Public Sector Radiological Resources and Utilization Patterns in the Western Cape Province of South Africa

Background There are marked disparities in radiological resources globally, particularly between metropolitan and rural populations. The World Health Organization (WHO) suggests that 90% of low- and middle-income country (LMIC) imaging needs can be addressed by one X-ray and ultrasound machine for every 50000 people. However, this figure is untested, as limited work on radiological resources and service utilization patterns globally, particularly in LMICs exists. The aim was to analyze provincial radiological service in a middle-income country. Methods An institutional review board-approved retrospective audit of radiological data for the public healthcare sector of the Western Cape Province (WCP) of South Africa (SA) for 2017, utilizing databases of the WCP Department of Health and Stats SA. We conducted population-based analyses of imaging equipment, personnel, and service utilization data for the province, metropolitan and rural areas. Results Metropolitan population density exceeds rural (1682 vs 19 people/km 2 ; 89:1). Rural imaging facilities by population are double the metropolitan (19 vs 11/10 6 people). Provincially, there are 36 X-ray and 18 ultrasound units/10 6 people. Rural X-ray (39.3 vs 33.6/10 6 people), ultrasound (24.7 vs 14.5/10 6 people) and mammography (14 vs 5 units/10 6 women > 40 years) resources exceed metropolitan by 17, 70 and 180 percent, respectively. Metropolitan personnel resources by population (n = 112 vs 53/10 6 people) and equipment unit (1.7 vs 0.7/10 6 people) are double the rural. Provincial imaging studies totalled 1.2778 million, averaging 262 examinations/10 3 people and 1.3 investigations/patient. Radiography (n=935607,73%) and ultrasound (n=202639,16%) together constituted 89% (n=1138246) of studies. Population-based utilization of imaging services was 30% higher in the metropole (279 vs 214 studies/10 3 people), with mammography (24 vs 5 studies/10 3 woman >40 years; 517%) and CT (21 vs 6/10 3 people; 380%) recording the highest differentials and plain radiography (203 vs 171/10 3 people; 19%) the lowest. Conclusion Our findings support the WHO contention that approximately ninety percent of a population’s diagnostic imaging needs can be met by plain radiography and ultrasound and underscore the complexity of achieving equitable utilization of services between rural and metropolitan areas.