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Item Survival rate of cervical cancer: a five year review at a Major Teaching Hospital in Ghana, West Africa(ecancer, 2024) Daniels, J.; Asante, K.; Tackie, J.N.O.; Kyei, K.A.Cervical cancer (CC) is one of the leading causes of cancer-related deaths among females in Ghana. Despite the magnitude of the public health challenge posed by CC in Ghana, survival data as well as reported incidence and mortality rates are primarily based on studies conducted in the capital city of the country. Even though age at diagnosis is known to affect the overall survival of CC patients, the role of this factor in the prognosis of CC patients in Ghana has not been sufficiently explored. The aim of this study was to determine the 5-year survival rate of Ghanaian woman treated for CC at a large tertiary healthcare facility in Ghana. This research was a single-institution-based quantitative ret rospective cohort study conducted among patients with histopathologically confirmed CC. Clinical and socio-demographic data were retrieved from patients’ medical records. Data analysis was done using the Statistical Package for the Social Sciences software ver sion 23. Kaplan Meier curves were used to present the survival rates and median survival time. The peak age at diagnosis was between 45 and 80 years with the modal age group of patients between 75 and 80 years. The mean age at diagnosis was 63.3 ± 15.7 years ranging from 27 to 104 years. The overall survival rates at 1, 3 and 5 years were 76.5%, 51.5% and 32.4%, respectively. The median survival time was 65.8 months. Age < 50 years was associated with higher survival estimates than age >50 years. The 5-year over all survival rate of CC patients reported in this study (32.4%) is relatively low compared with countries in the developed world but like previous reports at other healthcare facili ties in Ghana as well as in other underdeveloped countriesItem Biochemical outcome after curative treatment for localized prostate cancer with external beam radiotherapy: a cross-sectional study(ecancer, 2023) Daniels, J.; Kyei, K.A.; Badejoko–Okunade, K.A.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 clini copathological 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 col lected 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. Diar rhaea and desquamation experienced by treated CaP patients were exclusively attribut able to EBRT. RT produced a complete resolution of symptoms in some of the patientsItem The sexuality of women with cervical cancer undergoing definitive radiotherapy in Ghana(Radiography, 2024) Kyei, K.A.; Daniels, J.; Broni, R.; et al.Introduction: The purpose of this study was to assess the sexuality of cervical cancer patients undergoing radiotherapy at a major cancer treatment center in Ghana. This is an area of interest as globally; cervical cancer kills approximately 342,000 people per annum with an estimated number of 604,000 new cases in 2020. Acknowledging the World Health Organization's definition of sexual health as a state of physical, mental and social well-being in relation to sexuality, this paper sheds light on how these dimensions affect the quality of life of cervical cancer patients. Methods: This was a longitudinal study, which assessed the impact of radiotherapy on the sexuality of both premenopausal and postmenopausal cervical cancer patients presenting for primary treatment with chemoradiation from April to July, 2021 at a major cancer treatment centre in Ghana. The Female Sexual Function Index and Body Image Scale questionnaires were respectively used to evaluate the sexual functions scores among the cervical cancer patients, and to assess the impact of the treatment on their body image. MATLAB software was used for data analysis. Results: Most of the cervical cancer patients sampled were postmenopausal (57 %). About 79 % pre menopausal and 96 % postmenopausal cervical cancer patients were sexually inactive during radio therapy (day 15). Also, 48 % premenopausal and 24 % postmenopausal patients were very dissatisfied with their bodies at the onset of treatment. The frequency of orgasm in cervical cancer patients declined after treatment causing a deterioration in their sexual function. The patients' sexuality was influenced by age and menopausal status. The decreased sexual desire of the patients resulted in emotional distancing from their partners, which invariably induced changes in their partners’ level of sexual interest. This study established significant differences between premenopausal and postmenopausal cervical cancer patients who were generally very dissatisfied with their sexual relationships with their partners on day 1 (p ¼ 0.02) and on day 15 (p ¼ 0.00) of treatment. Conclusion: The majority of patients who presented for treatment for cervical cancer in this study were postmenopausal. Their interest in sexual activity was more influenced by their menopausal status than their antineoplastic treatment. This study indicates that cervical cancer patients are more likely to develop sexual health problems which could substantially worsen over the course of their treatment and beyond. Implication for practice: The study will contribute within the oncology team by assisting personnel in putting in place measures that will guide the treatment of cervical cancer patients and improve quality of care.Item Errors In Manual Radiotherapy Treatment Procedures And Their Evolution In A Low Resource Setting: Uganda’s Experience(Elsevier Ltd., 2023) Komakech, I.; Tagoe, S.N.A.; Orem, J.; et al.Purpose: In Uganda, two-dimensional (2D) radiotherapy treatments have been in use since the establishment of radiotherapy in 1995. Preliminary investigations of treatment records in November 2019 showed evidence of gaps requiring urgent attention. The purpose of this study was to improve the safety of the treatments. Methods: Records of 1164 patients treated in 1387 courses (1412 sites) on Cobalt-60 units were reviewed to determine the frequency and dosimetric implications of events that occurred at different steps of the radiotherapy process. The results were presented and discussed with the different professionals for learning purposes. Results: Most common dosimetric events were omission of block tray, bolus and couch transmission factors in time calculations, incorrect field sizes and depths, wrong beam weighting, independent calculations and prescription doses contributing 28.6%, 10.1%, 6.0%,11.9 %, 10.1%, 5.4%, 4.8%, and 8.9% to the 168 observed errors. Comparison of the calculated treatment doses with the prescribed doses showed that 88 % of the 1412 sites were treated with radiation doses with an accuracy of ± 5%. However, an analysis of the evolution along the years demonstrated an improvement from 82.8% in 2018 to 86.1% in 2019 and 93.2% in 2020. Most common procedural events were incomplete setup instructions and missing patient data in the record and verify system of the Co-60 units for 57% and 61.1% of the 1164 patients, respectively. Conclusions: Opportunities for improving safety in the delivery of radiotherapy treatments were identified. Learning from these past errors should raise awareness within the team, leading to safer treatments.Item Radiation Therapy Physics Quality Assurance and Management Practices in Low- and Middle Income Countries: An Initial Pilot Survey in Six Countries and Validation Through a Site Visit(Advances in Radiation Oncology, 2023) Yorke, A.A.; Williams, V.M.; Tagoe, S.N.A.Purpose: Our purpose was to assess physics quality assurance (QA) practices in less resourced radiation therapy (RT) centers to improve quality of care. Methods and Materials: A preliminary study was conducted in 2020 of 13 select RT centers in 6 countries, and in 2021, our team conducted onsite visits to all the RT centers in Ghana, one of the countries from the initial survey. The RT centers included 1 private and 2 public institutions (denoted as Public-1 and Public-2). Follow-up surveys were sent to 17 medical physicists from the site visit. Questions centered on the topics of equipment, institutional practice, physics quality assurance, management, and safety practices. Qualitative and descriptive methods were used for data analysis. Questions regarding operational challenges (machine downtime, patient-related issues, power outages, and staffing) were asked on a 5-point Likert scale. Results: The preliminary survey from 2020 had a 92% response rate. One key result showed that for RT centers in lower gross national income per capita countries there was a direct correlation between QA needs and the gross national income per capita of the country. The needs identified included film/array detectors, independent dose calculation software, calibration of ion chambers, diodes, thermoluminiscence diodes (TLDs), phantoms for verification, Treatment Planning System (TPS) test phantoms, imaging test phantoms and film dosimeters, education, and training. For the post survey after the site visit in 2021, we received a 100% response rate. The private and the Public-1 institutions each have computed tomography simulators located in their RT center. The average daily patient external beam workload for each clinic on a linear accelerator was: private = 25, Public-1 = 55, Public-2 = 40. The Co-60 workload was: Public-1 = 45, Public-2 = 25 (there was no Co-60 at the private hospital). Public-1 and -2 lacked the equipment necessary to conform to best practices in Task Group reports (TG) 142 and 198. Public-2 reported significant operational challenges. Notably, Public-1 and -2 have peer review chart rounds, which are attended by clinical oncologists, medical physicists, physicians, and physics trainees. All 17 physicists who responded to the post site visit survey indicated they had a system of documenting, tracking, and trending patient-related safety incidents, but only 1 physicist reported using International Atomic Energy Agency Safety in Radiation Oncology. Conclusions: The preliminary study showed a direct correlation between QA needs and the development index of a country, and the follow-up survey examines operational and physics QA practices in the RT clinics in Ghana, one of the initial countries surveyed. This will form the basis of a planned continent-wide survey in Africa intended to spotlight QA practices in low- and middle-income countries, the challenges faced, and lessons learned to help understand the gaps and needs to support local physics QA and management programs. Audits during the site visit show education and training remain the most important needs in operating successful QA programs.Item Generalisability of fetal ultrasound deep learning models to low‑resource imaging settings in fve African countries(Scientific reports, 2023) Sendra‑Balcells, C.; Campello, V.M.; Ohene‑Botwe, B.Most artifcial intelligence (AI) research and innovations have concentrated in high-income countries, where imaging data, IT infrastructures and clinical expertise are plentiful. However, slower progress has been made in limited-resource environments where medical imaging is needed. For example, in Sub-Saharan Africa, the rate of perinatal mortality is very high due to limited access to antenatal screening. In these countries, AI models could be implemented to help clinicians acquire fetal ultrasound planes for the diagnosis of fetal abnormalities. So far, deep learning models have been proposed to identify standard fetal planes, but there is no evidence of their ability to generalise in centres with low resources, i.e. with limited access to high-end ultrasound equipment and ultrasound data. This work investigates for the frst time diferent strategies to reduce the domain-shift efect arising from a fetal plane classifcation model trained on one clinical centre with high-resource settings and transferred to a new centre with low-resource settings. To that end, a classifer trained with 1792 patients from Spain is frst evaluated on a new centre in Denmark in optimal conditions with 1008 patients and is later optimised to reach the same performance in fve African centres (Egypt, Algeria, Uganda, Ghana and Malawi) with 25 patients each. The results show that a transfer learning approach for domain adaptation can be a solution to integrate small-size African samples with existing large scale databases in developed countries. In particular, the model can be re-aligned and optimised to boost the performance on African populations by increasing the recall to 0.92 ± 0.04 and at the same time maintaining a high precision across centres. This framework shows promise for building new AI models generalisable across clinical centres with limited data acquired in challenging and heterogeneous conditions and calls for further research to develop new solutions for the usability of AI in countries with fewer resources and, consequently, in higher need of clinical support.Item Perspectives of radiologists in Ghana about the emerging role of artificial intelligence in radiology(Heliyon, 2023) Edzie, E.K.M.; Brakohiapa, E.K.Background: The integration of Artificial Intelligence (AI)-based technologies in medicine is advancing rapidly especially in the field of radiology. This however, is at a slow pace in Africa, hence, this study to evaluate the perspectives of Ghanaian radiologists. Methods: Data for this cross-sectional prospective study was collected between September and November 2021 through an online survey and entered into SPSS for analysis. A Mann–Whitney U test assisted in checking for possible gender differences in the mean Likert scale responses on the radiologists’ perspectives about AI in radiology. Statistical significance was set at P ≤ 0.05. Results: The study comprised 77 radiologists, with more males (71.4%). 97.4% were aware of the concept of AI, with their initial exposure via conferences (42.9%). The majority of the re spondents had average awareness (36.4%) and below average expertise (44.2%) in radiological AI usage. Most of the participants (54.5%) stated, they do not use AI in their practices. The re spondents disagreed that AI will ultimately replace radiologists in the near future (average Likert score = 3.49, SD = 1.096) and that AI should be an integral part of the training of radiologists (average Likert score = 1.91, SD = 0.830). Conclusion: Although the radiologists had positive opinions about the capabilities of AI, they exhibited an average awareness of and below average expertise in the usage of AI applications in radiology. They agreed on the potential life changing impact of AI and were of the view that AI will not replace radiologists but serve as a complement. There was inadequate radiological AI infrastructure in Ghana.Item Development of size-specific dose estimates for common computed tomography examinations: a study in Ghana(Journal of Radiological Protection, 2023) Ohene-Botwe, B.; Anim-Sampong, S.; Nkansah, J.This study determined the size-specific dose estimate (SSDE) of computed tomography (CT) examinations and derived mathematical expressions for dose output estimation and optimization in a teaching hospital in Ghana. Demographic and scanner output indices, including CT dose index (CTDIvol) and dose length product for adult head, chest and abdominopelvic (ABP) CT examinations carried out at the hospital from 2018 to 2020, were retrieved from the picture archiving and communication system of the CT scanner machine. Other indices such as the antero-posterior diameter (DAP), lateral diameter (DL) and diagonal diameter (Ddia) of the patients’ bodies were measured on the mid-slice axial image using a digital caliper. The effective diameter (Deff) was then calculated as the square root of the product of the DAP and DL. The SSDEs were calculated as the product of the CTDIvol and the size-specific conversion factors obtained from Report 204 of the American Association of Physicists in Medicine. Regression analyses were performed to find the relationship between SSDE and the various parameters to derive mathematical equations for the dose estimations. There were more female samples (n = 468, 56.3%) than male samples (n = 364, 43.7%) for each CT procedure. The SSDEs and size-specific diagnostic reference levels (SSDRLs) were: head (83.9 mGy; 86.9 mGy), chest (8.1 mGy; 8.7 mGy) and ABP (8.4 mGy; 9.2 mGy). The variations between CTDIvol and SSDEs for head (2.50%), chest (25.9%), and ABP (26.2%) showed an underestimation of radiation dose to patients, especially in chest and ABP examinations, if CTDIvol is used to report patient doses. The SSDEs of the chest and ABP CT examinations showed linear correlations with the CTDIvol. The estimated values could be used to optimize radiation doses in the CT facility. The SSDE and SSDRLs for head, chest and ABP CT examinations have been developed at a teaching hospital in Ghana. The SSDEs of chest and ABP examinations showed linear correlations with the CTDIvol and hence can be calculated using the mathematically derived equations in the study.Item Assessment of diagnostic radiographers’ knowledge of work-related health problems and associated effects: A multicentre study in Ghana(Elsevier, 2022) Anim-Sampong, S.; Ashong, G.G.; Quansah, Z.H.; Botwe, B.O.; Sule, D.; et al.a b s t r a c t 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 ¼ 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 ¼ 0.313), years of professional practice experience level (p ¼ 0.319), and academic qualifications (p ¼ 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. © 2022 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.Item Career in radiology; the ghanaian clinical medical Student's perception(Heliyon, 2022) Dzefi-Tettey, K.; Edzie, E.K.M.; Brakohiapa, E.K.; Gorleku, P.N.; Amankwa, A.T.; Abdulai, A.B.; Yabasin, I.B.; Kekessie, K.K.; Idun, E.A.; Ntiamoah-Koufie, C.E.; Acheampong, F.; Oppong, B.; Quarshie, F.; Kusodzi, H.; Asemah, A.R.Background: The importance of radiology in this era of evidence-based medicine cannot be disputed. This has resulted in the increase in demand for radiologists. Thus, the issue of whether there would be sufficient numbers of medical students to meet this growing demand needs further probing. Purpose: To assess Ghanaian clinical medical students’ perceptions about a career in radiology. Materials and methods: This was an online questionnaire-based survey of 575 clinical medical students in five public medical schools in Ghana from September 2020 to February 2021. Student's t-test and one way analysis of variance was used to compare means. For the Likert scale questions, differences in the mean Likert scale responses were assessed among various clinical year groups and across gender using Kruskal-Wallis test and Mann–Whitney U tests. A logistic regression was used to determine the significant predictors of the choice of radiology as a career. Results: Most 340 (59.1%) of the participants were males. The average age of participants was 24.64 3.084 years. Students agreed that, radiology is relevant in this era of evidence-based medicine (mean Likert score ¼ 4.62, SD ¼ 0.819), which yielded significant responses in the third clinical year (p ¼ 0.004). Nearly 30% of respondents stated they did not receive enough didactic lectures or tutorials in radiology, citing insufficient lectures (89.9%), a lack of lecturers (9.5%), and trouble grasping ideas (0.7%) as their main concerns. 133 (23.1%) stated they would choose radiology as a specialty, with flexible working schedule (61.9%) and high income (68.3%) as their topmost reasons. Less patient contact (8.0%) was the least observed reason. A flexible working schedule increased the choice of radiology as a specialty by 2.319 folds (95% CI: 1.413–3.805, P ¼ 0.001). Teleradiology significantly contributed to the choice of radiology as a career (p ¼ 0.001). Conclusion: Generally, the clinical students had varied but positive perceptions on radiology as a specialtyItem Dose optimization of adult head computed tomography examination in an academic hospital in Ghana(Radiation Physics and Chemistry, 2023) Anim-Sampong, S.; Ohene-Botwe, B.; Adom, E.B.; Tagoe, S.N.AThe study investigated radiation doses and image quality of adult head CT and optimization options using an anthropomorphic RANDO phantom on the only available AquilionONE CT scanner in Ghana. Dose length product (DLP) and volume-weighted CT dose index (CTDIvol) dose descriptors were retrospectively obtained from 402 adult head CT examinations performed (from 2020 to 2021) at a Ghanaian hospital, while the effective dose (Deff) was estimated from the product of the DLP and a convention coefficient (k = 0.0023). Using the same routine head CT protocol, the anthropomorphic RANDO phantom was scanned with the hospital’s 640-slice Toshiba AquilionONE CT scanner. Subsequently, exposure factors were varied to study their effects on the dose and image quality. The adult head and phantom images were obtained in Digital Imaging and Communications in Medicine (DICOM) format, and their signal-to-noise (SNR) ratios were analyzed with ImageJ software. The facility’s mean CTDIvol, DLP, and effective dose (Deff) were 86.00 ± 0.00 mGy, 1559.68 ± 197.18 mGy cm, and 3.57 ± 0.46 mSv respectively (SNR = 7.04). For a fixed tube potential, CTDIvol, DLP, and Deff of 51.30 mGy, 1013.80 mGy cm, and 2.33 mSv were respectively achieved (SNR = 5.49) after optimization. Using automatic exposure control (AEC) in the optimization process, the respective CTDIvol, DLP and Deff values were 59.50 mGy, 1176.00 mGy cm and 2.70 mSv (SNR = 5.62). We conclude that substantial Deff reductions of 40.4% and 31.0% using a fixed tube potential, and AEC while maintaining diagnostic image quality were respectively achieved. The protocols associated with these dose-reductions are, therefore, recommended as optimization measures for head CT on the AquilionONE scanner in Ghana.Item Estimation of organ-specific cancer and mortality risks associated with common indication-specific CT examinations of the abdominopelvic region(Journal of Medical Imaging and Radiation Science, 2023) Ohene-Botwe, B.; Schandorf, C.; Inkoom, S.; Faanu, A.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.Item Dose optimization of adult head computed tomography examination in an academic hospital in Ghana(Radiation Physics and Chemistry, 2023) Anim-Sampong, S.; Ohene-Botwe, B.; Adom, E.B; Tagoe, S.N.AThe study investigated radiation doses and image quality of adult head CT and optimization options using an anthropomorphic RANDO phantom on the only available AquilionONE CT scanner in Ghana. Dose length product (DLP) and volume-weighted CT dose index (CTDIvol) dose descriptors were retrospectively obtained from 402 adult head CT examinations performed (from 2020 to 2021) at a Ghanaian hospital, while the effective dose (Deff) was estimated from the product of the DLP and a convention coefficient (k = 0.0023). Using the same routine head CT protocol, the anthropomorphic RANDO phantom was scanned with the hospital’s 640-slice Toshiba AquilionONE CT scanner. Subsequently, exposure factors were varied to study their effects on the dose and image quality. The adult head and phantom images were obtained in Digital Imaging and Communications in Medicine (DICOM) format, and their signal-to-noise (SNR) ratios were analyzed with ImageJ software. The facility’s mean CTDIvol, DLP, and effective dose (Deff) were 86.00 ± 0.00 mGy, 1559.68 ± 197.18 mGy cm, and 3.57 ± 0.46 mSv respectively (SNR = 7.04). For a fixed tube potential, CTDIvol, DLP, and Deff of 51.30 mGy, 1013.80 mGy cm, and 2.33 mSv were respectively achieved (SNR = 5.49) after optimization. Using automatic exposure control (AEC) in the optimization process, the respective CTDIvol, DLP and Deff values were 59.50 mGy, 1176.00 mGy cm and 2.70 mSv (SNR = 5.62). We conclude that substantial Deff reductions of 40.4% and 31.0% using a fixed tube potential, and AEC while maintaining diagnostic image quality were respectively achieved. The protocols associated with these dose-reductions are, therefore, recommended as optimization measures for head CT on the AquilionONE scanner in Ghana.Item Ghanaian radiographers experience and commitment to the mandatory reporting law regarding suspected child physical abuse(Radiography, 2023) Antwi, W.K.; Aziato, L.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 30e54 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.Item Construction and pre-evaluation of an in-house cylindrical ionization chamber fabricated from locally available material(Polish Journal of Medical Physics and Engineering, 2022) Tagoe, S.N.A.; Chaphuka, C.D.; Hasford, F.Introduction: The objectives of this study were to construct a very robust in-house cylindrical ionization chamber from locally available materials to minimize cost, and to assess its suitability for use in a clinical setting. Materials and Methods: The entire body of the constructed IC was composed of Perspex (PMMA). Other components of the IC were made from locally available materials, such as paper and discarded items. The in-house IC was made waterproof by passing the triaxial cable connecting its various electrodes through a plastic tube which once served as a drainage tube of a urine bag. This connection was made such that the chamber was vented to the environment. The completed in-house IC was evaluated for: polarity effect, ion recombination, ion collection efficiency, stability, dose linearity, stem effect, leakage current, angular, dose rate and energy dependences. Results: Although the pre-evaluation results confirmed that the in-house IC satisfied the stipulated international standards for ICs, there was a need to enhance the stem effect and leakage current characteristics of the IC. The in-house IC was found to have an absorbed dose to water calibration coefficient of 4.475 x 107 Gy/C (uncertainty of 1.6%) for cobalt 60 through a cross-calibration with a commercial 0.6 cc cylindrical IC with traceability to the Germany National Dosimetry Laboratory. Using a Jaffé diagram, the in-house IC was also found to have a recombination correction factor of 1.0078 when operated at the calibration voltage of + 400 V. In terms of beam quality correction factors for megavoltage beams, the in-house IC was found to exhibit characteristics similar to those of Scanditronix-Wellhofer IC 70 Farmer type IC. Conclusion: The constructed in-house Farmer-type IC was able to meet all the recommended characteristics for an IC, and therefore, the in-house IC is suitable for beam output calibration in external beam radiotherapy.Item Towards the establishment of national imaging practice guidelines: A preliminary study of the basic computed tomography imaging protocols in Ghana(Elsevier, 2022) Botwe, B.O.; Schandorf, C.; Inkoom, S.; Faanu, A.; Mensah, Y.B.; Antwi, W.K.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.Item Financial toxicity of cancer care in low‑ and middle‑income countries: a systematic review and meta‑analysis(Springer, 2022) Donkor, A.; Atuwo‑Ampoh, V.D.; Yakanu, F.; Torgbenu, E.; Ameyaw, E.K.; Kitson‑Mills, D.; Vanderpuye, V.; Kyei, K.A.; Anim‑Sampong, S.; Khader, O.; Khader, J.evidence of financial toxicity associated with cancer in low- and middle-income countries (LMICs) is scarce. Aim To determine the prevalence, determinants and how financial toxicity has been measured among cancer patients in LMICs. Methods Four electronic databases were searched to identify studies of any design that reported financial toxicity among cancer patients in LMICs. Random-effects meta-analysis was used to derive the pooled prevalence of financial toxicity. Subgroup analyses were performed according to costs and determinants of financial toxicity. Results A total of 31 studies were included in this systematic review and meta-analysis. The pooled prevalence of objective financial toxicity was 56.96% (95% CI, 30.51, 106.32). In sub-group meta-analyses, the objective financial toxicity was higher among cancer patients with household size of more than four (1.17% [95% CI, 1.03, 1.32]; p = 0.02; I2 = 0%), multiple cycles of chemotherapy (1.94% [95% CI, 1.00, 3.75]; p = 0.05; I2 = 43%) and private health facilities (2.87% [95% CI, 1.89, 4.35]; p < 0.00001; I2 = 26%). Included studies hardly focused primarily on subjective measures of financial toxicity, such as material, behavioural and psychosocial. One study reported that 35.4% (n = 152 of 429) of cancer patients experienced high subjective financial toxicity. Conclusions This study indicates that cancer diagnosis, treatment and care impose high financial toxicity on cancer patients in LMICs. Further rigorous research on cancer-related financial toxicity is needed.Item Variability of redundant scan coverages along the Z-axis and dose implications for common computed tomography examinations(Elsevier, 2022) Botwe, B.O.; Schandorf, C.; Inkoom, S.; Faanu, A.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.Item Radiological determination of the cranial index of present-day Ghanaians(Taylor & Francis Group, 2021) Botwe, B.O.; Boadu, J.N.A.; Kyei, K.A.; Thompson, J.D.The cranial index (CI) of Ghanaians is currently unknown. The aim of this study was to measure the CI in a population of Ghanaians in order to classify them against pre-determined CI categories. A systematic random sampling method was used to select 300 normal computed tomography (CT) head scans of adult Ghanaians from the largest hospital in Ghana. All patients were deemed to have a normal cranial image configuration based on the radiological report. The biparietal diameter (BPD, width) and the occipitofrontal diameter (OFD, length) were measured on transaxial CT images using a workstation with a calibrated measurement calliper tool. The CI ratio was calculated as the BPD multiplied by 100 and divided by the OFD. Mean, standard deviation (SD) and range were calculated for BPD, OFD and CI. Differences in measurements between demographic groups were compared using an unpaired t-test, with test α set at 0.05. Of the population of Ghanaians included in this study, 165 (55%) were male and 135 (45%) were females. The mean CI was 77.3±3.6 in males and 79.0±3.3 in females, placing both genders in the mesocephalic category. However, the difference between males and females was found to be statistically significant (P=0.02). The study indicated that most Ghanaian adults belong to the mesocephalic category of CI. Females also had a higher CI, which could be used to differentiate gender groups. This information can be useful for forensic medicine, plastic surgeries for clinical and research purpose.Item Antiretroviral therapy adherence and viral suppression among HIV-infected adolescents and young adults at a tertiary hospital in Ghana(NISC, 2021) Biney, I.J.K.; Kyei, K.A.; Ganu, V.J.; Kenu, E.; Puplampu, P.; Manortey, S.; Lartey, M.With the introduction of antiretroviral therapy (ART), many HIV-infected children are growing into adolescence and adulthood. A facility-based cross-sectional study was conducted at the Fevers Unit of one of the teaching hospitals in Ghana. The Morisky Medication Adherence Scale (MMAS-8) and pill count were used to assess adherence, while measured viral load levels of participants were used to assess viral suppression. The rate of viral suppression (<400 copies/ml) was 68.2%. Participants with high MMAS-8 scores were 8.4 times more likely to be virally suppressed compared to those with low MMAS-8 scores (OR = 8.4, p = 0.003, 95% CI: 2.11–33.48). The commonest reason for missing doses of their antiretroviral drugs (ARVs) was forgetfulness. Efforts must be made by all stakeholders involved in HIV care to engage adolescents and young adults living with HIV (AYALHIV) on personal and/or group levels to help identify and improve particular ART adherence issues so as to increase viral suppression rates.