"A grave shortage of MRIs is putting the life of patients at risk."
This apocryphal statement has been repeated so often in recent years that it has become a truism. Governments have made emergency allocations for MRI purchases. Others have turned to private enterprise, saying it is the only way to ensure access to the diagnostic service. Meanwhile, patients fret that interminable waiting lists will deny them access to the life-saving tests.
But a new report suggests that, while use of magnetic resonance imaging machines is soaring, and there is probably a real shortage, the figures to determine the true extent of waits are not available. It's not even possible to know whether the equipment is being used appropriately and to make sound decisions about resource allocation.
"Very significant gaps in information need to be addressed before waiting lists for MRIs can be managed and patient outcomes optimized," said Andreas Laupacis, president and chief executive of the Toronto-based Institute for Clinical Evaluative Sciences and senior author of a new study.
As a practising physician, he said he has a "gut feeling" the shortages are real but, as a researcher, he found the information is simply not there.
He said that until recently, diagnostic testing wasn't "on the radar screen," so little attention was paid to data collection.
To correct the problem, Dr. Laupacis and his colleagues recommend that a new body be created to monitor MRI use and to collect data that would make rational decision-making possible. He said such a body should be modeled along the lines of the Cardiac Care Network, which has used data collection and analysis to clear up waiting lists and to improve patient outcomes.
"This is great technology and we need to ensure that it is available to patients who will benefit most."
The report, based on Ontario Health Insurance Plan data, reveals that 145,810 MRIs were done on outpatients in the province in 2001, up from 25,406 in 1992 -- a fivefold increase.
During that same period, testing costs soared to $23.6-million from $2.8-million. More was spent on inpatient MRIs, but the report noted that there is not even basic information available on how many scans were performed.
The ICES report estimates that the mean wait time for a MRI in 2001 was seven weeks, but cautions this number is based on estimates from clinic managers, because basic figures are unavailable.
In fact, the researchers listed a litany of inadequacies in the information the government collects about MRIs, including:
An inability to determine when a test was ordered, making it impossible to calculate wait times;
No information about symptoms that led to the test;
No information about test results;
An inability to identify patients who would have benefited from a MRI but did not receive a scan.
MRI is a technique that produces high-quality images of the inside of the body. It has been used primarily for scans of the head and spine, but in recent years, as the technology improved, the variety of uses has grown.
There are 44 MRI scanners in operation in Ontario and probably as many again in the rest of Canada.