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Executive Summary - CMII 2017

In 2015, CADTH assumed the task of conducting a biennial survey of medical imaging providers in Canada, following the Canadian Institute for Health Information’s (CIHI’s) data collection until 2012. This report summarizes the results of the second iteration of the CADTH Canadian Medical Imaging Inventory.

Methods

We collected information on six modalities using a Web-based survey, supplemented with information from suppliers of diagnostic imaging equipment, data validators, report reviewers, and literature searches. The modalities were:

  • computed tomography (CT)
  • magnetic resonance imaging (MRI)
  • single-photon emission computed tomography (SPECT)
  • positron emission tomography–computed tomography (PET-CT)
  • positron emission tomography–magnetic resonance imaging (PET-MRI)
  • single-photon emission computed tomography–computed tomography (SPECT-CT).

The survey was launched on April 18, 2017, and data collection formally closed on June 9, 2017. Previous data were entered into a database with a Web interface and respondents were invited to amend the data associated with their sites — or, if there was no pre-existing entry, to complete the survey. High-level data were reviewed by pre-identified regional and provincial validators, who supplied corrections and supplementary data, which were entered into the database. Identified stakeholders and survey respondents were given the opportunity to review the report during the stakeholder feedback process.

Results

A submitted survey was received from 147 sites, and an additional 223 surveys were accessed and modified but not submitted as final. At least minimal data (modalities and unit counts) were available for a total of 505 sites. The majority of sites were publicly funded facilities. Sixty-nine per cent were urban, 29% were rural, and 2% were remote.

Computed Tomography

  • We identified a total of 561 CT units in Canada, up from 419 units in 2007. All provinces or territories had at least one unit. Ontario and Quebec had the most units, followed by British Columbia and Alberta. The three northern territories had one unit each.
  • From examination data reported by validators, we estimated that a total of 5.61 million CT examinations were performed in the most recent fiscal year in Canada, up from 3.38 million in 2007. This is equivalent to 153.0 exams per 1,000 people, up from 103.3 in 2007.
  • CT units operate for an average of 76.5 hours per week and 12.1 hours per day. Most operate on weekends. CT is used across disciplines, with approximately a quarter of the time used in the fields of oncology, followed by neurology, respiratory, and hepatobiliary.
  • When the number of CT units per population for Canada is compared with other countries that report CT units to the Organisation for Economic Co-operation and Development (OECD), Canada appears in the lower half of the reported numbers. For the number of exams per population, Canada appears around the midpoint.
  • Half the units reported on in the survey had 64 cross sectional images or slices, with about an eighth having 128 slices. Three-quarters incorporate image reconstruction techniques for dose reduction, 81% are equipped with dose management controls, and 92% record dose by exams.
  • One-third of CT units were five-years-old or less, 40% were six- to ten-years-old, and 23% were 11- to 15-years-old. None were older than 20 years.

Magnetic Resonance Imaging

  • We identified a total of 366 MRI units in Canada, up from 222 units in 2007. All provinces and one territory had at least one unit. Ontario and Quebec had the most units, followed by British Columbia and Alberta. Yukon has a single unit.
  • From examination data reported by validators , we estimated that a total of 1.86 million MRI examinations were performed in the most recent fiscal year in Canada, up from around 1 million in 2007. This is equivalent to 51.0 exams per 1,000 people, up from 31.2 in 2007.
  • MRI units operated for an average of 78.7 hours per week and 13.1 hours per day. Most also operated on weekends. MRI is used across disciplines, with approximately a quarter of the time used for musculoskeletal exams, followed by neurological, oncological and hepatobiliary exams.
  • When the number of MRI units per population for Canada is compared with other countries that report MRI units to the OECD, Canada appears in the lower half of the reported numbers. For the number of exams per population, Canada appears around the midpoint. This is consistent with the positions for 2015.
  • The majority (83%) of MRIs have field strengths of 1.5 Tesla.
  • Thirty-six per cent of MRI units were five-years-old or less, 33% were six- to ten-years-old, and 26% were aged 11- to 15-year-old. None were older than 20 years.

Positron Emission Tomography–Computed Tomography or Positron Emission Tomography

  • We identified a total of 51 PET-CT units in Canada, up from 21 units in 2007. All were PET-CT, indicating that PET had been replaced as a modality. Nine provinces had at least one unit, up from eight in 2007, with Ontario and Quebec having the most. Newfoundland and Labrador installed a unit between 2015 and 2017.
  • From examination data reported by validators, we estimated that a total of 90,530 PET-CT examinations were performed in the most recent fiscal year in Canada. Exam data for 2007 was not available.
  • PET-CT units operate for an average of 40.4 hours per week and 8.6 hours per day. PET-CT is primarily used for oncology (80%), followed by cardiac and neurological use.
  • Two-thirds of units have sixteen slices. The majority of units (90%) were equipped with dose management controls and 77% recorded patient radiation dose by exam.
  • Thirty-two per cent of PET-CT units are five-years-old or less, 53% are six- to ten-years-old, and 16% are between 11- and 15-years-old.
  • A quarter of sites had access to a cyclotron for generating radioisotopes. Two-thirds of the sites without access to a cyclotron obtained radioisotopes from commercial sources.

Positron Emission Tomography–Magnetic Resonance Imaging

  • The hybrid modality of PET-MRI is the newest specialist imaging modality. We identified three units currently operating for clinical research purposes in Ontario.
  • As the PET-MRI has yet to enter clinical use, we do not have any examination or use data.

Single-Photon Emission Computed Tomography

  • We identified a total of 330 SPECT units in Canada, down from 603 units in 2007, although this figure is approximate because Ontario reported a combined figure for SPECT and SPECT-CT. Nine provinces had at least one unit. Ontario and Quebec had the most units, followed by Alberta and British Columbia.
  • Individual data for SPECT exams were not available for all provinces, so the combined exams are reported under SPECT-CT. Exam data for 2007 was not available.
  • SPECT units operate for an average of 43.5 hours per week and nine hours per day. A minority operate on weekends. SPECT is primarily used for cardiac examinations (40%), followed by oncology and musculoskeletal exams.
  • Three-quarters of units have two detector heads, and one-quarter are dedicated cardiac units.
  • Overall, Canada has some of the oldest SPECT units. Thirteen per cent of these units are less than five-years-old, 29% are between six- and 10-years-old, 36% are 11- to 15-years-old, and 21% are more than 15-years-old.

Single-Photon Emission Computed Tomography–Computed Tomography

  • We identified a total of 261 SPECT-CT units in Canada, up from five units in 2007, although the number is approximate because Ontario reported a combined figure for SPECT and SPECT-CT. All 10 provinces had at least one unit. Ontario and Quebec had the most units, followed by British Columbia and Alberta.
  • From data reported by validators, with a small number of imputed exams, a total of 1.35 million SPECT or SPECT-CT exams were carried out in Canada.
  • SPECT-CT units operate for an average of 45.2 hours per week and nine hours per day. A minority operate on weekends. SPECT-CT is primarily used for cardiac examinations (36%), followed by oncology and musculoskeletal exams.
  • Almost all units have two detector heads. One-third have four slices, and 20% have one and 16 slices.
  • Two-thirds were equipped with dose management controls and 61% recorded patient radiation dose by exam. More than half incorporated image reconstruction techniques for dose reduction.
  • Forty per cent of SPECT-CTs are less than five-years-old, half (48%) are between six- and 10-years-old, and 12% are 11- to 15-years-old.

Picture Archiving and Communications System

  • One-third (28%) of sites had access to a local or institutional picture archiving communications system (PACS) network, 39% had access to a regional network, and one-third (33%) had access to a provincial network.
  • Almost all sites allowed access to PACS images outside the imaging department, and two-thirdsallowed access to other sites within the provincial health care system.
  • Almost all sites with CT, MRI, SPECT, PET-CT, or SPECT-CT stored and accessed images for these modalities on PACS. A minority of sites without each of these modalities could also access images. We do not have information about PET-MRI.

Limitations

  • For feasibility, this iteration of the survey was restricted to six specialist imaging modalities and does not include others that are more common and widespread (e.g., X-ray and ultrasound).
  • As we do not have a definitive list of facilities containing the equipment, and, as the survey was voluntary, we cannot ensure that all facilities or departments containing the modalities were contacted or responded.
  • A limited amount of imputation was used to carry forward data from previous years. Data for hours and types of use was available for only a limited number of sites.