This guideline summarizes suggested wait times for common indications where Magnetic Resonance Imaging (MRI) is the recommended first imaging test. The purpose is to inform primary care practitioners of how referrals are prioritized by Radiologists and Radiology departments across the province. This guideline is an adaptation of the British Columbia Radiological Society (BCRS) MRI Prioritization Guidelines (2013). 1 Management of the listed clinical problems is beyond the scope of this guideline. However, in some cases, notes and alternative tests are provided for additional clinical context. Primary care practitioners are encouraged to consult a Radiologist if they have any concerns or questions regarding which appropriate imaging test to choose for a problem. If in doubt consult with a Radiologist and review provincial guidance materials. 2 # Background
The 2013 BCRS MRI Prioritization Guidelines were developed to provide imaging departments with a consistent, provincial approach to prioritizing commonly ordered MRI tests according to suggested maximum wait times. The BCRS guidelines were developed by consensus and are based on BC expert opinion with representation of Radiologists from across the province. Several considerations apply:
- These are guidelines, and as such, are designed to apply in general terms. They are not intended to replace clinical judgement or practitioner-to-practitioner discussion. - Prioritization levels were selected to match other similar guidelines for Computed Tomography (CT) and Ultrasound (US) and are typically assigned by Radiologists rather than referring practitioners. - These guidelines should not be applied rigidly to each case, as varying clinical factors may shift an indication from one priority level to another. - Access to MRI and the ability to respond to MRI requests will depend on resourcing or local availability.
- Providing detailed patient information is essential to aid with the prioritization process.
- The clinical topics included in this guideline represent broad examples, and do not encompass all possible scenarios or all requirements for MRI examinations.

# Priority Level Definitions
The priority levels defined below (Table 1) are in alignment with the Canadian Association of Radiologists national designation Five Point Classification System. 3 

# P1
An examination immediately necessary to diagnose and/or treat life-threatening disease. Such an examination will need to be done either stat or not later than the day of the request.
Immediately to 24 hours

# P2
An examination indicated within one week of a request to resolve a clinical management imperative. Maximum 7 calendar days

# P3
An examination indicated to investigate symptoms of potential importance. Maximum 30 calendar days

# P4
An examination indicated for long-range management or for prevention. 

# Abdomen and Pelvis: Notes and Alternative Tests Potential Diagnosis
Notes and Alternative Tests

# P1
Acute abdomen in pregnancy (e.g. appendicitis, renal colic)
- CT is usually the best first test for acute abdomen, except for pregnant patients where MRI is preferred to reduce fetal radiation exposure Pelvic imaging for young women <35 years old (e.g. ovarian torsion, appendicitis)
- US is usually the best first test. MRI should be considered for young women to reduce radiation exposure if US equivocal