Breaking the Language Barrier in Radiology
Interpretation services are vital for optimal patient outcomes
More than 25 million Americans have limited English-language proficiency (LEP), according to the U.S. Census Bureau. These patients experience challenges accessing healthcare and are not as likely to receive preventive care, including screening mammograms, according to the authors of a recent Journal of Breast Imaging article.
“In a setting where the breast radiologist does not speak the language of their patient, using certified medical interpreter services is fundamental,” the authors asserted.
Lead author Yara Z. Feliciano-Rivera, MD, of the Department of Radiology at the University of Miami Miller School of Medicine, and colleagues highlighted the connection between the use of medical interpreters and improved clinical care and patient satisfaction in patients with LEP.
Access to medical interpreters improves adherence to screening mammograms and follow-up in this patient population, they noted.
“Breast radiologists can address disparities in breast cancer screening and treatment by promoting effective communication,” Dr. Feliciano-Rivera and colleagues wrote. “Proper training and certification of medical interpreters is essential to prevent misinterpretations and ensure patient safety.”
The authors emphasized the importance of speaking to and maintaining eye contact with the patient when using an interpreter service.
“Address the patient directly and seat the interpreter next to or slightly behind the patient, use visual aids whenever possible and have the patient repeat the information to verify comprehension,” the authors recommended.
Further, they cautioned against using untrained staff members or a patient’s family or friends as medical interpreters, as this may result in medical errors, poor health outcomes and violations of patient confidentiality.
The consequences of ineffective communication extend beyond patient satisfaction and can affect the quality and safety of imaging itself.
Communication Gaps Affect Imaging Quality
Language barriers can create challenges throughout experiences with radiology, said Daniel B. Chonde, MD, PhD, assistant professor of radiology at the University of Kentucky College of Medicine in Lexington.
“Some of the effects are obvious, such as confusion about follow-up recommendations or difficulty accessing care in the first place,” Dr. Chonde said. “However, language barriers can also have more subtle effects on diagnostic quality itself.”
He pointed to a study (Taffel et al. 2020) in which patients with limited English proficiency undergoing abdominal MRI had increased motion artifact and decreased image quality.
“Poor image quality can reduce sensitivity for subtle pathology or even require repeat imaging, which increases costs and may delay diagnosis and treatment,” Dr. Chonde said. “Similar issues can occur even with relatively simple imaging studies like chest radiographs if patients cannot clearly understand breathing instructions.”
In radiology, communication occurs continuously as patients move from registration to waiting areas to imaging suites and procedural rooms.
“Interpretation is especially critical in settings involving consent, patient education, safety screening, breast imaging and interventional radiology procedures where more nuanced communication/interpretation is vital,” he said. “However, even routine imaging depends heavily on effective communication.”
AI Tools Expand Access to Imaging Instructions
Dr. Chonde is lead author of a recent study describing how his institution used AI during the COVID-19 pandemic to assist with medical interpretation.
“Our hospital was seeing a large influx of patients with limited English proficiency presenting with respiratory symptoms,” he explained, noting these patients required chest radiographs.
Interpreter services across the hospital were under tremendous strain. In many cases, technologists were spending several minutes locating archaic interpreter hardware, plugging it into a phone jack, following instructions, waiting in a queue and relaying patient information so an interpreter could deliver only a few simple commands, such as, “Take a deep breath in and hold it.”
Dr. Chonde and colleagues sought to streamline this workflow while maintaining high-quality communication. They developed an AI-based tool, RadTranslate, to help.
“The concept was straightforward: Create a clean interface where technologists could select an imaging exam, choose a language and play standardized imaging instructions for the patient,” he said.
RadTranslate is a web-based application, meaning it can run on essentially any device with a browser, internet connection and speaker.
“The technologist selects the imaging exam type and desired language, then chooses from a list of standardized commands,” Dr. Chonde explained. “When the button is pressed, the instruction is played aloud in the patient’s preferred language.”
This tool helps patients understand instructions during imaging exams, he said, and provides technologists with a fast and reliable way to communicate without disrupting workflow.
“Ultimately, clearer communication can improve image quality, reduce repeat imaging and create a more equitable patient experience,” Dr. Chonde said.
If the technologist does not speak the target language, they have no way to independently verify whether a translation is accurate, Dr. Chonde noted.
“To address this, we partnered with hospital-certified translators to create and validate standardized translations for imaging commands,” he said. “This ensured the translations met hospital quality standards. We then used AI-based text-to-speech technology to generate audio files from the approved translations.”
Although he sees many opportunities for AI to assist with communication in radiology, Dr. Chonde does not think AI will replace professional medical interpreters anytime soon, particularly for nuanced clinical discussions.
“However, I do think AI-assisted professional medical interpreters can help expand access to standardized communication tools, simplify radiology reports, improve multilingual patient education materials and reduce barriers to care in high-volume clinical settings,” he said. “The goal should be augmentation rather than replacement.”
For More Information
Access the Abdominal Radiology study, “Retrospective Analysis of the Effect of Limited English Proficiency on Abdominal MRI Image Quality.”
Access the Journal of the American College of Radiology study, “RadTranslate: An Artificial Intelligence-Powered Intervention for Urgent Imaging to Enhance Care Equity for Patients with Limited English Proficiency During the COVID-19 Pandemic.”
Access the Journal of Breast Imaging article, “Appropriate Use of Medical Interpreters in the Breast Imaging Clinic.”
Access RSNA’s radiology health equity resources.
Read previous RSNA News stories on health equity: