Trends in public sector radiological usage in the Western Cape Province, South Africa: 2009–2019

Abstract

Background: Although global use of medical imaging has increased significantly, little is known about utilisation trends in low- and middle-income countries (LMICs).Objectives: To evaluate changes over a decade in public sector diagnostic imaging utilisation at provincial level in a middle-income country.Method: A retrospective analysis of medical imaging utilisation in the Western Cape Province of South Africa in 2009 and 2019. Use of conventional radiography, ultrasonography (US), fluoroscopy, CT, MRI, digital subtraction angiography (DSA) and whole-body digital radiography was assessed by total studies and studies/103 people, for the whole province, the rural and metropolitan areas. Mammography utilisation was calculated for every 103 females aged 40–70 years.Results: The provincial population and total imaging investigations increased by 25% and 32%, respectively, whilst studies/103 people increased by 5.5% (256 vs 270/103), with marked variation by modality. Provincial US, CT and MRI utilisation/103 people increased by 111% (20 vs 43/103), 78% (10 vs 18/103) and 32% (1.9 vs 2.5/103) respectively, whilst use of fluoroscopy (3.6 vs 3.7/103) and mammography (14.2 vs 15.9/103 women aged 40–70 years) was steady and plain radiography decreased by 20% (216 vs 196/103). For CT, mammography and fluoroscopy, percentage utilisation increases/103 people were higher in the rural than metropolitan areas.Conclusion: Population growth is the main driver of overall imaging utilisation in our setting. The relatively constant imaging workload per 1000 people, albeit with increasing ultrasound, CT and MR utilisation, and decreasing use of plain radiography, reflects improved provincial imaging infrastructure, and appropriate use of available resources.

A 6-year audit of public-sector MR utilisation in the Western Cape province of South Africa

“…5 Similarly, there are known inequities between healthcare systems (private vs public) and provinces in the same country. 7 , 19 , 21 , 32 However, to date there has been scant recognition of potential inequalities that can unwittingly exist on the same healthcare platform in a single region, province, or city. This study highlights the key role that the distribution and utilisation of sophisticated radiological equipment can play in providing equity and access to services in this setting.…”

“…This is particularly true in resource constrained environments, such as Southern Africa, where units are confined to the largest cities. 1,2,7,16,19,21 Additionally, in the US, persons who are 65 years and older undergo three times more MR investigations than their younger counterparts. 8 Equitable access to essential health services is a key consideration in the United Nations (UN) 2030 Agenda for Sustainable Development and its Sustainable Development Goals (SDGs).…”

“…6 In comparison, public sector MR utilisation in the Western Cape province (WCP) of South Africa (SA) increased by an average of 3% annually between 2009 and 2019. 7 However, MR is a capital- and labour-intensive modality and burgeoning clinical utilisation has the potential to increase healthcare costs substantially. 8 , 9 Furthermore, increasing imaging costs can accentuate existing inequalities in global access to healthcare, by widening the service gap between well- and poorly resourced environments.…”

“…5 The WCP performed 2.5 scans per 1000 people in 2019. 7 There are also marked global disparities in the annual clinical workload of MR units. In 2019 MR scanners in Turkey, UK and Canada performed an average of 5993, 8025 and 9872 studies, respectively, 5 , 20 while WCP units performed an average of 4168 scans in 2017.…”

“…This is particularly true in resource constrained environments, such as Southern Africa, where units are confined to the largest cities. 1 , 2 , 7 , 16 , 19 , 21 Additionally, in the US, persons who are 65 years and older undergo three times more MR investigations than their younger counterparts. 8 …”