Canada still lags globally on DI: study

VANCOUVER – Medical imaging technologies such as MRIs, CT scanners and even older technologies such as ultrasound machines are vital tools for medical decision-making and treatment.

Unfortunately, say Nadeem Esmail (pictured left) and Mackenzie Moir (pictured right) of the Fraser Institute in a new report, Canada tends to have fewer and older advanced medical technologies than other developed countries with universal health care, which has consequences for not only waiting lists but ultimately patient care and well-being.

Internationally when compared with other developed countries that also have universal health care, Canada ranks remarkably poorly when it comes to access to medical technologies.

In the latest international comparison, out of 31 universal health-care countries for whom data was available, Canada ranked 27th for MRI machines per population, and 28th for CT scanners per population. Canada also ranked 22nd of 28 countries for whom data was available in PET scanners per population.

Nadeem Esmail is director, health policy at the Fraser Institute, while Mackenzie Moir is senior policy analyst. Their new report is titled, “Canada’s healthcare system features old and outdated medical equipment.”

Perhaps unsurprisingly, Canadians also wait a remarkably long time for the medically necessary scans these machines provide. In 2025, the median wait time for a CT scan in Canada was 8.8 weeks, while Canadians experienced a median delay of 18.1 weeks for MRI scans.

Both wait times have grown considerably over the last two decades. Back in 2005, the median Canadian wait for a CT scan was 5.5 weeks, and for MRI scans was 12.3 weeks.

The age of these medical technologies also matters. Relative to their newer counterparts, older medical technologies are generally less reliable and need more maintenance; may provide a lower quality or less precise output; and may be less safe for patients and operators (for example, newer machines may reduce radiation exposure while simultaneously maintaining or improving image quality).

Newer, more sophisticated medical technologies also allow for shorter examination times and may provide diagnostic imaging capabilities for conditions or parts of the body that could not previously be scanned, or be more adaptable to advances like integration of artificial intelligence.

Both the Canadian Association of Radiologists and the European Coordination Committee of the Radiological, Electromedical, and Health IT Industry provide guidelines for the life expectancies for medical technology which can be used to assess the Canadian inventory. By either standard, too many of Canada’s already too few machines are in dire need of replacement.

According to the European “Golden Rules,” healthcare systems should strive to have 60 percent of their equipment under 6 years old, no more than 30 percent of their equipment 6 to 10 years old, and should have no more than 10 percent of their equipment older than 10 years.

The Canadian Association of Radiologists similarly recommends a life-expectancy of 10 years for machines used at medium volumes (with a lower 8 years for machines being used at high volumes).

In Canada in 2022/23, the latest data available, more than one-third of MRI and CT scanners were older than 10 years, which is more than three times the suggested rate by the European guidelines.

By the Canadian rules, more than one-in-three CT or MRI scanners in Canada was due for replacement. Almost three-quarters of Canada’s ageing SPECT units (which can provide insight on organ function) and almost half of their replacement SPECT-CT units were also past the 10-year-old mark.

Even our newest medical imaging technologies don’t come close to the European recommendation of having 60 percent of an inventory be under 6 years old (with only our PET-CT inventory at 51.5 percent coming close).

Just as troubling is the age of the oldest machines in Canada. The Canadian Association of Radiologists guidelines note machines over 15 years old are beyond their maximum life expectancy and clinical relevance. Yet nearly 8 percent of Canada’s CT scanners, almost 14 percent of Canada’s MRI machines, more than half of Canada’s SPECT units, and 14 percent of Canada’s SPECT-CT units were past their 15th birthday in 2022-23.

This failure in terms of both the absolute number of medical imaging technologies as well as their age is happening alongside some of the highest health spending in the developed world when compared with other universal healthcare countries. The lack of new and advanced medical technologies is not the result of a lack of spending on health care.

An examination of the diagnostic imaging technologies used in Canada’s health care system reveals yet another failure of the Canadian model.

Diagnostic technologies are not only relatively few in number in Canada when compared with the availability of technology in other universal healthcare countries, but the few technologies Canadians have access to are too often old, outdated and potentially no longer clinically acceptable. Canadians deserve much better for the world-class bill we pay.