Table 2 provides a set of recommendations that can facilitate the development of an inclusive patient experience within medical imaging.A recent review on workplace inclusion in radiology and radiation oncology further underlines the importance of creating an inclusive atmosphere. 45There are several overlapping recommendations between fostering staff inclusivity and improving patient experience, indicating that creating an inclusive workplace will also significantly benefit patients.
Creating an inclusive experience for the patient needs to consider every interaction with the medical imaging service.The patient experience evidence indicates that a welcoming environment can be signalled through cues, such as intersex-inclusive Progress Pride flags or badges (Fig. 1) and infrastructure changes like gender-neutral toilets. 15All language should be gender-affirming and mindful of the patient's privacy, including the language used by staff, intake forms and IT systems. 17Implementing this would require staff training and changes in the organisation's culture.Without adequate training and procedures, a welcoming environment may lead to mistrust if patients are misgendered or unable to select a gender category that aligns with them.Services can be continually modified and improved through active engagement with the TGDNB community through advisory panels and patient feedback. 18Broader recommendations include changing the Australian Medicare system to be more inclusive of TGDNB patients in its billing practices.This can, in turn, affect the national and state data collection practices in patient management IT systems.
In creating a more inclusive healthcare environment, it is essential to be mindful of potential consequences of the language used in such attempts.Achieving inclusivity involves considering the feelings of all individuals, including cisgender women who might feel objectified by specific terms or phrases.For example, the term 'bodies with vaginas' used by The Lancet in promoting an issue was criticised for simplifying cisgender women to their anatomy when presented without the context of the original essay. 46Fostering a safe and respectful space for everyone requires finding a balance in language and approach that ensures all patients feel acknowledged, respected and valued, regardless of their gender identity or biological characteristics.
While this review primarily addresses the challenges faced by TGDNB patients, we acknowledge the significance of intersex inclusion and the intersectionality of TGDNB and intersex issues in the context of pregnancy determination and data collection.TGDNB and intersex individuals may encounter challenges when navigating healthcare systems primarily designed for cisgender patients, as discussed throughout this review.Some of the methods proposed in this review, such as adopting gender-neutral language, fostering an inclusive environment and using forms that ask about reproductive organs or sex assigned at birth, can also benefit people with intersex variations.For instance, asking about reproductive organs instead of  Gender affirming Infrastructure Provide access to gender-neutral facilities 15,36,47,48 All-gender toilets and change rooms can help people who are not open about their gender presentation to be more comfortable Consult with LGBTQI+ advisors/patients of new buildings/renovations 49,50 Consumer advisory bodies can work with organisations to co-design and consult on the services' infrastructure, environment, training and education, and procedures of the services Staff Training and Education Educate staff in inclusive care 51,52 Staff training on inclusive patient-centred language, and TGDNB healthcare can reduce negative patient experiences during interactions with staff Include TGDNB people in delivering training 41,42 Involving people with lived experience in developing the educational materials allows the TGDNB community to be better engaged and heard.Seeing and hearing the perspectives of TGDNB people through presentations or videos about their interactions with healthcare providers and other issues has a significant impact Acknowledge the unique needs of genderdiverse patients, including service communications with patients 47,53 Providing affirming services entails not assuming anything about the patient and asking about pronouns, chosen names, and other information.Additional precautions regarding the privacy of clinic communications with patients may be needed to avoid accidentally outing individuals Build rapport 47,53 Rapport can be built by recognising that TGDNB patients have often encountered hostile clinical environments that have not considered their needs.Affirming practices facilitate a trusting environment Culture 49,50 Foster a culture of accountability 50 Opportunities for staff and patients to provide formal feedback or complaints about the services or instances of disrespectful or discriminatory behaviour keep organisations accountable.This assists both quality improvement and consumer engagement Provide access to peer support workers 53 Access to peer support services for patients and carers may allow the TGDNB community to feel supported Patient information Use gender-neutral language in all patient information 53 Inclusive language is gender-neutral and organ-specific.Respectful language that considers confidentiality when eliciting patient information allows services to be more sensitive Procedures Ensure procedures consider gender-diverse patients 47,54 Implementing procedures for sensitive information collection from gender-diverse patients cultivates a secure and respectful healthcare environment.This process, and revising existing practices through a gender-sensitive lens, ensures all interactions cater to diverse patient experiences.Furthermore, collaboration with consumer advisors possessing lived gender-diverse experiences provides crucial insights.Their input in co-designing procedures allows healthcare providers to more effectively meet the unique needs of this population Use appropriate gender-neutral language and terminology in procedures 17 Information that is typically collected through gender should be recorded using non-gendered terms that are accurate for the services that are being provided.Patient comfort can be optimised by appropriately explaining the pregnancy status determination method and risks associated with radiation exposure during pregnancy IT systems Design gender-affirming electronic systems 55 Alternative processes may need to be established where IT systems do not account for gender diversity.This could include questions regarding gender and sex assigned at birth (where this information is necessary to ask), chosen name and pronouns, address for mail, and consent regarding the use of chosen names in written communication.When legal, Medicare or insurance documents differ regarding name, sex or gender, confirming the patient's identity could require extra caution Communication Ask patients' preferred names and pronouns and use these to address the patient 18,47,50 Asking for the chosen name and pronouns and using these to address the patient affirms their gender.Avoiding the use of gendered honorifics in patient communication is inclusive, as it does not make assumptions Explain why it is important to ask about sex assigned at birth and ask only if it is clinically relevant 17,35 Questions regarding sex assigned at birth can trigger dysphoria or be perceived as intrusive.Patients may feel safer knowing why such questions are necessary and if they are only required to provide this information when clinically relevant.Questions of gender identity and sex assigned at birth are important to have alongside organ inventory questions.Patients may be unaware of the specific vocabulary related to specific organs; therefore, asking about sex assigned at birth alongside gender and organ-specific questions reduces errors.This two-step process is currently considered the best practice Reassure patients of the privacy of their gender-related data 17 Privacy statements tell the patient that the information being collected is for their care and will be protected with the rest of the clinical information complying with current laws making assumptions based on sex assigned at birth, appearance or perceived gender accommodates intersex individuals who might have ambiguous or atypical genitalia.
The need for Australia and Aotearoa New Zealandspecific guidance in this setting highlights the need for professional college involvement in establishing processes and procedures that instruct healthcare providers.This should be achieved through working parties that involve people with lived experience and consumer engagement.

Future recommended research
This paper primarily focuses on the medical imaging setting to promote gender-inclusive practices, however, it is important to note that any changes have broader implications.Specifically, they may also impact referring clinicians and the overall patient journey, necessitating a more uniform shift towards inclusivity across all healthcare interactions.However, the issue of integrating gender-inclusive practices within the referral process is beyond the scope of this paper.Future research and healthcare reforms should aim to address this critical area to ensure a comprehensive and seamless genderinclusive patient experience.
Future research needs to improve understanding of TGDNB patients' experiences navigating a medical imaging department.It is unknown how many TGDNB patients of childbearing capacity have missed screening for pregnancy in Australian medical imaging departments due to the use of screening forms that do not capture their gender diversity.Therefore, the authors recommend that future research assesses the lived experience TGDNB patients undergoing screening for pregnancy.This would require an investigation into the utilisation and acceptability of each method of establishing pregnancy status, that is asking all patients if they could be pregnant versus the tiered approach of asking gender and sex assigned at birth versus the organ inventory approach.Additionally, individual departments should consider conducting internal audits to guide the development of their own inclusive protocols.Case studies involving unintentional exposure to foetuses of TGDNB patients should be published to provide learning outcomes that help design a more inclusive medical imaging environment.
In addition to the challenges faced by TGDNB patients, it is crucial to explore the unique experiences of intersex patients in medical imaging departments.Intersex individuals may encounter specific obstacles during screening for pregnancy and data collection processes.For instance, an organ inventory approach could be particularly beneficial for intersex individuals, allowing them to provide accurate information about their reproductive anatomy without facing assumptions based on their sex assigned at birth.By examining the distinct challenges encountered by intersex individuals and developing targeted solutions, such as inclusive communication practices and staff training on intersex issues, healthcare professionals can create a more sensitive and inclusive environment for all patients.

Conclusion
A review of the literature indicates that this topic needs to be better explored, particularly in the Australian and Aotearoa New Zealand setting.The work done by the Society and College of Radiographers in the UK lays the foundations for establishing pregnancy status in transgender, gender-diverse and non-binary populations.However, once guidance is provided by regulatory bodies and professional colleges in Australia and Aotearoa New Zealand, standardisation in this setting may be achieved.In the absence of such guidance, this review can be used to advise the design of an inclusive practice.

Recommendation
Examples, actions Display gender-affirming print/online material 15,43,47 Explicit gender-affirming print and visual material, such as the intersex-inclusive Pride Progress flags and non-discrimination statements, signal to patients that the space is welcoming of TGDNB people Posters relating to radiation pregnancy risks should be recognisable to a diverse population, for example, using a group of pregnant people with varied gender presentations and race

Table 1 .
Summary of recommended practices for establishing pregnancy in a gender-inclusive manner prior to medical radiation exposure © 2023 The Authors.Journal of Medical Imaging and Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Radiologists.

Table 2 .
Recommendations to create an inclusive practice within medical imaging