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Research Article

Comparison of Advanced Imaging Resources, Radiology Workforce, and Payment Methodologies between the United States and Canada

H.A. Valand, S. Chu, R. Bhala, R. Foley, J.A. Hirsch and R.K. Tu
American Journal of Neuroradiology October 2018, 39 (10) 1785-1790; DOI: https://doi.org/10.3174/ajnr.A5755
H.A. Valand
aFrom the American University of Integrative Sciences (H.A.V.), Brampton, Ontario, Canada
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S. Chu
bVancouver Coastal Health Authority (S.C.), Washington State Radiological Society, Vancouver, British Columbia, Canada
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R. Bhala
cAmerican Society of Neuroradiology (R.B.), Oak Brook, Illinois
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R. Foley
dOntario Association of Radiologists (R.F.), Oakville, Ontario, Canada
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J.A. Hirsch
eMassachusetts General Hospital (J.A.H.), Harvard Medical School, Boston, Massachusetts
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R.K. Tu
fProgressive Radiology (R.K.T.), George Washington University, United Medical Center, Falls Church, Virginia.
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Article Figures & Data

Tables

    • View popup
    Table 1:

    Comparing vital and economic statistics of Canada versus US in 2015a

    CanadaUS
    Population3035.8 million320.9 million
    Uninsured (% of total population)56~0%b10%
    Average life expectancy (yr)2682.178.7
    Per capita health care spending25,27$4734$9994
    Total health care25,27$170 billion$3.2 trillion
    GDP25,57$1.6 trillion$18.1 trillion
    Total health care spending (% of GDP)25,5711.417.7
    • Note:—GDP indicates gross domestic product.

    • ↵a Currency is in US dollars.

    • ↵b According to the Wellesley Institute report, approximately 200,000–500,000 uninsured individuals reside in Canada. They include students, workers from overseas, undocumented refugees, and newly landed immigrants.58

    • View popup
    Table 2:

    Examples of differing procedure codes and professional reimbursement for an unenhanced CT of the head in the 10 provinces of Canada12–18,59–61

    ProvinceFee CodeProfessional Fee (CaD$)
    British Columbia0869044.88
    Albertaa
    Saskatchewanb
    Manitoba711349.15
    OntarioX40043.25
    Quebec0825933.40
    New Brunswick316667.00
    Nova Scotia110542.33
    Prince Edward Island892583.16
    Newfoundland and Labrador7380055.53
    • ↵a Benefits for noninvasive diagnostic procedures performed in hospitals and urgent care clinics are payable through hospitals or health authorities.12

    • ↵b Not listed in the Payment Schedule for Insured Services Provided by a Physician, October 1, 2017, published by the Government of Saskatchewan.

    • View popup
    Table 3:

    Comparison of CT scanner use in Canada versus US (2016)62

    ScansCanadaUS
    Total CT use (hospital + ambulatory + other)
        Total No. (MM)5.6882
        Per 1000 people156.6253.8
        Per scanner10,561.96062.8
    CT use
        CT in hospital setting
            Total No. (MM)5.6165.7
            Per 1000 people154.4203.3
            Per scanner8973.8a7373.7
        CT in ambulatory care setting
            Total No.79,26116.3 MM
            Per 1000 people2.250.4
            Per scanner2735.3a3532
    • Note:—MM indicates million.

    • ↵a Data were obtained in 2012. Remainder are from 2015.

    • View popup
    Table 4:

    Comparison of MRI scanner use in Canada versus US (2016)62

    ScansCanadaUS
    Total MRI use (hospital + ambulatory + other)
        Total No. (MM)2.0339
        Per 1000 people55.9120.7
        Per scanner5946.93287
    MRI use
        MRI in hospital setting
            Total No. (MM)1.816.5
            Per 1000 people49.451.1
            Per scanner6485.6a3064.1
        MRI in ambulatory care setting
            Total No.234,30822.5 MM
            Per 1000 people6.569.6
            Per scanner3170.9a3471.2
    • ↵a Data were obtained in 2012. Remainder are from 2015.

    • View popup
    Table 5:

    Neuro CT procedures in 2016 in the US63

    CT Procedure CategoriesTotal CT Procedure (MM)% of All CT Procedures% of CT Sites Performing
    Spine6.48%87%
    Brain15.319%94%
    Head and neck7.29%90%
    Total neuro CT procedure28.936%
    Total CT procedures82100%
    • Note:—Neuro indicates neurologic; MM, million.

    • View popup
    Table 6:

    All versus neuro CT and MR scans/1000 people

    Scans/1000 PeopleNeuro CTAll CTNeuro MRIAll MRI
    Canada31a156.614.2c55.9
    US96.4b253.865.2d120.7
    • Note:—Neuro indicates neurologic.

    • ↵a According to the Canadian Agency for Drugs and Technologies in Health, total neurologic CT examinations were 19.8% of all CT examinations in 2017.

    • ↵b Based on the Medical Information Division benchmark report, total neurologic (spine, brain, and head and neck) CT examinations were 36% of all CT examinations in 2016.

    • ↵c According to the Canadian Agency for Drugs and Technologies in Health, total neurologic MRI examinations were 25.4% of all MR imaging examinations in 2017.

    • ↵d Based on the Medical Information Division benchmark report, total neurologic (spine, brain, and head and neck) CT examinations were 54% of all MR imaging examinations in 2016.

    • View popup
    Table 7:

    Neuro MRI procedures in 2016 in the US64

    MRI Procedure CategoriesTotal MRI Procedures (MM)% of All MRI Procedures% of MRI Sites Performing
    Spine9.524%99%
    Brain (nonvascular)8.822%97%
    Head and neck3.08%84%
    Total neuro MRI procedure21.354%
    Total MRI procedures39100%
    • Note:—MM indicates million.

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American Journal of Neuroradiology: 39 (10)
American Journal of Neuroradiology
Vol. 39, Issue 10
1 Oct 2018
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H.A. Valand, S. Chu, R. Bhala, R. Foley, J.A. Hirsch, R.K. Tu
Comparison of Advanced Imaging Resources, Radiology Workforce, and Payment Methodologies between the United States and Canada
American Journal of Neuroradiology Oct 2018, 39 (10) 1785-1790; DOI: 10.3174/ajnr.A5755

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Comparison of Advanced Imaging Resources, Radiology Workforce, and Payment Methodologies between the United States and Canada
H.A. Valand, S. Chu, R. Bhala, R. Foley, J.A. Hirsch, R.K. Tu
American Journal of Neuroradiology Oct 2018, 39 (10) 1785-1790; DOI: 10.3174/ajnr.A5755
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