Incidental ultrasound finding of cholelithiasis in an 8-week-old infant: A case report.

Infantile cholelithiasis is a rare occurrence. It is often diagnosed incidentally during ultrasonography for other conditions as most cases are asymptomatic and may be self-limiting. A few cases may however present with prolonged neonatal or infantile jaundice. We report our initial experience with an incidental case of infantile cholelithiasis in an 8-week-old male infant who was brought to our ultrasound unit in Accra, Ghana, for an abdominal ultrasound on account of conjugated hyperbilirubinemia and pigmented stools. The patient had presented initially at the children's emergency unit of the Korle-Bu Teaching Hospital, 2 days after an uneventful delivery, with a history of yellowing of the eyes, noticed on the first day of life, which necessitated the request for the ultrasound examination, leading to this rare finding of infantile cholelithiasis. The availability and use of modern sonographic equipment are likely to result in more effective detection of this incidental finding and its subsequent management.

Patient radiation dose during diagnostic and interventional cardiology procedures: A study in a tertiary hospital.

BACKGROUND: Fluoroscopy-guided diagnostic and interventional cardiology (IC) procedures help to identify and treat several problems associated with the heart. However, these procedures expose patients, cardiologists, radiographers, and nurses to radiation doses. Due to the risk that ionizing radiation poses, concerns have been raised and studies are continually being done to ensure that optimization is achieved during such procedures. This study assessed patient radiation dose during diagnostic and interventional cardiology procedures as well as right heart studies at a tertiary hospital in Ghana to formulate the facility's diagnostic reference levels (DRLs) for optimization purposes. As this study was the first of its kind in Ghana, it was a vital step towards dose optimization within the local department, as well as contributing to future DRLs in Ghana. METHODS: The study collected dose (air kerma, and kerma area product (KAP) and procedural data, and assessed any correlation between parameters such as fluoroscopy time and KAP, and between body mass index (BMI) and KAP. The DRL values were determined as the 75th percentile level for the dose distribution for the various IC procedures including percutaneous coronary interventions (PCI), coronary angiography (CA), and right heart catheterization (RHC). Data were analyzed using SPSS version 23. RESULTS: CA was the most frequently performed IC procedure (77.3%), while RHC was the least recorded (3.3%). The highest mean KAP was observed during the PCI procedure. The proposed diagnostic reference levels (DRLs) were 162.0 Gy.cm2 (PCI), 69.4 Gy.cm2 (CA), 39.8 Gy.cm2 (RHC) and 159.9 Gy.cm2 (CA+PCI). Patients who presented for the CA+PCI and RHC procedures received the highest and lowest mean KAP of 159.9 Gy.cm2 and 39.8 Gy.cm2 of radiation respectively. CONCLUSION: This study, therefore, concludes that there is a need for dose optimization of radiation exposures for IC procedures at the cardiothoracic center in Ghana.

Contrast Medium Use in Computed Tomography for Patients Presenting with Headache: 4-year Retrospective Two-Center Study in Central and Western Regions of Ghana.

Background: Contrast medium (CM) administration during computed tomography (CT) enhances the accuracy in the detection and interpretation of abnormalities. Evidence from literature also validate the essence of CM in imaging studies. CT, by virtue of its ubiquity, ease of use, speed, and lower financial footprint, is usually the first investigation in cases of headache. Through a multicenter retrospective analysis, we compared findings of contrast-enhanced CT (CECT) to noncontrast-enhanced CT (NCECT) head examinations among patients presenting with headache. Methods: A multicenter retrospective analysis of four years' CT head examination data at two radiology centers located in Central and Western Regions of Ghana were reviewed. Records of patients who presented with headache as principal complaint between January 2017 and December 2020 were reviewed. A total of 477 records of patients with headache were identified, retrieved and evaluated. A Chi-square test and Fisher exact test were used to compare the CECT and NCECT groups. Binary logistic regression analysis was computed to assess association between CECT and each CT findings. Statistical significance was considered at p < 0.05 with a 95% confidence interval. Results: A significant proportion of the patients was females (51.8% in CECT and 60% in NCECT). The NCECT group (40.06 ± 14.76 years) was relatively older than the CECT group (38.43 ± 17.64 years). There was a significant difference between the CECT and NCECT in terms of age (p=0.002) and facility CT was performed (p < 0.0001). The rate of abnormalities was higher in CECT (43.5%, 166/382) compared NCECT (37.9%, 36/95). There was no significant association between CT head findings and contrast enhancement. Conclusion: CECT examination accounted for 5.6% increase in the detection of head abnormalities. Efforts required to establish local standard operation procedures (SOPs) for contrast medium use especially in CT head examinations. Further studies to improve the knowledge of agents, mechanism of action, and safety of contrast media used among practitioners in Ghana is recommended.

The assertiveness of final year student radiographers during their clinical practice: A study in Ghana.

INTRODUCTION: Speaking up by health professionals is essential for patient safety. To ensure that student radiographers are well equipped in professional practice at the time of graduation, their capacity to speak up openly in the clinical setting is very important. This study assessed student radiographers' ability to speak up in the face of patient safety compromises during their clinical rotation and how it impacts their learning. METHODS: Twenty-four (24) final-year radiography students at the University of Ghana, who were then the only final years in the country, were recruited for the study. Questionnaires about assertive communication using a harm index score were given to the students who consented to participate in the study. The data were analysed using Microsoft Excel version 13 and SPSS version 20. RESULTS: The study recorded a response rate of 96% of which the majority (66.7%) were males. The majority (75%) of the participants would not speak up about patient safety issues for reasons. Moreover, 95.8% of the participants got confused when they observed a disparity between clinical practice and lessons taught in the lecture room. CONCLUSION: The ability of students to speak up is dependent on several factors encountered in the clinical area. For students to be able to function well in a clinical team, they need to be competent to speak up to ensure patient safety irrespective of who they work with. This study identified that students preferred to express themselves non-verbally in some situations that deal with patient safety compromises, instead of speaking up. Improving a culture of respect and freedom to speak up in healthcare settings would ensure patient wellbeing.

Radiological determination of the cranial index of present-day Ghanaians.

The cranial index (CI) of Ghanaians is currently unknown. The aim of this study was to measure the CI in a population of Ghanaians in order to classify them against pre-determined CI categories. A systematic random sampling method was used to select 300 normal computed tomography (CT) head scans of adult Ghanaians from the largest hospital in Ghana. All patients were deemed to have a normal cranial image configuration based on the radiological report. The biparietal diameter (BPD, width) and the occipitofrontal diameter (OFD, length) were measured on transaxial CT images using a workstation with a calibrated measurement calliper tool. The CI ratio was calculated as the BPD multiplied by 100 and divided by the OFD. Mean, standard deviation (SD) and range were calculated for BPD, OFD and CI. Differences in measurements between demographic groups were compared using an unpaired t-test, with test α set at 0.05. Of the population of Ghanaians included in this study, 165 (55%) were male and 135 (45%) were female. The mean CI was 77.3 ± 3.6 in males and 79.0 ± 3.3 in females, placing both genders in the mesocephalic category. However, the difference between males and females was found to be statistically significant (P = 0.02). The study indicated that most Ghanaian adults belong to the mesocephalic category of CI. Females also had a higher CI, which could be used to differentiate gender groups. This information can be useful for forensic medicine, plastic surgeries for clinical and research purpose.Key pointsThis study found the mean CI of adult Ghanaians to be 78.0 ± 13.0.This indicates that most Ghanaian adults belong to the mesocephalic category of CI.Females had a higher CI, which could be used to differentiate gender groups.To the best of our knowledge, this is the first study which assessed CI of Ghanaians using CT scan.

Towards the establishment of national imaging practice guidelines: A preliminary study of the basic computed tomography imaging protocols in Ghana.

BACKGROUND: There is a need to harmonize imaging practices in computed tomography (CT) imaging. This study, therefore, investigated the variability of the basic imaging protocols used for CT imaging of common indications in Ghana in order to generate recommendations for the development of national imaging practice guidelines in CT imaging. METHOD: A cross-sectional study, utilizing a structured online questionnaire, was undertaken (between December 2018 to March 2019) to collect indication-based imaging protocol data (scan coverage, scan series, image quality requirement, slice thickness, reconstruction, scan mode and orientation, required window, AEC usage, scan and breath hold techniques etc.,) across the various CT facilities in the country. Data were analysed and with experts' input, recommendations were made. RESULTS: The imaging protocols used across the CT facilities in the country were largely similar, with a few variabilities for similar examinations. These variabilities were found in scan coverages, series and slice thicknesses. In particular, for a brain tumour examination, 92% of the 25 facilities used both non-contrast and contrast phases while 8% preferred only the IV contrast phase. Seventy percent of all the facilities (n=10) performing pulmonary angiograms in the country also used a two-sequence scan, and others (30%) worked with only the angiogram phase. A majority (89%) of the 19 facilities that were engaged in CT-IVU procedures also used 3-4 scan phases, while 11% preferred a split-bolus technique. None of the facilities employed the low-dose or ultra-low dose protocol for kidney stone examination. CONCLUSIONS: The study's outcome provides an important preliminary roadmap that could lead to the development of imaging practice guidelines to ensure harmonization of imaging practices to improve the protection and safety of patients across the CT facilities.

Variability of redundant scan coverages along the Z-axis and dose implications for common computed tomography examinations.

BACKGROUND: Scan length optimization is a method of optimization which ensures that, imaging is performed to cover just the area of interest without unnecessarily exposing structures that would not add value to answer a given clinical question. PURPOSE: This study assessed the variability and degree of redundant scan coverages along the z-axis of CT examinations of common indications and the associated radiation dose implications in CT facilities in Ghana for optimization measures to be recommended. METHODS: On reconstructed acquired CT images, the study measured extra distances covered above and below anatomical targets for common indications with calibrated calipers across 25 CT facilities. The National Cancer Institute Dosimetry System for CT (NCICT) (Monte Carlo-based-software) was used to simulate the scanning situations and organ dose implications for scans with and without the inclusion of the redundant scan areas. RESULTS: A total of 1,640 patients' CT data sets were used in this study. The results demonstrated that CT imaging utilized varying scan lengths (16.45±21.0-45.99±4.3 cm), and 70.6% of the scans exceeded their pre-defined anatomic boundaries by a mean range of 2.86±1.07-5.81±1.66 cm, thereby resulting in extra patient radiation dose. Hence, scanning without the redundant coverages could generate a dose length product (DLP) reduction of 17.5%, 18.8%, 15.5% and 9.0% without degrading image quality for brain lesion, lung lesion, pulmonary embolism and abdominopelvic lesion CT imaging, respectively, whilst ensuring organ dose reduction of0.8%-79.1%. CONCLUSION: The study strongly recommends that radiographers should avoid the inclusion of redundant areas in CT examinations to reduce organ doses.

High degree of prostate related LUTS in a prospective cross-sectional community study in Ghana (Mamprobi).

BACKGROUND: Changing voiding patterns, volume and frequency, may sometimes be mistaken for anxiety, stress or increase in fluid consumption. In the aging male population, the commencement of lower urinary tract symptoms (LUTS) may be silent and perceived as "normal" and unrelated to Benign prostatic enlargement (BPE). The purpose of the study was to determine the prevalence of apparently "silent LUTS" (perceived asymptomatic LUTS) in men in a Ghanaian Community as well as its underlying risk factors. METHODS: One hundred and eleven (111) men (40-70 years) were recruited from a community in Ghana. The International Prostate Symptoms Score (IPSS) questionnaire (administered in the local language and English) and ultrasonographic imaging of the prostate volume (PV) were utlized to collect data. IPSS score >7 plus PV > 30 cm3 was definitive of lower urinary tract symptoms. Eighty-one (81) participants were classified "LUTS Negative" (LN) and 30, "LUTS Positive" (LP). Risk factors i.e., cholesterol (CHOL), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), very low-density lipoprotein (VLDL), coronary risk (CR), BMI and Blood Pressure were also determined. RESULTS: The prevalence of LUTS using only IPSS definition alone was 42.3%. However, IPSS in combination with Prostate Volume gave a prevalence of 27.0%. LN subjects had enlarged prostate (41.98%) and LP, 100%. Quality of life (QoL) was better in the LUTS Negative than LUTS Positive group (p < 0.001). In the univariant analysis coronary risk, triglyceride and VLDL contributed to LUTS (p = 0.023, 0.22, 0.22, respectively). In a multivariant analysis HDL-C (p = 0.027), BMI (p = 0.047) and triglyceride (p = 0.019) significantly contributed to LUTS. CONCLUSIONS: The prevalence of LUTS (42.3%) is high. Components of Metabolic Syndrome- HDL-C, BMI, and coronary risk were associated with LUTS. This emphasizes the need for community education.

Audit of the appropriateness of the indication for obstetric sonography in a tertiary facility in Ghana.

INTRODUCTION: the use of ultrasound is one of the most vital tools in the management of pregnancies and contributes significantly in improving maternal and child health. Certain indications in pregnancy, guide the obstetrician as to which obstetric scan deems appropriate. The full realization of the benefits of ultrasound depends on whether it is being used appropriately or not, and hence this study aimed at auditing for the appropriate indications for obstetric ultrasound. METHODS: a review of all request forms for obstetric scan between June 2019 and July 2020 was performed to assess the appropriateness of requests for obstetric ultrasound at the Cape Coast Teaching Hospital. The data obtained was analyzed using SPSS (SPSS Inc. Chicago, IL version 20.0). A Chi-squared test of independence was used to check for statistically significant differences between variables at p ≤ 0.05. RESULTS: three hundred and fourteen (314) out of the 527 request forms had clinical indications stated. 174 (81.7%) of requests from Cape Coast Teaching Hospital and 39 (18.3%) from other health centers did not indicate patients clinical history/indication on the request forms. Majority 76 (68.5%) of scans in the first trimester were done without indications/history. Only 29 of requests with clinical history were inappropriate. CONCLUSION: practitioners should be mindful of adequately completing request forms for obstetric investigations since a large number of practitioners do not state the history/indications for the scans. There should be continuous medical education on the importance of appropriate indication for obstetric ultrasound.

Gender and Age Differences in Cardiac Size Parameters of Ghanaian Adults: Can One Parameter Fit All? Part Two.

BACKGROUND: The cardiothoracic ratio (CTR) is a radiographic parameter commonly used in assessing the size of the heart. This study evaluated the gender and age-based differences in the average cardiothoracic ratios, and transverse cardiac diameters (TCD) of adults in Ghana. METHOD: Plain chest radiography reports of 2004 patients (without known chest related diseases) generated by two radiologists with at least 15 years' experience from July 2016 to June 2020 were retrospectively analyzed for this study. The CTR for each radiograph was calculated using the formula CTR=(TCD÷TTD)×100, where TCD and TTD represent transverse cardiac diameters and transverse thoracic diameters, respectively. Data were analyzed with the statistical package for social sciences version 23. The independent t-test and One-way Analysis of Variance tests were used in the analyses. RESULTS: A total of 2004 patients' chest x-rays were used in the analyses. The ages of the patients ranged from 20-86 years old with a mean of 39.4±14.04 years. The mean CTR for males was 46.6 ± 3.7% while that of females was 47.7±3.7%. The difference in the overall CTR among the gender groupings was statistically significant (p = 0.001). There were statistically significant differences between the gender categories among patients in the following age groups: 30-39 (p=0.046), 40-49 (p=0.001), 50-59 (p=0.001) and 60-69 (p=0.001). CONCLUSION: The study reveals there are significant gender and age-related differences in cardiac size parameters obtained from routine, frontal chest radiographs. These differences, if considered, may result in early and appropriate treatment of cardiac pathology in some age groups.

STATUS OF RADIATION DOSE LEVELS IN PAEDIATRIC CHEST RADIOGRAPHY IN A TERTIARY HOSPITAL IN GHANA.

Determination of appropriate radiation doses to paediatric patients in accordance with the as low as reasonably achievable (ALARA) principle is important, as it allows for effective optimization of imaging techniques. This study assessed the status of radiation dose levels in paediatric patients undergoing chest X-ray examinations at a tertiary hospital in Ghana. A population encompassing 86 paediatric patients categorised as infants (<1 y), young children (1-5 y) and older children (6-12 y) was selected using a quasi-experimental study design. The patients' anatomical data and X-ray beam exposure parameters were used to indirectly calculate the entrance surface doses (ESDs) received during the examinations. The infants received the highest mean ESD of 196 µGy (uncertainty = 0.37) compared to 158 µGy (uncertainty = 0.46) among the older children. The risk of developing radiation-induced biological effects was therefore higher for infant patients. The ESDs were generally higher than the internationally recommended reference doses. Careful adoption of internationally accepted exposure factors (high tube voltage and low tube load) is most recommended to optimise the dose.

Artificial intelligence in medical imaging practice in Africa: a qualitative content analysis study of radiographers' perspectives.

PURPOSE: Studies have documented the clinical potentials of artificial intelligence (AI) in medical imaging practice to improving patient care. This study aimed to qualitatively explore the perception of radiographers relating to the integration of AI in medical imaging practice in Africa. METHODS: The study employed a qualitative design using an open-ended online instrument administered between March and August 2020. Participants consisted of radiographers working within Africa during the time of the study. Data obtained were analysed using qualitative content analysis. Six themes of concerns were generated: expectant tool; career insecurity; cost of new technology, equipment preservation and data insecurity; service delivery quality; need for expanding AI awareness. RESULTS: A total of 475 valid responses were obtained. Participants demonstrated a positive outlook about AI in relation to clinical quality improvement, competent diagnosis, radiation dose reduction and improvement in research. They however expressed concerns relating to the implementation of this technology, including job security and loss of core professional radiographer skills and roles. In addition, concerns regarding AI equipment maintenance, lack of awareness about AI and education and training opportunities were evident. CONCLUSION: Awareness of the importance of AI in medical imaging practice was acknowledged; however, concerns relating to job security, data protection must be given critical attention for successful implementation of these advanced technologies in medical imaging in Africa. Inclusion of AI modules in the training of future radiographers is highly recommended.

National indication-based diagnostic reference level values in computed tomography: Preliminary results from Ghana.

PURPOSE: This study was conducted to develop national indication-based DRL values for common indications of adult computed tomography (CT) examinations for clinical application in Ghana. MATERIALS AND METHODS: The methodological approach recommended by the International Commission on Radiological Protection (ICRP), Publication 135, for the development of DRLs, was employed. Studies on CT infrastructure, common indications and quality control tests were first undertaken. A sample of 20 CT dose descriptor/quantity data sets were collected from each centre for each indication. Overall, 3960 data sets were collected for all identified common indications from 71.4% of the total CT scanners in Ghana (25/35). The data were collected from image folders reported and accepted by radiologists. The objective image quality was assessed through a signal to noise ratio (SNR) analysis prior to using the data and extracting DRL values. RESULTS: Clinical indications and their respective DRL values in terms of volume weighted CT dose index (CTDIvol) and dose length product (DLP) were cerebrovascular accident (CVA)/stroke (77 mGy; 1313 mGy.cm), head trauma/injury (76 mGy; 1596 mGy.cm), brain tumour/space occupying lesion (SOL) (77 mGy; 2696 mGy.cm), lung tumour/cancer (12 mGy; 828 mGy.cm) and chest lesion with chronic kidney disease (CKD) (13 mGy; 467 mGy.cm). Others were abdominopelvic lesion (17 mGy; 1299 mGy.cm), kidney stones (15 mGy; 731 mGy.cm), urothelial malignancy/CT-intravenous urogram (CT-IVU) (11 mGy; 1449 mGy.cm) and pulmonary embolism (PE) (14 mGy; 942 mGy.cm). CONCLUSION: National Indication-based DRL values developed in this study are recommended to be used to manage CT radiation dose in Ghana.

Falling post-MRI examinations: 2 case reports.

BACKGROUND: The phenomenon where ambulant patients suffer sudden falls during the process of getting off the couch and walking to the changing room post magnetic resonance imaging (MRI) examination is uncommon. However, it can be a very disturbing experience for such patients. Therefore, there is the need to effectively support patients to avoid falls when they are getting off the MRI couch when the examination is completed. METHODS: Two ambulant patients who had undergone MRI were observed to have lost their balance when they attempted to get off from the MRI couch after their procedures. Face-to-face interrogations were made about what they felt. RESULTS: The two patients complained of experiencing some form of dizziness/vertigo when they got off the MRI couch. CONCLUSION: This paper reported two cases of falls that occurred in an MRI facility. The aim was to emphasize the need for extra care and support for all patients who undergo MRI examinations due to the potential risk of MRI induced vertigo or dizziness regardless of the patient's condition.

Percutaneous transhepatic biliary stent placement in the palliative management of malignant obstructive jaundice: initial experience in a tertiary center in Ghana.

INTRODUCTION: one of the mainstays of management of malignant biliary obstruction is the decompression of the biliary system and its associated obstructive symptoms. Non-surgical palliative treatment such as percutaneous transhepatic biliary stenting is desirable in many selected patients. However, this service is often not available in many resource-limited countries. We share our initial experience of percutaneous transhepatic biliary stenting for the management of malignant biliary obstruction in our first set of patients with surgically non resectable malignant biliary obstruction in Ghana. METHODS: percutaneous transhepatic biliary stenting was performed on the first 23 consecutive patients at the Korle Bu Teaching Hospital. The procedure served as the first palliation for malignant obstruction through interventional radiology. Medical records as well as serum levels of total bilirubin (TBil), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) were used to assess the efficiency of the intervention. Microsoft Excel 2010 was used to analysis the data. RESULTS: most patients had resolution of jaundice with marked improvement in liver function and resolution of the itching associated with obstructive jaundice. During the follow-up of cases, one major complication of hemoperitoneum occurred requiring laparotomy. No other major complications such as bile leakage or death occurred. Four (4) patients had sepsis, which was managed. CONCLUSION: the introduction of the intervention in Ghana has proven to valuable for palliative drainage and relief of obstructive symptoms, hence contributing to better patient management. It is relatively safe with minor complications among Ghanaians with non-resectable obstructive symptoms.

Women in Radiography Practice in Ghana: Motivating and Demotivating Factors.

PURPOSE: To investigate and establish reasons for the smaller but increasing population of female radiographers in Ghana, and to evaluate the motivating and demotivating contributory factors associated with women's choice of the profession. METHODS: A descriptive quantitative survey design and a purposive sampling technique were used to recruit participants from hospitals, clinics, and private imaging centers in Ghana. Forty registered female radiographers were invited to participate in the survey, and 30 participants completed and returned the questionnaires. RESULTS: Fear of the possible effects of radiation exposure (57%) and other associated risks were identified by female radiographers as the primary reasons for the low number of women practicing radiography. Lack of training centers and lecturers (27%) and lack of books (23%) were other major demotivating factors. Job security (23%) and a desire to work in a hospital (30%) motivated their continued practice. DISCUSSION: Most of the motivating and demotivating factors found in this study were in agreement with the literature; however, approximately 27% of the respondents observed that lack of training centers and lecturers were the main challenges encountered during their professional studies, which is inconsistent with 1 study that found that the primary detractors for radiography students included poor remuneration, radiation hazards, poor societal recognition, lifestyle of radiographers, curriculum content, lack of a professional title, and male dominance. CONCLUSION: The number of women practicing radiography in Ghana is increasing. The male-to-female ratio is estimated to be 3 to 1. Although fear of the biologic effects of working with radiation was demotivating, job availability and a desire to work in health facilities were motivating. The need for effective career guidance and continued education at the high school level was identified as necessary to abate fears about the risks of working with radiation and to increase the number of women practicing radiography in Ghana.

Radiographic determination of cardiomegaly using cardiothoracic ratio and transverse cardiac diameter: can one size fit all? Part one.

INTRODUCTION: The cardio-thoracic ratio (CTR) and the transverse cardiac diameter (TCD) on Plain chest radiography are the two parameters commonly used to diagnose cardiomegaly and heart disease. A CTR of greater than 50% on a PA film is abnormal and normally indicates cardiac or pericardial disease condition, whiles an increase of TCD from 1.5 to 2cm on two consecutive radiographs, taken at short interval, suggests possible cardiac pathology. The aim was to determine the suitability of using the same TCD and CTR to detect cardiomegaly for all age groups and genders respectively. METHODS: A retrospective study involved the review of 1047 radiological images of adults aged 21 to 80 years, who had plain postero-anterior chest radiographs between January 2012 and November 2013 by 3 radiologists. Data recorded included the transverse cardiac, thoracic diameter and the cardiothoracic ratios. Descriptive analyses were carried out using the Microsoft excel 2010. RESULTS: The mean age and standard deviation for the study population was 35.1 ± 12.7. The mean and standard deviations for the transverse cardiac diameter, thoracic diameter, and the cardiothoracic ratios for male participants were 13.08cm ± 1.2, 29.7cm ± 2.7 and 46.6% ± 3.9; and 12.9 cm ± 1.3, 27.1 cm ± 2.6, and 47.8% ± 4.8 for females. An increase in TCD of 1cm resulted in a CTR of greater than 50.0% in all but the males aged 21-40 years. CONCLUSION: The study found that the same TCD and CTR values are not suitable in detecting cardiomegaly for all age groups and genders.

Radiologic evaluation of orbital index among Ghanaians using CT scan.

BACKGROUND: Orbital index (OI) expresses the proportion of the orbital height to the orbital width and varies with race, regions within the same race and periods in evolution. This index is useful in forensic medicine, anthropology and surgery. However, the average OI among Ghanaian adults was unknown. AIM: The aim of this study was to determine the orbital index of adult Ghanaians and classify them under one of the three predetermined groups. METHOD: The study design was a retrospective cross-sectional. A systematic random sampling method was used for selecting 350 adult Ghanaian head computed tomography images available from 1 January to 31 December 2015 at KBTH Hospital. The orbital height and orbital width of each orbit were measured on a 3D CT skull. Data was analysed using Microsoft Excel and Statistical Package for Social Sciences version 20. RESULTS: The study had more females than men (167, 47.71%, vs 183, 52.29%). The observed orbital index of Ghanaians in the study was 81.22 ± 4.22. The mean orbital index was 80.52 ± 4.66 in males and 82.15 ± 3.83 in females with their difference being statistically significant (p value <0.05). This placed both genders in the Microseme category of orbit. There was no significant difference between the orbital index of the two orbital sides (left and right orbits). CONCLUSION: The study found Ghanaians in the category of the Microseme and also indicated a strong sexual dimorphism. The outcome of this study may be useful in forensic medicine for skull classification and also for better surgical approach in neurosurgery as well as cosmetic surgery.

Congenital transpositions of stomach and spleens with partial pyloric stenosis.

The occurrence of chromosomal aberrations resulting in congenital transposition of internal organs is rare. Isolated congenital stomach and spleen (multiple) transposition with partial pyloric stenosis, where the rest of the internal organs remain in their normal positions, to the best of our knowledge has not been reported before. Attention to, knowledge and records of this case should be considered vital for understanding future symptoms and occurrences and also for prevention of surgical mistakes.