Original Research

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

Monica van Wijk, Michelle M. Barnard, Amanda Fernandez, Keith Cloete, Matodzi Mukosi, Richard D. Pitcher
South African Journal of Radiology | Vol 25, No 1 | a2251 | DOI: https://doi.org/10.4102/sajr.v25i1.2251 | © 2021 Monica van Wijk, Michelle Monique Barnard, Amanda Fernandez, Keith Cloete, Matodzi Mukosi, Richard Denys Pitcher | This work is licensed under CC Attribution 4.0
Submitted: 23 July 2021 | Published: 30 November 2021

About the author(s)

Monica van Wijk, Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
Michelle M. Barnard, Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, Cape Town, South Africa
Amanda Fernandez, Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, Cape Town, South Africa
Keith Cloete, Sub-Directorate Medical Imaging Services, Directorate: Health Technology, Western Cape Department of Health, Cape Town, South Africa
Matodzi Mukosi, Tygerberg Hospital, Department of Health, Western Cape Government, Cape Town, South Africa
Richard D. Pitcher, Division of Radiodiagnosis, Department of Medical Imaging and Clinical Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa


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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.


Keywords

radiology; trends; utilisation; middle-income country; healthcare; public sector

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