Evaluation dosimétrique des tomodensitométries adultes auTogo / Dosimetric evaluation of adult CT scans in Togo

Objectif: Evaluer les doses délivrées aux patients adultes lors des examens TDM en vue de l'établissement des niveaux de référence diagnostiques tomodensitométriques au Togo.Matériel et méthodes: Etude transversale réalisée du 6 Mars au 30 Juillet 2018 dans 5 structures sanitaires disposant d'une unité tomodensitométrique au Togo ayant inclus les TDM cranio-encéphaliques, abdomino-pelviennes, thoraciques, thoraco-abdomino-pelviennes, rachidiennes cervicales et lombaires des patients d'au moins 15 ans.Résultats: Les 1155 TDM adultes inclus étaient dominées par les TDM cranio-encéphaliques et abdomino-pelviens avec respectivement 34,2% et 15,15%. La sex-ratio était de 1,42. Les appareils de marque GE dans 80%, étaient de 6 et 16 barrettes et 60% installés 2010. L'IDSvol de la TDM cérébrale était le plus élevé par rapport à l'IDSvol des autres types d'examen. La dispersion des PDL par acquisition et pour un examen complet inter et intra structure sanitaire était significative. Les NRD (75e percentile du PDL) par acquisition était de 1199,14mGy.cm (cérébral non traumatique), 1596,45mGy.cm (cérébral-traumatique), 635,63mGy.cm (cervical), 401,98mGy.cm (thorax), 594,42mGy.cm (abdomino-pelvien), 675,73mGy.cm (thoraco-abdomino-pelvien) et 681,35mGy.cm (lombaire). Les doses efficaces moyennes associées auxdifférents types d'examens étaient comprises entre 2-3mSv pour l'exposition de la tête et le cou et de 24mSv pour la TDM abdomino-pelvienne.

Objective: To evaluate the doses delivered to adult patients during CT scans in order to establish CT-scans diagnostic reference levels (DRL) in Togo.Material and methods: Cross-sectional study carried out from 6 March to 30 July 2018 in 5 health facilities with a CT-scans unit in Togo that included cranio-encephalic, abdominal-pelvic, thoracic, thoraco-abdominal-pelvic, cervical and lumbar spines CT-scans in patients at least 15 years of age. Results: The 1155 adult CT-scans included were dominated by cranio-encephalic and abdominal-pelvic CTs with 34.2% and 15.15% respectively. The sex-ratio was 1.42. GE brand devices in 80%, were 6 and 16 bars and 60% installed 2010. The brain CT IDSvol was the highest compared to the CTDIvol of other types of exams. The dispersion of the DLP by acquisition and for a complete inter and intra-structure examination was significant. DRLs (75th percentile of DLP) per acquisition were 1199.14mGy.cm (non-traumatic cerebral), 1596.45mGy.cm (traumatic cerebral), 635.63mGy.cm (cervical), 401.98mGy.cm (thorax),594.42mGy.cm (abdominal-pelvic), 675.73mGy.cm (thoracic-abdominal-pelvic) and 681.35mGy.cm (lumbar). The average effective doses associated with the different types of exams ranged from 2-3mSv for head and neck exposure and 24mSv for abdominal-pelvic CT. Conclusion : The high dispersion of dose delivered during CT-scan in Togo requires a process of homogenization of procedures and optimization from DRLs thus determined.(abdominal-pelvic), 675.73mGy.cm (thoracic-abdominal-pelvic) and 681.35mGy.cm (lumbar). The average effective doses associated with the different types of exams ranged from 2-3mSv for head and neck exposure and 24mSv for abdominal-pelvic CT.Conclusion: The high dispersion of dose delivered during CT-scan in Togo requires a process of homogenization of procedures and optimization from DRLs thus determined.

Conformité des demandes d'imagerie par résonance magnétique à Ouagadougou (Burkina Faso)

Objectif : L'objectif de cette étude a été d'évaluer la conformité des demandes d'imagerie par résonance magnétique à l'Hôpital Saint Camille de Ouagadougou.Matériel et méthodes : étude transversale descriptive à collecte prospective étendue sur deux mois (de juillet à septembre 2018) réalisée à l'Hôpital Saint Camille de Ouagadougou (HOSCO). Les variables étudiées étaient les critères administratifs et cliniques établis par la Haute Autorité de Santé (HAS). La conformité d'une demande était établie sur le présence des huit variables.Résultats : les examens d'IRM représentaient 3,97% de l'activité d'imagerie médicale. 400 demandes d'IRM ont été exploitées durant la période de l'étude. La conformité globale était de 24,25%. Les conformités administrative et clinique globales étaient respectivement de 70% et de 32,75%. D'une façon générale, les demandes les plus conformes étaient rédigées par les médecins spécialistes, les DES et les généralistes dans respectivement 29,47%, 28% et 22,73% des cas et provenaient des CHU.Conclusion : cette étude a montré des insuffisances dans le remplissage des demandes d'IRM, aboutissant à un taux bas de conformité globale. Une sensibilisation des prescripteurs par l'utilisation d'imprimés-type et par l'informatisation des demandes pourraient améliorer cet indicateur, pour une prise en charge efficiente des patients

Occupational hazards among medical radiation workers

Objectives: The objective of the study was to determine the prevalence of occupational hazards among medical radiation workers in Northern Nigeria and to assess the adequacy of existing occupational safety measures in the region. Materials and Methods: A prospective cross-sectional study of 139 medical radiation workers in six tertiary health-care institutions in northern Nigeria. Structured questionnaires were used to obtain vital information about the occurrence of occupational hazards, prevention and control measures. Data were analyzed using descriptive and inferential statistics using the computer software SPSS. Results: Out of 159 questionnaires distributed 139 were retrieved giving a response rate 87.4%. Stress, direct contact with bodily fluids, and contrast media splashes were the three most prevalent hazards reported by 121 (87.1%), 78 (56.1%), and 72 (51.8%), respectively. Conclusion: Medical radiation workers in Northern Nigeria face a wide range of occupational hazards, and therefore concerted efforts must be channeled toward mitigating these hazards

Apport de l'imagerie dans le diagnostic d'une thrombose veineuse cérébrale idiopathique: à propos d'un cas à Cotonou

Introduction : Une symptomatologie apparemment banale peut cacher une authentique pathologie grave. Nous rapportons un cas historique de thrombose veineuse cérébrale (TVC) révélé par la tomodensitométrie cérébrale chez un sujet jeune pris en charge pour des céphalées isolées et persistantes. Observation : patient de 25 ans, sans antécédents particuliers, admis pour des céphalées isolées,atroces, initialement temporales gauche, puis secondairement en casque sans aucun autre signe associé. L'examen neurologique était normal et le scanner révélait des signes directs et indirects de thrombose de plusieurs sinus cérébraux. Aucune étiologie n'a été retrouvée. L'évolution a été rapidement favorable et sans séquelles sous traitement anticoagulant.Conclusion : l'imagerie a un rôle capital dans le diagnostic de la TVC

On the Safety of Diagnostic Ultrasound in Pregnancy: Have we Handled the Available Data Correctly?

Robust evidence of the bioeffects of ultrasound is available from animal studies but human studies are less convincing. Nevertheless; it is disturbing that the only response to safety issues is a twenty-year old principle known as ALARA (As Low As Reasonably Applicable). Using experience from obstetrics and toxicology; and drawing information mainly from two recent systematic reviews and meta-analysis that extensively covered the subject of ultrasound safety; this review captures the current knowledge of ultrasound bioeffects and suggests that it may be time for an international; multidisciplinary meeting on ultrasound safety to decide how to provide the evidence (available data) to patients and sonographers in a succinct manner

Role of Radiology in Infectious Diseases; HIV/AIDS Overview

"INTRODUCTION: Since the first case of HIV/AIDS appeared in USA and Africa more than two decades ago; the incidence of HIV/AIDS has continuously been increasing worldwide. It is estimated that 42 million people lived with HIV/AIDS in 2009 among whom 29.4 million (70) were in Sub-Saharan Africa. Since there is no cure or vaccine presently available or in sight in near future; the current treatment strategy is to treat the opportunistic infections and HIV associated conditions. Developing countries account for about 60of prevalence and 90of new infections arise in the poor countries.2 In Africa the ""worst case"" scenario projections in the next 20 years are that: One quarter of the workforce will die; life expectancy will decrease from average of 63 to 47 years and 14 million children will be orphaned. OBJECTIVES: Emphasis on Diagnostic Imaging as the mainstay of management of patients with HIV/AIDS and related diseases. Demonstration of the role of radiology in the evaluation of patients; as guidance in interventional procedures such as drainages and biopsies as well as in the follow up of patients. Establishment of correct diagnosis of HIV associated conditions as they are very important so that patients can get appropriate treatment and less expenses are incurred during management. METHODOLOGY: This paper is a product of reviewing manuscripts and data available in journals;books and internet as stipulated in the reference section. The role of radiology in diagnosing and treating HIV/AIDS manifestations in each body system: HIV/AIDS spares no organ or system hence all radiological modalities have a role to play in the diagnosis and follow up of HIV/AIDS patients as is demonstrated in this imaging summary."

The Status of Clinical Diagnostic Imaging Services in Uganda's Regional Referral Hospitals in 2007

Background: Clinical imaging is an essential component of health care which supports and improves the effectiveness of clinical decision-making. Quality care saves lives and resources of both the patient and the health system. However; many developing countries have neglected iagnostics; especially clinical imaging. Non-use of or poor imaging services lead to wrong diagnosis and treatment; unnecessary health expenditures; and poor health outcomes. Regional Referral Hospitals should have good diagnostic imaging services to provide expert care and bridge the continuum of care by stemming the flow of uncomplicated cases from general hospitals to National Referral Hospitals. Aim: To determine the situation of diagnostic imaging services at regional referral hospitals in Uganda. Methods: A descriptive cross-sectional survey of all the nine Regional Referral Hospitals of Uganda was done in 2007. Environmental inspection of the imaging units; process observation and exit interviews with 156 patients present on the day of the visit were done to assess their satisfaction with the imaging services. Staff were also interviewed. However; quality validation of the imaging outputs was not done. Selected health facilities in the capital Kampala were visited to obtain data on patients referred from upcountry. Five-year hospital records were reviewed for outputs. Results: The premises were of poor quality and staff and patients were not safe from radiation exposure. No radiosurveillance measures were operational. The output of imaging services was generally very low; (mean: 16 procedures per day; range: 6 - 22) due to lack of consumable inputs. Only 37(range: 14 - 64) of approved staff positions were filled. Nurses were insufficient and some cadres lacked altogether. Stock-outs of key consumable inputs were prolonged (ultrasound gel: 90 days) and patients were required to buy their own. Many patients were referred to private services but not recorded. Central level supervision by the Ministry of Health was lacking. Conclusion and recommendation: The quality of imaging services was poor; and could be improved through higher prioritization of imaging services in hospital planning; better financing; better support supervision and establishment of an active radiosurveillance mechanism

Diagnosis of Breast Cancer: is there any Protocol Which is Applicable Worldwide?

Objectives: to study the accuracy of cytopathology and to evaluate it as diagnostic pathological tool in breast diseases.Method:a prospective study in the period between Jan 2006 and Feb 2008.Data were analysed using the SPSS. Sensitivity; specificity and accuracy were calculated and compared to literature. Results: Total number of reports was 542; 271 for each cytopathology and histopathology. The overall mean age was 41.0+ 15.3 (ranging between 14- 80) years.The overall sensitivity; specificity and accuracy of cytopathology were 56.1; 80.9 and 63.8respectively while those of histopathology were 93.5; 83.5 and 89.7respectively.Conclusion: FNAC has low sensitivity; specificity and accuracy

Latex Glove Sensitivity amongst Diagnostic Imaging Healthcare Personnel: a Study in Southeastern Nigeria

The paper reports a cross-sectional study to determine the prevalence and type of symptoms; causal agents and awareness of latex glove reactions amongst four professional groups. The study was done at diagnostic imaging departments within ten major hospitals in Southeastern Nigeria. Radiologists/resident radiologists; radiographers; radiology nurses and darkroom technicians who were occupationally exposed to latex gloves were investigated between June and September 2006 to determine the level of latex hypersensitivity. The results show that prevalence is similar to that demonstrated elsewhere with 12.4of individuals expressing latex associated symptoms. Symptoms included itching and redness of hands; dry cracked skin; soreness of eyes; and upper respiratory tract complaints. There are strong relationships between number of gloves used per day; duration of glove use and expression of symptoms. About 62.8(n=76) of the respondents had previous knowledge of hypersensitivity reaction to latex gloves prior to this investigation. The paper concludes that latex hypersensitivity is a real problem amongst diagnostic imaging healthcare personnel in our locality. This preliminary work; therefore; provides the basis of a much larger controlled study in the future

Clinical diagnostic imaging in - Ascites

An appropriate sequence of diagnostic imaging procedures which will permit a rapid; accurate diagnosis with the least number of tests and with minimum expense and disconfort to the patient. Ascites if used in the wider sense as free fluid collection within the intraperitoneal cavity; should include serous fluid; blood (bloody); urine; pus; chylous as well as galliger Ascites. In the majority of cases the clinical and laboratory evaluation of patients with ascites is sufficient to reveal the cause of fluid accumulation. However even when the cause of asctes seems pretty obvious; it is important to look for other diseases that might supervene. For example ascites by cirrhosis complicated by occult hepatoma

Clinical diagnosis imaging in intestinal obstruction

In these days of sophisticated technology; the diagnosis of intestinal obsruction (and pseudo-obstruction) still depends almost entirely on plain X-rays and barium studies. Although rigid routines (and old myths) interfere with the interpretation of plain X-ray; nevertheless; the first step in intestinal obstruction is a series of plain X-rays without contrast. An erect; lateral left decubitus (2) supine and chest X-ray (3); (4); should be obtained because of several reasons. One of these reasons is the fact that a chest X-ray is necessary in all plain X-ray series for obstruction; in order not to be trapped into a wrong diagnosis of mechanical small bowel obstruction in pneumonia (not even only those limited to the lower lobes) and this; especially in aging adults and young children