The theme of this year’s International Women’s Day (IWD) — “Inspire Inclusion” – takes on added meaning when it comes to neurology and neuroimaging. In fact, data from multiple credible sources indicate that inclusion has impacts on healthcare far beyond improving gender equality.

You could even consider “All Hands on Deck” as an alternative theme to describe the urgent need to improve the detection and treatment of brain diseases for an aging population in the U.S. and worldwide. That’s why “inclusion” – clinically, operationally, professionally and socially — matters to us at SpinTech MRI. It’s integral to the work we’re doing to expand clinical adoption of our STAGE software platform, increase MRI efficiency and diagnostic value with ground-truth data and quantitative MRI, and expand patient access to advanced imaging.

Understanding the challenges

Over the past decade, multiple sources including The Lancet Neurology, Neuroepidemiology, JAMA Neurology, and The Women’s Brain Project have described the scope and scale of neurological diseases and their impacts. As the latter summarized in a 2023 white paper:

“The burden of death and disability from brain diseases is a global health challenge, costing over US$800bn in the United States (US) alone, exceeding that of cancer and cardiovascular disease. Brain disorders have been described as a pandemic far worse than Covid-19, with one in three people having some form of these conditions.”

According to a study published in 2021 in JAMA Neurology, the number of cases of stroke, Alzheimer’s, dementia and migraine increased between 1990 and 2017 “largely because of aging.” While the overall incidence of traumatic brain injury (TBI), Parkinson Disease, multiple sclerosis (MS) and epilepsy decreased during that period, the rates of disease varied widely across the US.

A 2023 editorial in The Lancet stated that the global economic costs of neurological disorders were more than $1.7 trillion per year. It also noted that while gender differences affect the risks, diagnosis and treatment of brain diseases, “sex and gender are still rarely considered in brain research.” It concluded that a better understanding of the differences can “lead to earlier and more reliable diagnosis and more effective prevention, treatment, and disease management” and reduce the enormous personal, social and economic impacts.

Inclusion also affects neurologists, radiologists, researchers and educators, and administrators. Writing in the May 2023 issue of Neurologic Clinics, Editor Dr. Rima M. Dafer, MD, MPH, noted that gender variations, social or cultural perceptions and even the medical community’s understanding of different diseases can affect diagnosis and treatment. For example, preconceived ideas of who is more likely to have a disease may cause some people not to seek care or lead to delayed or missed diagnoses.

A study published in May 2023 in BMJ found that despite increased recognition of gender-based differences, “there has historically been a male bias with fewer females included in clinical trials and the absence of sex-based analysis.” It noted that greater inclusion of women and consideration of gender differences generally “advance our understanding of disease mechanisms and precision-based therapeutics, highlight disparities in care and outcomes, and inform policy changes aimed towards greater equity.”

Compounding the higher incidence of neurological diseases is a global shortage of neurologists. According to a 2021 study published in Cureus, only 2.8% of 51,816 medical school graduates surveyed intended to become neurology residents despite an increased number of openings. It called for greater efforts to attract more diverse students to neurology, train non-neurologist physicians, and use new technology to make neurology more efficient.

Bias and gender differences also filter down to radiology reading rooms. A study published in Academic Radiology in May 2020 analyzed work performed by 22,445 radiologists identified in the 2016 Medicare Physician and Other Supplier Public Use File. It found “horizontal occupational segregation,” with female radiologists more likely to enter academic practices and less likely to be reading MRI and other advanced imaging modalities used in neuroimaging.

In 2017, the Gender Disparity Task Force (GDTF) formed by the American Academy of Neurology found that male neurologists and physicians at medical schools earned significantly more than their female counterparts. It recommended increased salary transparency, opportunities for professional networking, recognition of implicit bias and accommodation of physician work/life balance. GDTF Chair and AAN board member Dr. Elaine C. Jones, MD, FAAN, noted that gender disparities should be understood not as male vs. female but the result of implicit biases shared by both genders. “I think it’s something we can change,” she said. “I’m very positive and hopeful.”

Why it matters

I’ve had many of the same observations and reasons for optimism throughout my career as a radiology IT vendor. To me, healthcare outcomes and gender equality are tightly intertwined. In other words, they matter equally.

For example, at SpinTech MRI, we are working closely with neuroradiologist Dr. Karen Tong, MD, and her colleague Daniel Kido, MD, at Loma Linda University Health to increase clinical adoption of our STAGE software platform. We’re also working with Dr. Melissa A. Davis, MD, MBA, Vice Chair for Imaging Informatics, Radiology & Biomedical Imaging at Yale New Haven Hospital (YNHH) and Associate Professor of Radiology and Biomedical Imaging at the Yale School of Medicine to document how STAGE improves brain MRI efficiency, patient access and care costs.

Finally, we are receiving invaluable guidance and input from Dr. James Backstrom, MD, a neuroradiologist, STAGE user and CMO at Armstrong County Memorial Hospital in Pennsylvania. Dr. Backstrom has been instrumental in helping us enhance STAGE. He also initiated our collaboration with Canon Medical Systems USA to further improve MRI efficiency with STAGE and Canon AI models.

Inclusion in neuroradiology and neurology matters not only because it’s right. It matters because all of us – IT vendors, physicians, administrators, researchers, patients and their families – need all of the knowledge, expertise and commitment that’s available to improve the diagnosis and treatment of neurological diseases as soon as possible.