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Diagnostic imaging

Canada obtains more MRs and CTs, but long wait times persist

OTTAWA – The supply of magnetic resonance imaging (MRI) and computed tomography (CT) scanners in Canada increased significantly over four years, according to a new report from the Canadian Institute for Health Information (CIHI).

The study, titled Medical Imaging in Canada, 2007, reports that in 2007 the number of CT machines increased to 419, up from 325 in 2003.

And the number of MRI machines increased to 222 in 2007 from 149 in 2003.

In the most recent year surveyed, between 2006 and 2007, the number of CT scanners increased by 27 and the number of MRI scanners increased by 21.

The rate of MRI and CT exams performed per 1,000 population in Canada rose by 43% and 28%, respectively, in the four years between 2003 and 2007, and rose by 4% and 5%, respectively, in the most recent year.

Nevertheless, relatively long wait times for MRI and CT exams persist across Canada. For example, the province of Ontario targets a 28 day wait period for an MRI exam, but the average wait time in the province is 98 days – more than three months. The data can be found on the Ontario government’s Wait Times Strategy web site.

Ontario is targeting a wait of 28 days for a CT exam, but the average wait time is 47 days, according to the government web site. In some regions, such as the Champlain Local Health Integration Network, in eastern Ontario, the CT wait time is an average of 72 days.

Patients in other parts of the country are also experiencing delays. In Nova Scotia, the government web site notes a wait time of 199 days for an MRI at Capital Health, in Halifax. (July 31 data). However, at the IWK Health Centre, also in Halifax, the wait for an MRI is only 15 days.

For a CT exam, the expected wait at the QE II Health Sciences Centre, in Halifax, is 103 days. At the IWK Health Centre, in the same city, the wait is only eight days, and in Antigonish, the wait for a CT exam is only five days.

The CIHI observed that despite the increased stock of CT and MRI machines, Canada, with 12 CT scanners and 6 MRI machines per million population, still falls below the Organisation for Economic Co-operation and Development (OECD) median of 15 CT scanners and 7 MRI machines per million population in 2005, the latest year for which data are available.

There were 103 CT exams per 1,000 people performed in Canada in 2007, less than the rate performed in both the United States (207) and Belgium (138), but higher than the rate in Sweden (89), Spain (57), England (54) and Denmark (34). In comparison, Canada’s rate of MRI exams per 1,000 population (31) was higher than that in England (25), Spain (21) and Denmark (17), and lower than in the U.S. (89), Belgium (43) and Sweden (39). Information on scans per 1,000 population was available for only six OECD countries other than Canada.

“Increases in the number of imaging scanners over the last few years mean that the majority currently installed and in use in Canada are less than six years old,” says Francine Anne Roy, Director of Health Resources Information at CIHI. “These newer machines are using the latest technology to produce more detailed scans.”

The average number of MRI exams performed per scanner in Canada was 5,123 in 2007, up from 4,408 in 2003; for CT scanners, the average number of exams performed per scanner increased from 7,411 in 2003 to 8,735 in 2007. At the same time, the hours of operation for MRI scanners increased only slightly between 2003 and 2007 (66 to 71 hours per week) and decreased slightly for CT scanners (62 to 60 hours per week).

The newest CT scanners have the capacity to obtain 64 or more ‘slices’ or pictures per rotation of their circular gantries, resulting in improved images, greater imaging speed and more coverage. The advances are leading to in non-invasive cardiac imaging and virtual colonoscopy. Sixty-four-slice machines have been available in Canada since 2004. In recent years, 64-slice scanners have represented more than 70% of new CT installations.

Last year, vendors introduced 256-slice and 320-slice CT machines to the market.

Positron emission tomography (PET) is a type of nuclear medicine examination used to detect cancerous tumours, some brain disorders and diseases of the heart and other organs. Another new technology combines PET and CT imaging, allowing physicians to examine both the function of an organ and the anatomical details of its tissues at the same time. As of January 1, 2007, there were 18 PET/CT scanners in Canada and 13 PET scanners.

All provinces have CT and MRI scanners in hospitals, where almost all of their operating costs are covered by public insurance. Between 2003 and 2007, the number of CT scanners in hospitals grew by 82, while the number of MRI scanners grew by 58.

Imaging services are also provided outside of hospitals in free-standing imaging facilities. CT scanners in free-standing facilities are found in four provinces (Quebec, Ontario, Alberta and British Columbia) and MRI scanners are found in six provinces (Nova Scotia, Quebec, Ontario, Manitoba, Alberta and British Columbia), with most of their operation privately funded.

Between 2003 and 2007, the number of MRI scanners in free-standing imaging facilities increased from 26 to 41. Over the same time period, the number of CT scanners in free-standing imaging facilities grew from 9 to 21. As of January 2007, about 5% of all CTs and 18% of all MRIs were in free-standing facilities. This is up from 3% and 17%, respectively, in 2003.
In general, more exams per scanner are performed in hospitals than in free-standing facilities. For jurisdictions with MRI scanners in free-standing facilities, hospitals performed about twice the number of MRI exams per scanner than free-standing facilities (5,970 versus 2,530). In jurisdictions with CT scanners in free-standing facilities, the number of CT exams per scanner performed in hospitals was more than four times that in free-standing facilities (9,506 versus 2,160).

The number of medical imaging professionals per 100,000 population remained steady between 2003 and 2006, the latest year available. Canada’s 16,464 medical radiation technologists made up the bulk of the workforce in 2006, up from 15,289 in 2003. Some other medical imaging professionals include sonographers (3,000 in 2003, down to 2,900 in 2006), diagnostic radiology physicians (1,906 in 2003, up to 2,034 in 2006), nuclear medicine physicians (213 in 2003, up to 221 in 2006) and medical physicists (350 in 2003, down to 322 in 2006).

About CIHI
The Canadian Institute for Health Information (CIHI) collects and analyzes information on health and health care in Canada and makes it publicly available. Canada’s federal, provincial and territorial governments created CIHI as a not-for-profit, independent organization dedicated to forging a common approach to Canadian health information. CIHI’s goal: to provide timely, accurate and comparable information. CIHI’s data and reports inform health policies, support the effective delivery of health services and raise awareness among Canadians of the factors that contribute to good health.

 

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