RESUMO
OBJECTIVE: To determine the common factors that affect the diagnostic quality of radiographs in radiodiagnostic centers in Lagos state, Nigeria. METHODS: Self-administered questionnaires containing both open- and close-ended questions were distributed to the supervising radiographers in radiodiagnostic centers within the Lagos metropolis. The questions asked included the film/reject ratio in each center and reasons why each film was rejected. RESULTS: Faulty x-ray machines, movement on the part of the patient, poor darkroom film processing, and suboptimal radiographic techniques were the main reasons respondents identified as factors commonly responsible for the production of faulty films. In some cases, more than one of these factors was responsible. CONCLUSION: There is a need to routinely ensure that x-ray machines are properly calibrated in order to reduce the rate of film rejects in our x-ray facilities. In addition, equipment that is old and cannot be properly calibrated should be replaced. This would guarantee optimum performance and reduce radiation dose to patients and personnel. Younger radiographers should also be open to mentoring by older colleagues so they can acquire useful tips on how to reduce the production of films with unacceptable diagnostic quality. They should be encouraged to attend continuing education programs for improved expertise. Also, quality control and maintenance programs such as the reject film analysis or regular equipment maintenance should be enforced in radiodiagnostic centers.
RESUMO
BACKGROUND: In the Sub Saharan Africa Rickets has now been established to be due primarily to calcium deficiency and sometimes in combination with vitamin D deficiency. The main thrust of management is calcium supplementation with or without vitamin D. An observation was made that some children with nutritional rickets do not respond to this management modality. The recently reported high prevalence of Incomplete Distal Renal Tubular Acidosis (idRTA) in adults with osteoporosis as brought to fore the possibility of this being a possible cause of calcium wastage and therefore the poor response in these group of children with rickets. AIM: To determine the prevalence of idRTA amongst a cohort of subjects with ricketsTo show a relationship between rickets and incomplete distal renal acidosisTo determine the response of children with rickets and idRTA to addition of Shohl's solution to therapy METHODOLOGY: Two separate cohorts of children with rickets performed the ammonium chloride loading test to detect those with incomplete renal tubular acidosis. Following identification for idRTA, Shohl's solution was added to therapy of calcium and vitamin D supplementation and their response compared to those without idRTA on calcium and vitamin D supplementation solely. RESULTS: 50 children with rickets aged from two to six years of age and composed of 29 females and 21males were investigated. Incomplete renal tubular acidosis was found in 38% of them. Prevalence of idRTA was highest amongst those aged 3-6 years of age. Those with idRTA had worse limb deformities, biochemical and radiological parameters than those who hadn't. Rate of response on those with idRTA treated with Shohl's solution was at par with those without idRTA. CONCLUSION: Incomplete idRTA exist amongst children with rickets and should be looked out for in severe rickets and older children. Treatment of idRTA will lead to optimal response and healing of rickets.
