The Problem 

 

The National Health Service (NHS) is facing the worst crisis in its history (Department of Health and Social Care, 2025).  A recent landmark independent investigation found public satisfaction with the NHS in England is at an all-time low (Department of Health and Social Care, 2024).  According to the King’s Fund (Taylor, et al., 2025) there has been an astonishing collapse in public confidence in the service provided.  Just 21% of people are content with the way the NHS runs, and dissatisfaction with waiting times and the ability to get an appointment is widespread (Taylor, et al., 2025).  

 

Diagnostic services are incorporated into 85% of clinical pathways, giving them significant potential to influence the overall efficiency of patient management – either facilitating timely care or contributing to delays (Royal College of Radiologists, 2024b).  In the UK, by the end of March 2024, over 1.6 million patients were currently waiting for a diagnostic test (NHS England, 2024b).  NHS England sets a target of 99% of patients to undergo a diagnostic test within 6 weeks of a referral, but this target has not been achieved since February 2017 (The King’s Fund, 2024).  

 

The demand for medical imaging is increasing at a rate that exceeds that of most other healthcare services and is currently outstripping the capacity of NHS radiology departments to meet it effectively (Maskell, 2022).  Magnetic Resonance Imaging (MRI) is currently seen as the diagnostic imaging gold standard for examining a wide range of conditions and body parts, primarily due to its superior soft-tissue contrast, precise tissue characterisation and image acquisition in multiple planes (Jones, et al., 2025).  Despite the number of MRI scans performed during March 2024 increasing by 8.1% from the same period the preceding year, MRI reported waiting lists rose 2.8% at the same time (NHS England, 2024b).  

 

The median waiting time for a patient from request to MRI in 2023 to 2024 was 20 days, however, this is only one day faster than in 2017 to 2018 and masks the fact that 1,030,370 patients waited more than 6 weeks; with 609,380 waiting more than 62 days (NHS England, 2024c).  Prompt and accurate diagnosis is vital for improving patient survival, optimising the use of resources and preventing deterioration in patient outcomes, as well as essential to preventive healthcare, facilitating the early identification and management of illness (The King’s Fund, 2024).  In contrast, delays and complications during diagnosis can hinder the entire healthcare process.  Patients are left waiting longer to understand their condition and commence appropriate treatment, which leads to worse health outcomes (Royal College of Radiologists, 2024a).  

 

This is reflected in statistics such as the UK lagging far behind many other European countries in cancer survival rates, with recent analysis suggesting it is as much as 25 years behind the best performing countries (Sarkar, 2024).  Delayed diagnosis is cited as a major contributing factor in low cancer survival rates (Tudor Car, et al., 2016).  There are many determinants of health that are causing pressure on the health system in the UK – aging population, rising levels of poverty, increased food insecurity, poor quality housing, low income and insecure employment (Department of Health and Social Care, 2024) – but there are also some specific reasons why MRI waiting lists continue to increase. 

 

 

The Challenge

 

The latest figures from the UK Government’s Life Sciences Competitive Indicators (Office for Life Sciences, 2024) show that in 2021 the UK had the lowest number of MRI units – 8.6 per million of population – amongst comparator countries with similar levels of economic development.  Despite government pledges to drastically increase capacity in MRI scanning in recent years (National Audit Office, 2025; Labour Party, 2024), this number – using the latest population estimates (Office for National Statistics, 2024) and the National Imaging Data Collection, Asset Count from NHS England (2024a) – has only risen to approximately 10.25.  This is still well below the Organisation for Economic Co-operation and Development (2021)average of 16.9 MRI units per million of population.  The UK Government has committed to doubling the number of MRI scanners – an additional 587 – at a cost of £1.0m each (Labour Party, 2024).  This is not including ongoing maintenance costs, additional installation costs or the replacement of aging equipment (HM Treasury, 2024).

 

Diagnostic equipment older than 10 years is often technologically obsolete, produces lower quality images, is less efficient, and is more prone to breakdowns and requiring repairs v).  Although data regarding the age of NHS equipment is rarely published, a survey in 2017 claimed 29% were over 10 years old (Royal College of Radiologists, 2017), and more recently data provided by the main scanner manufacturers in 2023 suggested a similar age profile of scanners in the UK, with 26% over 10 years old (COCIR, 2023).  Not only are MRI machines expensive assets, the number and cost of scanners must be considered alongside wider concerns, including limited physical space in hospitals, the need for additional IT infrastructure, and sufficient workforce capacity to operate them (Royal College of Radiologists, 2024b).  

 

According to The Society of Radiographers (SoR) the battle to both retain and recruit diagnostic radiographers to the NHS is currently being lost (SoR, 2025).  Despite an independent review of diagnostic services for NHS England in 2020 recommending a minimum of 4000 additional radiographers were needed by 2026 (Richards, 2020), in the most recent SoR (2022) Workforce Census the position vacancy rate for diagnostic radiographers continued to rise.  This extended the trend over several years, from 9.6% in 2019 to 12.8% in 2022 (SoR, 2022).  Although the current diagnostic radiography workforce has been steadily growing at 3% each year since 2014, to operate the number of MRI scanners required and to fully implement the initiatives accepted by the government, workforce growth will need to double to 6% a year (SoR, 2025).  

 

The pressure group TaxPayers’ Alliance (2025) have pointed to data suggesting an underutilisation and inefficient use of MRI machines in the NHS, with some trusts performing over 12,000 scans per machine per year, while others average fewer than 2,000.  Data on MRI unit opening times is limited, but a previous National Audit Office (2011) report found wide variations, ranging from 40 to over 100 hours per week.  Anecdotal evidence suggests little progress since, with hours ranging from 7 am to 10 pm in some hospitals, to just 9 am to 4.30 pm weekdays in others.  Although differences in patient needs, scan complexity, and staffing must be considered, it is estimated that better cooperation, resource management, and extended hours could deliver capacity equivalent to over 40 additional MRI machines (TaxPayers' Alliance, 2016).  

 

Although it is difficult to compare individual healthcare systems directly around the world, the UK is far from alone in experiencing significant challenges affecting its radiography services.  In Europe, 46% of German hospitals reported staffing issues in 2019 (Blum, 2019), Italy has vacancy rates of up to 25% (HealthManagement, 2024), Lithuania requires a threefold increase in radiographer recruitment to meet demand (Vanckavičienė et al., 2024), and in Sweden, retirements now outpace new entrants, leading to severe shortages alongside rising demand for imaging (Andersson, Lundgren and Lundén, 2017).  Outside Europe, in the United States, MRI radiographer vacancy rates rose sharply from 8.7% in 2021 to a record 16.2% in 2023 (American Society of Radiologic Technologists, 2023), and in Canada, MRI service volumes increased by 62% between 2010 and 2020, with significant growth in out-of-hours scanning further intensifying workforce pressures (Chao, et al., 2021).

 

 

The Solution

 

One proposed solution – and one that is already being used in several countries, with Australia, Belgium, China, Denmark, Germany and United States being prominent examples – is remote scanning (Quinsten, Apel and Oliveira, 2023).  Remote MRI scanning enables radiographers to operate scanners or aid onsite colleagues from any location, using dedicated software to manage the procedure (Quinsten, Apel and Oliveira, 2023).  Originally developed as a tool for service engineers or application support teams to provide assistance without being physically present at the scanner site, it is now being promoted as a means for experienced senior staff to monitor multiple scanners simultaneously or even enable a single radiographer to operate several scanners at once (Hudson and Sahibbil, 2022).  

 

Some healthcare systems are exploring a model where a junior radiographer or a less-qualified healthcare professional remains onsite to manage patient care – answering questions, connecting coils, positioning patients, inserting intravenous lines – while a senior colleague operates the MRI remotely. The onsite operator can also prepare subsequent patients for the same scanner, or a second scanner, and assist those experiencing discomfort, claustrophobia, restlessness, or breathing difficulties (Deistung, et al., 2024).  

 

It is claimed that remote radiographers can make more efficient use of both current staffing levels and scanners available, allowing them to work longer hours, increasing scan capacity, reduce backlogs and spread the knowledge and experience of the most senior and highly qualified radiographers across several scanners in a supervisory role (Quinsten, Apel and Oliveira, 2023).  Importantly this could be achieved at, comparatively, a much lower cost than the construction and installation of hundreds of MRI scanners and could be done in a much shorter time frame.  

 

 

Parallels

 

Parallels can be drawn between the current situation in diagnostic radiography and challenges faced in general practice.  The NHS faces a shortage of general practitioners (GP); England has fewer GP per 100,000 population than many other European countries (The King’s Fund, 2019).  While GP numbers continue to fall, demand for consultations has risen sharply – from 30.8 million in 2019 to 34.3 million in 2023 (Atherton, et al., 2025).  In the UK, patient-reported satisfaction with access to GP appointments has steadily declined since 2018 (Dawson and Elsey, 2025).  

 

To address this, the NHS and Government have pledged GP training places will increase 50% by 2032 (Doyle and Fuller, 2024).  In the short term, strategies to manage demand have largely focused on boosting system capacity, including funding extended working hours (Scott, 2025).  Initiatives such as the Prime Minister’s Challenge Fund (Department of Health and Social Care, 2013) sought to improve access to GP services, aiming to make appointments more convenient, including during evenings and weekends (NHS England and NHS Improvement, 2018).  Although thousands of extended-hours appointments were introduced, uptake was significantly lower than expected and resulted in oversupply and underutilisation, particularly on weekends, leading many practices to discontinue Sunday services (NHS England, 2016).  A national cross-sectional survey later revealed that most patients were already satisfied with their GP surgery's opening hours – 37.2% were “very satisfied” and 42.7% “fairly satisfied” – suggesting that simply increasing appointment availability outside traditional hours does not necessarily improve patient satisfaction (Cowling, Harris and Majeed, 2017).

 

However, when studies break down the patients who aren’t satisfied with traditional working hours, dissatisfaction with core hours is more concentrated among certain patient groups.  A survey of orthodontic patients found that 77.4% would use Saturday appointments, rising to 93% among full-time workers and 87% of parents who would otherwise need to take children out of school (Tabbaa, et al., 2025).  Similarly, a 2018 cohort study of out-of-hours GP services reported that women under 35 accounted for 70% of visits for themselves and their children, with the highest uptake among economically disadvantaged patients (Kelly, et al., 2018).  This mirrors evidence from older studies in other European countries (Huber, et al., 2011; Buja et al., 2015; Jansen, et al., 2015), and the United States. where out-of-hours availability for diagnostic imaging has demonstrated improved access, especially for patients under 50 and those in less affluent regions (Rossi, et al., 2024).  

 

In the UK, a 2019 analysis of extended-hours pilot schemes by Whittaker et al. (2019) found that 80.4% of out-of-hours users were aged 20 to 60, with women aged 20 to 29 making up nearly a quarter of female appointments.  Collectively, these findings highlight that standard opening hours may not adequately serve younger adults and those with limited work flexibility (Whittaker, et al. (2019).

 

 

Risks and Barriers

 

From a patient safety and human factors perspective, it is essential to recognise the cognitive demands of remote scanning, especially if operating more than one scanner.  Research shows that multitasking in healthcare slows performance, increases errors, and requires sustained concentration (Skaugset, et al., 2016; Douglas, et al., 2017).  Remote scanning can be more fatiguing than standard onsite scanning, even if proficiency is developed (Hudson and Sahibbil, 2022).  Healthcare workers performance has been shown to be negatively impacted by late evening shifts (Edgerley, et al., 2018).  Extending scanning into night hours raises the risk of errors that must be carefully managed.  Mistakes – such as cannulation errors causing extravasation, inaccurate documentation by onsite staff, or remote radiographer errors leading to repeat scans, misdiagnosis, or reporting delays – can result in significant harm to the patient (Elliott and Williamson, 2020).  

 

Adopting remote work also demands clear safeguards, especially strong IT security and robust data protection (Quinsten, Apel and Oliveira, 2023).  The healthcare sector has experienced a steady surge in data breaches since 2010, ranking it today among the most frequent victims of global cyberattacks (Argaw, et al., 2020).  The disruptive ability of cyberattacks was demonstrated in 2017 when the NHS was a victim of the WannaCry ransomware attack (Argaw, et al., 2020).  The attack disrupted many services – including radiology – causing widespread delays in patient care and even forcing ambulances to be diverted after hospitals lost access to vital information systems (Millard, 2017).  Patient records can be very valuable to cybercriminals as much of health information is unable to be altered – past surgeries, diagnoses, blood type, genetic data – as well as general private details like name, date of birth, and insurance providers (Williams, Chaturvedi and Chakravarthy, 2020).  

 

Remote work environments pose heightened security risks; employees may use outdated or insecure equipment connected to home networks shared with multiple other devices (Naidoo, 2020).  With Wi-Fi often poorly secured and firewalls uncommon, protecting patient’s sensitive personal data requires robust safeguards on both devices and networks to prevent unauthorised access (Sablin, 2021).

 

 

UK pilot scheme

 

From January to July 2025 Imperial College Healthcare NHS Trust ran a pilot scheme aiming to maximise capacity, reduce waiting lists and give patients greater flexibility by using remote radiographers to extend the hours of the MRI service from 8 pm to midnight (Philips and Imperial College Healthcare NHS Trust, 2025).  Although activity levels were high, the imaging service had been experiencing significant delays in scheduling, attributable to rising demand, limited scanner capacity, and unexpected downtime caused by ageing MRI equipment (NHS Employers, 2025).   

 

The pilot programme addresses increasing demand from NHS patients who are prepared to attend appointments during nighttime hours as an alternative to prolonged waiting times.  According to a survey by Imperial College Healthcare NHS Trust, 88% of patients expressed willingness to attend out-of-hours appointments (Philips, 2025).  Although the full results of the pilot are pending publication, preliminary figures are highly encouraging.  Over a two-month period, remote scanning enabled 750 additional MRI examinations, achieved a 75% reduction in non-attendance, an 85% utilisation rate of MRI resources, and ensured that 90% of patients received diagnostic tests within three weeks of referral (NHS Employers, 2025).  The pilot reduced waiting times for extended-hours patients by over two-thirds and patient feedback indicated high satisfaction, especially with the increased appointment availability (Imperial College Healthcare NHS Trust, 2025).  

 

To ensure patient safety and effective operations, MRI safety was strengthened through training, simulation, and expert-led sessions. A governance framework clarified roles for onsite and remote staff, while a reliable IT infrastructure supported growing demands and new workflows (NHS Employers, 2025).  

 

 

Conclusion

 

For many patients the waiting time for a diagnostic test represents not only a delay in diagnosis and treatment, but also a period of uncertainty and worsening symptoms.  Timely access to diagnostic imaging, particularly MRI, is essential for early detection and intervention across a range of conditions.  However, current waiting lists, equipment shortages, and workforce constraints have created systemic delays with direct implications for patient health and quality of care.  

 

Efforts to address these challenges have included commitments to expand MRI capacity and increase workforce numbers.  While additional resources are essential, the way in which services are organised and delivered is equally important.  Persistent underutilisation of scanners, alongside significant variation in opening hours and operational efficiency, highlights the need to optimise existing assets rather than relying solely on expansion.  Within this context, innovative approaches such as remote scanning show considerable potential. Early pilot schemes demonstrate these models can enhance flexibility, reduce waiting times, and improve patient experience, while partially mitigating current workforce and equipment shortages.  Notably, patient willingness to attend evening or night appointments reflects a demand for services that are designed around their lives, rather than requiring them to adapt to rigid healthcare schedules.  

 

The introduction of remote scanning also presents new challenges, including risks of workforce fatigue, human error, communication breakdowns, and data security concerns.  Robust safeguards and governance will be essential to protect patient safety, diagnostic accuracy, and confidentiality.  As the NHS considers wider adoption of remote radiographer scanning it will be important to ensure efficiency gains are not achieved at the expense of quality or public trust.  Addressing MRI bottlenecks requires sustainable, patient-centred solutions that balance technological innovation with modern equipment, effective service design, and a well-supported workforce.

 

 

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Images and graphs  

 

Figure 1.  Royal College of Radiologists (2024) Equipped for the future: Diagnostics equipment in NHS England – the case for investment. Available at: https://www.rcr.ac.uk/media/m3jp5niq/equipment-policy-paper-2024-final-v3.pdf (Accessed: 31 August 2025).

 

Figure 2. The King’s Fund (2024) What are diagnostics, and how are diagnostics services performing? Available at: https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/what-are-diagnostics (Accessed: 30 August 2025).

 

Figure 3. Siemens Healthineers (2023) [Screenshot] Running MRI exams from home. 9 August.  Available at: https://www.youtube.com/watch?v=59rrbA5o0-s (Accessed: 31 August 2025).