Key Messages
What Is the Issue?
Canada’s Drug Agency received a request to examine strategies used in medical imaging departments to reduce patient no-shows (i.e., missed medical imaging appointments), as well as the underlying reasons behind missed appointments. Reducing no-shows in medical imaging has the potential to help:
- shorten wait times and limit unnecessary emergency department visits — fewer no-shows may shorten wait-lists, enable more timely diagnosis, and reduce reliance on emergency care
- increase cost savings and efficiencies — no-shows can result in lost operational time for imaging staff, underused equipment, and added administrative costs related to rescheduling and managing missed appointments
- enable targeted solutions — understanding why individuals miss appointments allows for the development of tailored, evidence-informed solutions to improve attendance and optimize service delivery.
What Did We Do?
Canada’s Drug Agency conducted an informal survey of health care leaders from every province and territory to gather insights on no-shows in medical imaging. Our survey focused on CT, MRI, X-ray, and ultrasound services across both urban and rural settings, and collected information on:
- estimated no-show rates
- proactive and reactive strategies used to mitigate no-shows
- the perceived effectiveness of those approaches in minimizing no-shows.
To build on the survey findings, we also reviewed supporting literature and held patient engagement sessions to better understand reasons for missed appointments and the strategies to reduce them. Together, these sources offer a complementary view of current practices, challenges, and opportunities related to no-show management in medical imaging services in Canada.
What Did We Find?
Of the 85 respondents who participated in the survey, 63 (74%) reported that they tracked no-show rates, either formally or informally. According to survey estimates:
- No-show rates for CT, MRI, X-ray, and ultrasound were generally low nationwide, typically not exceeding 5%. This aligns with the published literature, which reports radiology no-show rates between 3% and 8%.1,2
- No-show rates varied by modality and geographic region, with ultrasound appointmentsing the highest rates of nonattendance overall.
- Proactive strategies (i.e., implemented to prevent no-shows before they occur) were reported as more effective at reducing no-show rates than reactive strategies (i.e., implemented after a no-show has occurred), with 88% of responding sites reporting positive outcomes from proactive interventions, compared to 35% for reactive measures.
- A variety of factors are believed to contribute to no-shows, including social, cultural, logistical, environmental, psychological, behavioural, and cognitive considerations.
What Does This Mean?
Missed imaging appointments may disrupt care, contribute to wait times, and reduce system efficiency. While our survey estimates suggest no-show rates are generally low (typically under 5%), they vary by modality and region. This variability suggests strategies must be tailored to local contexts and informed by continuous monitoring.
Reducing no-shows requires an understanding of their root causes and tracking patterns over time. Proactive, targeted strategies appear to be more effective than reactive ones, underscoring the need for early, patient-centred approaches.
Monitoring of no-show rates supports:
- measuring their impact on imaging capacity
- identifying trends by region or modality
- informing tailored interventions to improve attendance and access.
These findings highlight the value of data-driven, patient-centred approaches to managing no-shows and improving imaging services.