Evaluation of Iodinated Contrast Media Use in Abdominal CT Scans in Cancer Assessments: A Cross-Sectional Study in Lomé (Togo).

Background: There is great variability between centers regarding contrast injection protocols. They should only be injected if they can provide useful information for diagnosis with the necessary and sufficient quantity of iodine. We wanted to know through this study if the use of iodinated contrast media is optimised in abdominal CT scans performed for cancer assessment in Lomé. Materials and Methods: It was a cross-sectional, descriptive, and analytical study with a prospective collection over a period of 6 months in three CT units in Lomé. It involved abdominal CT scans performed for oncological evaluation. Data were reported as the mean ± standard deviation. The Pearson correlation coefficient, ANOVA, chi-square, and the Fisher test were used. Results: A total of 218 examinations were recorded. The female sex represented 56.88% of the patients. The mean age was 50.92 ± 15.78 years. The mean weight was 70.46 ± 15.23 kg. The mean BMI was 24.91 ± 5.32 kg/m2. The examinations were performed with a voltage of 120 kV in 195 cases (89.45%). The mean dose of injected iodine was 0.42 ± 0.09 gI/kg with a dose of 0.40 gI/kg at 80 kV and 0.45 gI/kg at 130 kV. The mean injection rate was 2.90 ± 0.34 mL/s. The mean injected volume was 83.19 ± 7.29 mL. The mean duration of the injection was 30.60 ± 7.39 s. The mean iodine delivery rate was 0.98 ± 0.17 gI/s. There was no saline injection in 152 cases (69.72%). Liver contrast enhancement was satisfactory in 94.5% of cases. There was a strong negative linear correlation between the dose of injected iodine and weight. Conclusions: Optimization guidelines for the use of iodinated contrast media are not always applied. Therefore, monitoring and benchmarking programmes for iodinated contrast injection protocols that involve all radiology personnel should be implemented.

Knowledge and perception of nuclear medicine by radiologists in French-speaking sub-Saharan Africa.

OBJECTIVES: to assess the knowledge and perception of nuclear medicine by radiologists in French-speaking sub-Saharan Africa. METHODS: cross-sectional study conducted from April 8 to June 7 2020 including radiologists practicing in French-speaking sub-Saharan African countries. Data were collected electronically via a google form. RESULTS: Of the 142 radiologists surveyed, 45.8% had already completed an internship in Europe, 3.52% in a nuclear medicine department and 72.54% had a nuclear medicine department in their country of practice. Among these radiologists, 21.13% knew the three main techniques of nuclear medicine and only 9.15% knew that nuclear medicine allows functional, metabolic and molecular studies. On average, 56.8% were aware of clinical indications for the main fields of nuclear medicine. In 47.18% of cases, they thought that scintigraphic imaging was more irradiating than radiological imaging, 71.1% knew about hybrid imaging techniques, 43.66% had read a scientific article on nuclear medicine, 4.93% had attended a nuclear medicine conference and 28.9% had recommended a scintigraphic imaging examination in their report. Half of them would like to see nuclear medicine and radiology merged into a single specialty and 95.77% considered it essential to create a nuclear medicine department in their country. CONCLUSION: The level of knowledge of radiologists in French-speaking sub-Saharan Africa about nuclear medicine was, on the whole, unsatisfactory with a generally encouraging perception.

Knowledge and attitudes of ultrasonography physicians regarding the biological effects of ultrasound in French-speaking sub-Saharan Africa.

OBJECTIVE: To assess the knowledge and practical attitudes of ultrasonography physicians regarding the biological effects of ultrasound in French-speaking sub-Saharan Africa. MATERIALS AND METHODS: A descriptive cross-sectional study carried out over a period of 03 months (from 1st August to 31st October 2019) which included doctors carrying out ultrasound examinations in French-speaking sub-Saharan African countries via an electronic survey form. RESULTS: The 137 ultrasonography physicians came from 13 different countries and included 58% radiologists, 15% gynecologists, 14% cardiologists and 13% general practitioners. The majority of ultrasonography physicians had less than 10 years of professional experience (87.60%) and performed more than 25 ultrasonographies per week (65.69%). The biological effects of ultrasound were known by 69.34% of ultrasonography physicians. Only 44% were able to cite the two biological effects of ultrasounds; 59.13% were unaware of the existence of thermal and mechanical indexes and 66.42% had no idea about the normal values of these indexes. They were unaware that their devices showed mechanical or thermal index in 48.91% of cases, consulted these indexes at the beginning of ultrasound explorations in 26.92%, and had no idea about the practical attitudes to adopt in the face of an increase in these indexes in 54.74% of cases. Half of the gynecologists and general practitioners and 55% of the radiologists affirmed that they avoid using Doppler as much as possible to explore the embryo. CONCLUSION: The level of knowledge of ultrasonography physicians about the biological effects of ultrasound was unsatisfactory in French-speaking sub-Saharan Africa and good attitudes to ultrasound safety were not always adopted.

Analyse de la justification de l'irradiation médicale pédiatrique liée à la Tomodensitométrie (TDM) à Lomé (Togo).

OBJECTIVE: To evaluate the justification of medical irradiation related to CT scans performed in children in Lome. MATERIALS AND METHODS: Descriptive cross-sectional study of CT scans performed from 1 September to 30 November 2019 in children aged 0 to 18 years. The analysis of the justification was made particularly on the formulation of the clinical indication, the consistency of the clinical indication with the requested CT and the conformity of the clinical indication with the Good Practice Guide (GPG) medical imaging examinations of the French Society of Radiology (SFR) and French Nuclear Medicine Society (SFMN). RESULTS: The 175 CT scans included were dominated by cerebral CT (72.57%) followed by abdominal-pelvic CT (8%). Boys-dominated children (sex ratio=1.19) had an average age of 10.47+/-5.9. Prescribers composed of medical specialists (49.14%), general practitioner (31.43%) and paramedics (5%), requested in 21.14% of cases an imaging examination not or less irradiant before the CT. Clinical indication formulation was good in 70.86%, acceptable in 26.86%, and poor in 1.71%. This was consistent with the exam requested in 99.43% and conform with the GPG of the SFR in 48.57%. The more consistent the indications were with GPG, the more pathological the results were. Approximately 53% of the CT scans performed were not a priori justified. CONCLUSION: Pediatric medical irradiation related to CT at Lome was in more than half of the cases a priori unjustified. Efforts must be made by practitioners to ensure that paediatric medical irradiation is judicious in Togo.

Dosimetry of pediatric chest X-Ray examinations in Togo.

OBJECTIVE: To assess the entrance surface dose (ESD) of pediatric chest X-ray examinations in order to establish a diagnostic reference levels (DRLs) in Togo. MATERIALS AND METHODS: The study was carried out in 13 radiology departments within the 6 health regions of the country. This is a descriptive cross-sectional study relating to the dosimetric assessment of the skin of children aged from 0 to 15 years during chest X-ray examinations. The assessment was made by the empirical formula calculation of the entrance surface dose (ESD = 0.15 × (U/100)2 × Q × (1/FSD)2) and with the Internet Dose Calculation Module (MICADO) software online. Statistical assessment was performed using IBM SPSS 21 software. RESULTS: Our sample numbered 390 with a sex ratio of 1.3 and predominantly male. Examinations performed with the analog radiography units were more irradiating (0.14 mGy) than ones performed with digital detectors (0.12 mGy). The mean dose calculated with MICADO was low (Avg. = 0.12 mGy) compared to that calculated with the theoretical method (Avg. = 0.16 mGy). No significant relationship was found between the professional experience of operators and the entrance surface dose (r  > -1 with p = 0.146 not significant). MICADO doses increased with age. The values of the diagnostic reference levels used for the antero-posterior or postero-anterior chest X-ray examinations for children aged 0-1 year; 1-5 years; 5-10 years and 10-15 years were respectively, 0.15 mGy; 0.14 mGy; 0.15 mGy and 0.17 mGy. CONCLUSION: The entrance surface dose varied greatly from one health facility to another for this same examination. In most of the different age groups of children, the diagnostic reference level was higher than that found in literature. Thus, effective measures must be put in place to optimize the doses delivered to children during chest X-ray examinations.

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

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

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

Usage des Rayonnements ionisants en milieu médical à Cotonou (Benin)

Objectif : Faire l'état des lieux des applications médicales des rayonnements ionisants dans la ville de Cotonou.Matériels et méthode : Etude prospective du 16 avril au 22 juin 2018 dans les structures sanitaires disposant de générateurs ou sources de rayonnements ionisants utilisés à des fins médicales dans la ville de Cotonou. Les paramètres étudiés étaient : les caractéristiques des structures sanitaires utilisant les rayonnements ionisants, les infrastructures techniques et ressources humaines impliquées, et la mise en oeuvre des mesures de radioprotection.Résultats : Les rayonnements ionisants étaient utilisés respectivement dans 22 services pour les rayons X, et 1 service pour les rayons gamma. Ces services ne couvraient que les 2/3 des arrondissements. Les générateurs de rayons X comprenaient les appareils de radiologie classique (52,1%), de mammographie (19,6%), de radiologie dentaire (15,2%) et de scanner (8,7%). Ces appareils étaient acquis à l'état neuf dans 52,1% et utilisés dans 63,1% dans les structures privées. Ils étaient dominés par les marques Siemens (20,8%), Schimadzu (12,5%) pour la radiologie classique. Les scanners avaient un âge compris entre 5 et 9 ans et étaient de 16 barrettes dans 50%. Quatorze radiologues et 65 manipulateurs étaient recensés. Près des 2/3 des manipulateurs avaient moins de dix années d'expérience. Aucune structure n'utilisait de dosimètre. Seulement 2 structures sanitaires disposaient de pictogramme et de règlement de zone. Un peu plus de 1500 patients étaient exposés aux rayons X par semaine et 150 dosages radio immunologiques étaient réalisés par semaine.Conclusion : L'usage des rayonnements ionisants était exclusivement à but diagnostique à Cotonou avec des mesures de radioprotection peu satisfaisantes

Qualité des demandes d'examens radiologiques: à propos de 552 demandes évaluées par des radiologues

Objectifs : Evaluer la qualité des demandes d'examens radiologiques. Matériels et méthodes : Il s'est agi d'une étude transversale descriptive réalisée dans le service de radiologie du CHU Campus du 1er août au 15 août 2015. Résultats : Au cours de la période d'étude, nous avons colligé 144 demandes d'examens de tomodensitométrie (26,1%) et 408 demandes d'examens de radiographie (73,9%). Les demandeurs étaient des médecins spécialistes dans 25% des cas (102 examens) pour la radiographie et 19,4% des cas (28 examens) pour la tomodensitométrie. Les demandeurs d'examen de radiographie étaient des rhumatologues dans 8,8% des cas (36 examens) et aucun urologue n'avait demandé un examen de radiographie ; les demandeurs d'examen de tomodensitométrie étaient des neurologues dans 19,4% des cas (28 examens) et aucun gynécologue ni pédiatre n'avait demandé un examen de tomodensitométrie. Les demandes sans question et les demandes sans retour étaient les deux principaux types de demandes observés. L'âge et le sexe des patients n'avaient pas été précisés respectivement dans 4,4% (18 cas) et 2,9% (12 cas) des demandes d'examen de radiographie. Les résultats d'examens para-cliniques pouvant être utiles à l'interprétation et au compte-rendu radiologique manquaient sur 384 cas (94,1%) des demandes d'examens de radiographie et sur 140 cas (97,2 %) des demandes d'examens de tomodensitométrie. Sur les demandes d'examen de radiographie, le demandeur ne pouvait être identifié par son nom dans 78 cas (19,1%) et le motif de demande était précisé dans 402 cas (98,5 %) ; sur les demandes d'examen de tomodensitométrie, le demandeur ne pouvait être identifié par un numéro de téléphone dans 96 cas (66,7%). Conclusion : Les demandes d'examen radiologiques sont établies de manière incomplète. L'exercice radiologique suppose cependant une obligation de moyens, avec sérieux, prudence et réflexion

Tuberculous Abscess of the Chest Wall Simulate Pyogenic Abscess.

The chest wall tuberculosis abscesses is rare. We present a case of a 27-year-old immunocompetent male who presented chest wall abscesses. Imaging (chest radiographic, ultrasound, and computed tomography) and Ziehl-Neelsen staining demonstrated chest wall tuberculosis abscesses.

Can atlas spina bifida-occulta be a cause of cervicogenic headaches?

Cervicogenic headaches are a nosologic entity recently recognized. In our common practice, we have noticed a relative frequency of the atlas spina-bifida occulta during the brain CT scan realized for headaches without cranio-encephalic causes or any other anomaly of the upper cervical region. The aim of this study was to determine a possible connection between cervicogenic headaches (CEH) and atlas spina-bifida occulta. A 2 years prospective and descriptive study in 20 black patients having an atlas spina-bifida occulta diagnosed with a brain CT scan. The mean age of the patients was 43.17 ± 18.35 years (extremes: 24 and 72 years). A light female predominance was noticed (sex-ratio = 1.5). The frequency of symptomatic spina-bifida was 1.72 % (17 cases). The mean age at onset was 31.84 years. The pain was sub-occipital in 14 cases, occipital in 8 cases, bilateral in 12 cases and unilateral in 5 cases. The mean duration of the attacks was 72 ± 24 h and the pain intensity was moderate (16 cases); mean and range were 3.6 and 3-6. The frequency of attacks varied between 1 per 7 months (n = 2) and 2 per week (n = 1) in those with non-daily headache. One attack per 5-7 weeks was the most commonly occurring attack frequency. The pain was reproduced by the pressure of the occipital region or upper cervical in 15 cases. The mean number of criteria was five and there was a strong positive correlation between criteria and CEH (χ (2) = 45.57; V = 0.62). The associated signs were photophobia and nausea in one case each. Indomethacin, Ergotamine and/or Sumatriptan were without any antalgic effect in 16 cases. Pain ceased after an anesthetic blockade of C2 (16 cases). The results show that atlas spina-bifida occulta is not involved in CEH pure form genesis. On a small sample, the atlas spina-bifida seems to be a cause of CEH associated with headache and disorders of the neck.

Intravenous Contrast Medium Administration for Computed Tomography Scan in Emergency: A Possible Cause of Contrast-Induced Nephropathy.

The goal of this study was to assess risk for CIN after CT Scan during an emergency and to identify risk factors for the patient. Prospective review of all patients admitted to the emergency room (ER) of the Teaching Hospital of Lomé (Togo) during a 2-year period. CIN was defined as an increase in serum creatinine by 0.5 mg/dL from admission after undergoing CT Scan with intravenous contrast. A total of 620 patients underwent a CT Scan in the emergency room using intravenous contrast and 672 patients took the CT Scan without intravenous contrast. Out of the patients who received intravenous contrast for CT Scan, three percent of them developed CIN during their admission. Moreover, upon discharge no patient had continued renal impairment. No patient required dialysis during their admission. The multivariate analysis of all patients who had serial creatinine levels (including those who did not receive any contrast load) shows no increased risk for acute kidney injury associated intravenous contrast (odds ratio = 0.619, p value = 0.886); only diabetes remains independent risk factor of acute kidney injury (odds ratio = 6.26, p value = 0.031).

Aspects tomodensitometriques des demences au Togo

Introduction : La demence est une pathologie en rapport avec l'age dont la prevalence est en progression dans le monde; et en particulier dans les pays en developpement. L'objectif de cette etude etait de determiner les aspects tomodensitometriques des demences au Togo. Patients et Methodes : Il s'agit d'une etude prospective et analytique portant sur 144 patients durant la periode allant de janvier 2011 a decembre 2012. Etaient inclus a l'etude; tout patient presentant une deterioration des fonctions superieures et ayant beneficie d'une tomodensitometrie (TDM) cerebrale. L'examen tomodensitometrique avait ete realise sur un scanner de 16 barrettes de marque General Electric; avec des acquisitions volumiques sans et avec injection du produit de contraste (en cas de necessite) suivies de reconstructions coronales. Resultats : Au total 2320 TDM cerebrales avaient ete realisees pendant la periode d'etude dont 144 pour deterioration des fonctions superieures (6;2). La repartition des patients en fonction de l'age montre une predominance masculine (sex ratio = 1;5). La frequence de la pathologie augmentait avec l'age avec une moyenne de 60 ans. Les causes curables avaient ete retrouvees chez 41 patients (28;5); dominees par l'hydrocephalie chronique de l'adulte. Les causes non curables representaient 78 patients (54;2). La TDM etait normale chez 25 patients (17;3). Conclusion : La tomodensitometrie peut etre suffisante dans l'exploration des demences dans les pays en developpement ou l'acces a l'imagerie par resonnance magnetique est limite

A low-cost tele-imaging platform for developing countries.

PURPOSE: To design a "low-cost" tele-imaging method allowing real-time tele-ultrasound expertise, delayed tele-ultrasound diagnosis, and tele-radiology between remote peripherals hospitals and clinics (patient centers) and university hospital centers (expert center). MATERIALS AND METHODS: A system of communication via internet (IP camera and remote access software) enabling transfer of ultrasound videos and images between two centers allows a real-time tele-radiology expertise in the presence of a junior sonographer or radiologist at the patient center. In the absence of a sonographer or radiologist at the patient center, a 3D reconstruction program allows a delayed tele-ultrasound diagnosis with images acquired by a lay operator (e.g., midwife, nurse, technician). The system was tested both with high and low bandwidth. The system can further accommodate non-ultrasound tele-radiology (conventional radiography, mammography, and computer tomography for example). The system was tested on 50 patients between CHR Tsevie in Togo (40 km from Lomé-Togo and 4500 km from Tours-France) and CHU Campus at Lomé and CHU Trousseau in Tours. RESULTS: A real-time tele-expertise was successfully performed with a delay of approximately 1.5 s with an internet bandwidth of around 1 Mbps (IP Camera) and 512 kbps (remote access software). A delayed tele-ultrasound diagnosis was also performed with satisfactory results. The transmission of radiological images from the patient center to the expert center was of adequate quality. Delayed tele-ultrasound and tele-radiology was possible even in the presence of a low-bandwidth internet connection. CONCLUSION: This tele-imaging method, requiring nothing by readily available and inexpensive technology and equipment, offers a major opportunity for telemedicine in developing countries.