Computed tomography scanner census and adult head dose in Nigeria

Operational challenges and collaborative solutions in radiology image interpretation: perspectives from imaging departments in a low-resource setting

INTRODUCTION

Medical imaging's critical role in diagnosis requires prompt and precise image interpretation. Numerous radiology departments, especially in low-resourced settings, encounter challenges such as a shortage of radiologists in their operational setup. This study explored the perceptions of radiographers and radiologists from low-resourced departments in a single country regarding operational challenges and potential solutions in image interpretation.

METHODS

A qualitative approach was utilised, involving heads of departments, senior radiographers, and radiologists with a minimum of 5 years of experience, from three major state referral hospitals. Face-to-face, semi-structured interviews were conducted in November 2022, using an interview guide that included questions on the challenges encountered during image interpretation and the proposed solutions. Data analysis was conducted using Atlas.ti version 9.0, following the four-step content analysis method. All participants willingly provided consent to participate in the study.

RESULTS

Ten participants, comprising two radiologists and eight radiographers participated in the study. The research identified three main themes: image interpretation pathways, image interpretation operational challenges and proposed solutions for image interpretation. In addition, a total of 10 subthemes were generated from the three main themes.

CONCLUSION

The study revealed critical challenges and the need to explore the formal inclusion of radiographers in image interpretation, as a way to improve efficiency. However, a comprehensive assessment of the image interpretation system, encompassing radiographers' knowledge and competence, is recommended for context-specific, empirical-based modifications to enhance service provision.

Profile of Pediatric Neurosurgery in Nigeria from 1962 to 2021: A Systematic Review

OBJECTIVE

This study aims to provide a comprehensive overview of pediatric neurosurgery in Nigeria, since 1962, by assessing epidemiological data, management strategies, and case outcomes.

METHODS

A systematic bibliometric review of Nigerian neurosurgical literature was reported with the PRISMA guidelines. The Risk of Bias Assessment Tool was applied to all nonrandomized studies, and a descriptive analysis was performed for all variables.

RESULTS

We identified 12,295 pediatric patients from 196 published studies. Most publications (72.4%) occurred in the recent 2 decades, of which 40.3% were observational case reports/series. The patients were predominantly male (57.2%) and aged 0-18 years, with the majority (66.1%) belonging to the 0-5 age range. Most patients (63.4%) presented between 1-12 months. The most common presenting feature was altered consciousness (7.7%), with computed tomography (38.8%) being the most frequently utilized diagnostic imaging modality. The diagnoses with the greatest prevalence (60.2%) were congenital abnormalities such as hydrocephalus and neural tube defects. 57.5% of cases received surgical therapy, with ventriculoperitoneal shunt placement being the most noticeable procedure performed (36.4%). Complications were identified in 9.5% of cases, with a 4.5% death rate. The Glasgow Outcome Score (95.7%) was the primary outcome measure utilized, with positive outcomes reported in 59.3% of cases.

CONCLUSIONS

This review provides significant epidemiological data which emphasizes the country's enormous burden of pediatric neurosurgical cases. The findings can help guide clinical decisions as well as future research and policy development.

Epidemiology and Management Trends of Neuro-Oncology in Nigeria: A Systematic Review and Pooled Analysis

OBJECTIVE

Access to neuro-oncologic care in Nigeria has grown exponentially since the first reported cases in the mid-1960s. In this systematic review and pooled analysis, we characterize the growth of neurosurgical oncology in Nigeria and build a reference paper to direct efforts to expand this field.

METHODS

We performed an initial literature search of several article databases and gray literature sources. We included and subsequently screened articles published between 1962 and 2021. Several variables were extracted from each study, including the affiliated hospital, the number of patients treated, patient sex, tumor pathology, the types of imaging modalities used for diagnosis, and the interventions used for each individual. Change in these variables was assessed using Chi-squared independence tests and univariate linear regression when appropriate.

RESULTS

A total of 147 studies were identified, corresponding to 5,760 patients. Over 4000 cases were reported in the past 2 decades from 21 different Nigerian institutions. The types of tumors reported have increased over time, with increasingly more patients being evaluated via computed tomography (CT) and magnetic resonance imaging (MRI). There is also a prevalent use of radiotherapy, though chemotherapy remains an underreported treatment modality.

CONCLUSIONS

This study highlights key trends regarding the prevalence and management of neuro-oncologic pathologies within Nigeria. Further studies are needed to continue to learn and guide the future growth of this field in Nigeria.

The Epidemiological Burden of Neurovascular Pathology in Nigeria: A Systematic Review and Pooled Patient-Level Analysis

OBJECTIVE

Vascular neurosurgery has developed significantly in Nigeria, but its burden and challenges remain unclear. This study systematically reviewed vascular neurosurgical literature from Nigeria.

METHODS

Four research databases and gray literature sources were searched from 1962-2021. ROBINS-I tool was used to assess risk of bias. Descriptive, narrative, and statistical analyses were conducted on all variables. Where appropriate, paired t-tests and Chi-squared independence tests were used (α = 0.05).

RESULTS

56 articles were included and 3203 patients pooled for analysis. Risk of bias was moderate-high. Most articles were published over the last 20 years with retrospective cohort studies and case reports being the most common study designs. The cohort had a relatively even gender split and an average age of 49 years (±22). Cerebrovascular accidents accounted for over 85% of diagnoses, with most etiologies being traumatic. Headache and motor deficit were the most prevalent clinical features. X-ray and carotid angiography were the most commonly reported imaging modalities, closely followed by computed tomography (CT) and CT angiography. The top two radiological diagnoses were ischemic cerebrovascular disease and intracerebral hematoma. Aneurysmal clipping and hematoma evacuation were the most commonly reported treatment modalities. Outcome at last follow-up was favorable in 48%. The mortality rate was 6%. Post-treatment complications included chest infection and rebleeding.

CONCLUSIONS

This study illustrates the epidemiological burden of neurovascular pathology (based on the available data in published literature) in Nigeria, and raises awareness amongst service providers and researchers of the attendant challenges and epochal trends seen within vascular neurosurgery in Nigeria.

Assessing the Neurosurgical Capacity in Nigeria Using the Modified Neuro-PIPES Tool

BACKGROUND

Like many low- and-middle-income countries in Africa, documented assessment of the neurosurgical workforce, equipment, infrastructure, and scope of service delivery in Nigeria is lacking. This study aimed to assess the capacity for the delivery of neurosurgical services in Nigeria.

METHODS

An 83-question survey was disseminated to neurosurgeons and residents in Nigeria. We report the findings from the capacity assessment section of the survey, which used the modified neurological-PIPES (personnel, infrastructure, procedures, equipment, and supplies) (MN-PIPES) tool to evaluate the availability of neurosurgical personnel, infrastructure, procedures, equipment, and supplies. A comparative analysis was done using the domain and total MN-PIPES scores and MN-PIPES index.

RESULTS

The national average MN-PIPES score and index were 176.4 and 9.8, respectively. Overall, the southwest and northwest regions had the highest scores and frequently had high subscores. The survey respondents reported that the main challenges impeding neurosurgery service delivery were a lack of adjunctive supplies (75.2%), a dearth of diagnostic and interventional equipment (72.4%), and an absence of a dedicated intensive care unit (72.4%).

CONCLUSIONS

The availability of workforce, infrastructure, equipment, and supplies needed to provide optimal neurosurgical care is uneven in many institutions in Nigeria. Although major strides have been made in recent years, targeted collaborative interventions at local, national, regional, and international levels will further improve neurosurgical service delivery in Nigeria and will have positive ripple effects on the rest of the healthcare system.

The essential role of neuroimaging in diagnosing and managing cerebrovascular disease in Africa: a review

BACKGROUND

Cerebrovascular disease is a significant cause of morbidity and mortality in Africa, and using neuroimaging techniques has improved the diagnosis and management of this disease. However, there is a lack of comprehensive reviews of the role and effectiveness of neuroimaging techniques in the African context.

METHODS

We reviewed the literature to evaluate the role of neuroimaging in diagnosing and managing cerebrovascular disease in Africa. Our search included electronic databases such as PubMed, Scopus, and Google Scholar from 2000 to April 2023. We included peer-reviewed studies written in English that reported on the use of neuroimaging in diagnosing and managing cerebrovascular disease in African populations. We excluded non-peer-reviewed articles, letters, editorials, and studies unrelated to cerebrovascular disease, neuroimaging, or Africa. A total of 102 potential articles were identified; after applying our exclusion criteria and removing duplicated articles, 51 articles were reviewed.

RESULTS

Our findings suggest that neuroimaging techniques such as CT, MRI, and Skull x-ray play a crucial role in diagnosing and managing cerebrovascular disease in Africa. CT and MRI were the most commonly used techniques, with CT being more widely available and less expensive than MRI. However, challenges to using neuroimaging in Africa include the high cost of equipment and maintenance, lack of trained personnel, and inadequate infrastructure. These challenges limit the widespread use of neuroimaging in diagnosing and managing cerebrovascular disease in Africa.

CONCLUSION

Neuroimaging techniques are essential for diagnosing and managing cerebrovascular disease in Africa, but challenges to their use must be addressed to improve healthcare outcomes. Our policy recommendations can help improve the availability and accessibility of neuroimaging services in Africa.

DEVELOPING DIAGNOSTIC REFERENCE LEVELS FOR CT EXAMINATIONS IN ADDIS ABABA, ETHIOPIA

Diagnostic reference level (DRL) is an appropriate instrument toward promoting radiation doses optimisation in medical imaging. The goal of this research is developing DRL to optimise computed tomography (CT) doses in patient examination. Parameters were collected in CT facilities for common procedures such as head, chest, pelvic and cervical spine (c-spine) imaging. The dose descriptors considered were volume computed tomography dose index (CTDIv) and dose length product (DLP). The DRLs were proposed at 75th percentile CTDIv for head (without and with contrast materials), chest (without and with contrast materials), pelvic and c-spine only without contrast materials; their values were 52, 52, 17, 14, 14 and 38 mGy, respectively. Whereas, DLP values for the aforementioned protocols were 1237, 1459, 625, 565, 605 and 1106 mGy.cm, respectively. This study fruitfully developed the DRLs for head, chest, pelvic and c-spine and can be accepted for clinical purposes.

Estimation of lifetime attributable risk incidence and mortality for breast cancer attributed to computed tomography of the head in the Niger Delta Region of Nigeria

Background

The rising increase in the incidence of breast cancer among women is worrisome and a great concern to all. More disturbing is that the incidence of breast cancer and death has been attributed to exposure to imaging modalities that utilize ionizing radiation such as computed tomography. The aim of this study was to estimate the lifetime attributable risk (LAR) incidence and mortality for breast cancer for female patients who had head computed tomography in two imaging facilities (centres) in the Niger Delta region of Nigeria.

Result

The overall estimated mean effective dose in centres G1 and G2 is 5.76 mSv and 1.54 mSv, respectively. There was a statistical significant difference in the mean effective dose between centres G1 and G2 (P < 0.001). The LAR breast cancer incidence obtained in this study ranged between 0.5 and 26.45 per 100,000 population in centre G1, while in centre G2, it ranged between 0.14 and 6.56 per 100,000 population. The LAR breast cancer mortality obtained in this study ranged between 0.07 and 6.25 per 100,000 population in centre G1, while in centre G2, it ranged between 0.03 and 1.55 per 100,000 population.

Conclusion

The estimated mean LAR of breast cancer incidence and mortality for the women who had head CT examination in the two study centres was found to be minimal to negligible among the female patients of the different age groups in the study population. The overall mean risk of breast cancer incidence was very low in centre G1 and minimal in centre G2. The obtained risk values can be used to optimize the dose delivered to patients and also ensure that CT examinations are justified.

Assessment of diagnostic reference levels awareness and knowledge amongst CT radiographers

Background

Reports indicated that numerous factors, including inadequate personnel knowledge, contributes to insufficient patient data for setting up diagnostic reference levels (DRLs) in developing countries. This study aims to evaluate the knowledge of DRLs as an optimisation tool amongst computed tomography (CT) radiographers in northern Nigeria. This is a quantitative cross-sectional study. A structured questionnaire was devised and distributed on site to sixty-two CT radiographers in northern Nigeria. A total of fifteen questions were included in the questionnaire focusing on DRLs, dose optimisation and dose descriptors generating quantitative data concerning overall CT radiographers’ perceived knowledge and awareness about DRLs.

Results

A response rate of 77.4% (48/62) was achieved. About 83.3% of the participants declare DRLs awareness, and 37.5% carried out a local dose survey. The percentage correctly perceived knowledge of concepts; DRLs was 45.8%, dose optimisation (42%) and CT dose descriptor (39%). Radiographers with work experience ranging from 4-10 years had the highest score.

Conclusion

In this survey, deficiencies were noted in radiographers’ knowledge about DRLs with precise knowledge gap in the implementation of local dose survey for DRLs and optimisation. There is a need for continuous radiographers’ training with greater emphasis on dose optimisation and institutional based dose evaluation.

Stroke in Africa: profile, progress, prospects and priorities

Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.

The Haleem-Botchu classification: a novel CT-based classification for lumbar foraminal stenosis

PURPOSE

No clinical CT-based classification system is currently in use for lumbar foraminal stenosis. MRI scanners are not easily available, are expensive and may be contraindicated in an increasing number of patients. This study aimed to propose and evaluate the reproducibility of a novel CT-based classification for lumbar foraminal stenosis.

MATERIALS AND METHODS

The grading was developed as four grades: normal foramen-Grade 0, anteroposterior (AP)/superoinferior (SI) (single plane) fat compression-Grade 1, both AP/SI compression (two planes) without distortion of nerve root-Grade 2 and Grade 2 with distortion of nerve root-Grade 3. A total of 800 lumbar foramen of a cohort of 100 random patients over the age of 60 who had undergone both CT and MRI scans were reviewed by two radiologists independently to assess agreement of the novel CT classification against the MRI-based grading system of Lee et al. Interobserver(n = 400) and intraobserver agreement(n = 160) was also evaluated. Agreement analysis was performed using the weighted kappa statistic.

RESULTS

A total of 100 patients (M:F = 45:55) with a mean age of 68.5 years (range 60-83 years were included in the study. The duration between CT and MRI scans was 98 days (range 0-540, SD-108). There was good correlation between CT and MRI with kappa scores (k = 0.81) and intraobserver kappa of 0.89 and 0.98 for the two readers.

CONCLUSION

The novel CT-based classification correlates well with the MRI grading system and can safely and accurately replace it where required.

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.