Value of MRI in the cervical spine imaging series of trauma patients: A state-of-the-art review

INTRODUCTION

Clinical decision protocols for evaluation and assessment of traumatic cervical spine injuries (TCSI) lean more towards the use of CT imaging. Investigation with MRI is therefore considered unnecessary following negative CT findings according to some local protocols. This review aims to explore what benefits MRI may offer in the clinical management of TCSI patients.

METHODS

A systematic search of the literature was conducted in the following databases: AMED, CINAHL, EMBASE and MEDLINE using defined key terms and synonyms optimised for each database. The eligible articles were subjected to data extraction and thematic synthesis.

RESULTS

The initial electronic search yielded 2527 articles. Of these, 15 articles remained following the application of a pre-defined inclusion criteria and full-text assessment. Four themes (mechanism of injury, type of patient, injuries detected on MRI, significance of injuries detected on MRI) were developed relating to the usage and value of MRI in the management of CSI.

DISCUSSION

Our findings indicate that MRI may be very valuable in some situations for the evaluation of TCSI, however, its usage must be cautiously considered on a case-by-case basis in light of additional clinical benefit, patient safety and resource availability following a normal CT scan or in conjunction with CT or projection radiography where appropriate.

IMPLICATIONS FOR PRACTICE

MRI may serve as a confirmatory test in the management pathway of TCSI based on individual clinical needs. Consideration for key limitations (e.g., patients' cooperation) and accessibility challenges (e.g., cost) against the clinical benefit to the patient must be noted. Development of centre-specific policies from standard trauma imaging protocols may be essential for the timely management of TCSI.

Assessment of average glandular dose in mammography practice of a teaching hospital in Ghana

Introduction

above the age of 40, women are advised to begin breast examinations and screenings for early detection of breast cancer. The average glandular dose (AGD) provides dosimetric information about the quantity of radiation received by the mammary glands during mammographic exposures. There is, therefore, the need to analyse the radiation dose received by patients presenting for mammography examinations.

Methods

a retrospective cross-sectional design was carried out on the data of 663 participants, conveniently sampled between the months of July 2021 and June 2022. Paired T-test was used to compare imaging parameters for cranio-caudal (CC), medio-lateral (ML), automatic exposure control (AEC), manual exposure control (MEC), and left and right breast. Pearson´s correlation was used to test for relationship between imaging parameters and AGD.

Results

the mean AGD per exposure was 1.9 ± 0.7 mGy for CC projections and 2.3 ± 1.2 mGy for ML projections. The mean AGD per examination for the study was 4.1 ± 1.4 mGy. A positive correlation was found between AGD per examination and exposure factors (tube loading and tube voltage), compressed breast thickness, and compression force. Patient age had no statistically significant relationship with the AGD per examination.

Conclusion

average glandular dose (AGD) was consistent with other findings in literature studies. It was also observed that MEC yielded lower AGD per exposure values than AEC. There was no significant difference in the mean AGD per exposure for left and right breasts.

Biochemical outcome after curative treatment for localized prostate cancer with external beam radiotherapy: a cross-sectional study

Although many patients who receive definitive radiotherapy (RT) for localised prostate cancer (CaP) experience long-term disease-free survival and better quality of life, some also have biochemical progression during follow-up. Oftentimes this implies additional treatment for patients with the accompanying challenges of cumulative treatment side effects, inconvenience and financial toxicity. This study retrospectively assessed the clinicopathological characteristics and biochemical outcomes of patients treated for localised CaP with external beam radiotherapy (EBRT) between 2015 and 2020 at a major cancer treatment centre in Accra, Ghana. Patients' socio-demographic and clinical data were collected from their hospital records and analysed with the Statistical Package for Social Sciences version 26. Biochemical failure (BCF) was defined as an increase in the level of serum prostate-specific antigen (PSA) >2 ng/mL above the nadir after curative therapy based on the Phoenix definition. The mean age was 67.6 years (SD ± 6.2). The majority of the study participants (n = 79, 64.8%) had initial PSA >20 ng/mL, with the highest recorded value of 705 ng/mL. All the patients had biopsy-proven adenocarcinoma of the prostate gland. Some patients received 3-dimensional conformal radiotherapy (3DCRT) on a cobalt-60 teletherapy machine whereas others were treated with either 3DCRT or intensity-modulated radiotherapy (IMRT) on a 6 MV Linac. In all, 13.1% of the patients experienced BCF after receiving EBRT after an average follow-up of 31.3 months. This study demonstrated a low rate of BCF among patients treated with EBRT for localised CaP in Ghana. Strong prognostic factors of biochemical outcome demonstrated in this study were the percentage of cores positive, grade group, and risk stratification. Diarrhaea and desquamation experienced by treated CaP patients were exclusively attributable to EBRT. RT produced a complete resolution of symptoms in some of the patients.

Perception of professionalism in clinical practice among clinical year radiography students in a tertiary institution in Ghana

INTRODUCTION

Professionalism describes the positive attitudes, conduct, aims, values, skills, and behaviours that characterize a profession or a group of professionals. The steady professional growth of radiographers, which begins during undergraduate training, continues to be significantly influenced by education. As professional traits are ingrained in radiography students through official clinical instruction and observations, research on professionalism is necessary to monitor the perception of the subject matter. However, no study on Ghanaian radiography students on professionalism has been conducted. The goal of this study was to determine how clinical radiography students at a higher education facility in Ghana viewed the professionalism of radiography practice.

METHODS

Sixty-four consenting Level 300 (3rd year) and Level 400 (4th year) students in the University of Ghana School of Biomedical and Allied Health Sciences' BSc Diagnostic Radiography and BSc Therapy programmes completed the Pennsylvania State College of Medicine Professionalism Questionnaire (PSCOM-PQ) which was used to determine the impacts and challenges to professionalism. Version 23.0 of the Statistical Package for Social Science program (SPSS 23.0) was used to analyze the collected data.

RESULTS

A good sense of professionalism in clinical practice was held by the majority of clinical radiography students. More than 56% of them observed professional practice among the majority of radiographers, contrary to 40.6% of them who witnessed it among only a few radiographers. The students observed both positive and negative effects on the professionalism of radiography practice. As a result, 77.9% of the students said that it was difficult to exhibit professionalism in radiography during their clinical training.

CONCLUSION

The students agreed that professionalism impacted positively and negatively on radiography practice, and consequently identified to need to address the mitigating challenges to improve the level of professionalism. By this, most of the clinical year students had a better understanding of perceptions of the professionalism of radiography practice.

IMPLICATION FOR PRACTICE

According to the study's findings, clinical students' radiography practice is affected either positively or negatively by their conceptions of professionalism and their adherence to them during the entire training period.

Patient radiation dose during diagnostic and interventional cardiology procedures: A study in a tertiary hospital

BACKGROUND

Fluoroscopy-guided diagnostic and interventional cardiology (IC) procedures help to identify and treat several problems associated with the heart. However, these procedures expose patients, cardiologists, radiographers, and nurses to radiation doses. Due to the risk that ionizing radiation poses, concerns have been raised and studies are continually being done to ensure that optimization is achieved during such procedures. This study assessed patient radiation dose during diagnostic and interventional cardiology procedures as well as right heart studies at a tertiary hospital in Ghana to formulate the facility's diagnostic reference levels (DRLs) for optimization purposes. As this study was the first of its kind in Ghana, it was a vital step towards dose optimization within the local department, as well as contributing to future DRLs in Ghana.

METHODS

The study collected dose (air kerma, and kerma area product (KAP) and procedural data, and assessed any correlation between parameters such as fluoroscopy time and KAP, and between body mass index (BMI) and KAP. The DRL values were determined as the 75th percentile level for the dose distribution for the various IC procedures including percutaneous coronary interventions (PCI), coronary angiography (CA), and right heart catheterization (RHC). Data were analyzed using SPSS version 23.

RESULTS

CA was the most frequently performed IC procedure (77.3%), while RHC was the least recorded (3.3%). The highest mean KAP was observed during the PCI procedure. The proposed diagnostic reference levels (DRLs) were 162.0 Gy.cm² (PCI), 69.4 Gy.cm² (CA), 39.8 Gy.cm² (RHC) and 159.9 Gy.cm² (CA+PCI). Patients who presented for the CA+PCI and RHC procedures received the highest and lowest mean KAP of 159.9 Gy.cm² and 39.8 Gy.cm² of radiation respectively.

CONCLUSION

This study, therefore, concludes that there is a need for dose optimization of radiation exposures for IC procedures at the cardiothoracic center in Ghana.

Ghanaian radiographers experience and commitment to the mandatory reporting law regarding suspected child physical abuse

INTRODUCTION

The best interests of the child shall be paramount in any matter concerning a child and it should be the primary consideration by any court, person, institution, or other body in any matter concerned with a child. This study sought to explore the influence of legislation on and professional commitment of radiographers towards suspected child physical abuse.

METHOD

A semi-structured interview was conducted with 20 radiographers selected across all the regions in Ghana. The interviews were conducted exclusively by the first author with radiographers who reporting having experience of handling suspected child physical abuse cases. There were 14 male respondents with an age range of 30-54 years and six females aged from 25 to 57 years. Upon attaining data saturation, the thematically analysed data was managed using NVivo10 software.

RESULTS

Findings from the study showed that the legal framework for mandatory reporting of suspected child physical abuse was not known by radiographers. A lack of professional commitment to report cases of suspected child physical abuse was also identified. Themes that emerged from the study formed the basis of the discussion.

CONCLUSION

This study revealed that radiographers interviewed were not well acquainted with national legislation requiring mandatory reporting. There is the urgent need to train radiographers on the laws protecting children to enhance their commitment to the reporting of suspected child physical abuse.

IMPLICATION FOR PRACTICE

The understanding of the legal framework under which radiographers operate is imperative when considering obligations to report suspicious injuries among children.

Assessment of diagnostic radiographers' knowledge of work-related health problems and associated effects: A multicentre study in Ghana

INTRODUCTION

Work-related health problems (WRHPs) are health conditions peculiar to a group of people or occupations including radiography in a specific work setting. These WRHPs occur as a result of prevailing work conditions which predispose workers to risks of physical or psychological distress.

AIM

This study assessed the knowledge of WRHPs among practicing radiographers in Ghana and evaluated the sources, causes, effects and preventive measures of WRHPs.

METHODS

A prospective cross-sectional design incorporating a quantitative data collection approach was used. A questionnaire was used to assess the knowledge and evaluate the effects of WRHPs among two cohorts of 31 practicing radiographers at a regional hospital (RH) and a teaching hospital (TH).

RESULTS

An average score of 4.2 (SD = 0.4) out of 5 (84.8%) obtained on the knowledge scale indicated very good knowledge of WRHPs among the radiographers. Physical work demands, ergonomic issues, increased workload and stress levels on on-duty radiographers due to sick absence by colleagues, large numbers of daily cases, and extra work without incentives were reported as WRHPs effects mostly experienced by the radiographers. The study also showed no significant difference between gender groups (p = 0.313), years of professional practice experience level (p = 0.319), and academic qualifications (p = 0.287) on knowledge of WRHPs.

CONCLUSION

Radiographers working in some referral and teaching hospitals in Ghana demonstrated very good knowledge of WRHPs and identified several effects of WRHPs on professional practice.

IMPLICATION FOR PRACTICE

The study concludes that WRHPs predispose radiographers to adverse health conditions, and administrative protocols are required to prevent or mitigate the burden.

Artificial intelligence in medical imaging practice in Africa: a qualitative content analysis study of radiographers' perspectives

Purpose

Studies have documented the clinical potentials of artificial intelligence (AI) in medical imaging practice to improving patient care. This study aimed to qualitatively explore the perception of radiographers relating to the integration of AI in medical imaging practice in Africa.

Methods

The study employed a qualitative design using an open-ended online instrument administered between March and August 2020. Participants consisted of radiographers working within Africa during the time of the study. Data obtained were analysed using qualitative content analysis. Six themes of concerns were generated: expectant tool; career insecurity; cost of new technology, equipment preservation and data insecurity; service delivery quality; need for expanding AI awareness.

Results

A total of 475 valid responses were obtained. Participants demonstrated a positive outlook about AI in relation to clinical quality improvement, competent diagnosis, radiation dose reduction and improvement in research. They however expressed concerns relating to the implementation of this technology, including job security and loss of core professional radiographer skills and roles. In addition, concerns regarding AI equipment maintenance, lack of awareness about AI and education and training opportunities were evident.

Conclusion

Awareness of the importance of AI in medical imaging practice was acknowledged; however, concerns relating to job security, data protection must be given critical attention for successful implementation of these advanced technologies in medical imaging in Africa. Inclusion of AI modules in the training of future radiographers is highly recommended.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13244-021-01028-z.

A qualitative description of how Ghanaian radiographers identify suspected child physical abuse

INTRODUCTION

Child physical abuse is intentionally inflicted injury of a child and presents a challenging diagnosis to clinicians mostly as a result of doubts about whether the findings were perpetrated by carers of these children. Suspected child physical abuse cannot be reported without its initial identification, substantiation and reporting. Imaging findings is one way of providing evidence of abuse in court.

METHODS

A qualitative design was used to gather data. Twenty (20) radiographers were recruited using purposive criterion sampling to share their experiences of mode of identification of suspected child physical abuse. Semi-structured interviews were conducted to gain deeper insight into their experiences.

RESULTS

Radiographers' suspicion or identification of child physical abuse was based on four (4) constructs: pre-radiographic observation; child's physical signs; caregiver secrecy and imaging findings. These observations provoked further investigations through questioning of the child (if of verbal age), parent or both. Their initial suspicion through assessment of cases was sometimes strengthened by the imaging findings.

CONCLUSION

Radiographers suspected child physical abuse using several approaches some of which were found to be unacceptable although it led to other important information, such as additional imaging performed by the radiographers without doctor consultation. However, being able to identify child physical abuse is important in child protection activities.

IMPLICATION FOR PRACTICE

Identification and reporting of suspected abuse to the appropriate child protection authorities are imperative for child protection. The possibility that some experienced radiographers may fail to deal with serious instances of child abuse exist. A radiographer's inability to identify such cases, could that the victim would miss the required protection from the professional.

The integration of artificial intelligence in medical imaging practice: Perspectives of African radiographers

INTRODUCTION

The current technological developments in medical imaging are centred largely on the increasing integration of artificial intelligence (AI) into all equipment modalities. This survey assessed the perspectives of African radiographers on the integration of AI in medical imaging in order to offer unique recommendations to support the training of the radiography workforce.

METHODS

An exploratory cross-sectional online survey of radiographers working within Africa was conducted from March to August 2020. The survey obtained data about their demographics and perspectives on AI implementation and usage. Data obtained were analysed using both descriptive and inferential statistics.

RESULTS

A total of 1020 valid responses were obtained. Majority of the respondents (n = 883,86.6%) were working in general X-ray departments. Of the respondents, 84.9% (n = 866) indicated that AI technology would improve radiography practice and quality assurance for efficient diagnosis and improved clinical care. Fear of job losses following the implementation of AI was a key concern of most radiographers (n = 625,61.3%).

CONCLUSION

Generally, radiographers were delighted about the integration of AI into medical imaging, however; there were concerns about job security and lack of knowledge. There is an urgent need for stakeholders in medical imaging infrastructure development and practices in Africa to start empowering radiographers through training programmes, funding, motivational support, and create clear roadmaps to guide the adoption and integration of AI in medical imaging in Africa.

IMPLICATION FOR PRACTICE

The current study offers unique suggestions and recommendations to support the training of the African radiography workforce and others in similar resource-limited settings to provide quality care using AI-integrated imaging modalities.

Exploration of Ghanaian radiographers' reporting of suspected physical abuse amongst children

INTRODUCTION

The success of the child protection process is dependent on rapid actions by healthcare professionals who encounter a child in possible need of protection and make appropriate referrals to statutory agencies. Clear rules that promote inter-professional working among health professionals is necessary to enhance child protection.

AIM

To explore the internal factors leading to bystander attitude towards reporting of suspected physical abuse amongst Ghanaian radiographers.

METHODS

Twenty radiographers across Ghana who have encountered suspected child physical abuse during practice interviewed. Data was collected using qualitative methodology using semi-structured interviews. Participants were radiographers who were selected using purposive sampling. Data was thematically analysed and managed with NVivo version 10. Themes developed formed the basis of the discussion.

RESULTS

Participants reported barriers such as training deficits, lack of knowledge in reporting regulations, and the absence of a framework or structures in place to guide suspected physical abuse (SPA) management. The results showed that the majority of participants were ignorant of the role of the social worker in identified cases of SPA. Additionally, there was no teamwork in the majority of the hospitals in the management of suspected physical abuse.

CONCLUSIONS

Participants' behaviour towards child protection was congruent with the situation where an individual would assess the consequences of an action. Fear, lack of direction and collaboration characterised the management of suspected physical abuse.

IMPLICATION FOR PRACTICE

The timely identification of child abuse is key to providing the necessary intervention for the child. However, the mere identification of abuse would be of no use to the child when no action was taken by radiographers handling the case as a result of impediments on their way.

Cognisance of magnetic resonance imaging-induced vertigo and supported care: A study among a cohort of MRI radiographers in a country in West Africa

INTRODUCTION

Magnetic resonance imaging (MRI) can induce vertigo in patients undergoing such examinations. The severity of the vertigo is thought to increase with higher magnetic field strengths and could cause a patient to fall. The study assessed the awareness levels on MRI-induced vertigo among a cohort of MRI radiographers and their perspectives on the care that should be administered to patients post MRI examinations.

METHODS

The study utilized a quantitative cross-sectional research design and a questionnaire. Out of a total of 40 MRI-radiographers identified nationwide, 31 participated in the study. Statistical Package for Social Sciences v.21.0 was used to analyse the data.

RESULTS

Most participants (n = 21, 67.7%) were aware of MRI-induced vertigo. Many knew that patients (able and weaker) need to be assisted off the couch (n = 28, 90.3%) and escorted to the changing rooms post MRI examinations (n = 31,100%). There were statistically significant associations between the size of magnetic field strength used by the participants and their level of awareness about MRI-induced vertigo (r = 0.691, p = 0.003), appreciation of the needed support for patients post MRI examinations (r = 0.530, p = 0.041) and the frequency of occurrence of MRI-induced vertigo among their patients (r = 0.530, p = 0.001).

CONCLUSION

The radiographers were mostly cognisant of MRI-induced vertigo and the supported care they were supposed to administer to their patients. The size of magnetic field strength used by the participants correlated with their level of awareness about MRI-induced vertigo and their appreciation of the needed support for patients post MRI examinations.

IMPLICATION FOR PRACTICE

The study highlights the need for a refresher training to expand the knowledge-base of a few of the radiographers who were not very cognisant about MRI-induced vertigo.

Comparison of patient radiation dose from chest and lumbar spine X-ray examinations in 10 hospitals in Ghana

This study estimated the patient dose in chest and lumbar spine radiographic examinations in 10 hospitals in Ghana. Dose estimations were done on 1045 patients (aged, 39.6 ± 10.6 y; range 18-85 y) involving 501 (47.9%) males and 544 (52.1%) females for a total of 1495 individual projections. The entrance surface dose (ESD) for the patients was assessed by an indirect method, using the patient's anatomical data and exposure parameters utilised for the specific examination and a Quality Assurance Dose Database software developed by Integrated Radiological Services Ltd in Liverpool, UK. The study showed variations in the ESDs for chest examinations with five of the hospitals having values above the internationally recommended levels. ESDs for lumbar spine anterior-posterior and lateral projections were within acceptable limits. Diagnostic reference levels proposed by the International Commission on Radiological Protection based on patient dose data are imperative to the current Ghanaian situation and will lead to a reduction of the radiation dose.