Department of Radiography
Permanent URI for this collectionhttp://197.255.125.131:4000/handle/123456789/23067
Browse
66 results
Search Results
Item Breast cancer radiotherapy in Sub-Saharan Africa: a comparative study of acute toxicity between conventional and hypofractionated treatment regimens(ecancer, 2024) Daniels, J.; Obeng-Mensah, T.; Kyei, K.A.Hypofractionated radiotherapy for breast cancer has been increasingly adopted glob ally due to its comparable efficacy and reduced treatment burden. The study compared the incidence and severity of four main acute radiation-induced toxicities between breast cancer patients treated with conventional versus hypofractionated radiotherapy. Stratified purposive sampling was used to recruit participants into two groups: group #1 received conventional radiotherapy (50 Gy in 25 fractions over 5 weeks), whereas group #2 received hypofractionated radiotherapy (40.05 Gy in 15 fractions over 3 weeks). A closed-ended questionnaire administered by the researcher was used for quantitative data collection. The Common Terminology Criteria for Adverse Events tool (version 5) was used for grading acute toxicities. Data were analyzed using the Statistical Package for Social Sciences (version 23). The study involved 53 patients with a mean age of 47.9 years (± 12.4) ranging from 26 to 75 years. The patients had breast cancer ranging from stage IIA (13.2%) to IIIC (9.4%). A considerable majority (62.3%) were treated with conventional fractionation whereas 37.7% were treated with a hypofractionated regimen. Dermatitis was the most prevalent side effect among patients in both groups #1 (67%) and #2 (70%). There were no statistically significant differences in the incidence of dermatitis, pharyngi tis, chest wall/ breast pain and fatigue between the two groups. However, the mean inci dence of overall acute toxicity was significantly lower in group #2 (2.15 ± 1.14) compared with group #1 (2.42 ± 1.48), with a p-value of 0.001. Comparatively, the conventional 50 Gy dose regimen was associated with more acute radiation-induced toxicity.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.