By Nicole Dhanraj
There are specific radiology questions we ask so often that they become automatic.
“Can you take that off?” is one of them.
Most days, it truly is simple. Jewelry comes off, the exam proceeds, and no one gives it a second thought. But now and then, that question lands with a weight we don’t immediately anticipate.
I once had a Native American patient wearing a lot of beaded jewelry around his wrists and ankles. He told me the beads honored deceased ancestors, and I paused to acknowledge their sanctity and asked if he could take them off. He told me he had them on for 7 years, and he would have to explain this to his elders.
I paused again, not because I didn’t believe him, but because I wasn’t immediately sure how to proceed. I explained that I understood the importance of what he was wearing, but that they needed to be removed for the exam. I also explained that because I couldn’t identify the materials or paint used on the beads, I couldn’t safely determine whether scanning him as-is would be appropriate, especially given the possibility of burns. I told him, as clearly and calmly as I could, that he should let me know what he needed to do.
There was no clasp or stretchiness to the bracelets, and then, with a heavy sigh, he said he would cut them off.
That wasn’t what I wanted. Cutting something that meaningful felt wrong, and I didn’t like that decision resting solely on his shoulders without further consideration.
I called the radiologist to see if there was any way we could safely proceed with the beads in place. After reviewing the situation, the radiologist agreed that it was a risk we couldn’t responsibly take.
So, we explained the imaging limitation again and offered options, proceed (but with the beads off) or reschedule. There was no pressure. No urgency imposed.
But “reschedule” isn’t always a simple alternative.
For many patients, delaying an exam means time off work they can’t afford, transportation challenges, childcare issues or prolonged anxiety while waiting for answers. In some systems, it means weeks or months before another appointment is available. Access to imaging is not evenly distributed, and patients know this. The choice to proceed is often shaped as much by practicality as by preference.
And still, it was awkward. He continued to talk about his elders and how they wouldn’t be happy as he cut the beads. I kept reiterating that he had a choice not to proceed. The exam moved forward. But the moment didn’t feel resolved.
That same weight shows up in other, quieter ways.
We see it when we ask some of our patients to remove clothing or change into a hospital gown. For many, modesty isn’t simply about comfort; it is tied to religious practice and personal dignity. Being asked to disrobe, even partially, or wear an open-back gown can feel deeply exposing or distressing, especially if privacy, coverage or the gender of staff isn’t carefully considered. What feels like a routine preparation step to us may feel like a loss of dignity to them.
Again, the issue isn’t that imaging requirements are unreasonable. Positioning, access, safety and image quality still matter. But it’s easy to forget how vulnerable these moments can be when we’re focused on getting the exam done.
What stayed with me wasn’t uncertainty about whether we followed protocol as we did. It was the weight of witnessing patients give up something meaningful to access care, even when the choice was informed and voluntary.
Across many cultures, items worn on the body and the way bodies are covered carry meaning far beyond what we can see. Sikh kara bracelets, Hindu sacred threads, Christian crosses, hamsa pendants worn in Jewish and Muslim communities as symbols of protection, Native American beads or medicine items, and religious clothing tied to modesty; these are not simply accessories or preferences. They can represent faith, ancestry, protection, grief and identity.
This isn’t about lowering imaging standards. Safety, diagnostic accuracy and image quality remain essential. It’s about recognizing that what feels routine to us can carry profound significance for someone else.
I still think about that patient. About the pause before I spoke, and the feeling of standing there knowing there was no perfect option. I had done what was clinically necessary, and I had done my best to be respectful, but that didn’t make the moment light. It made it heavy in a different way.
“Can you take that off?” is a question we ask without thinking.
But every once in a while, we feel the full weight of that question because we understand what it costs the patient, even when there is no other way forward.
Nicole Dhanraj, Ph.D., SHRM-SCP, PMP, GPHR, CPSS, CRA, R.T(R)(CT)(MR), is an experienced imaging director.
