The diagnosis is not in dispute. Canada has too few scanners, too few people to operate them, wait times that have worsened for a decade, and a governance structure that makes coordinated action genuinely difficult.

The previous piece laid out the evidence. This one is less interested in the problem than in what actually gets done about it.

The good news, such as it is, is that Canada’s imaging crisis is not a mystery disease. The causes are known, the interventions are understood, and several other countries have navigated versions of this successfully.

The bad news is that knowing what to do and doing it are different problems, and the distance between them in Canadian healthcare is substantial.

What follows is a set of concrete actions — not aspirations, not frameworks, not calls for further study — that would materially change the trajectory of Canadian diagnostic imaging over the next decade if pursued with sustained political will.

Most of them are neither radical nor expensive relative to the cost of the status quo. A patient who stops working while waiting 18 weeks for an MRI is not a statistic. She is a productivity loss, a delayed cancer diagnosis, a preventable surgical complication, and a downstream cost to the system that will dwarf whatever was saved by not funding the scan sooner.

The economic case for action is no longer abstract.

Replace the Equipment Fleet on a Fixed Schedule

Canada cannot keep running scanners that belong in museums.

The fact that 37% of MRI machines and 33% of CT scanners are more than 10 years old is not a funding shortfall — it is a capital planning failure that has compounded over two decades. Older machines are slower, less reliable, more prone to downtime, and increasingly unable to support advanced protocols that modern oncology, cardiac, and neurological care require.

The federal and provincial governments should jointly establish a National Diagnostic Imaging Equipment Renewal Fund with a 10-year mandate and a fixed replacement schedule. The target should be no more than 15% of any modality fleet older than 10 years by 2035.

This is not aspirational. It is what several comparable health systems already do with routine capital planning. The CAR has called for $2 billion over three years for equipment and workforce investment. That number is in the right order of magnitude. What is missing is the multi-year commitment that allows provinces and health authorities to plan procurement rather than scramble for one-time capital.

Critically, equipment renewal must be tied to operating funding. A new scanner without additional technologist hours, booking infrastructure, and radiologist capacity is a stranded asset.

Every equipment announcement should require a corresponding staffing and operations plan before a single dollar is released. Canada has too many examples of scanners sitting underutilized because the money for the machine came without the money for the people.

Train Significantly More Technologists and Sonographers

The workforce constraint is the binding limit on Canadian imaging capacity, and it is the area where government has been most passive.

Training pipelines for medical radiation technologists, MRI technologists, CT technologists, and sonographers have not expanded proportionally with demand for more than a decade. Provinces have added machines while the number of available technologists has grown slowly, creating a structural mismatch that will not resolve itself through market forces alone.

Concrete action requires federal and provincial governments to co-fund a significant expansion of accredited MRT and sonography training programs at colleges and technical institutes. The target should be a 30% increase in annual training capacity within five years.

This is achievable. The bottleneck is not student demand — it is program capacity, clinical placement availability, and instructor supply. All three are solvable with directed investment.

Simultaneously, credential recognition pathways for internationally educated technologists and sonographers need to be simplified and accelerated. Canada is actively recruiting internationally in almost every other health profession while leaving internationally trained imaging professionals in bureaucratic limbo for one to three years.

This is indefensible given the scale of the shortage. A streamlined national bridging framework — developed jointly by CAMRT, provincial regulatory bodies, and immigration authorities — would not solve the workforce gap on its own, but would meaningfully accelerate it.

Retention matters as much as recruitment. Technologists leave the profession because of call burden, physically demanding workflows, equipment frustrations, and limited career progression.

Health authorities that invest in modernizing equipment, reducing mandatory overtime, and creating clinical leadership pathways for senior technologists will hold their staff. Those that do not will continue to lose them to private clinics, other provinces, or other careers entirely.

Extend Operating Hours System-Wide

Canada operates most of its publicly funded MRI and CT capacity on weekday daytime schedules. This is an organizational choice, not a physical constraint.

A scanner that runs from 7am to 5pm on weekdays and sits idle evenings and weekends is a stranded asset in the middle of a capacity crisis.

The target should be a minimum of 12-hour daily operating windows and meaningful weekend utilization in all publicly funded MRI and CT facilities within three years.

Some hospital radiology departments already do this. Many do not. The barrier is not technical. It is a combination of collective agreement constraints, staffing models designed for another era, and budget envelopes that do not reward throughput.

Provinces should tie operating funding to minimum utilization thresholds. A facility that runs an MRI scanner at less than 60% theoretical capacity while patients wait six months for a scan should be required to explain why before receiving renewal funding.

This is not punitive. It is basic accountability for public assets.

For after-hours staffing, distributed teleradiology reading pools already exist and work. The technology for remote interpretation is mature. What is needed is the willingness of hospital boards and health authorities to design workflows around extended operation rather than around administrative convenience.

Build a National Imaging Waitlist and Appropriateness System

Canada does not have a coherent national picture of who is waiting for what, where, for how long, or why.

Provincial wait-time reporting is inconsistent in methodology, granularity, and frequency. CIHI provides aggregate data with meaningful delay. The result is that provinces cannot effectively manage demand because they cannot see it clearly, and patients cannot navigate the system because the system cannot navigate itself.

A national diagnostic imaging registry — tracking referral-to-scan intervals by modality, indication, geography, and priority — is technically feasible and long overdue.

It would allow health authorities to identify bottlenecks in real time, redirect capacity across regions, and hold facilities accountable against published benchmarks. It would also allow appropriateness monitoring: identifying referral patterns that are generating low-value imaging and diverting capacity from patients who need it more.

Clinical decision support tools that embed appropriateness criteria directly into electronic ordering systems exist, have evidence behind them, and are used in several peer countries. Canada has piloted them in isolated contexts and not scaled them.

A national rollout of ordering-integrated CDS, aligned with the Canadian Association of Radiologists’ referral guidelines, would reduce low-value imaging volume, shorten effective wait times for appropriate referrals, and improve the overall quality of the imaging encounter.

It is one of the few interventions that simultaneously improves access, quality, and cost.

Expand Community Delivery With Mandatory Safeguards

The hospital system alone cannot absorb the next decade of imaging demand. This is not a political position. It is an arithmetic one.

The question is not whether community and private delivery should expand, but how it expands without damaging the public system it is supposed to complement.

Ontario’s model — publicly funded, privately delivered, licensed, accredited, integrated with provincial wait-time reporting, and prohibited from charging patients for insured services — is the template. It is not perfect, but it is defensible, and early evidence suggests it is adding net capacity rather than simply redistributing it.

Other provinces should adopt versions of this model with appropriate provincial adaptation rather than relitigating the ideological debate while patients wait.

The non-negotiable safeguards are straightforward: any community facility delivering publicly funded imaging must participate in central intake and wait-time reporting, must submit staffing plans demonstrating it is not systematically drawing from hospital pools without replacing those resources, must meet national accreditation standards, and must not charge patients for insured services.

Provinces that can enforce those conditions can expand community delivery with confidence. Those that cannot should build the enforcement infrastructure before they expand.

Private-pay imaging for uninsured or legally permissible services will exist regardless of provincial preference. The more productive policy question is how to ensure it adds workforce and capital to the system rather than extracting them, and how to prevent it from creating diagnostic fragmentation where private imaging results are invisible to the public record.

Use AI Where It Demonstrably Saves Time

Artificial intelligence will not solve the imaging crisis. That expectation should be retired now before more procurement budgets are wasted on tools that add screens without reducing bottlenecks.

What AI can do — specifically, narrowly, measurably — is triage urgent findings, reduce report turnaround time, standardize measurements, manage follow-up recommendations, and support protocoling.

Those contributions are real and worth pursuing.

Health authorities should adopt an AI procurement standard that requires demonstrated, locally validated time savings before deployment. Every AI tool entering a Canadian radiology workflow should answer one question first: how many minutes per study does this save, measured in your environment, on your scanners, with your patient population?

Tools that cannot answer that question are not ready.

The Decade Ahead

None of these steps requires inventing new policy mechanisms.

Equipment renewal funds, training program expansion, extended operating hours, national registries, clinical decision support, community licensing frameworks — these are known tools with documented track records in comparable systems.

What has been missing in Canada is the political will to implement them with the scale and sustained commitment the problem requires.

The window for action is not indefinite. Canada’s senior population will cross 23% of the total within this decade. Cancer incidence will keep rising. Emergency medicine will remain structurally dependent on imaging. The workforce shortage will deepen before new training pipelines mature.

A system that is already running at maximum capacity, with aging equipment and a constrained workforce, does not have the slack to absorb a decade of inaction.

The patients waiting 198 days for an MRI in Saskatchewan, or 18 weeks for a scan across much of the country, are not waiting for a new policy framework. They are waiting for the decisions that were deferred in 2015, and 2018, and 2022 to finally be made.

The next decade either closes that gap or compounds it.

There is no stable middle ground.