title: Transient elastography in Canada: current state and future directions.
abstract: BACKGROUND
  Transient elastography (TE) is a safe and effective technology to noninvasively assess hepatic fibrosis in patients with numerous liver conditions. TE is not readily available to all Canadians, and data regarding how this technology is incorporated into clinical practice are lacking.
  
  
  OBJECTIVE
  To describe TE practices in Canada, and to identify strategies to optimize access and usage.
  
  
  METHODS
  All Canadian centres with TE devices were invited to complete a survey after obtaining purchasing data from the national distributor of the device. Descriptive statistics were generated.
  
  
  RESULTS
  Forty-two devices were available in Canada as of January 2015. Seventy-one percent are used in academic settings, 74% are hospital based and 26% are in private clinics. The test is performed by trained nurses in 48% of centres, physicians in 19%, technicians in 9.5% and by any member of the health care team in 19%. Nineteen percent of centres provide satellite clinics to perform the test. While the majority of the centres perform the test at no additional cost to patients, 29% charge a variable fee.
  
  
  CONCLUSIONS
  In Canada, most TE devices are used in academic and⁄or hospital-based settings, thus limiting access to this technology to many patients. A sizeable minority of centres mandate patients pay variable out-of-pocket fees. Satellite clinics offered by some centres could increase access, but are not widespread. The lack of uniformity with TE practices in Canada suggests that a national policy is needed.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Aljawad
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sirpal
authors.forename: Eric M
authors.initials: EM
authors.lastname: Yoshida
authors.forename: Natasha
authors.initials: N
authors.lastname: Chandok
mesh_terms: D002170:Canada; D054459:Elasticity Imaging Techniques / Q000379:methods / Q000639:trends*; D005544:Forecasting; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging*; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011795:Surveys and Questionnaires