Forensic radiography services: The experiences of radiographers and forensic pathologists in Nigeria.

INTRODUCTION: Radiographers can play an essential role within forensic teams and contribute by producing high quality images. There are several aspects of forensic imaging, these commonly include but are not limited to imaging as part of post-mortem investigations, evaluation of non-accidental injuries and the identification of the presence of illicit drugs. In some countries radiographers perform post-mortem imaging before conventional autopsy, a practice that needs to be advanced in less developed countries. In this study, we explored experiences, attitudes and knowledge of radiographers' and forensic pathologists' in delivering forensic radiography services in Nigeria. METHOD: A qualitative exploratory descriptive study was undertaken. Three focus group interviews were conducted with 14 radiographers and five forensic pathologists. Participants were recruited through purposive sampling from two government owned tertiary hospitals in Lagos-State, Nigeria. Focus groups were audio recorded and lasted approximately 1 h. Data were thematically analysed and managed using the Atlas Ti computer software. RESULTS: Forensic pathologists and radiographers perceived forensic radiography differently. Radiographers reported a reluctance to take images of deceased people and were generally not aware of medicolegal issues involved in performing forensic examinations. Three themes emerged in the study, namely participants' experiences in forensic radiography, participants' knowledge of forensic radiography principles and guidelines, and participants' attitude towards forensic radiography services. CONCLUSION: Improving forensic radiography services is likely to require development of postgraduate curricula in forensic radiography and a fellowship curriculum in radiography for forensic pathologists. IMPLICATION FOR PRACTICE: This paper argues that, for radiographers to produce high quality diagnostic images that can assist the forensic team in medico-legal investigations subspecialisation in the field of forensic radiography would be advantageous.

Relationship between Sonographic Placental Thickness and Gestational Age in Normal Singleton Fetuses in Enugu, Southeast Nigeria.

BACKGROUND: The accuracy of common ultrasound parameters for the estimation of gestational age (GA) decreases as pregnancy advances in age. Hence, there is need to explore other parameters that may complement the established fetal biometric parameters in predicting GA in late pregnancy. AIM: The aim of this study is to determine the relationship between the sonographic placental thickness (PT) and GA in the second and third trimesters. SUBJECTS AND METHODS: A cross-sectional study of 627 normal pregnant women with GA between 14 and 40 weeks was conducted at the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu from May 2013 to February 2014 by sonography. Anteroposterior diameter of the placenta was measured at the level of the umbilical cord insertion. The last menstrual period of the women, femur length, biparietal diameter, head circumference, and abdominal circumference of the fetus were measured for GA estimation. Descriptive statistics, regression analysis, and independent sample t-test were used in statistical analysis. RESULTS: Mean PT was 23.2 (2.8) mm in the second trimester and 36.1 (3.6) mm in the third trimester. There was a significant difference between the values in the present study and values from similar studies in other populations (P < 0.04). There was a strong relationship between GA and PT and the following mathematical relationships for the second and third trimesters were obtained in the GA = 0.982 (PT) + 3.614 and GA = 0.977 (PT) + 3.354, respectively. CONCLUSION: Population-specific charts for PT may be used to estimate GA in the second and third trimesters.

Prediction of Normal Ovulation by Sonographic Folliculometry Involving Natural Cycles among Women in Ojo, Southwest Nigeria.

BACKGROUND: Accurate prediction of ovulation is important in the management of female infertility. AIM: To determine the sonographic sensitivity of reduction in follicular size and disappearance of ovarian follicle as predictors of imminent ovulation. METHODS: This was a longitudinal study involving 100 women between the ages of 18 and 35 years. Transvaginal sonography with 6.5 MHz probe frequency was performed with a General Electric (RT 2800) ultrasound machine. Dominant follicles were identified and measured in both the longitudinal and transverse planes and their disappearance was monitored prior to ovulation. Laboratory luteinizing hormone test strips were used to test serum samples collected daily from each patient to confirm the time of ovulation. RESULTS: Pre-ovulation follicular size among the subjects was in the range of 18-36 mm while the mean follicular size was 26.78 ± 4.03 mm. Prior to ovulation, disappearance and reduction in follicular size was noted in 59% and 41% of subjects, respectively. Luteinizing hormone test was also positive and peaked prior to ovulation in 92% of the subjects among whom follicles disappeared in 37% while their size reduced in 55%. There was no statistically significant difference between sonographic and laboratory findings (p > 0.05). Age, height, weight and body mass index do not have significant influence (p > 0.05) on follicular size and ovulation. CONCLUSION: Sonographic observation of complete disappearance of a dominant follicle and reduction in follicular size of surrogate follicles after follicular rupture appeared to be a reliable predictor of imminent ovulation.

Sonographic Biometry of Fetal Interorbital Distance as a Predictor of Gestational Age in Enugu, Southeast Nigeria.

OBJECTIVE: The objective of this study was to develop a sonographic technique for the measurement of fetal interorbital distance (IOD) for gestational age (GA) determination and to establish a normogram of IOD for the local population. METHODS: The fronto-transverse sonographic technique was established as a feasible and reproducible technique for IOD measurement. Two independent and experienced sonographers tested the technique and had a coefficient of variation of 17.64% and 19.72%, respectively, which is statistically insignificant. The established technique was used to measure the IOD of 320 fetuses from the 13th week to 40th week GA, while standard technique was used to measure biparietal diameter (BPD), head circumference (HC) and femur length (FL) of the fetuses. The data obtained were used to determine the regression equation GA = 6.24 + 4.89 IOD for the prediction of the gestational age. RESULTS: There was good correlation between IOD, BPD, HC and FL. The predicted normogram of IOD was compared with normogram of the Caucasian population. The result showed that there was no statistical difference between them (p < 0.05). CONCLUSION: Results from the study suggest that the fronto-transverse technique is a feasible and reproducible technique for IOD measurement and the established normogram of IOD can be a veritable statistic for GA prediction in our locality.

Sonographic Biometry of Normal Kidney Dimensions among School-age Children in Nsukka, Southeast Nigeria.

BACKGROUND: Some kidney diseases are usually associated with changes in kidney size. OBJECTIVE: To determine sonographically the normal limits and percentile curves of the kidney dimensions according to age, gender and somatometric parameters among school-age children. METHODS: A prospective cross-sectional research design and convenience sampling method were utilized. Participants included 947 normal subjects (496 boys and 451 girls) aged 6-17 years old. The sonographic examination was performed on a Shenzhen DP-1100 machine with 3.5 MHz convex transducer. Longitudinal and transverse dimensions of the kidneys were obtained in coronal plane with the subject in the supine or left lateral decubitus position. RESULTS: The means of right and left kidney lengths in mm were 79.6 ± 8.1 and 81.6 ± 8.3, respectively while that of the right and left kidney widths in mm were 35.03 ± 3.6 and 35.09 ± 3.6, respectively. Dimensions of the kidneys were not statistically different in boys and girls (p > 0.05). There was a statistically significant difference between right and left kidney length (p < 0.05). Height correlated best with both kidney lengths. Thus the normal limits, prediction models and percentile curves of kidney lengths were established with respect to height. CONCLUSION: Sonographic determination of pathologic changes in the size of the kidneys necessitates knowing the normal ranges of its lengths especially with respect to height in school-age children.

Sonographic determination of spleen to left kidney ratio among Igbo school age children of south east Nigeria.

BACKGROUND: Clinical determination of mild splenomegaly is notoriously inaccurate. OBJECTIVES: To determine sonographically the spleen to left kidney ratio according to age and somatometric parameters among school age children in a tropical environment. METHODS: A cross sectional study and convenience sampling were done on 947 apparently healthy subjects (496 boys and 451 girls) aged 6-17 years at the University of Nigeria Medical Centre, Nsukka. The sonographic examination was performed on Shenzhen DP-1100 machine with 3.5 and 5 MHz convex transducers. Spleen and left kidney lengths were obtained using appropriate techniques. The weight and height of the subjects were obtained with the participants wearing light weight street clothes without shoes. RESULTS: Measurement of spleen and left kidney lengths were reliable within and between sonographers. The spleen and left kidney lengths were not statistically different in boys and girls (p > 0.05). The spleen to left kidney ratio according to age and somatometric parameters is constant at about 1.13 with 1.3 as the upper limit of normal in the studied population. CONCLUSION: Sonography can be used to detect mild splenomegaly if the spleen to left kidney ratio is greater than 1.3 in the absence of renal disease among school age children.

Sonographic biometry of spleen among school age children in Nsukka, Southeast, Nigeria.

BACKGROUND: Normative value of spleen size among school age children is important for objective assessment of the spleen. OBJECTIVES: This study was aimed at determining sonographically the normal limits of the spleen size according to age, sex, and somatometric parameters among school age children. METHODS: A cross sectional study was done on 947 apparently healthy subjects (496 boys and 451 girls) aged 6 - 17 years. The subjects were recruited from some primary and secondary schools within Nsukka metropolis and also from out patients in the study centre. A pilot study was done to determine the intra- and inter rater reliability of sonographic measurements of the spleen. The sonographic examination was performed on Shenzhen DP-1100 machine with 3.5 and 5 MHz convex transducers. Spleen sizes were obtained with the subject in a right lateral decubitus position. RESULTS: Measurement of spleen length was reliable while measurement of spleen width was less reliable within and between sonographers. Dimensions of the spleen were not statistically different in boys and girls (p > 0.05). Height correlated best with spleen dimensions. CONCLUSIONS: Normogram of the spleen size with respect to height is important in the determination of some pathology associated with changes in its size.

Sonographic assessment of pregnancy co-existing with uterine leiomyoma in Owerri, Nigeria.

BACKGROUND: Uterine myomas co-existing with pregnancy could cause obstetric complications. OBJECTIVES: To assess sonographically the frequency of occurrence and effect of uterine myomas co-existing with pregnancy. METHODS: A longitudinal study was conducted during a period of 23 months. A convenience sample of 816 consecutive consenting pregnant women who met the inclusion criteria was evaluated during routine prenatal ultrasound scan. The women were referred for prenatal sonography. One hundred of the subjects who had myoma co-existing with pregnancy and another 100 subjects without myoma were selected for follow-up. These groups were followed up till delivery and obstetric complications and outcomes were documented. Any changes in size and growth rate of myoma were documented. RESULTS: Subjects with myoma co-existing with pregnancy were 12.3%. This was commoner with increasing maternal age. An increase was observed in myoma mean size from 60mm to 63mm from the 1(st) scan sequence to the 2(nd) scan sequence and a reduction from 63mm to 59mm in the 3(rd) scan sequence. Myoma growth rate was 0.667mm per week. Myomas in pregnancy especially large ones caused more complications during delivery when compared to pregnancies without myomas. CONCLUSION: Routine sonography is important in pregnancy management of uterine myomas co-existing with pregnancy.

Analysis of film reject rate in the diagnostic x-ray facility of a tertiary health institution in Benin, Nigeria.

BACKGROUND: Film rejects analysis (FRA) as part of quality assurance tests in radiography services, is carried out periodically to identify causes of film rejection and to proffer solutions to ameliorate such problems. OBJECTIVE: The study was carried out to estimate film rejection rate in a tertiary health facility in Benin, Nigeria and also to identify causes of film rejection in the centre. METHODS: This prospective study was carried out within 6 months. Ethical approval was obtained from the local committee on research and ethics before the study commenced. Only routine x-ray procedures were included in the study. Four x-ray rooms and four radiographers with equal training and job experience were selected for the study. Different boxes labeled for each room were used to daily collect rejected films. RESULTS: Overall rejection rate was 6.7%. Improper exposure caused the highest rate of repeats (> 12% in the old x-ray rooms). Highest rejection rates (31%) were found in the old x-ray rooms. Paranasal sinuses examination accounted for highest rejection rate (25%) among all routine x-ray investigations considered. CONCLUSION: Rejection rate found was within recommended limits.Obsolete but poorly maintained x-machines layed major roles in overall film rejection rate in the centre. X ray of paranasal sinuses was challenging to radiographers observed. Radiographers should embrace CPD while obsolete x-ray equipments found in the centre should be scrapped to further reduce film reject rate in the centre.

Observer Variability in Sonographic Measurement of Kidney Sizes among Children in Benin-City, Nigeria.

AIM: To assess the level of inconsistency in replicating sonographic kidney size measurements in a population of healthy Nigerian children. SUBJECTS AND METHODS: In this prospective cross-sectional study, convenience sampling technique was used to select a sample of Nigerian children. Both consent from participants and ethical approval from the local authority were obtained before the study commenced. Three radiologists carried out the replicate sonographic measurements using a DP-1100 mechanical sector scanner with a 3.5 MHz convex probe. All examinations were done with subjects in the supine oblique position. Longitudinal and transverse scans were performed. Renal lengths and widths were measured from the longitudinal scans while thickness was measured from the transverse scans. Renal volumes were calculated with the ellipsoid formula. Analysis of variance, Student's t-test, Pearson's correlation coefficient and z-test were used to test the statistical significance of results. SPSS version 17.0 was used in the analysis of results while statistical significance of all results was tested at p < 0.05. RESULTS: Mean intra-observer measurement errors in replicate sonographic measurements of kidney sizes ranged from 0.36-0.43 cm, 0.22-0.63 cm, 0.37-0.52 cm and 5.93-9.62 ml for kidney length, width, thickness and volume, respectively. Mean inter-observer measurement errors were in the range of 0.29-0.48 cm, 0.18-0.23 cm, 0.34-1.82 cm and 5.92-7.28 ml for length, width, thickness and volume, respectively. Mean intra-observer errors were not statistically significant (p < 0.05) but mean inter-observer errors were (p < 0.05). Differences in all measurement errors of right and left kidney length, width, thickness and volume were not statistically significant (p > 0.05). Measurement errors correlated weakly with kidney sizes. Observer errors in renal length were not significantly different from what was reported among Caucasians (p > 0.05) whereas that of volume was (p < 0.05). CONCLUSION: Errors in replicate sonographic kidney size measurements obtained by a single observer were less than errors in the same measurements by different observers; therefore, replicate sonographic measurements by a single observer were more consistent in this population.

An audit of ultrasonography performed and reported by trainee radiologists.

BACKGROUND: Proforma information, instructions and procedures of training in radiology are lacking in Nigeria. OBJECTIVE: To describe the errors in ultrasonography performed by unsupervised trainee radiologists. METHODS: The radiology records of all ultrasound scans (USS) carried out and all reports that came back to the unit of the authors on account of misdiagnosis, doubtful diagnosis, misinformation or error in the reports were studied. The patients with the returned reports were rescanned where available by consultants and the collected data analysed. RESULTS: A total of 4680 patients had ultrasound studies without supervision resulting in 605 (12.93%) queried reports. The USS scans of 235 (5.02%) patients were repeated with consultants in attendance resulting in significant change in reports of 95 (2.03%) patients. Analysis of the request cards of 605 queried reports showed omission of relevant clinical information 463 (76.53%), outright wrong information 65 (10.73%),and unconventional abbreviations 139 (22.98%), while 493 (81.49%) were completed by a nurse, medical student or junior resident. Typographical errors comprised 174 (28.76%) of the 605 queried reports. False negative error was the highest type of error seen in 55 (57.89%) of the 95 patients with significant change in their report after repeat scan as lesions not detected were not documented. CONCLUSION: Trainee radiologists make significant errors in carrying out and reporting ultrasonography without adequate direct supervision of the study by their training consultants. Majority of the errors originate from lack of accurate filling of the patients request cards by the requesting physicians, lack of adequate preparation for the intended study, and typographical errors in writing reports. False negative reports are by far the greatest cause of errors recorded as lesions not detected were not documented.

Isolated dextrogastria: a case report.

BACKGROUND: Isolated dextrogastria is a rare congenital anomaly in which the stomach is right-sided while the intestines, the organs in the chest, and the other organs in the abdomen are in normal situs. The importance of recognising the spectrum of situs anomalies is because the altered anatomy associated with these anomalies may result in misdiagnosis. OBJECTIVE: To report a case of isolated dextrogastria in an 18-year old woman who was seen during pre-university admission medical examination. METHODS: The routine chest X-ray of a young woman as a part of pre-admission medical examination showed the gastric air bubble under the right diaphragm rather than on the left. She was then subjected to further clinical and radiological evaluation. FINDINGS: The personal, past and family histories were uneventful as was the physical examination. Trans-abdominal ultrasonography showed a normal-sized and a normally sited liver in the right hypochondrium with normal gall bladder, and normally sited left and right lobes of the liver. The liver echo pattern was normal. The stomach was found below the lower border of the right lobe of the liver. The kidneys and the spleen were normal in number, position, size and architectural pattern. A barium meal showed a well-defined and a well developed stomach with a reverse J shape and duodenal C loop that was reversed in shape. CONCLUSION: The practice of the radiographer is always placing the marker before exposing the film instead of marking the radiograph after processing, which is the key to accurate identification of situs anomalies need emphasis.

Radiation protection practices of staff during extra-corporeal shock wave lithotripsy at Okada, Nigeria.

BACKGROUND: The study was designed to find out the radiation protection practices of radiologists and other staff involved in the first extra-corporeal shock wave lithotripsy in Nigeria, performed at Igbinedion Hospital and Medical Research Centre, Okada. METHODOLOGY: Some members of staff who were present when the extra-corporeal shock wave lithotripsy (ESWL) was used in the hospital at Okada were interviewed between November 2002 and August 2003. Radiology records of the hospital were studied. Literature search involved available publication on the procedure in local and international journals with interest in precautions to reducing radiation exposure. RESULTS: Only lead apron and lead gloves were used by the radiologists for radiation protection and shielding during fluoroscopy procedures. The fluoroscopy was the screen type with TV monitor. Multiple sessions were used in several patients with multiple pre- and post- treatment radiographic studies including contrast studies with average of two sessions per patient. All the patients were adults aged between 26 and 65 years with mean age of 42.5 years. 627-6000 shock waves were delivered over 45-135 minutes at intensity of 143-19KV depending on patients build and the size of the stones. The sizes of the patients varied from very obese with large bulk to slim built. Radiation monitoring of the staff and patients was not done. Staff believed that radiation effect from the lithotripsy procedure was low therefore adequate radiation monitoring and radiation reducing alteration in the procedure was rarely adopted. CONCLUSION: Extended fluoroscopy time, multiple fluoroscopy examinations, multiple treatment sessions and multiple x-ray examinations which increased both the patients' and staff's radiation exposures were noted. Proper radiation protection and monitoring of patients and staff are necessary to avoid the risks from low-level exposure to radiation such as in ESWL.

Computed tomography study of complicated bacterial meningitis.

OBJECTIVE: To monitor the structural intracranial complications of bacterial meningitis using computed tomography (CT) scan. DESIGN: Retrospective study of medical and radiological records of patients who underwent CT scan over a 4 year period. SETTING: A University Teaching Hospital in a developing country. SUBJECTS: Thirty-three patients with clinically and laboratory-proven cases of bacterial meningitis who had clinical features of central nervous system complication of the disease. OUTCOME MEASURES: Only patients with available complete records were studied with material obtained from the medical records and radiology departments of the hospital. RESULTS: Persistent headache (30.3%), persistent fever (18.18%), seizures (15.5%) and torticollis (12.12%) were the most common presenting features that necessitated the request for CT scan. Communicating hydrocephalus (36.36%), cerebral abscess (12.12%), multiple areas of cerebral infarction (12.12%) and subdural empyema (9.09%) were the most common CT scan findings. The complications were more common in children aged less than 15 years. CONCLUSIONS: Computed Tomography is an accurate and useful means of diagnosing intracranial complications of bacterial meningitis. Early and effective diagnosis of treatable lesions such as hydrocephalus, cerebral abscess and subdural empyema will help improve prognosis of the patients. There appears to be no alternative to prevention, adequate and early treatment of this condition to reduce its long-term neurological sequelae.

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

Radiation Protection Practices of Staff During Extra-Corporeal Shock Wave Lithotripsy at Okada, Nigeria

Background: The study was designed to find out the radiation protection practices of radiologists and other staff involved in the first extra-corporeal shock wave lithotripsy in Nigeria, performed at Igbinedion Hospital and Medical Research Centre, Okada. Methodology: Some members of staff who were present when the extra-corporeal shock wave lithotripsy (ESWL) was used in the hospital at Okada were interviewed between November 2002 and August 2003. Radiology records of the hospital were studied. Literature search involved available publication on the procedure in local and international journals with interest in precautions to reducing radiation exposure. Results: Only lead apron and lead gloves were used by the radiologists for radiation protection and shielding during fluoroscopy procedures. The fluoroscopy was the screen type with TV monitor. Multiple sessions were used in several patients with multiple pre- and post- treatment radiographic studies including contrast studies with average of two sessions per patient. All the patients were adults aged between 26 and 65 years with mean age of 42.5 years. 627-6000 shock waves were delivered over 45-135 minutes at intensity of 143-19KV depending on patients build and the size of the stones. The sizes of the patients varied from very obese with large bulk to slim built. Radiation monitoring of the staff and patients was not done. Staff believed that radiation effect from the lithotripsy procedure was low therefore adequate radiation monitoring and radiation reducing alteration in the procedure was rarely adopted. Conclusion: Extended fluoroscopy time, multiple fluoroscopy examinations, multiple treatment sessions and multiple x-ray examinations which increased both the patients/' and staff/'s radiation exposures were noted. Proper radiation protection and monitoring of patients and staff are necessary to avoid the risks from low-level exposure to radiation such as in ESWL

Relationship between sonographic renal length and renal parenchymal thickness in normal adult southeast Nigerians.

AIM: To determine the relationship between sonographic renal parenchymal thickness (RPT) and renal length (RL) in normal adult Nigerian. STUDY DESIGN: The RL and RPT of 309 normal subjects within the age range of 18-80 years were measured sonographically and prospectively. Correlation was performed between RL values and RPT usingPearson Linear 'r' test RESULTS: The range of RL value were 8.5-12.9 cm and the corresponding mean were 10.33 +/- 0.7 cm and 10.45 +/- 0.63 cm for the right and left kidneys respectively. The range of values for the RPT was 1.40-2.4 and the corresponding mean values were 1.91 +/- 0.20 cm and 1.95 +/- 0.19 cm for the right and left kidneys respectively. There was a strong positive correlation between RPT and RL (r = 0.72 and 0.77 for the right and left kidney respectively. However for RL values above 11.0 cm the RPT values fluctuated. CONCLUSION: From this study, for RL above 11.0 cm there was no relationship with RPT. The study suggests that for our population groups, kidneys with RL lower than 8.5 cm and RPT of 1.40 cm or less should not be biopsied in contrast to webb's criteria.

Estimation of radiation dose during diagnostic X-ray examinations of newborn babies and 1-year-old infants.

OBJECTIVE: It was the aim of this study to investigate radiation doses for commonly performed paediatric X-ray examinations (skull, chest, abdomen and pelvis) in public hospitals in Kuwait in order to establish national reference or guidance dose levels. MATERIALS AND METHOD: Exposure factors used for six commonly performed X-ray examinations - antero-posterior (AP) chest, lateral chest, AP abdomen, AP skull, lateral skull and AP pel vis - were obtained from various hospitals, and entrance surface doses (ESD) were measured using a Victoreen model 660 survey meter. Effective doses (E) and the corresponding risk of developing fatal malignancies were calculated using published conversion factors and methods recommended by the International Commission of Radiological Protection for newborn babies to 1-year-old infants. RESULTS: The range of ESD values was 26- 668 microGy for newborn babies and 40-700 microGy for 1-year- old infants. The range of E values was about 4-150 microSv for the two age groups. The risk of developing long-term stochastic effects due to radiation exposure ranges between 0.6 and 23.4 per million. CONCLUSION: The range of ESD values, E values and risk of development of fatal malignancies obtained in this study can be used as a guide for the risk-benefit analysis of an X-ray examination for newborn babies and 1-year-old infants. Tube voltages used for these examinations should be kept above 60 kV, whenever possible, to minimise the radiation dose.

Relationship between sonographic renal length and renal parenchymal thickness in normal adult southeast Nigerians

Aim: To determine the relationship between sonographic renal parenchymal thickness (RPT) and renal length (RL) in normal adult Nigerian. Study design: The RL and RPT of 309 normal subjects within the age range of 18 - 80years were measured sonographically and prospectively. Correlation was performed between RL values and RPT using Pearson Linear `r' test Results: The range of RL value were 8.5-12.9cm and the corresponding mean were 10.33+ 0.7cm and 10.45+ 0.63cm for the right and left kidneys respectively. The range of values for the RPT was 1.40 - 2.4 and the corresponding mean values were 1.91+ 0.20cm and 1.95+ 0.19cm for the right and left kidneys respectively. There was a strong positive correlation between RPT and RL (r = 0.72 and 0.77 for the right and left kidney respectively. However for RL values above 11.0cm the RPT values fluctuated. Conclusion: From this study; for RL above 11.0cm there was no relationship with RPT. The study suggests that for our population groups; kidneys with RL lower than 8.5cm and RPT of 1.40cm or less should not be biopsied in contrast to webb's criteria

Survey of patient satisfaction with obstetric ultrasound service at University of Nigeria Teaching Hospital; Enugu; Nigeria

A semi-structured questionnaire study of 326 randomly selected pregnant women referred for ultrasound examination at the ultrasound Laboratory of University of Nigeria Teaching Hospital (UNTH); Enugu was undertaken. The main objectives of this survey included assessment of women's perception and satisfaction with obstetric ultrasound service at UNTH; Enugu and to reflect on our practice. Questions were asked about gestational age; reasons for the scan; information provided before and during the scan; the women's expectations when attending for the scan; their waiting time; their opinion regarding the scan service and suggestions to improve services. Results showed that majority of the patients (66; N = 215) were not given adequate in formation required to make a knowledgeable decision about their scan. Large number of the women (67.5; N = 220) waited for a long time (1-4 hours) before their scan. About half of the respondents (53; N = 173) were satisfied with the way the result of the scan was communicated to them. Results suggest that full implementation of informed consent; reduced waiting time; better communication; explanation and counseling of scan findings to patients would improve the quality of our obstetric ultrasound service