Modern diagnostic technologies play an important role in health systems, allowing physicians to better diagnose health issues. However, they are also a major cost driver in health systems, particularly if they are overused. This section focuses on the use of three diagnostic imaging technologies that can help diagnose different health issues: computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) exams. CT and MRI exams both show images of internal organs and tissues, while PET scans show other information and problems at the cellular level. Unlike more traditional radiography and CT scanning, MRI and PET exams do not expose patients to ionising radiation, which can increase the risk of cancer if the exposition of radiation is not properly managed. CT exams were first introduced in the 1970s, MRI exams in the 1970s and the 1980s, while PET exams were introduced around the year 2000.
Government authorities and medical societies in some countries are working together to promote a more effective use of MRI, CT, PET and other medical imaging exams. For instance, in Belgium, the Federal Public Service Health is launching several actions to support doctors and the general public in making more informed decisions. The National Health Insurance, the Federal Public Service and the Belgian Medical Imaging Platform are working together to integrate evidence‑based decision rules in physicians’ electronic prescribing so that they are supported when choosing whether a radiological exam is necessary and, if so, which one would be most appropriate for the patient. Citizens will also be informed about situations in which a scan is not necessary, for example for back pain (Sciensano, 2024[1]).
Before the pandemic, the use of the CT, MRI and PET diagnostic exams taken together was increasing in all EU countries. Between 2012 and 2019, the number of these exams increased on average across EU countries by over 40%, from 162 exams per 1 000 population in 2012 to 229 exams in 2019. In 2020, diagnostic activities as many other health services were disrupted and sometime temporarily suspended to divert efforts towards COVID‑19 patients and avoid people getting infected while seeking diagnostics or care. On average, diagnostic exams decreased by 12% across EU countries in 2020 compared to 2019.
Most EU countries then quickly restored diagnostic activities during the second year of the pandemic in 2021, with most countries reaching higher numbers of diagnostic exams in 2021 than in 2019 partly to catch up the reduction in 2020. This surge was supported in several countries by creating diagnostic dedicated hubs and performance monitoring (OECD, 2023[2]).
In 2022, the use of the CT, MRI and PET exams further increased in most countries. On average, 247 exams per 1 000 population were performed across EU countries, 12% more than before the pandemic (Figure 7.19). The use of these three diagnostic exams taken together was highest in Austria, France and Luxembourg, with utilisation rate at least 50% higher than the EU average. The utilisation rate was lowest in Bulgaria, Finland and Romania, with rates less than half the EU average, although in Finland this is partly due to underreporting of exams in the National Capital Region.
Figure 7.20 highlights the large variation in the use of MRI exams between Western European countries and Central and Eastern European countries. While the use of MRI exams has increased over the past two decades in all countries, there was still more than a five‑fold difference in their use in 2022 between the three countries that used them the most (Austria, Germany and France) and those that used them the least (Bulgaria and Romania, as well as Serbia and Northern Macedonia).
