The SoR has responded to an inaccurate and misleading article appearing in the Telegraph as it believes it could further alienate trans, nonbinary and intersex people from accessing healthcare services.
Published initially on Sunday (August 11), the article – entitled 'NHS staff told to ask men if they are pregnant before X-rays' is inflammatory and inaccurate. The Society has responded to the claims made within the article by emphasising the significant damage such an article can have on patients’ and members’ confidence to access and deliver safe and effective services.
This will do nothing to nurture relationships between patients, the public and healthcare providers. The fact of the matter is that ionising radiation (x-ray) employers and radiographers have a legal responsibility to make enquiries of individuals of childbearing potential to establish whether the individual is or may be pregnant or breastfeeding.
An ethical duty
Compliance with The Ionising Radiation (Medical Exposure) Regulations 2017 and The Ionising Radiation (Medical Exposure) Regulations (Northern Ireland) 2018 is mandatory in the United Kingdom, and the guidance is aimed at ensuring radiographers can do so in an inclusive way.
Radiographers also have an ethical duty as registered healthcare professionals to challenge discrimination and not to discriminate against service users, carers or colleagues by allowing their personal views to affect their professional relationships or the care, treatment or other services that they provide.
The medical use of ionising radiation is regulated by the Care Quality Commission (CQC) in England. In its IR(ME)R annual report 2019/20, the CQC recommended that imaging and radiotherapy departments should ensure their procedures are inclusive of transgender and non-binary patients, including the procedure for making pregnancy enquiries.
Communicating effectively
Radiologists are aware of the legal requirement for all operators to have the skills to communicate effectively with any individual to be exposed to radiation, and to provide them with adequate information relating to the benefits and risks associated with the radiation dose.
Radiographers and radiologists are skilled at communicating sensitive information and this is no less important for gender diverse people. It has always been a legal requirement to check for pregnancy before an individual is exposed to ionising radiation.
Radiographers across the UK understand that if an individual indicates they were born male they are not asked about the possibility of pregnancy. If an individual indicates they were born female, then potential for pregnancy can be determined in a number of sensitive and compassionate ways which should be led by the individual once they have been given adequate information to inform their decision.
This group includes trans males and gives people with variations of sex characteristics the opportunity to disclose information relevant to their care.
'A responsibility to treat patients equally'
Errors throughout the article indicate a poor understanding of these regulations which are intended to protect patients from the harmful effects of ionising radiation. To be clear, MRI does not involve ionising radiation, although there are other safety considerations healthcare staff must take into account when performing MRI on individuals with potential for pregnancy.
Richard Evans OBE, CEO of the Society, said: "Health professionals have a responsibility to treat all patients and service users equitably. It is insulting to suggest that personal ideology takes precedence when clinical practitioners such as radiographers are dealing with patients.
“It is specifically the case that radiographers using ionising radiation have a legal duty to ensure that a foetus is protected from exposure to harm. It is therefore essential that our members have policy backing and good practice guidance in making these important checks."
'The psychological impact is unimaginable'
Considering the Equality Act of 2010, the SoR believes that where there is sufficient risk to justify the creation of a safety check for one group of individuals, to omit this safety check in another cohort with the same potential for harm is potentially discriminatory and could be considered grounds for prosecution, where the group being disadvantaged share a protected characteristic such as gender reassignment.
James Barber, chair of the SoR’s LGBTQI+ Equalise Workers Group and radiotherapy pre-treatment superintendent Therapeutic Radiographer, expressed how he was “incredibly disappointed” by the Telegraph’s publication.
“Despite their efforts to downplay the numbers this may impact, if the risk of unintentionally exposing an unborn child to ionising radiation exists at all then it is incumbent on us as healthcare professionals to take every reasonable step to prevent this,” Mr. Barber said. “The possible psychological impact on both patient and staff of discovering a previously unknown pregnancy in this manner coupled with the knowledge of having put them at risk is unimaginable.”
'A complete lack of understanding'
The SoR added that guidance was based on the evidence available at the time and was clear about the lack of data collected from British adults who identify as trans or non-binary. The Office for National Statistics census data referred to by the Telegraph was published two years after the SoR guidance and was welcomed and promoted by the SoR.
Regardless of the numbers, no healthcare professional should knowingly put someone at risk because they represent a minority of the population. In the same way as patients would not expect to be refused treatment on the basis that their condition is rare, it is offensive to suggest that any healthcare professional choses how to care for people based on their own personal beliefs.
The article shows a “complete lack of understanding” about the process the Inclusive Pregnancy Status questionnaire advocates, Mr. Barber added.
'Extremely delicate and complex'
“Working in a busy London department, we have not had any negative responses from patients in the two and a half years since we implemented this process,” he continued. “These checks do not require any additional time in departments which are already undertaking their due diligence with patient pre-exposure checks.
“We now live in an age where we know that we cannot assume someone’s biological ability to become pregnant based on the gender they present as. Historic approaches left unborn children vulnerable to incorrect radiation exposure, which is entirely unacceptable by anyone’s standards.”
Putting the appropriate changes and safeguards in place to reduce these risks is the responsibility of organisations with knowledge and understanding of ionising radiation and the associated medico-legal regulations, such as the SoR, Mr. Barber concluded.
He said: “People who do not have this extremely specialist knowledge should consider very carefully if they are suitably qualified to give opinions on a topic which is extremely delicate and complex. This is not a measure implemented for inclusivity for its own sake, but for the safety of unborn children who are otherwise at risk.”
A lack of alternatives
The SoR notes that none of the expert commentators in this, or other opinion pieces, have offered an alternative method of achieving inclusive care or regulatory compliance. Instead, at best they seem intent on ensuring the needs of trans, non-binary and intersex people are ignored and at worst they are encouraging others towards exclusionary practices and behaviours.
This guidance was co-produced by Therapeutic and Diagnostic Radiographers, patients and people who are experts by experience.
It added: “Radiographers should be led by the narrative chosen by the person with whom they are communicating. Patients might also be at risk of harm from our actions and inactions if we fail to practise in an inclusive way. Understanding gender diversity and diversity in sex characteristics enhances safe practice.”
The SoR Inclusive pregnancy status guidelines for ionising radiation: Diagnostic and therapeutic exposures was published in 2021 in direct response to members seeking support, advice and education around the sensitive nature of making pregnancy enquiries of gender diverse people.
'Clearly motivated by transphobia'
The SoR is clear that anyone promoting actions that might be perceived as homophobic, biphobic or transphobic by suggesting we do not treat individuals with equity, is putting patients at risk. They are also failing to meet the standards required for professional registration.
Stewart O’Callaghan, CEO of LGBTIQ+ cancer charity OUTpatients emphasised that the IPS was created to help staff comply with the law and that the statement within the Telegraph’s article, suggesting the guidance plays a role in indoctrinating children was “clearly motivated by transphobia”.
They added that the article “suffers from poor journalism and is littered with inaccuracies and misrepresentations in its characterisation of both the IPS guidance and OUTpatients”.
The SoR guidance and associated training and education resources are available here and the list of FAQs for radiographers based on enquiries to the professional body and trade union can be found here.