Further reflections on diagnostic imaging in Canada

Diagnostic imaging in Canada requires careful rethinking, retooling and innovative management. Much of the attention directed to diagnostic imaging services has focused on cost containment and most of this on supply-side management. These "reflections" reinforce and supplement the perspectives offered by Drs. Laupacis and Evans and extend considerations around demand-side management, from the perspectives of physician and patient. Focusing on physicians makes sense, since, in the end, they are the ones who order diagnostic imaging tests. Multidimensional reinforcing modalities are required to sustain changes in physician test-ordering behaviour. This should be combined with peer review and audit, clinical guidelines and a consultant role for radiologists, as described by Laupacis and Evans. Educating patients about risk, cost and appropriateness of diagnostic imaging tests is of supplementary importance.