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Guidelines focus of MRI review

Running existing machines longer, buying new ones among options

Friday, May 16, 2003
By Dan Arsenault / Health Reporter
The Halifax Herald Limited

The province is reviewing MRI waiting lists and will even consider buying more machines.

The review, which could take up to a year, will also look at taking some people off the lists, says Abram Almeda, executive director of acute and tertiary care with the Health Department.

"One wants to put guidelines, based on best practices, in place so that when people do get sent, they're being sent for the right (test)," he said, noting that CAT scans can be equally useful in some cases.

The radiologists in charge of the MRIs now assess patients' needs and do all scheduling based on experience and the severity of the case, Mr. Almeda said.

"There are no guidelines in this province for that (procedure), but there will be," he said.

There is some relief in sight for patients, who now wait as long as 10 months for the test.

An MRI will start operating in September in Sydney, bringing to four the number of machines in Nova Scotia's public health-care system.

The other three machines are in Halifax - one at the IWK Health Centre and two older units at the Queen Elizabeth II Health Sciences Centre.

A privately owned machine is available to people willing and able to pay more than $700 at Canadian Diagnostic Centres in Halifax.

Despite the backlog, Nova Scotians who desperately require an MRI get one, Mr. Almeda stressed.

"Anybody that really needs an MRI in this province in an emergency, they get it," he said. "True emergencies are done within a 24-hour period."

Magnetic resonance imagers use strong magnets that alter the magnetic field in body tissues, with normal and abnormal tissues responding differently.

They are used to diagnose conditions ranging from multiple sclerosis, tumours and brain and spine infections to torn ligaments and back problems.

Mr. Almeda said the longest waits are for the least urgent cases, such as chronic back problems.

Mr. Almeda said other options for cutting waiting times include extending the operating hours of MRIs or buying more machines.

"Our task is to bring in the appropriate clinical experts in the field and have a serious discussion about what we really need for MRI equipment in this province and how we use it," he said, mentioning $45 million in federal funds recently given to Nova Scotia to buy medical equipment in the next three years.

If the best bet is to run the existing MRIs longer, the federal funds for buying new equipment won't be available, Mr. Almeda said.

"We'd have to find the funding from a different bucket of dollars," he said.

Guidelines are definitely needed, said NDP health critic Maureen MacDonald.

"We need a very good plan to maximize use of the MRIs so that they're not sitting idle while people languish on waiting lists."

The IWK's machine runs weekdays from 9 a.m. to 4 p.m., but two of those days are set aside for testing adults to reduce overflow from other centres. Waiting times for children don't exceed six weeks.

The MRI at the QEII's Infirmary site runs seven days a week, from 8 a.m. to 8 p.m. The Victoria General's MRI operates weekdays from 8 a.m. to 10 p.m., but staff devote one night a week for groups not covered by provincial health insurance, such as workers' compensation claimants and RCMP officers.

Mr. Almeda said longer hours of operation seem to make sense.

"It's certainly an honest thing to do - there's no reason why you couldn't take this equipment and use it for longer hours," he said.

But it's hard to find staff to run the machines, said Dr. Matthias Schmidt, the IWK's interim chief radiologist.

"MRI units are proliferating throughout Canada and the world," Dr. Schmidt said. "MRI technologists are in short supply."

Training is also a problem. With an Edmonton program coming to an end, Canada will have just two training facilities - in Toronto and Winnipeg.

And starting wages for MRI technologists in Nova Scotia are about $6 less per hour than in Ontario, Alberta and British Columbia.

An expected addition of 20 MRIs in Ontario should place that province ahead of the rest of the country, but Mr. Almeda believes Nova Scotia will be able to keep up with the other provinces once Sydney's MRI is running.

"We're certainly going to be as well off on a ratio basis - machines to population - as any jurisdiction in Canada," he said.

Dr. Bob Miller, president of the Nova Scotia Medical Society and a radiologist, said waiting lists will drop "substantially" when Cape Bretoners no longer need to travel to Halifax for MRIs.

Dr. Miller said that as well as freeing up units on the mainland, the new machine will mean more island residents get MRIs, since some are reluctant to make the five-hour trip to Halifax.

And Cape Breton surgeons will request MRIs that they would have put off previously to avoid a long wait before surgery.

Nova Scotia doesn't have the longest MRI waiting times in Canada - those in Newfoundland are 16 months, says a study by the Canadian Association of Radiologists.

The shortest waiting lists are in New Brunswick, rarely approaching eight months.

Copyright © 2003, The Halifax Herald Limited