Establishment and utilisation of national diagnostic reference level for adult computed tomography examinations in Ghana.

The International Atomic Energy Agency, as part of the new regional project (RAF/9/059), recommend the establishment of diagnostic reference levels (DRLs) in Africa. In response to this recommendation, this project was designed to establish and utilise national DRLs of routine computed tomography (CT) examinations. These were done by estimating CT dose index and dose length product (DLP) from a minimum of 20 patient dose report of the most frequently used procedures using 75th percentile distribution of the median values. In all, 22 centres that formed 54% of all CT equipment in the country took part in this study. Additionally, a total of 2156 adult patients dose report were randomly selected, with a percentage distribution of 60, 12, 21 and 7% for head, chest, abdomen-pelvis and lumber spine, respectively. The established DRL for volume CT dose index were 60.0, 15.7, 20.5 and 23.8 mGy for head, chest, abdomen-pelvis and lumber spine, respectively. While the established DRL for DLP were 962.9, 1102.8, 1393.5 and 824.6 mGy-cm for head, chest, abdomen-pelvis, and lumber spine, respectively. These preliminary results were comparable with data from 16 other African countries, European Commission and the International Commission on Radiological Protection. Hence, this study would serve as a baseline for the establishment of a more generalised regional and national adult DRLs for Africa and other developing countries.

Assessment of the Impact of Turbo Factor on Image Quality and Tissue Volumetrics in Brain Magnetic Resonance Imaging Using the Three-Dimensional T1-Weighted (3D T1W) Sequence.

Background: The 3D T1W turbo field echo sequence is a standard imaging method for acquiring high-contrast images of the brain. However, the contrast-to-noise ratio (CNR) can be affected by the turbo factor, which could affect the delineation and segmentation of various structures in the brain and may consequently lead to misdiagnosis. This study is aimed at evaluating the effect of the turbo factor on image quality and volumetric measurement reproducibility in brain magnetic resonance imaging (MRI). Methods: Brain images of five healthy volunteers with no history of neurological diseases were acquired on a 1.5 T MRI scanner with varying turbo factors of 50, 100, 150, 200, and 225. The images were processed and analyzed with FreeSurfer. The influence of the TFE factor on image quality and reproducibility of brain volume measurements was investigated. Image quality metrics assessed included the signal-to-noise ratio (SNR) of white matter (WM), CNR between gray matter/white matter (GM/WM) and gray matter/cerebrospinal fluid (GM/CSF), and Euler number (EN). Moreover, structural brain volume measurements of WM, GM, and CSF were conducted. Results: Turbo factor 200 produced the best SNR (median = 17.01) and GM/WM CNR (median = 2.29), but turbo factor 100 offered the most reproducible SNR (IQR = 2.72) and GM/WM CNR (IQR = 0.14). Turbo factor 50 had the worst and the least reproducible SNR, whereas turbo factor 225 had the worst and the least reproducible GM/WM CNR. Turbo factor 200 again had the best GM/CSF CNR but offered the least reproducible GM/CSF CNR. Turbo factor 225 had the best performance on EN (-21), while turbo factor 200 was next to the most reproducible turbo factor on EN (11). The results showed that turbo factor 200 had the least data acquisition time, in addition to superior performance on SNR, GM/WM CNR, GM/CSF CNR, and good reproducibility characteristics on EN. Both image quality metrics and volumetric measurements did not vary significantly (p > 0.05) with the range of turbo factors used in the study by one-way ANOVA analysis. Conclusion: Since no significant differences were observed in the performance of the turbo factors in terms of image quality and volume of brain structure, turbo factor 200 with a 74% acquisition time reduction was found to be optimal for brain MR imaging at 1.5 T.

Africa's readiness for artificial intelligence in clinical radiotherapy delivery: Medical physicists to lead the way.

BACKGROUND: There have been several proposals by researchers for the introduction of Artificial Intelligence (AI) technology due to its promising role in radiotherapy practice. However, prior to the introduction of the technology, there are certain general recommendations that must be achieved. Also, the current challenges of AI must be addressed. In this review, we assess how Africa is prepared for the integration of AI technology into radiotherapy service delivery. METHODS: To assess the readiness of Africa for integration of AI in radiotherapy services delivery, a narrative review of the available literature from PubMed, Science Direct, Google Scholar, and Scopus was conducted in the English language using search terms such as Artificial Intelligence, Radiotherapy in Africa, Machine Learning, Deep Learning, and Quality Assurance. RESULTS: We identified a number of issues that could limit the successful integration of AI technology into radiotherapy practice. The major issues include insufficient data for training and validation of AI models, lack of educational curriculum for AI radiotherapy-related courses, no/limited AI teaching professionals, funding, and lack of AI technology and resources. Solutions identified to facilitate smooth implementation of the technology into radiotherapy practices within the region include: creating an accessible national data bank, integrating AI radiotherapy training programs into Africa's educational curriculum, investing in AI technology and resources such as electronic health records and cloud storage, and creation of legal laws and policies to support the use of the technology. These identified solutions need to be implemented on the background of creating awareness among health workers within the radiotherapy space. CONCLUSION: The challenges identified in this review are common among all the geographical regions in the African continent. Therefore, all institutions offering radiotherapy education and training programs, management of the medical centers for radiotherapy and oncology, national and regional professional bodies for medical physics, ministries of health, governments, and relevant stakeholders must take keen interest and work together to achieve this goal.

Patient skin dose measurement and risk of deterministic effect during fluoroscopy cardiac procedures.

This study aimed at assessing patient's peak skin doses (PSD) during fluoroscopy cardiac procedures and proposed a look up table to enhance patient's dose management. Perspex phantom and thermoluminescent dosemeters (TLD) were irradiated for different dose levels with X-ray equipment (Philips Azurion 7). It was found that PSD measures were higher than the kerma at the interventional reference point [K (IRP)] reported with factors 1.55, 1.75 and 2.88 for anterior posterior (AP0o), left anterior oblique (LAO45o) and right anterior oblique (RAO45o), respectively. The equations describing the correlation between the PSD measured kerma area product and cumulative air kerma were found with R-square values of 0.98 and 0.99, respectively. The statistical analysis shows a strong linear correlation between PSD and K (IRP) (P-value = 0.05). It was also found that 27% of the patients population considered in this work, received a skin dose higher than the threshold of deterministic effect of 2 Gy and a look up table with the equation of fitness were proposed to be implemented in the facility for K (IRP) higher than 500 mGy.

Estimation of organ-specific cancer and mortality risks associated with common indication-specific CT examinations of the abdominopelvic region.

INTRODUCTION: There is a paucity of large-scale studies reporting organ doses and cancer risks in patients who undergo indication-specific CT examinations. This study estimated organ-specific lifetime attributable risk (LAR) of cancer incidence and mortality among patients who underwent indication-based computed tomography (CT) examinations [(involving abdominopelvic lesion, kidney stones and computed tomography-intravenous urography (CT-IVU)] in about 70% of the functioning CT facilities in Ghana. METHODS: With a total of 1,100 data sets, organ doses were first determined using the National Cancer Institute Dosimetry System for CT (NCICTX) software version 2.1, and LAR values were predicted using the BEIR VII model. RESULTS: The estimated radiation-induced colon cancer risks were likely in 39.4-59.8 out of 100,000 patients who underwent CT because of abdominopelvic lesion. The risk was even higher in CT-IVU examinations (53.3-66.4 patients in 100,000 procedures) but was relatively less (16.8-26.3 patients) in kidney stone procedures. Accordingly, the risk of radiation-induced colon mortality was more common in CT-IVU than in kidney stone procedures (22.7-28.2 versus 7.2-12.5 patients in 100,000 procedures). CONCLUSION: These results call for further optimisation actions for indication-specific CT examinations to appropriately reduce the potential risk levels for patients' protection and safety.

A review of MRI studies in Africa with special focus on quantitative MRI: Historical development, current status and the role of medical physicists.

This scoping review provides overview on the historical and major developments, current status, quantitative magnetic resonance (MR) studies and the role of medical physics bodies in MR imaging in Africa. The study analyzed MRI availability in 32 (59 %) of the 54 African countries. South Africa and Egypt have the most dominant MR systems. Number of MR systems in the 4 northern countries (Egypt, Morocco, Algeria and Libya) alone constitute 53 % of the total number of machines in the studied countries. Less than one-third of the countries have 1 MR system serving less than a million population. Libya recorded the most MR systems per million population. The studied countries altogether have an average of 1 machine per million population. The private sector far dominates number of installed MR systems across the region, making up two-thirds of the distribution. A major challenge was revealed where less than 3 % of Medical Physicists in the studied countries are engaged in MRI facilities. Review of MRI published studies in the last 5 years indicates dominance of literature on brain studies and most of such published works coming from Nigeria. Only 7 out of 27 published studies reviewed were quantitative. The African region has no dedicated MRI physics societies; however, the regional medical physics body and national associations have big roles to play in developing MRI through education, research, training and leveraging on awareness creation. Thisreview is the first of such wide scale study on MRI availability and quantitative studies in the African region.

ESTABLISHMENT OF REGIONAL DIAGNOSTIC REFERENCE LEVELS IN ADULT COMPUTED TOMOGRAPHY FOR FOUR AFRICAN COUNTRIES: A PRELIMINARY SURVEY.

This preliminary study aims towards the establishment of regional diagnostic reference levels (DRLs) for routine adult computed tomography (CT) examinations. The study was performed on 54 CT facilities from four African countries (Ghana, Kenya, Namibia and Senegal) and the results compared with international DRLs. Data were collected from facilities using a structured questionnaire provided by the International Atomic Energy Agency. Dose descriptors (volume computed tomography dose index [CTDIvol] and dose length product [DLP]) evaluations were performed on CT head and body phantoms for head, chest and abdomen CT examination protocols using standard methods. The estimated dose indices were compared with console-displayed dose values. Experienced radiologists accepted the diagnostic image quality of the images as per departmental imaging requirements. Median CTDIvol and DLP data from each facility were compiled to estimate the typical dose in each country. National DRLs were established based on the 75th percentile of median values, whereas the regional DRLs were based on the median of the national DRLs. Comparison of measured CTDIvol with console values of all facilities in all four countries was within 20% as recommended. The established CTDIvol DRLs for head CT, chest CT and abdomen CT were 60.9 mGy, 15.2 mGy and 15.7 mGy, respectively. Similarly, that of DLP, DRLs were 1259 mGy.cm, 544 mGy.cm and 737 mGy.cm, respectively for head CT, chest CT and abdomen CT. The established DRLs from this study were comparable to DRLs from other countries with some variations. This study would serve as baseline for establishment of a more generalized regional adult CT DRLs for Africa.

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.

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.

BENCHMARKING OF A NEW AUTOMATIC CT RADIATION DOSE CALCULATOR.

Information on patient radiation dose is essential to meet the radiation protection regulations and the demands of dose optimization. Vendors have developed different tools for patient dose assessment for radiological purposes. In this study, estimated effective doses derived from a new image-based software tool (DoseWatch, GE Healthcare) was benchmarked against the corresponding doses from a dose calculator (CT-Expo, SASCRAD) and a conversion coefficient method. Dose data from 150 adult patients (66 male and 84 female), who underwent CT head, abdominopelvic or chest examinations, were retrospectively collected using DoseWatch. Effective dose estimated by DoseWatch was significantly lower than that of CT-Expo and DLP-E (k) (p ≤ 0.001). For the organ doses, DoseWatch resulted in lower dose than CT-Expo for all the organs with the exception of testis (p ≤ 001) and eye lenses (p ≤ 0.026).

Status of Quality Management Systems in Computed Tomography Facilities in Ghana.

PURPOSE: To assess the status of quality management systems in computed tomography (CT) facilities in Ghana. METHODS: A questionnaire and quality control measurements were used to assess the status of quality management systems in CT facilities in Ghana. Thirty-one CT facilities took part in the study. The evaluation included quality assurance (QA), quality control (QC), and quality improvement (QI). RESULTS: Seventeen (54.8%) of the 31 CT facilities had a QA-QC committee in place to ensure patient protection. Fifteen facilities (48.4%) had documented protocols for CT scanning. Ten facilities (32.3%) lacked QC assessment and recordkeeping after notable repairs. Regular QC check records were available in 20 (64.5%) facilities. All scanners passed the QC assessments; however, none of the facilities had established local diagnostic reference levels. DISCUSSION: Quality management systems in some Ghanian CT facilities are unsatisfactory; not all facilities have the needed infrastructure in place for quality management system purposes. CONCLUSION: Quality management systems in Ghanaian CT facilities should be strengthened to optimize patient protection and safety with acceptable image quality.

An Investigation into the Infrastructure and Management of Computerized Tomography Units in Ghana.

INTRODUCTION: In Ghana, there is a need to document computed tomography (CT) infrastructure and management systems for the development of interventions to promote CT practices while ensuring patient protection through the establishment of diagnostic reference levels and improved dose management systems. METHODS: A quantitative inquiry using a descriptive, cross-sectional approach was used to collect data, using a semistructured questionnaire related to CT infrastructure and management from the technical heads responsible for CT scanners. Data collected included the scanner characteristics, basic management system and organizational arrangements, number of attending practitioners, clinical indications for CT examinations, and the operation of CT facilities in Ghana. RESULTS: Of the 35 CT scanners installed across the country, 31 were involved in the study. The majority (29%) were Toshiba models. Equipment slices ranged from 1 to 640, of which 45.2% were 16-slice scanners. Many (n = 28, 90.3%) were functioning, and most were installed in the capital city, Accra. The equipment mean age was 7.3 ± 4.4 years, and 25.6% were 10 or more years old. There were 107 operating radiographers, 60 reporting radiologists, and 10 medical physicists employed across the facilities. A total of 204,760 CT examinations were performed yearly (6.8 CT procedures per 1000 people in Ghana). Head CT procedures were the most common, and suspicion of cerebrovascular accident or stroke (32.8%) was the most common indication. Some basic quality management system and policy driving CT infrastructure in Ghana were lacking. CONCLUSION: The results have provided essential information on the status of CT infrastructure and management systems for policy development and planning in CT facilities in Ghana. This study provides those interested in CT services, jobs, or medical equipment investment in Ghana the information needed to make appropriate decisions.

PAEDIATRIC NECK MULTIDETECTOR COMPUTED TOMOGRAPHY: THE EFFECT OF BISMUTH SHIELDING ON THYROID DOSE AND IMAGE QUALITY.

This study investigated the effect of bismuth shielding on thyroid dose and image quality in paediatric neck multidetector computed tomography (MDCT) performed with fixed tube current (FTC) and automatic exposure control (AEC). Four paediatric anthropomorphic phantoms representing the equivalent newborn, 1-, 5- and 10-y-old child were subjected to neck CT using a 16-slice MDCT system. Each scan was performed without and with single- and double-layered bismuth shield placed on the skin surface above the thyroid. Scans were repeated with cotton spacers of 1, 2 and 3 cm thick placed between the skin and shield, to study the effect of skin-to-shielding distance on image noise. Thyroid dose was measured with thermoluminescent dosemeters. The location of the thyroid within the phantom slices was determined by anthropometric data from patients' CT examinations whose body stature closely matched the phantoms. Effective dose (E) was estimated using the dose-length product (DLP) method. Image quality of resulted CT images was assessed through the image noise. Activation of AEC was found to decrease the thyroid dose by 46 % to the 10-y-old phantom subjected to neck CT. When FTC technique is used, single- and double-layered bismuth shielding was found to reduce the thyroid dose to the same phantom by 35 and 47 %, respectively. The corresponding reductions in AEC-activated scans were 60 and 66 %, respectively. Elevation of shields by 1-, 2- and 3-cm cotton spacers decreased the image noise by 69, 87 and 92 %, respectively, for single-layered FTC, without considerably affecting the thyroid dose. AEC was more effective in thyroid dose reduction than in-plane bismuth shields. Application of cotton spacers had no significant impact on thyroid dose, but significantly decreased the image noise.

Medical physics practice and training in Ghana.

Medical physics has been an indispensable and strategic stakeholder in the delivery of radiological services to the healthcare system of Ghana. The practice has immensely supported radiation oncology and medical imaging facilities over the years, while the locally established training programme continues to produce human resource to feed these facilities. The training programme has grown to receive students from other African countries in addition to local students. Ghana has been recognised by the International Atomic Energy Agency as Regional Designated Centre for Academic Training of Medical Physicists in Africa. The Ghana Society for Medical Physics collaborates with the School of Nuclear and Allied Sciences of the University of Ghana to ensure that training offered to medical physicists meet international standards, making them clinically qualified. The Society has also worked together with other bodies for the passage of the Health Profession's Regulatory Bodies Act, giving legal backing to the practice of medical physics and other allied health professions in Ghana. The country has participated in a number of International Atomic Energy Agency's projects on medical physics and has benefited from its training courses, fellowships and workshops, as well as those of other agencies such as International Organization for Medical Physics. This has placed Ghana's medical physicists in good position to practice competently and improve healthcare.

Location of radiosensitive organs inside pediatric anthropomorphic phantoms: Data required for dosimetry.

PURPOSE: The aim of this study was to determine the location of radiosensitive organs in the interior of four pediatric anthropomorphic phantoms for dosimetric purposes. METHODS: Four pediatric anthropomorphic phantoms representing the average individual as newborn, 1-year-old, 5-year-old and 10-year-old child underwent head, thorax and abdomen CT scans. CT and MRI scans of all children aged 0-16 years performed during a 5-year-period in our hospital were reviewed, and 503 were found to be eligible for normal anatomy. Anterior-posterior and lateral dimensions of twelve of the above children closely matched that of the phantoms' head, thoracic and abdominal region in each four phantoms. The mid-sagittal and mid-coronal planes were drawn on selected matching axial images of patients and phantoms. Multiple points outlining large radiosensitive organs in patient images were identified at each slice level and their orthogonal distances from the mid-sagittal and mid-coronal planes were measured. In small organs, the coordinates of organs' centers were similarly determined. The outlines and centers of all radiosensitive organs were reproduced using the coordinates of each organ on corresponding phantoms' transverse images. RESULTS: The locations of the following radiosensitive organs in the interior of the four phantoms was determined: brain, eye lenses, salivary glands, thyroid, lungs, heart, thymus, esophagus, breasts, adrenals, liver, spleen, kidneys, stomach, gallbladder, small bowel, pancreas, colon, ovaries, bladder, prostate, uterus and rectum. CONCLUSIONS: The production of charts of radiosensitive organs inside pediatric anthropomorphic phantoms was feasible and may provide users reliable data for positioning of dosimeters during direct organ dose measurements.

Retrospective patient dose analysis of Ghana's first direct digital radiography system.

The log file generated in the flat panel detector of a direct digital x-ray machine (General Electric, Haulun Medical Systems, Serial Number 8M0392) after x-ray exposure was used to acquire data regarding the entrance surface air kerma (ESAK) for some routine x-ray examinations. The data were collected for a minimum of 10 standard adult patients undergoing each examination considered. The mean ESAK were found to be 0.25, 0.33, 0.14, 7.33, 9.76, 7.38, and 6.86 mGy for skull AP and LAT, chest AP, lumbar spine AP and LAT, pelvis AP and abdomen AP series, respectively. The mean ESAK values recorded from this study show wide variations but were below diagnostic reference levels (DRLs) of the Commission of European Communities and also compare with other recommendations. The comparisons of this study's dose levels with DRLs were undertaken as an approach to dose optimization. The study revealed that a dose audit of digital radiography systems is necessary because of the potential high doses one is likely to receive. Continuous dose evaluation in digital radiography is therefore encouraged in order to optimize doses to patients.

Cancer incidence risks to patients due to hysterosalpingography.

Cancer incidence estimates and dosimetry of 120 patients undergoing hysterosalpingography (HSG) without screening at five rural hospitals and with screening using image intensifier-TV at an urban hospital have been studied. Free in air kerma measurements were taken for patient dosimetry. Using PCXMC version 1.5, organ and effective doses to patients were estimated. Incidence of cancer of the ovary, colon, bladder and uterus due to radiation exposure were estimated using biological effects of ionising radiation committee VII excess relative risk models. The effective dose to patients was estimated to be 0.20 ± 0.03 mSv and 0.06 ± 0.01 mSv for procedures with and without screening, respectively. The average number of exposures for both procedures, 2.5, and screening time of 48.1 s were recorded. Screening time contributed majority of the patient doses due to HSG; therefore, it should be optimised as much as possible. Of all the cancers considered, the incidence of cancer of the bladder for patients undergoing HSG procedures is more probable.

Systematic approach to training occupationally exposed workers in Ghana and the rest of Africa.

The International Basic Safety Standards requires that all personnel on whom protection and safety depends be trained and qualified. The Radiation Protection Institute of the Ghana Atomic Energy Commission has adopted a systematic approach to training those occupationally exposed to ionizing radiation in the course of their work. In collaboration with the International Atomic Energy Agency several training courses have been implemented at the national level and in the African region. From 1993 to 2008, more than 400 occupationally exposed workers in Ghana were trained on radiation safety. Several African regional training events on radiation safety have also been executed with a total participation number of 583 individuals. The training events have contributed towards upgrading the safety culture within institutions that have participated.