A 2022 systematic review, which included 34 studies evaluating practices undertaken by health care professionals in a Canadian health care setting, reported that diagnostic imaging was underused or overused a median of 13.8% of the time (interquartile range 4.5%-29.0%). 1 This over-and underuse of diagnostic imaging may result in iatrogenic harms to the patient, longer wait times, poorer health outcomes due to delays in diagnosis, and inefficient use of scarce health care resources. 1,2 Demand for diagnostic and medical imaging is increasing as the Canadian population ages. In fact, the number of computed tomography and magnetic resonance imaging examinations is expected to more than double in the period from 2017 to 2040. 3 Imaging referral guidelines can be an important tool in ensuring that patients get the safest and bestclinical-value diagnostic imaging study at the right time. 4,5 Trustworthy guidelines, and the recommendations within, should be evidence based and developed using rigorous methodology. 6 Guidelines developed for other countries (e.g., from the American College of Radiology [ACR] and the Royal College of Radiologists [RCR] in the United Kingdom) can serve as an important reference. However, Canadian guidelines are required to ensure that geographic distribution, population characteristics and the structure of the health care systems are considered in the guidelinedevelopment process. This highlights the need to develop country-specific, systematically produced diagnostic im aging referral guidelines.
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