3.4. Medical technologies: CT scanners and MRI units
New medical technologies are improving
diagnosis and treatment, but they are also increasing health spending. This section
presents data on the availability and use of two diagnostic technologies: computed
tomography (CT) scanners and magnetic resonance imaging (MRI) units. CT scanners and
MRI units help physicians diagnose a range of conditions by producing images of internal
organs and structures of the body. Unlike conventional radiography and CT scanning, MRI
exams do not expose patients to ionising radiation.
The availability of CT scanners and
MRI units has increased rapidly in most European countries over the past two decades. For
example, in the Netherlands, the number of MRI units per capita was multiplied by ten
between 1990 and 2010, while the number of CT scanners nearly doubled. Similarly, in
Italy, the number of MRI scanners per capita was increased by nearly six times
between 1997 and 2010, and the number of CT scanners more than doubled.
In 2010, Greece, Italy and Cyprus had
the highest number of MRI and CT scanners per capita among EU member states. Iceland and
Switzerland also had significantly more MRI and CT scanners than the EU average (Figure 3.4.1
and Figure 3.4.2). The numbers of MRI units and CT scanners per
population were the lowest in Hungary and Romania.
There is no general guideline or
benchmark regarding the ideal number of CT scanners or MRI units per population. However,
if there are too few units, this may lead to access problems in terms of geographic
proximity or waiting times. If there are too many, this may result in an overuse of these
costly diagnostic procedures, with little if any benefits for patients.
Data on the use of these diagnostic
scanners are available only for a smaller group of countries. Based on this more limited
country coverage, the number of CT and MRI exams per capita is the highest in Greece,
consistent with the fact that Greece also has the highest number of these two types of
scanners. The number of MRI exams per capita is also above average in Germany and
Luxembourg, as well as in Iceland and Turkey. It is the lowest in Ireland and Slovenia,
although in these two countries only CT exams and MRI exams carried out in hospitals are
reported, resulting in an underestimation.
In Greece, most CT and MRI scanners
are installed in privately-owned diagnostic centres and only a minority are found in
public hospitals. While there are no guidelines regarding the use of CT and MRI scanners
in Greece (Paris et al., 2010), since late 2010, a
ministerial decree has established certain criteria concerning the purchase of imaging
equipment in the private sector (Official Gazette,
No. 1918/10, December 2010). One of the main criteria is based on a minimum threshold of
population density (30 000 population for CT scanners and 40 000 for MRIs). These
regulations do not apply to the public sector.
Clinical guidelines have been
developed in some European countries to promote a more rational use of such diagnostic
technologies (OECD, 2010b). In the United Kingdom, since the creation of the Diagnostic
Advisory Committee by the National Institute for Health and Clinical Excellence (NICE), a
number of guidelines have been issued on the appropriate use of MRI and CT exams for
different purposes (NICE, 2012).
Definition and comparability
For MRI units and CT scanners, the
numbers of equipment per million population are reported. MRI exams and CT exams
relate to the number of exams per 1 000 population. In most countries, the data cover
equipment installed both in hospitals and the ambulatory sector.
However, there is only partial
coverage for some countries. MRI units and CT scanners outside hospitals are not
included in some countries (Belgium, Germany and Spain, as well as Switzerland for MRI
units). For the United Kingdom, the data only include scanners in the public sector.
MRI and CT exams outside hospitals are not included in certain countries (Austria,
Ireland, Slovenia, Spain and the United Kingdom). Furthermore, MRI and CT exams for
Ireland only cover public hospitals. The Netherlands only report data on