Canadian Radiologists Call for Better Medical Imaging Access

Inadequate access to medical imaging has become a crisis in Canada, with wait lists growing longer, staff vacancy rates rising, and old or malfunctioning equipment slowing down the process, according to radiologists and technologists across the country.

As medical associations begin to submit their budgets and pre-budget considerations to the federal government this month, radiology-related groups are asking for improvements in the three major areas of people, equipment, and technology.

“This is a huge problem where I work in Toronto — and it’s the same in the rest of Ontario and the rest of the country. We cannot get these wait lists under control,” Ania Kielar, MD, president of the Canadian Association of Radiologists (CAR) and deputy chief of radiology at the Joint Division of Medical Imaging in Toronto, told Medscape Medical News.

Expected average wait times for CT or MRI for non–life-threatening conditions should be about 30 days, Kielar said. However, wait times have stretched to about 80-100 days in many areas nationwide.

“This is not acceptable, especially when our patients have to take off work and spend time worried about their health without an answer,” she said. “It’s hard to move on with therapy if you don’t have a diagnosis. Imaging plays a vital role in most patients’ health journeys.”

In July, CAR, along with the Canadian Association of Medical Radiation Technologists (CAMRT) and Sonography Canada, put forth several recommendations to increase capacity for medical imaging. CAR also submitted these recommendations with its 2025 pre-budget considerations to the House of Commons Standing Committee on Finance in August.

Investing in People

First, the medical groups have asked for investments in the workforce, including radiologists, sonographers, and medical radiation technologists as part of a health human resource strategy to reduce backlogs.

Even before the COVID-19 pandemic, the demand for imaging was increasing by about 4% per year, Kielar said. The increase has now reached about 8%-10% per year.

Since the onset of the pandemic, medical professionals have reported a higher rate of burnout, which has led to high vacancy rates, she added. At many hospitals, for instance, vacancy rates now surpass 11%.

To draw more people, CAR, CAMRT, and Sonography Canada are advocating for more slots in existing training programs and the establishment of medical radiation technologist (MRT) schools in all provinces. Less populated areas tend not to have specialist training, and radiologists are more likely to live and work in the areas where they receive training, Kielar said.

The medical societies have also called for a focus on retention for existing professionals, including an emphasis on reducing burnout and improving equipment ergonomics to reduce physical strain.

“Canadian radiologists report a much higher degree of burnout than average Canadian physicians,” said Michael Patlas, MD, professor and chair of medical imaging at the University of Toronto and president of the Canadian Emergency, Trauma, and Acute Care Radiology Society. Patlas has previously researched the prevalence of burnout among Canadian radiologists and trainees.

“The problem existed before the COVID-19 pandemic, but it is exacerbated by the backlog of imaging cases related to the pandemic, the shortage of medical radiation technologists and sonographers, and our aging radiology equipment,” he said.

Replacing Old Equipment

Although the Ministry of Health announced $2 billion in new funding in 2023 to address backlogs, including with diagnostics and allocation of provincial funding through the 2024 bilateral provincial agreements, additional investments are needed, according to CAR.

In 2024, for instance, CAR has asked for some of that funding to be repurposed over the next 3 years to purchase new radiology equipment and streamline the process for equipment installation. 

Recent studies have indicated that Canada has less imaging equipment per capita than similar countries, which reduces imaging access from the outset, said Kielar. Older equipment also breaks down more often, leading to longer wait times for repairs. 

Moreover, out-of-date equipment may entail longer procedure times, lead to more radiation exposure, or be less advantageous for detecting abnormalities of patient conditions.

“In Canada, we have fewer MRI and CT scanners per person than the Organization for Economic Cooperation and Development (OECD) average, and the current shortage of MRT has resulted in some scanners being underutilized,” said Christian van der Pol, MD, associate professor of radiology at McMaster University and site chief of diagnostic imaging at the Juravinski Hospital and Cancer Centre, both in Hamilton, Ontario.

He called today’s diagnostic imaging challenges the “worst that most of us have seen in our careers.” In Ontario, for instance, van der Pol and colleagues found that CT and MRI exam volumes, exams per capita, and exams per MRT increased significantly between 2000 and 2020. 

“This increase has exacerbated patient wait times,” he said. “Direct investment is desperately needed to expand the MRT pool and the number of MRI and CT scanners to increase scanning capacity and meet the needs of our growing population.”

Considering New Technology

Finally, to support the two main concerns about people and equipment, CAR has asked the federal government to promote the technological infrastructure that would support healthcare efficiency and improve access.

For instance, establishing the Health Artificial Intelligence Validation Network framework could improve the evaluation and regulation of AI as part of Health Canada’s Medical Devices Directorate regulatory process, Kielar said. As healthcare institutions continue to invest in and deploy AI systems, medical imaging will probably be affected — and require regulation.

In addition, implementing clinical decision support systems could help streamline the imaging referral process and ensure that patients receive the right test at the right time, she said.

“It can be hard for a radiologist to receive an imaging request, read a patient’s history, and know they can’t get the test done in a reasonable time. You really have empathy for the patients,” Kielar said. “It’s also hard on technologists, who are trying to get through as many patients as possible. They’d love to work more and harder and faster — but to do that, we need more people, equipment, and leadership.”

In an email statement to Medscape Medical News, Health Canada pointed to the federal, provincial, and territorial collaboration under the Working Together to Improve Health Care for Canadians plan, particularly with recent bilateral agreements focused on workforce development and technology investments.

“The federal government acknowledges that it has a key leadership role to play in supporting solutions to the challenges facing health systems across the country, including those related to Canada’s health workforce,” a Health Canada spokesperson wrote. “However, it is important to recognize that in Canada, management of the health workforce is within the jurisdiction of provinces and territories. This includes actions to recruit and retain the health workforce.” 

Kielar, Patlas, and van der Pol reported no relevant financial disclosures. 

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.