MRI Waiting Time Disparities in Saudi Public Hospitals: A Six-Year Retrospective Study

Background: Timely access to magnetic resonance imaging (MRI) is essential for accurate diagnosis and effective patient management. Prolonged waiting times can compromise care quality and may signal inefficiencies or inequities within imaging services. Evidence on MRI waiting time patterns in Saudi Arabia's public healthcare system remains limited. This study aimed to quantify MRI waiting times and compare differences across urgency categories, patient demographics, and referring specialties in two Saudi Ministry of Health hospitals. Methods: A retrospective cohort study was conducted using Radiology Information System data from two Ministry of Health hospitals between 2017 and 2022. Waiting time was defined as the interval between the physician's imaging request and the MRI examination date, following the Western Canada Waiting List Project definition. All completed examinations with valid timestamps were included. Descriptive statistics summarized waiting time distributions, and Mann-Whitney U tests assessed differences by urgency (emergency vs. non-emergency), gender, nationality, and referring specialty. Temporal trends were examined descriptively across annual cohorts. Results: A total of 35,934 MRI examinations were analyzed. The overall mean waiting time was 24.8 days (SD = 32.61), with a median of 12.9 days. Emergency examinations (n = 1,128) had considerably shorter waits than non-emergency examinations (n = 34,806), with medians of 1.12 versus 13.73 days (p < 0.001). Within the non-emergency pathway, female patients waited longer than males (median = 14.94 vs. 10.76 days; p < 0.001), and Saudi nationals waited longer than non-Saudi patients (median = 14.12 vs. 4.16 days; p < 0.001); these differences may reflect case-mix, demand concentration, or scheduling dynamics rather than confirmed inequitable practices. No significant gender difference was observed in emergency cases (p = 0.410). The longest specialty-specific delays were recorded for pediatric (41.17 days), neurology (35.15 days), and urology (35.05 days) referrals. Year-to-year fluctuations were noted, with the shortest non-emergency waits in 2020 and the longest in 2021, consistent with pandemic-related service disruptions and backlog accumulation. Conclusion: Emergency MRI prioritization appears effective, with consistently short waiting times for urgent referrals throughout the study period. The primary operational challenge lies within the non-emergency pathway, where substantial variability was observed across gender, nationality, and referring specialty. Given the retrospective observational design, findings are descriptive and hypothesis-generating; observed differences should not be interpreted as confirmed structural inequity without further investigation. More granular non-emergency prioritization, specialty-sensitive capacity planning, and data-driven scheduling strategies may help reduce avoidable delays and promote fairer access to MRI services in public healthcare settings.