Canada does not have an imaging demand problem. It has a capacity problem, a workforce problem, a capital allocation problem, and a governance problem spread across thirteen provincial and territorial markets that each operate as if the others do not exist.

Demand is rising. Equipment density is low. Wait times are longer than they were before the pandemic. The workforce is insufficient. And the political debate about what to do is, depending on the province, somewhere between cautious and actively counterproductive.

This is the state of Canadian diagnostic imaging in 2026, and it is worth understanding clearly, because the system’s contradictions have sharpened to a point where muddling through is becoming increasingly untenable.

A Market That Is Not Really One Market

The first thing to understand is that there is no single Canadian imaging market. There are thirteen of them, loosely constrained by the Canada Health Act and radically differentiated by provincial politics, fee schedules, licensing regimes, facility rules, capital budgets, and tolerance for private delivery.

The federal government sets the framework for what counts as medically necessary and insured. The provinces determine everything that actually matters operationally.

The core of the system is publicly funded and hospital-anchored. Hospital radiology departments perform acute, inpatient, emergency, interventional, complex oncology, trauma, stroke, and tertiary imaging. Private and community outpatient clinics handle large volumes of ultrasound, x-ray, mammography, and bone mineral density scanning, and in some provinces, MRI and CT as well.

The public/private divide does not map neatly onto funded/unfunded. A privately owned clinic may deliver entirely publicly funded exams under provincial contract. Another may bill patients, employers, or insurers for services purchased outside the provincial plan.

Provincial variation is substantive. Quebec has a more visible private MRI ecosystem. British Columbia has private MRI capacity but a history of legal conflict over extra billing. Ontario has deliberately expanded community surgical and diagnostic centres. Alberta was moving, as of late 2025, toward permitting private purchase of diagnostic screening including MRI, CT, and blood work — legislation that attracted immediate criticism framing it as the creation of a two-tier imaging industry [1]. Saskatchewan has used private MRI policy mechanisms. The maritime provinces and territories operate at smaller scales and frequently rely on mobile or contracted solutions rather than full clinic networks.

Health Canada’s ongoing Canada Health Act reporting matters here because it functions as a ceiling on how far provinces can go: patient charges for insured services at private clinics can trigger mandatory federal financial deductions [2]. The tension between provincial experimentation and federal compliance obligations is not resolved and is unlikely to be resolved in the next decade.

Why Demand Will Not Stop Growing

The demand trajectory is not complicated. Canada had approximately 41.5 million people on January 1, 2026, with Statistics Canada projecting a medium-growth scenario reaching 57.4 million by 2075 [3]. Even if immigration moderates significantly from recent peaks, the absolute population base is materially larger than it was five years ago, and the health system has not built proportional imaging capacity.

Aging is the more important structural driver. Statistics Canada reported approximately 8.1 million Canadians aged 65 or older as of July 1, 2025 — about 18.9% of the population in 2023, with projections of 21.4% to 23.4% of the population reaching senior status by 2030 [3].

Older patients generate disproportionately more imaging. They have more cancer, cardiovascular disease, falls, fractures, degenerative spine and joint disease, renal disease, pulmonary disease, abdominal pathology, vascular disease, and cognitive decline. Imaging is also increasingly deployed not just for initial diagnosis but for staging, treatment planning, response assessment, procedural guidance, and longitudinal surveillance.

Demand grows faster than population alone because each patient generates more imaging encounters over a longer clinical course.

Cancer is a major volume driver. The Canadian Cancer Society estimated approximately 254,800 new cancer cases and 87,400 cancer deaths in Canada in 2025 [4]. Oncology produces high-frequency demand across CT, MRI, PET/CT, ultrasound, biopsy, and interventional radiology, much of it recurring. A patient in active treatment may require imaging every few months for years.

Emergency medicine has become structurally dependent on imaging in a way that would have seemed extraordinary two decades ago. CT is now embedded in emergency pathways for trauma, stroke, pulmonary embolism, acute abdomen, renal colic, sepsis source identification, and cancer complications. MRI is increasingly required in spine, neurological, musculoskeletal, pediatric, and oncology presentations. Ultrasound remains first-line in abdominal, pelvic, obstetrical, vascular, soft-tissue, and procedural contexts.

Imaging is now the gateway through which many downstream clinical decisions pass. When imaging bottlenecks, the system downstream backs up with it.

The Equipment Problem

Canada is materially under-equipped relative to international peers, and the situation has not meaningfully improved in a decade.

OECD’s Health at a Glance 2025 country profile for Canada reports 26 CT scanners, MRI units, and PET scanners per million population, against an OECD average of 51 [5]. Canada is not close to the average.

The Canadian Medical Imaging Inventory maintained by CDA-AMC shows Canada had an average of 10.8 MRI units per million people, placing it in the bottom quartile of OECD countries for MRI units per capita and in the bottom half for publicly funded MRI exams per 1,000 population [6]. In fiscal 2022–2023, 2,214,157 publicly funded MRI exams were performed in Canada — 55.6 per 1,000 people, up 4.3% from 2019–2020 [6].

For CT and MRI specifically, Deloitte and the Canadian Association of Radiologists reported that Canada maintained approximately 10.8 MRI units and 14.0 CT units per million residents as of 2023, compared to 9.5 and 15.0 respectively in 2015 [7]. MRI density has risen modestly over nearly a decade. CT density has actually declined slightly relative to population. Meanwhile, the complexity and volume of imaging per capita have risen substantially.

Equipment age compounds the density problem. CDA-AMC reported that as of 2019–2020, 10.7% of MRI units and 5.5% of CT units were older than 15 years, with SPECT reaching 36.7% [6]. The CAR’s 2026 policy statement uses a stricter benchmark — 10 years, reflecting international standards for safety and reliability — and the figures at that threshold are considerably more alarming: 37% of MRI machines and 33% of CT scanners in Canada exceed it [10].

The two datasets use different cutoffs and different base years, but they point in the same direction. Aging equipment means more downtime, more limitations on advanced protocols, less energy efficiency, greater service costs, and reduced throughput. A province can have an apparently adequate scanner count on paper and still have a functional capacity problem if a material fraction of those scanners are unreliable or protocol-limited.

A scanner, in any case, is not a completed examination. Equipment is one input among many. Technologists, operating hours, patient prep, booking infrastructure, contrast availability, IT uptime, infection-control workflows, radiologist availability, reporting infrastructure, and quality assurance all determine whether a machine generates useful output.

Canada has regularly failed to staff and operate its equipment fully, which means the effective capacity deficit is larger than the raw hardware count suggests.

Wait Times: The Visible Consequence

CIHI’s 2025 wait-time release confirmed that diagnostic imaging waits remain materially longer than pre-pandemic levels, with median MRI waits up 15 days and CT waits up 3 days compared to 2019 [8]. Framing this as a post-pandemic lag is misleading: waits were already poor in 2019.

Fraser Institute’s 2025 survey estimated diagnostic technology waits of 8.8 weeks for CT, 18.1 weeks for MRI, and 5.4 weeks for ultrasound after specialist referral [9]. The Fraser methodology differs from CIHI’s administrative data and should be read as physician-survey evidence rather than precise administrative measurement, but it is consistent in direction with every other data source.

The Canadian Association of Radiologists stated in its 2026 policy position that Canada ranks 27th of 31 universal health systems for MRI units and 28th for CT [10].

Provincial-level data shows wide variation. Saskatchewan’s public wait-time reporting for Q3 of the 2025–2026 fiscal year showed a 90th percentile wait of 198 days for MRI and 75 days for CT in October through December 2025 [11]. Those are not statistical outliers being averaged away by better-performing provinces.

British Columbia showed impressive throughput growth — more than 322,000 MRI exams in 2023–2024, an 83% increase from 2016–2017, with per capita MRI exams rising from 36.1 to 58.3 per 1,000 population [12] — and yet wait-list pressure persists because demand has risen alongside supply.

The policy framing around wait times has become more economically explicit. Deloitte Canada’s 2025 report on delayed diagnostics cited a 2025 Nanos survey finding that 11.4% of diagnostic imaging patients had to stop working while awaiting a scan [17]. CAMRT’s MRT Workforce Crisis report estimated that 14% of CT patients and 18% of MRI patients needed to quit work while waiting, with approximately 2 million Canadians having to step away from employment during an imaging wait [14].

These figures come from advocacy-adjacent sources and should be used carefully, but they reflect a shift in how the wait-time problem is being publicly argued: no longer just a clinical and equity failure, but a direct economic productivity loss.

The Workforce Constraint Is the Real Ceiling

The largest practical constraint on Canadian imaging capacity is not scanners. It is people. Radiologists, medical radiation technologists, MRI and CT technologists, sonographers, nuclear medicine technologists, interventional radiology nurses, PACS analysts, and booking staff all determine whether a scanner operates and generates interpretable output.

CAMRT’s MRT Workforce Crisis report links delayed imaging to delayed diagnosis, worsened clinical presentations, later-stage cancer discovery, anxiety, occupational disruption, and caregiver burden [14]. CAR’s 2026 pre-budget submission argued that Canada needs more technologists, radiologists, and sonographers and called for $2 billion over three years for radiology equipment, streamlined installation, and workforce investment [15].

The radiologist labour market has its own structure. Subspecialty depth is concentrated in academic centres and larger urban groups. Community and rural coverage remains difficult. Teleradiology has partially solved the geography problem but has not expanded total labour supply.

Demand for after-hours coverage, emergency CT, complex oncology MRI, breast imaging, interventional radiology, and subspecialty interpretation continues rising. Radiologist productivity has increased with PACS, voice recognition, and cross-sectional volume, but complexity, case mix intensity, and interruption load have also increased. Burnout risk is real.

Sonographer and technologist shortages are, if anything, more acute than the radiologist shortage in certain contexts. Training pipelines are limited and slow. International credential recognition pathways exist but remain cumbersome. Retention is as much a problem as recruitment.

Any provincial plan to expand imaging capacity by purchasing new equipment without simultaneously solving workforce pipeline is a plan that will produce stranded assets.

What the Hospital System Can and Cannot Do

Hospitals remain the strategic core of Canadian imaging. They control high-acuity imaging, subspecialty interpretation, interventional radiology, complex MRI, inpatient imaging, emergency CT, stroke pathways, cancer centre integration, academic training, and multidisciplinary care.

That will not change.

What will change is the proportion of total imaging that passes through hospitals.

The hospital model has structural weaknesses. Capital and operating decisions are routinely separated: a hospital may receive approval for a scanner without adequate staffing or operating hours. Budget envelopes create disincentives for extended evening and weekend operations. Referral growth is difficult to control because imaging functions as a workaround for limited access elsewhere in the system — primary care scarcity, specialist wait times, emergency crowding, and defensive medicine all generate incremental imaging demand that hospitals absorb without corresponding resource expansion.

Hospital imaging procurement is also slow. MRI installation can require major construction, shielding, electrical upgrades, HVAC work, and lengthy procurement and project management cycles. PET/CT expansion is constrained by tracer supply, cyclotron geography, nuclear medicine workforce, and funding decisions.

The result is that when demand rises faster than hospitals can respond — which has been the case continuously for years — the wait list grows.

Private and Community Delivery: The Political Tightrope

Private outpatient imaging is already substantial in x-ray, ultrasound, mammography, and BMD. In advanced imaging, it is more politically sensitive but increasingly relevant.

CDA-AMC identified 56 privately owned MRI and/or CT facilities in Canada in the 2020–2021 fiscal years. Quebec had at least 31, all offering MRI, with 12 providing CT. British Columbia had at least 15, with 14 offering MRI and 4 providing CT [6].

Private outpatient clinics can operate with more scheduling flexibility, extend hours more readily, concentrate on planned outpatient work, and attract capital more quickly than public hospital procurement. They support employer-funded, insurer-funded, medico-legal, occupational health, and patient-pay markets. They are generally better suited for high-throughput MSK MRI, spine MRI, neuro MRI, ultrasound, image-guided procedures, screening-adjacent services, and rapid-access pathways.

Their limitations are equally concrete. Private clinics draw technologists, sonographers, radiologists, and nurses from the same scarce labour pool as the public system. If private facilities pull staff from hospitals without growing total workforce supply, they reduce public-system capacity rather than adding net capacity. Private-pay MRI and CT for services that are otherwise insured and medically necessary can trigger Canada Health Act scrutiny [2]. Private facilities tend to avoid contrast complexity, sedation requirements, emergency add-ons, inpatients, unstable patients, and complex protocols — meaning they serve a selected portion of the total imaging need, not its hardest cases.

Ontario’s community surgical and diagnostic centre expansion is the most clearly articulated model currently operating at scale. In June 2025 the Ontario government announced a $155 million two-year investment to add 57 new community surgical and diagnostic centres licensed for MRI, CT, and GI endoscopy, and reported that it had already funded up to 65,568 MRI and 31,220 CT operating hours in existing centres over the prior year [13]. The model is publicly funded, privately delivered, and explicitly framed as a mechanism for reducing wait times by offloading routine outpatient work from hospitals.

Alberta’s proposed private-purchase diagnostic framework is politically more contested. As of October 2025, planned legislation would allow private purchase of diagnostic screening and testing outside the provincial plan — MRI, CT, and blood work — alongside existing publicly funded streams [1]. Critics characterize this as enabling a for-profit model that could divert public resources and clinician time.

The legal and political durability of that framework will determine whether it represents a lasting structural shift or a contested interim position.

AI and Software: Useful, Not Transformative Yet

Artificial intelligence will be one of the defining themes of Canadian radiology over the next decade. It will not solve the capacity crisis on its own.

The most commercially useful AI applications in the near term are operational and triage-focused rather than diagnostically autonomous: worklist prioritization for intracranial hemorrhage, pulmonary embolism, stroke, pneumothorax, and critical results; mammography decision support; lung nodule detection; fracture identification; bone age assessment; prostate MRI assistance; report structuring; protocoling support; and dose optimization.

These tools reduce misses, triage urgent cases, standardize measurements, and pre-populate reports. They do not replace radiologists. They are most valuable when they save measurable time or reliably improve turnaround.

Adoption barriers are real. Canadian institutions require evidence that an algorithm performs in their specific patient population, scanner mix, protocol environment, and workflow. Radiologists remain legally responsible for final interpretation, which creates liability ambiguity around AI-assisted reads. Tools that do not integrate with existing PACS, RIS, worklist, and reporting systems are operationally useless regardless of algorithm quality.

The software market is consolidating. GE HealthCare’s November 2025 announcement of a $2.3 billion acquisition of Montreal-based Intelerad — which was projected to generate approximately $270 million in revenue in its first full year post-acquisition — signals that outpatient enterprise imaging, cloud-based workflow, and SaaS capabilities are now viewed as strategically important by major vendors [16].

For Canadian radiology groups and health systems, PACS architecture, cloud migration, AI integration, cybersecurity posture, and workflow scalability are no longer back-office decisions. They determine operational performance, acquisition value, and ability to participate in distributed reading networks.

Where This Goes

The next decade will not resolve the Canadian imaging gap. It will reshape how the gap is managed.

Hospital imaging will become more specialized. Routine outpatient MRI, CT, ultrasound, and procedural work will shift increasingly toward community settings where provincial policy permits. Hospitals will use this offload to maintain capacity for acute, complex, and tertiary work rather than to reduce overall throughput. AI triage, distributed worklists, centralized booking, appropriateness scoring, and protocol standardization will become standard operational infrastructure rather than optional enhancements.

Private and community delivery will grow, unevenly. Ontario, Quebec, Alberta, British Columbia, and Saskatchewan will remain the markets where the structural questions are being actively contested. Smaller provinces will continue relying on contracted, mobile, and teleradiology solutions. The defining question in each market is whether new private or community capacity adds net workforce and capital or simply reallocates scarce people away from hospitals.

Teleradiology will become normalized infrastructure. The distinction between local and remote radiology will blur as groups use distributed reading pools, subspecialty routing, after-hours coverage, and cloud worklists. Provincial licensing and credentialing remain barriers, but workforce scarcity is a more powerful force. Groups with cross-provincial credentialing, strong quality systems, and subspecialty depth will have structural advantages.

Equipment replacement will become urgent. Aging SPECT, MRI, and CT fleets will require capital. Vendors will increasingly sell managed-service, software, and lifecycle solutions alongside hardware. Cybersecurity and data governance will emerge as board-level risks as radiology systems become more digital, more connected, and more exposed.

The core tension — between a publicly funded system with insufficient capacity and a private delivery layer that can add throughput but introduces equity and legal risk — will not be politically resolved in the next decade. It will be managed province by province, awkwardly, with outcomes that reflect political temperature as much as clinical need.

The patients waiting 198 days for MRI in Saskatchewan in late 2025 [11] are the visible measure of how far the management of that tension has failed so far.

References

[1] Global News. “Alberta plans legislation allowing private purchase of MRI, CT, and diagnostic testing.” October 2025.

[2] Health Canada. Canada Health Act Annual Report 2024–2025. Private clinic charges and mandatory federal deductions.

[3] Statistics Canada. Population Projections for Canada, 2026. Senior population estimates: 2023 and July 1, 2025.

[4] Canadian Cancer Society. Canadian Cancer Statistics, 2025. Projected 254,800 new cases and 87,400 deaths.

[5] OECD. Health at a Glance 2025: Canada Country Profile. Diagnostic imaging units per million population; OECD average comparisons.

[6] Canada’s Drug and Health Technology Agency (CDA-AMC). Canadian Medical Imaging Inventory. MRI units per capita; publicly funded exam volumes, fiscal 2022–2023; equipment age analysis, 2019–2020; private MRI and CT facility count and provincial distribution, fiscal 2020–2021.

[7] Deloitte / Canadian Association of Radiologists. Economic Footprint of Radiology in Canada, 2025. Equipment density: 10.8 MRI and 14.0 CT units per million, 2023 vs. 2015; per-capita funding and scan-volume comparisons to OECD.

[8] Canadian Institute for Health Information (CIHI). Wait Times for Health Services, 2025. Median MRI waits up 15 days and CT waits up 3 days vs. 2019.

[9] Fraser Institute. Waiting Your Turn: Wait Times for Health Care in Canada, 2025. Physician survey: CT 8.8 weeks, MRI 18.1 weeks, ultrasound 5.4 weeks after specialist referral.

[10] Canadian Association of Radiologists (CAR). Reducing Diagnostic Imaging Wait Times in Canada. CAR Policy Statement, Board Approval March 2026. Canada ranked 27th of 31 universal health systems for MRI units and 28th for CT.

[11] Saskatchewan Health Authority. Surgical and Diagnostic Imaging Wait Times, Q3 2025–2026, October–December 2025. 90th percentile: MRI 198 days, CT 75 days.

[12] British Columbia Ministry of Health. Diagnostic Imaging Activity Report, 2023–2024. MRI exam volume 322,000+; 83% increase from 2016–2017; per capita rise from 36.1 to 58.3 per 1,000 population.

[13] Government of Ontario. Community Surgical and Diagnostic Centres Announcement, June 2025. 65,568 MRI and 31,220 CT operating hours funded in existing centres over the prior year; $155 million investment for 57 new centres licensed for MRI, CT, and GI endoscopy.

[14] Canadian Association of Medical Radiation Technologists (CAMRT). MRT Workforce Crisis, December 2025. Links between delayed imaging and downstream clinical and occupational harm; 14% of CT and 18% of MRI patients required to leave work while waiting; approximately 2 million Canadians affected.

[15] Canadian Association of Radiologists (CAR). 2026 Pre-Budget Submission, September 2025. Call for $2 billion over three years for equipment, installation, and workforce investment.

[16] Reuters. “GE HealthCare to acquire Montreal-based Intelerad for $2.3 billion.” November 2025. Projected Intelerad revenue approximately $270 million in first full year post-close.

[17] Deloitte Canada. The Impact of Delayed Diagnostics, 2025. Nanos Research survey: 11.4% of diagnostic imaging patients had to stop working while awaiting a scan; estimated $17.9 billion in lost employment income, $64 billion in lost GDP, and $6.1 billion in lost tax revenues annually.