The Problem 

 

The National Health Service (NHS) in England is under significant operational and financial pressure (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), public satisfaction has fallen to a record low, with only 21% satisfied with how the NHS operates and widespread dissatisfaction with waiting times and appointment access.

Diagnostic services are embedded in 85% of clinical pathways, giving them significant potential to influence patient management efficiency, either facilitating timely care or causing delays (Royal College of Radiologists, 2024). In the UK, by the end of March 2024, over 1.6 million patients were waiting for a diagnostic test (NHS England, 2024a). NHS England's target that 99% of patients receive a diagnostic test within six weeks of referral has not been achieved since February 2017 (The King's Fund, 2024).

 

Demand for medical imaging is rising faster than in most other healthcare services, outstripping the capacity of NHS radiology departments to meet it effectively (Maskell, 2022). The most recent Royal College of Radiologists workforce census confirms the trend, reporting an 8% year-on-year increase in CT and MRI activity in 2024 against only 4.7% growth in the consultant radiologist workforce (Royal College of Radiologists, 2025). Magnetic Resonance Imaging (MRI) remains the diagnostic imaging modality of choice for examining a wide range of conditions and body regions, due to its superior soft-tissue contrast, precise tissue characterisation and multiplanar imaging capabilities (Westbrook and Talbot, 2019; Jones et al., 2025). Despite an 8.1% increase in the number of MRI scans performed in March 2024 compared to the previous year, waiting lists increased by 2.8% during the same period (NHS England, 2024b).

In the Diagnostic Imaging Dataset, the median period from request to MRI in 2023/24 was 20 days – only marginally improved compared to 2017–2018 (NHS England, 2024c). These request-to-test figures are not directly comparable with diagnostic waiting-list statistics, but separate waiting-list data show that over 1,030,000 patients waited more than six weeks for a diagnostic test by March 2024, including 609,380 waiting over 62 days (NHS England, 2024b). Timely and accurate diagnosis is crucial for improving patient survival, optimising resource utilisation and preventing deterioration in outcomes. It also underpins preventive healthcare by enabling early detection and management of disease (The King's Fund, 2024).

In contrast, delays and complications during diagnosis can hinder the entire healthcare process. Patients face prolonged uncertainty, delayed treatment initiation and worse clinical outcomes (Royal College of Radiologists, 2025). Oncology provides one illustrative example, with a relatively developed literature on the consequences of diagnostic delay. A BMJ systematic review and meta-analysis by Hanna et al. (2020) of 34 studies covering 1.27 million patients found that each four-week delay in cancer treatment was associated with a 6–13% increase in mortality across surgical, systemic and radiotherapy indications. Earlier work on diagnostic intervals specifically found similar associations for breast, colorectal, head and neck, testicular cancers and melanoma, although strength of association varied by tumour type (Neal et al., 2015). International comparisons drawing on CONCORD data indicate that UK survival for several cancers remains below that of many comparable high-income countries (Allemani et al., 2018; Sarkar, 2024). Delayed diagnosis is cited as a major contributing factor in poor cancer survival rates (Tudor Car et al., 2016). Although MRI is used across a far wider range of indications, cancer provides a clear link between delay and patient harm, and MRI is a routine step in diagnostic and staging pathways for many cancers where timely access matters.

While broader societal factors such as population ageing, rising poverty, food insecurity, poor housing, low income and insecure employment increase pressure on the NHS, there are also specific operational reasons why MRI waiting lists continue to grow, including equipment shortages, staffing constraints and suboptimal service organisation (Department of Health and Social Care, 2024; Royal College of Radiologists, 2024).

 

 

The Challenge

 

The UK Government's Life Sciences Competitive Indicators report that in 2021 the UK had the lowest number of MRI units among comparator countries with similar economic development – only 8.6 per million population (Office for Life Sciences, 2024). Despite government pledges to drastically increase capacity (National Audit Office, 2025; Labour Party, 2024), this figure has risen only to approximately 10.25 per million, based on the latest population estimates and the National Imaging Data Collection Asset Count (Office for National Statistics, 2024; NHS England, 2024a). This remains well below the OECD average of 16.9 units per million (Organisation for Economic Co-operation and Development, 2021).

To close that gap, the Labour Party pledged to double the number of MRI and CT scanners in the NHS (Labour Party, 2024). HM Treasury's opposition policy costing applied that pledge to the existing NHS fleet, using a baseline of 587 operational MRI scanners at approximately £1 million each, excluding ongoing maintenance, installation and replacement costs (HM Treasury, 2024). The age profile of existing equipment compounds the capacity problem. Diagnostic equipment over ten years old is often technologically obsolete, less efficient, produces lower-quality images and is prone to breakdowns (Royal College of Radiologists, 2024). Although comprehensive data on NHS equipment age are rarely published, a 2017 survey found 29% of scanners were over ten years old (Royal College of Radiologists, 2017), and industry data from the European imaging manufacturers' trade body suggest a similar profile more recently, with 26% over ten years old (COCIR, 2023).

Beyond the scanners themselves, MRI capacity depends on physical space, IT infrastructure and – most acutely – workforce availability (Royal College of Radiologists, 2024). The NHS Long Term Workforce Plan identifies diagnostic radiographers as among the allied health professions facing the greatest workforce shortfalls over the coming decade, and projects that domestic education and training will need to grow by 50–65% over the next fifteen years to close the gap (NHS England, 2023). Earlier analyses reached similar conclusions. Richards (2020) estimated that at least 4,000 additional radiographers would be required by 2026 to meet projected service demand, vacancy rates rose from 9.6% in 2019 to 12.8% in 2022 (Society of Radiographers, 2022), and the Society of Radiographers has warned that workforce growth of at least 6% per year – double the current rate – will be needed to meet government imaging targets (Society of Radiographers, 2025).

These shortages place a practical ceiling on what scanner expansion alone can achieve. The Royal College of Radiologists' 2024 workforce census found that 83% of imaging clinical directors surveyed cited lack of radiographers as a barrier to accommodating an additional fully funded CT or MRI scanner, with 72% citing lack of radiologists to report on the images and 53% citing lack of physical space (Royal College of Radiologists, 2025). Scanner numbers and workforce capacity must therefore grow in parallel if diagnostic bottlenecks are to be meaningfully addressed.

Utilisation of existing machines is also highly variable. FOI-based analysis by the TaxPayers' Alliance found that some NHS trusts perform over 12,000 scans per machine per year, while others average fewer than 2,000 (TaxPayers' Alliance, 2025). Data on MRI unit opening times is very patchy. A National Audit Office (2011) report identified wide variation, ranging from 40 to over 100 hours per week, and anecdotal evidence suggests little improvement since – with hours at some hospitals running 7 am to 10 pm, and at others only 9 am to 4.30 pm on weekdays. Although variation in patient need, scan complexity and staffing must be considered, better coordination of resources and extended operating hours could deliver capacity equivalent to more than 40 additional MRI machines (TaxPayers' Alliance, 2016).

International comparators reinforce the picture. In Europe, 46% of German hospitals reported staffing shortages in 2019 (Blum, 2019), Italy has radiographer 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, creating further workforce gaps (Andersson, Lundgren and Lundén, 2017). Outside Europe, MRI radiographer vacancy rates in the United States rose from 8.7% in 2021 to 16.2% in 2023 (American Society of Radiologic Technologists, 2023), while Canada saw a 62% increase in MRI service volume between 2010 and 2020, with significant growth in out-of-hours scanning intensifying workforce pressures further (Chao et al., 2021).

Collectively, this data shows that access to MRI is driven by a combination of limited scanner numbers, underutilisation of existing equipment, workforce shortages and variable service organisation – factors that must all be addressed if diagnostic access in the NHS is to improve.

 

 

The Solution

 

One proposed response to these combined pressures is remote MRI scanning, an operational model already in use or under evaluation in several healthcare systems internationally (Quinsten, Apel and Oliveira, 2023). Dedicated software allows a qualified radiographer at a secure remote workstation to connect to one or more scanners, monitor image acquisition in real time, adjust scanning parameters, and communicate with onsite colleagues and the patient. Commercial products in this space include Siemens Healthineers' syngo Virtual Cockpit, GE HealthCare's Digital Expert Access and Philips' Radiology Operations Command Center.

Remote scanning supports two distinct workflows. In a supervisory model, the scan is driven by a radiographer at the scanner, with a remote senior or specialist radiographer observing, advising or second checking – useful for training, unfamiliar protocols or complex cases. In a fully remote model, the remote radiographer runs the scan themselves, while an assistant practitioner or support worker manages patient-facing tasks onsite such as coil placement, positioning, cannulation for contrast administration, and reassurance of patients experiencing discomfort, claustrophobia or anxiety (Deistung et al., 2024; Quinsten, Apel and Oliveira, 2023). The two workflows have different workforce implications. Supervisory use can extend the reach of senior expertise without changing local staffing; fully remote operation can unlock genuine capacity gains, for example by allowing one radiographer to run more than one scanner, or by extending operating hours without requiring a full onsite radiographer team (Quinsten, Apel and Oliveira, 2023; Hudson and Sahibbil, 2022).

In the UK, any remote scanning service must sit within the safety framework set out by the MHRA (Medicines and Healthcare products Regulatory Agency, 2021). Two principles are particularly relevant. First, accountability for patient safety during a scan rests with the supervising MR operator, wherever they are physically located – remote operation reconfigures, but does not remove, this responsibility. Second, existing professional guidance advises against lone working and requires continuous visual and audio contact with the patient throughout the scan (Society of Radiographers, 2019). Both principles are compatible with remote scanning, but require clear local rules on role allocation, patient contact and escalation.

Evidence on UK radiographer acceptance of the technology remains limited but informative. A service evaluation by Hudson and Sahibbil (2022) across two UK services using the syngo Virtual Cockpit found that perceived ease of use was high, but perceived usefulness was lower and correlated with radiographers' overall willingness to adopt the technology. The authors concluded that acceptance depends more on the practical benefit radiographers see in their own workflow than on the usability of the software itself, and that clear governance and a defined vision for how remote scanning is used are prerequisites for successful implementation.

In principle, capacity gains from remote scanning can be achieved more quickly and at lower capital cost than installing new MRI scanners, although robust comparative cost and throughput evaluations in UK settings remain limited.

 

 

Parallels

 

A useful parallel can be drawn between the current situation in diagnostic radiography and recent attempts to improve access to general practice. England has fewer GPs per 100,000 population than many other European countries (The King's Fund, 2019), while consultation volume has grown from 30.8 million in 2019 to 34.3 million in 2023 (Atherton et al., 2025) and patient-reported satisfaction with access has continued to decline (Dawson and Elsey, 2025). The policy response has combined long-term workforce expansion – a commitment to increase GP training places by 50% by 2032 (Doyle and Fuller, 2024) – with short-term attempts to boost system capacity, including funding for extended working hours (Scott, 2025).

Previous extended-hours initiatives have met with mixed success. The Prime Minister's Challenge Fund, launched in 2013, aimed to provide more GP appointments in evenings and at weekends (Department of Health and Social Care, 2013). Several pilot sites struggled with lower-than-expected weekend uptake, and some extended services were discontinued (NHS England, 2016; NHS England and NHS Improvement, 2018). A national cross-sectional survey subsequently found that most patients were already satisfied with their practice's opening hours – 37.2% "very satisfied" and 42.7% "fairly satisfied" – suggesting that extending hours without reference to who actually wants them risks creating unused capacity (Cowling, Harris and Majeed, 2017).

Where uptake has been strong, it has been concentrated among specific groups. Out-of-hours GP services have been used disproportionately by women under 35 and their children, with particularly high uptake among economically disadvantaged patients (Kelly et al., 2018). Whittaker et al. (2019) similarly found that 80.4% of out-of-hours users were aged 20 to 60, with women aged 20–29 accounting for nearly a quarter of all female appointments. Previous international evidence from several European healthcare systems points in the same direction, with extended primary-care access improving service use among younger adults, working-age parents and economically disadvantaged populations (Huber et al., 2011; Buja et al., 2015; Jansen et al., 2015). Standard weekday hours, in other words, systematically underserve patients with work and caring responsibilities – an equity concern as much as a capacity one.

These findings indicate that adding capacity alone does not guarantee improved access or patient satisfaction, and that uptake depends heavily on alignment with the circumstances of specific patient groups. For MRI, the implication is not that extended hours are inherently valuable, but that any extension should be designed around the patients most likely to benefit from it – those who find standard working-hour appointments difficult to attend – rather than treated as a uniform capacity intervention.

 

 

Risks and Barriers

 

Remote MRI scanning introduces several important considerations from a patient safety and human factors perspective. Operating more than one scanner simultaneously increases cognitive demand, and established research demonstrates that multitasking in healthcare slows performance, heightens error risk and requires sustained concentration (Skaugset et al., 2016; Douglas et al., 2017). These findings are borne out in the UK context, where radiographers using remote MRI scanning have reported cognitive load and mental exhaustion as explicit concerns, alongside practical limitations such as system responsiveness and reduced direct visualisation of the patient (Hudson and Sahibbil, 2022).

Fatigue is a related concern. Even in experienced hands, remote scanning can be more fatiguing than onsite operation (Hudson and Sahibbil, 2022), and performance declines are well documented during late evening and night shifts (Edgerley et al., 2018). Extending scanning hours into evenings or overnight therefore raises the potential for errors, including cannulation errors, mispositioned patients, documentation lapses or scan errors by the remote radiographer. Each of these can lead to repeat scans, reporting delays or misdiagnosis, all of which carry significant patient risk (Elliott and Williamson, 2020).

Adopting remote scanning also requires robust safeguards for communication and IT security (Quinsten, Apel and Oliveira, 2023). The healthcare sector has experienced a steady increase in data breaches since 2010 and is now among the most frequent targets of global cyberattacks (Argaw et al., 2020). Remote working environments can exacerbate these vulnerabilities through unsecured home networks, shared devices and inconsistent firewall use (Naidoo, 2020; Sabin, 2021). The disruptive potential of such attacks was demonstrated in 2017, when the WannaCry ransomware incident disrupted NHS services including radiology, causing widespread delays to patient care and forcing ambulances to be diverted after hospitals lost access to vital information systems (Argaw et al., 2020; Millard, 2017). Patient health records are particularly attractive to cybercriminals, since they combine personal identifiers with clinical information that cannot be altered, such as past surgeries, diagnoses, blood type and genetic data (Williams, Chaturvedi and Chakravarthy, 2020).

Clear role allocation is critical in remote MRI workflows. Human factors research demonstrates that ambiguity in responsibilities increases cognitive load and error risk across healthcare settings (Skaugset et al., 2016; Douglas et al., 2017). UK radiographers using remote MRI have also raised concerns about trust and teamworking with onsite colleagues when the remote operator does not work with them regularly, as well as the loss of direct patient interaction for the remote radiographer – with some describing a perceived risk of the role being reduced to a purely technical function (Hudson and Sahibbil, 2022). Assigning onsite staff to manage patient care, positioning and preparation, while the remote radiographer oversees acquisition, supports both patient safety and professional identity; but this allocation depends on clear local rules and established working relationships, neither of which can be assumed.

There are two other considerations. Emergency response pathways require careful planning. If a patient develops a contrast reaction, a claustrophobic crisis, a seizure or an MRI safety incident during a remotely operated scan, the onsite assistant practitioner or support worker must be able to summon the right clinical help immediately, with clear escalation routes to the remote radiographer,  and, where relevant, the supervising clinician. Also, remote operation changes how junior radiographers are trained. Traditional apprenticeship-style learning depends on sustained side-by-side contact with experienced colleagues at the scanner, and if senior expertise is increasingly delivered remotely, training frameworks may need to be redesigned to preserve the quality of practical instruction and professional development (Hudson and Sahibbil, 2022).

Taken together, these risks do not argue against remote scanning, but they define the conditions under which it can be safely implemented. These include robust governance, clear role allocation, strong IT security, deliberate training pathways and tested emergency response arrangements.

 

 

UK pilot scheme

 

From January to July 2025, Imperial College Healthcare NHS Trust ran a pilot to extend MRI service hours from 8 pm to midnight, using remote radiographers and Philips' Radiology Operations Command Center technology (Imperial College Healthcare NHS Trust, 2025; NHS Employers, 2025). The pilot followed a twelve-month proof-of-concept evaluation at the trust, during which the same technology was used in a supervisory capacity to support training and image acquisition (Philips and Imperial College Healthcare NHS Trust, 2025). Despite high activity levels, Imperial's imaging service had been experiencing significant scheduling delays driven by rising demand, limited scanner capacity and unplanned downtime of ageing equipment (NHS Employers, 2025).

The pilot ran at the Wembley Community Diagnostic Centre, using remote radiographers to staff evening sessions rather than requiring a full onsite team during extended hours (NHS Employers, 2025). Patient appetite had been established by a prior trust survey of 102 patients over two weeks, in which 88% expressed willingness to attend out-of-hours appointments (Philips, 2025). The pilot focused on simpler examinations suitable for evening delivery, with more complex cases continuing to be seen during standard hours (Philips and Imperial College Healthcare NHS Trust, 2025).

Reported outcomes were substantial. NHS Employers' published case study records 750 additional MRI examinations delivered over an initial two-month period, a utilisation rate of 85% or higher for MRI assets during extended-hours sessions, a 75% reduction in the did not attend (DNA) rate for remote scanning lists compared with conventional-hours services, and 90% of patients on the pilot pathway receiving their diagnostic test within three weeks of referral (NHS Employers, 2025). Imperial's own first-month update indicated that patients attending the extended-hours service saw their waiting times reduce by more than two-thirds (Imperial College Healthcare NHS Trust, 2025). By the end of the pilot, Philips reported that a total of 1,356 additional patients had been seen in the evenings across the full six-month period (Philips and Imperial College Healthcare NHS Trust, 2025).

Safety and governance arrangements were described by NHS Employers as central to the pilot's design. MRI safety was addressed through intensive training, simulation and dedicated sessions with MRI safety experts, a governance framework defined responsibilities for onsite and remote staff, and the trust used existing IT infrastructure, adapted where needed, to support the new workflows rather than implementing entirely new systems (NHS Employers, 2025).

When interpreting these early findings, it is helpful to keep in mind the stage of evaluation the pilot represents. As an early service evaluation, it reflects experience at a single site rather than results tested across multiple services and case-mixes. It was delivered collaboratively with the technology provider, Philips, as is typical for service-level evaluations of new commercial platforms. The outcomes currently in the public domain are those reported by the trust, by Philips and by NHS Employers, and a peer-reviewed evaluation would be a useful next step in establishing how the model performs across a wider range of settings. The service was designed to prioritise simpler examinations suitable for evening delivery, and the reported outcomes therefore describe performance within that scope rather than across a full MRI case-mix. Patient experience was captured through feedback rather than a validated instrument, which is common at the service-evaluation stage. The 88% willingness figure, drawn from the pre-pilot survey, is most usefully read as an indicator of patient appetite ahead of implementation rather than as a measure of sustained uptake. None of these considerations diminishes the pilot's value as a proof of concept; they are the natural characteristics of an early-stage service evaluation and help to frame how the findings can inform wider adoption.

Taken as such a proof of concept, the pilot suggests that remote radiography can meaningfully expand MRI capacity and improve access for patients who cannot attend during standard hours, provided it is supported by robust training, clear governance and reliable IT infrastructure.

 

 

Conclusion

 

For many patients, waiting 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, and 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, service organisation and delivery are equally important. Persistent underutilisation of scanners and variable operational efficiency highlight the need to optimise existing assets rather than relying solely on expansion.

Remote MRI scanning is one practical response to this challenge. Preliminary pilot data suggest it can increase scan capacity, reduce waiting times and improve patient experience while making efficient use of existing staff and equipment. The value of extending hours is not, however, uniform across patients. Evidence from both primary care and the Imperial pilot suggests that out-of-hours appointments are most likely to benefit those whose work or caring responsibilities make standard weekday scheduling difficult, making extended access as much a question of equity as of capacity.

Adoption of remote scanning also carries real risks, including cognitive demand, workforce fatigue, communication failures, data security exposure and implications for how junior radiographers are trained. These risks do not argue against remote scanning but define the conditions under which it can be safely adopted. Clear governance, defined role allocation between onsite and remote staff, robust IT infrastructure and tested emergency response pathways are all prerequisites, not optional extras.

On balance, remote radiography has the potential to alleviate MRI bottlenecks, improve access for patients who cannot attend during standard hours, and make better use of an overstretched workforce, complementing rather than replacing broader efforts to strengthen NHS imaging capacity. Realising that potential at scale will require peer-reviewed, multi-site evaluations that test the model beyond a single Community Diagnostic Centre and beyond the simpler examinations to which it has so far been applied.

 

 

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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).