Journal of Radiography and Radiation Sciences
The Journal of Radiography and Radiation Sciences (JRRS) is the official journal of the Association of Radiographers of Nigeria (ARN). It covers all aspects of diagnostic and therapeutic radiography, diagnostic and interventional radiology, hospital practice, radiography education, forensic and industrial radiography. Papers published include original articles, case reports, systematic reviews, technical notes, and relevant letters to the editor geared towards advancing the knowledge and practice of radiography in Africa and beyond.
All articles in JRRS are published under the Creative Commons Attribution 4.0 International License (CC BY 4.0). This permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
OVERVIEW OF ROUTINE ULTRASONOGRAPHY IN DETECTING FETAL ANOMALIES IN A SUBURBAN SETTING IN NIGERIA
Introduction: Fetal structural abnormalities significantly impact the health and well-being of both the fetus and the expectant mother, ranking among the leading causes of perinatal mortality and morbidity worldwide. This study aimed to evaluate the effectiveness of routine prenatal ultrasound scans in detecting fetal anomalies in a suburban setting in Nigeria. Methods: This retrospective study was conducted at a major diagnostic center in southwestern Nigeria from June 2022 to April 2023. Routine prenatal ultrasound scans were evaluated for pregnant women referred predominantly by Traditional Birth Attendants (TBAs). Results: A total of 2,392 pregnant women, including 43 with twin pregnancies, underwent routine prenatal scans during the study period. Among these, 41 anomalies (1.7%) were detected in the scanned low-risk population. However, 45 fetuses were confirmed to have anomalies at delivery or termination, with 7 cases (15.5%) resulting in stillbirths. Most abnormalities (n=37) were identified before 24 weeks of gestation, yielding a sensitivity of 90.2%. The genitourinary tract was the most frequently affected system (39.1%), followed by the central nervous system (21.2%). The specificity of the scans was 99.1%, with one false positive reported. Six anomalies (13.3%) were classified as lethal. Conclusion: Routine prenatal ultrasound scans in suburban settings are effective in detecting fetal anomalies but pose challenges in counseling. The establishment of standardized fetal anomaly detection protocols could help reduce perinatal mortality and morbidity in such settings. Lack of awareness and inadequate funding, particularly among TBAs, remain significant barriers to effective implementation. Keyword: Ultrasound, Prenatal, Fetal Anomaly, Traditional Birth Attendants
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REGIONAL AND GENDER-BASED NORMATIVE VALUES OF THE TALOCALCANEAL ANGLE IN AN AFRICAN POPULATION
Background: The talocalcaneal angle (TCA) is an important radiographic parameter used to evaluate hindfoot alignment and diagnose various foot deformities. While extensive data exist for non-African populations, research on normal TCA ranges for African populations remains limited, despite their importance for region-specific diagnostic and surgical planning. Objective: This study aimed to establish a nomogram for the TCA in an African population, evaluating potential gender and age differences and comparing findings with non-African studies. Methods: A prospective cross-sectional study was conducted with 120 participants (60 males, 60 females) aged 19–70 years. Standardized lateral weightbearing foot radiographs were obtained following clinical examination to exclude pathological conditions. The TCA was measured three times by two independent raters, and the intraclass correlation coefficient (ICC) was used to assess inter- and intra-rater reliability. Statistical analyses, including independent t-tests and ANOVA, were performed to evaluate gender and age effects. Results: The mean ± 2SD TCA was 39.20 ± 6.76 degrees, with a normal range of 32.44 to 45.96 degrees. No significant differences were observed between genders or across age groups (p > 0.05). ICC analysis demonstrated excellent reliability for averaged measures (p < 0.001). The TCA was significantly higher than reported values in non-African populations (p < 0.05). Conclusion: This study provides a population-specific normal range for TCA in an African cohort, emphasizing the importance of regional norms for clinical and surgical decision-making. Future research should explore factors influencing TCA and validate these findings across diverse African populations.
A SURVEY OF DIAGNOSTIC X-RAY ROOM DESIGN AND SHIELDING INTEGRITY OF LEAD APRONS IN A STATE IN NORTH EASTERN NIGERIA
Background: X-ray facility design and shielding integrity is meant to optimize radiation safety of patients, staff and the general public. Objectives: To determine the conformity to x-ray room design standards and the functional efficacy of lead aprons in the surveyed facilities. Materials and Method: The survey was conducted in six radio diagnostic centers in Gombe State Nigeria, labeled A to F for anonymity. The building layout of the radiology departments was sketched to show the dimensions (L x B x H) and adjoining structures. Data sheets were also used to record information about radio-diagnostic facility. Lead aprons were inspected for defects by physical observation and by x-ray exposure. Results: The x-ray room dimension of the six radio diagnostic centers with A(24m2 ), B (14.8 m2 ), C (30 m2 ), D (36 m2 ), E (21.2 m2 ) and F (25 m2 ). All the walls of radio-diagnostic room of facility A, B, C and D were lined with 2 mm lead equivalent, whereas E and F were not. About 7 (38.8%) of lead aprons inspected were defective, while 11 (61.1%) were not defective. Conclusion: There are compromises noted in the design of facility B and majority of the lead aprons inspected showed good functional efficacy.
PAEDIATRIC DIAGNOSTIC REFERENCE LEVELS IN LOW RESOURCE SETTINGS: A GUIDE FOR DEVELOPING COUNTRY PRACTITIONERS WITH EXCERPTS FROM ICRP 135
Background: The practical implementation of Diagnostic Reference Level in paediatric imaging is a complex task due to their unique individuality in terms of high sensitivity to radiation, varying body sizes and presenting pathology. Hence, good knowledge of medical technology, skill to perform patient dosimetry and to analyze image quality is required. Purpose: To provide a guide on the methodological requirements for the establishment of Paediatric Diagnostic Reference Levels (PiDRLs) based on the revised and updated guidelines from the current ICRP publication 135 on Diagnostic Reference Levels (DRLs). Materials and method: An extensive review of the ICRPreport Publication 135 on Diagnostic Reference levels in medical imaging with a focus on paediatric imaging and other related studies were undertaken. Results: The ICRPreport 135 updates and refines the recommendations of 2001. It highlights that the application of DRLs in paediatrics alone is not sufficient for optimization of protection. Image quality must be evaluated. Quantities used for DRLs should be appropriate to the imaging modality being evaluated, assess the amount of ionizing radiation applied to perform a medical imaging task, and be measured directly. For interventional procedures, complexity of the procedure may be considered in setting DRLs. DRLs shall not be used for individual patients or as trigger (alert or alarm) levels for individual patients. Appropriate weight bands (generally with 5 or 10 kg intervals) are recommended for establishing paediatric DRLs and should be promoted. Conclusion: The amount of radiation used for examinations of children can vary tremendously due to great variation in patient size and weight from neonates to adult-sized adolescents. This variation in patient radiation dose is appropriate. However, variation in patient doses due to inappropriate technique or failure to child-size the imaging protocol is not appropriate. This forms the basis of the new ICRPguideline and should form the basis of developing PiDRLs.
PATIENT WAITING TIME ANALYSIS AT SERVICE POINTS IN THE ULTRASOUND UNIT OF A NIGERIAN TEACHING HOSPITAL
Background: Quality of service, as perceived by patients in any healthcare facility is to a great extent, dependent on the waiting time. Reducing patients' waiting time increases patients' satisfaction and improves system efficiency. Purpose: To measure and analyze the waiting time of patients at the service points in the ultrasound unit of a Nigerian tertiary hospital and to determine the mean examination time for the different ultrasound investigations carried out. Methods: This prospective cross-sectional study was carried out in the ultrasound unit of the Radiology department at University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla, Enugu. The waiting and examination times of patients were measured directly through observation of system operations. The waiting time at the various service points identified as costing, update, payment and examination were recorded. Mean, range and standard deviation of waiting and service times formed the descriptive statistics for the. For inferential statistics, ANOVA test was carried out to test for significance in the different service point waiting times, and the different examination times for the different investigations. Results: Mean waiting time was 3 hours 31 seconds and average exam time was 26 minutes 31 seconds. Analysis of variance on the service point where patients wait the most showed that the point after making payment was the most significant. There was no significant difference found in the amount of time spent for different examinations (P< 0.05). Conclusion: Timely delivery of services is of optimum importance, considering the need for patient-centered service. With information provided on the waiting time at the different service points in a typical teaching hospital ultrasound unit, departmental managers will be guided in the planning of the departmental operations, to enhance patient satisfaction and system efficiency.
HYSTEROSALPHINGOGRAPHIC FINDINGS IN INFERTILE WOMEN: A SYSTEMATIC REVIEW
Background: Hysterosalpingography (HSG) is a valuable radiological procedure for imaging the female reproductive tract. Structural abnormalities on hysterosalpingography (HSG) are among the important factors in the evaluation of female infertility. Objectives: The study was aimed at reviewing the available literatures on hysterosalphingography findings in infertile women, identifying the missing gap in the subject area, coming up which area of further that will further enhance the role of HSG in the diagnosis of infertility. Methods: The study was a systemic review that focused on literature on the topic and key wards of research. The references were obtained using a database; IEEE Xplore, EBSCO, Cochrane and MEDLINE. The search terms used were; hysterosalphingography findings, HSG, detection of infertility, fluoroscopic examinations. The inclusion criteria are articles published in English language, non-duplicated and those that full text are available online. Result: Eleven articles were considered for the review. Four of the articles were prospective, whereas the other seven were retrospective studies. Ten of the reviewed articles are from Africa and only one is from Asia. The most frequent finding in the reviewed articles on the two continents was bilateral tubal blockage whereas the least frequent finding is associated with the cervix. The majority of the reviewed articles used short study duration, retrospective, or mall sample size. None of the reviewed articles established a relationship between the HSG findings with demographic information or clinical history of the selected subjects. Conclusion: The findings of the published articles have proven the potentiality of HSG in detecting uterine abnormalities related to infertility. None of the reviewed articles established a relationship between relationship between the HSG findings with demographic information or clinical history of the selected subjects.
INTERDISCIPLINARY COLLABORATION AMONG HEALTH PROFESSIONALS: A PANACEA FOR EFFECTIVE AND EVIDENCE BASED HEALTH CARE DELIVERY
Introduction: Interdisciplinary collaboration (IDC) is important in health care settings as the complex nature and demands of the health care work environment requires the expertise and knowledge of differing individuals or specialists working together to solve multifaceted and complex patient care problems. Objective: To assess the health professionals' attitude towards development of an interdisciplinary collaborative approach to patient care in health institutions and to systematically review the impact of IDC as a panacea for effective health outcomes in Nigeria. Methodology: The research is a systematic review that provides various approaches for studying interdisciplinary teams. Fifty articles were selected from different search engines such as google, google scholar, science direct and research gate with the search term Interdisciplinary collaboration among health care professionals. Articles were arranged based on most relevant, relevant and closely related articles. Result: The study revealed that IDC is pivotal in evidence based care and contributes immensely to effective and efficient health outcomes. It puts the patient at the center of the healthcare team's focus and allows all health professionals, with the patient, to collaboratively provide input, be part of the decision making, and improve outcomes.Although there are several obstacles to IDC, adopting this team-based culture of mutual respect and understanding is possible and, in fact, necessary. Conclusion: This study reveals that there are many benefits to IDC. It can improve safety and healthcare delivery, as well as reduce costs. Interprofessional team supports patient and personnel engagement, organizational efficiency and innovation.
SONOGRAPHIC ASSESSMENT OF KIDNEYS IN HUMAN IMMUNODEFICIENCY VIRUS SERO-POSITIVE PATIENTS: A SYSTEMATIC REVIEW
Background: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) remains a major challenge globally, and approximately 180,000 people died from AIDS related illnesses in Nigeria in 2015. HIV associated nephropathy is the third most common cause of end-stage renal failure. Objectives: To review published original research articles on the sonographic evaluation of kidneys in HIV sero-positive patients, identifying missing gaps and coming up with an area of further study. Methodology: The study was retrospective and a secondary source of data from published original research articles was used. The search was performed through Google search using Google scholar, EMBASE, PubMed and Medline. All the published original research articles in English language and the availability of full text articles were included in the study. The results: An electronic search using the search terms had identified 58 related published articles, but only 12 articles were reviewed. This study found out that human immunodeficiency virus-associated nephropathy (HIVAN) to be most predominant renal disease in HIV positive patients leaving in sub-Saharan Africa with increased renal parenchymal echogenicity and decreased corticomedullary differentiation sonographically, which correlate in raised of serum creatinine level and the degree of patients' immune competence (CD4 count).Few studies correlated the sonographic findings with histopathological feature and none uses Dopplar ultrasound. Conclusion: This study has identified correlation of the sonographic findings with the histopathological features and the use of Doppler ultrasound as the missing gaps from the previous published research articles in the subject area.
NIGERIAN RADIOGRAPHERS OBLIGATION TO DIAGNOSTIC REFERENCE LEVELS (DRLs) IN MEDICAL IMAGING
Background: Diagnostic reference levels (DRLs) help to identify unusually high dose levels in medical procedures involving radiation. This will subsequently, stimulate quality control. There are legislations and guidelines requiring Member States of European Union to adopt DRLs. While about 72% of European countries as well as the United States have complied, and with subsequent reviews demonstrating significant dose reductions (16% – 30%), no evidences link any African country to replicating the same. Objective: This work briefly reviewed the progress of Nigeria with regards to diagnostic reference levels (DRLs) and with particular attention to efforts by radiographers. Methods: Google search was made with keywords of 'diagnostic reference levels' as well as 'radiation dose in Nigeria.' Over forty works were retrieved but only twentytwo which had specific relevance to the focus of the review were archived and read. The works were subsequently scrutinized to piece together the trend of DRLs globally, and locally. Results: Publications on x-ray, mammography, fluoroscopy and computed tomography dose abound in Nigeria. Doses had wide variations in all modalities. There were no accessible evidence to indicate that any regulatory agency in Nigeria had keyed into the imperative of dose investigation, monitoring and reporting. Conclusion: In conclusion, diagnostic reference levels in x-ray, mammography and computed tomography have been recommended by independent researchers in Nigeria. Regulatory agencies are urged to summon the will to give guidelines on implementation of these DRLs in order to improve optimization of protection for patients.
IMPACT OF ULTRASOUND AND SOCIODEMOGRAPHIC VARIABLES ON MATERNAL FOETAL ATTACHMENT IN TARABA STATE, NIGERIA
Background: Maternal foetal attachment is manifested in behaviors that demonstrate care and commitment to the foetus. Ultrasound decreases maternal anxiety and confers psychological benefit following a reassuring sonogram. Maternal-foetal attachment is affected by many socio-demographic factors which include maternal age, occupation, educational level, race, marriage duration, ethnicity, Religion, income status, pregnancy planning, and identification of the foetal gender Aim: This study was aimed at assessing the effect of ultrasound and sociodemographic factors on maternal foetal attachment during pregnancy. Method: A prospective study was conducted from November, 2019 to March, 2020. A convenient sampling method was employed and included 404 pregnant and rd women aged 18-45 years old in their 2 and 3 trimester. The data were collected using a maternal foetal attachment scale questionnaire. Descriptive and inferential statistics were carried out at p value < 0.05. Result: The score of maternal foetal attachment scale was greater with post ultrasound than the pre ultrasound. There was statistically significant difference between the pre and post ultrasound maternal foetal attachment scale (p=0.000).. A statistically significant difference was observed in the maternal foetal attachment across the different ethnic groups (p=0.000), planned and unplanned pregnancy (p=0.000). Conclusion: This study revealed that ultrasound scan has influence on maternal foetal attachment, planned pregnancy. Hausa, Bandawa and Jenjo were found to be more attached to their foetuses.
CAROTID DOPPLER INDICES WITH AGE AND BODY MASS INDEX IN A SAMPLED NIGERIAN POPULATION
Background: Carotid doppler studies are frequently carried out to assess for possible stenosis resulting from presence of carotid plaques. The carotid peak systolic velocity (PSV) and end diastolic velocity (EDV) are key indices for determining the severity of the stenosis. However, normative values of these parameters may be dependent on anthropological variables like age and body mass index (BMI) Objective: The study was aimed at assessing the variations of PSV and EDV with age and BMI in a sampled Nigerian population. Materials and Methods: A total of 204 participants (72 males and 132 non-gravid females) aged between 20 and 70 years who were normotensive with no cardiovascular diseases were selected. Their ages, BMI, PSV and the EDV were measured using standard protocols for the four segments of the carotid artery: common carotid (CC), carotid bulb (CB), internal carotid (IC) and the external carotid (EC). Data obtained were presented using tables and line graphs while the analysis of variance (ANOVA) was used to determine significant difference in measurement across the groups. Results: The mean PSV recorded were 88.25 ± 7.43 cm/s for the CC, 73.93 ± 6.23 cm/s for the IC, 51.01 ± 4.30 cm/s for the CB and 50.41 ± 4.25 cm/s for the EC. There was a steady increase of the PSV between 20 and 46 years from 74.91 cm/s to 98.78 cm/s for the CC, from 62.76 cm/s to 82.75 cm/s for the IC, from 42.80 cm/s to 56.43 cm/s for the EC and from 43.30 cm/s to 57.10 cm/s for the CB. The maximum EDV measured for the IC was (24.75 ± 2.11 cm/s). Others were 21.12 ± 1.8 cm/s for the CC, 19.38 ± 1.65 cm/s for CB and 16.92 ± 1.44 cm/s for the EC. The EDV also increased steadily between 20 to 46 years from 17.76 cm/s to 23.68 cm/s for the CC, from 21.04 cm/s to 27.75 cm/s for the IC, from 14.38 cm/s to 18.97 cm/s for the EC and from 16.48 cm/s to 21.73 cm/s for the CB. The PSV and EDV varied significantly with age (p > 0.05). Also, the PSV and EDV 2 2 increased slightly with increasing BMI from 30 – 31.9 kg/m2 . For a BMI of 20 kg/m2 to 32 kg/m2 , the increase in PSV were from 79.48 cm/s to 90.75 cm/s for the CC, from 66.58 cm/s to 76.03 cm/s for the IC, from 45.40 cm/s to 51.85 cm/s for the EC and from 45.94 cm/s to 52.46 cm/s for the CV. Similarly, the PSV and EDV values decreased at a 2 BMI of 30 – 31.99 kg/m2 . Thus, the BMI was significantly associated with PSV and EDV across all segments of the carotid artery (p > 0.05). Conclusion: There are significant variations in carotid PSV and EDV with age and BMI. These variations should be taken in to consideration when diagnosis on alterations in carotid artery flow are to be made using PSV and EDV values.
SONOGRAPHIC FEATURES OF RADIOLOGICALLY NON-FUNCTIONING KIDNEYS ON INTRAVENOUS UROGRAPHY (IVU) IN KANO METROPOLIS, NIGERIA
Background: Despite technological advancement in uro-radiology, renal ultrasonography remains the imaging modality of choice for evaluating various pathological conditions affecting urinary tract (GIT) system. Aim: This study was aimed at evaluating sonographic features of radiologically nonfunctional kidneys in Kano metropolis, Nigeria. Methods: A prospective study involving 94 each of disease and control group were conducted in Kano metropolis from January 2019 to January 2021. Renal scans were performed using a digital ultrasound imaging system; model DP-8800Plus fitted with a 3.5MHz curvilinear transducer. The maximum length, width, and thickness were measured. The renal echogenicity was assessed and graded. Data was analyzed using SPSS Version 22.0 Results: The mean values of the right and left renal volumes among adult patients was 3 3 400.5 ± 527.3 cm and 177.6 ± 174.3 cm respectively. For pediatric patients it was 272.3 3 3 ± 308.6 cm and 241.6 ± 228.7 cm for the right and left kidney respectively. The renal parenchymal echogenicity of the right kidney among adult patients were sored as grade II 2 (5.3%), grade III 27 (71%), and grade IV 9 (23.7%), while that pediatric patients were Grade 0 (11.1%), and 8 (88.9%) as grade III. The adults left kidney were scored grade II 2 (6%), and 16 (47%) each as grades III and IV, while the pediatric group scored 3 (25%) as grade II, and 9 (75%) as grade III. Conclusion: Increased renal volume, shrunken kidney, increased renal parenchymal echogenicity, and severe hydronephrosis were strong sonographic indicators of nonfunctional kidneys.
THE RACE TOWARDS THE UNIVERSAL HEALTH COVERAGE AND FACTORS INFLUENCING RADIOGRAPHERS' CAREER CHOICE IN RURAL SETTLEMENTS IN NORTH-EASTERN NIGERIA
Background: There is a human resource crisis in the healthcare sector in Nigeria. This is because of the existing inequitable distribution of the available meagre workforce which is itself not helped by the increasing and currently trending brain drain. Purpose: This study aimed at assessing the factors that influence radiographers' choice of career in rural settlements in Northeastern Nigeria. Methods: A cross-sectional study was conducted among Radiographers in Northeastern Nigeria. A 21-item, self-administered semi-structured questionnaire was distributed over a six (6) month period, where 130 questionnaires were distributed. The questionnaire consisted of two sections; a: on demography; b: on factors (attractors and detractors) for career choice in rural areas. Content analysis was used to analyze qualitative data; descriptive statistics were used to analyze quantitative data. Statistical Package for Social Sciences (SPSS) version 21.0 was used. Results: A total of 91 questionnaires were retrieved, giving a response rate of 70%. There were 56 (61.5%) males and 35 (38.5%) females. About 82 (90.1 %) had B.Sc and 9 (9.9 %) had M.Sc as their highest qualification. The major attractors for accepting rural jobs were improved remuneration 97 (86.8%) and opportunity for continuous professional development 72 (79.1%). While major detractors were, the cultural and traditional beliefs of the people in rural areas 23 (25.3%) and the lack of social amenities/poor infrastructure 22 (24.2%). Conclusion: The attractors for radiographers to rural areas in this study were; improved remuneration, availability of equipment, professional development, availability of social amenities and security among others. To recruit and retain radiographers in the rural areas, government, recruitment agencies and employers should in addition to good remuneration motivate the radiographers by providing adequate power, security, rural posting allowances, good functional equipment and working and learning environment.
RADIOLOGICAL EVALUATION OF LEAD APRON INTEGRITY IN FIVE SELECTED HOSPITALS IN ABUJA, NIGERIA
Background: The general consensus is that any exposure to ionising radiation carries a risk. Diagnostic radiology is the largest (87%) contributor to man-made ionising radiation, therefore any economical and socially acceptable means of reducing dose without compromising the diagnostic value of the procedure must be worth implementing. Aim: This study is aimed at evaluating lead apron integrity in five selected Hospitals in Abuja, Nigeria. Methodology: The methodology approach includes the application of a large area beam for transmission measurement with the placement of OSLD before and behind the ten (10) lead aprons to determine the entrance and exit dose as well as the transmission factor. In this study, lead apron consisting of 0.25mm and 0.35mm thickness were examined. Results: The result shows that the transmittance factor of the entrance and exit dose through the lead equivalent aprons is directly proportional to the age of the apron with NHA1 having the highest transmission factor (0.83) and oldest age (16 years). WGH2 has the lowest transfer factor (0.12) and the least age (1 year). Conclusion: Lead aprons loses their attenuation capability over time and should be replace after 15 years at most for effective protection against ionizing radiation.
Optically Stimulated Luminescence Dosimeter
AN EVALUATION OF THE EVIDENCE OF BURNOUT AMONG ULTRASOUND PRACTITIONERS IN RIVERS STATE
Background: Occupational burnout has become a critical issue among ultrasound practitioners. Inappropriate management of occupational burnout can lead to serious health problems. Aim: To evaluate the evidence of burnout among ultrasound practitioners in Rivers State. Materials and methods: A survey of ultrasound practitioners in selected diagnostic imaging facilities in Port Harcourt and its environs was conducted between November, 2018 and March, 2019 to evaluate the evidence of burnout. A descriptive survey design was employed and selection of the facilities was done using systematic sampling technique. 21 diagnostic imaging facilities were used. Ethical clearance was obtained from Management of the facilities. Data were obtained from structured questionnaires administered to 50 ultrasound practitioners in these facilities, who accepted to participate in the study. The questionnaire surveyed basic demographic data, time taken to get to work, experiences, practices, number of night shifts and other factors that predispose burnout. Data analysis was done using SPSS version 20. Results: The factors contributing to burnout among ultrasound practitioners are understaffing leading to work overload and excessive overtime work (41%), hostile interactions with patients' relatives (34%), interactions with colleagues (20%), and conflict with Boss/supervisor (5%). Burnout manifests differently among the practitioners as feelings of: being worn-out and weary (46%), being sick (31%), being emotionally drained (23%). Conclusion: Ultrasound practitioners in Rivers State suffer high level of burnout. Issues of understaffing and interpersonal communication skills should be addressed in order to minimize the incidence of burnout.
TOXICITY EFFECT OF RADIOGRAPHIC DEVELOPER EFFLUENT ON GIANT AFRICAN SNAIL (ACHATINA FULICA)
Background: The decline in the population of snails, a source of protein of people living in the high forest zone due to environmental pollution and the hazard caused by the disposal of radiographic developer effluent into streams, bushes or forests and public sewer systems makes the assessment of the effect on giant African snails (Achatina fulica) from environmental pollution due to radiographic developer effluent very important. Materials and Methods: Ninety 5 months old, 12 months old and 24 months old giant African snails were randomly divided into 6 groups of 15 snails for each age group based on the dose of developer effluent to be administered. One group from each age group was designated the control and the remaining, the experimental group. Range finding test was performed at effluent concentrations of 100 %, 50 %, 25 %, 12.5 %, 6.25 %, 3.125 %, 1.6 % and 0 % (control) in 150 ml of distilled water. The effluent solution was administered on the feed and soil of the experimental snails only. Results: Behavioural changes occurred between 0.2 – 1.0 % concentration and mortality at 24 – 96 hours exposure to the effluent solutions. The percentage (%) mortality of the giant African snails increased as the effluent concentration increased from 0.2 - 1.0 % and at increased exposure time of 24 – 96 hours. The estimated 96 hours LD50 for the 5, 12 and 24 months old giant African snails were 0.20 0.23, 0.23 0.25 and 0.30 0.26 respectively. Conclusion: Radiographic developer effluent is harmful to the giant African snails, with the % mortality increasing with increase in concentration and exposure time to the developer effluent. Legislation is recommended to ensure safe disposal of radiographic developer effluents into the Nigerian environment considering the importance of giant African snails (Achatina fulica) to the ecosystem and the economy.
KNOWLEDGE AND PRACTICE OF IMAGING OF CHILDREN WITH SUSPECTED CASES OF NON-ACCIDENTAL INJURIES AMONG RADIOGRAPHERS WITHIN MAIDUGURI METROPOLIS, NORTHEASTERN NIGERIA
Objectives: To assess the knowledge and practice of Non-accidental injuries (NAI) among radiographers practicing within Maiduguri Metropolis. Methods: A cross-sectional study was conducted using a questionnaire to elicit information on knowledge and practice of imaging children with Non-accidental injuries. The information elicited from the questionnaire related to the following themes: Demographic characteristics, knowledge and practice of imaging children with NAI. Informed consent was sought from participants. Descriptive statistics (mean, frequencies) were used to analyze the data. Results: A total of 45 questionnaires were distributed to radiographers, and 36 (100%) were completed and returned. A total of 23 (63.9%) were males and 13 (36.1%) were females. The majority 34 (94.4%) of the respondents had good knowledge of NAI. Skeletal survey was the examination commonly requested in children with NAI as reported by 23 (63.9%) respondents, and the majority of the participants 31 (86.1%) had no specialty training in pediatric imaging. A total of 23 (63.9%) participants knew that using a single film to image the whole body (baby-gram) was an obsolete examination. Conclusion: Radiographers in this study have good knowledge of NAI in children and are involved in imaging children with suspected cases of non-accidental injury. It is evident from the results of this study that NAI among children occursin our environment and a majority of these cases are underreported and may even go unnoticed. Having adequate knowledge of clinical and radiologic manifestations of NAI in children will enable the radiographer to deliver evidence-based practice in line with international best practices.
COP27 CLIMATE CHANGE CONFERENCE: URGENT ACTION NEEDED FOR AFRICA AND THE WORLD
Wealthy nations must step up support for Africa and vulnerable countries in addressing past, present and future impacts of climate change. The 2022 report of the Intergovernmental Panel on Climate Change (IPCC) paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction, and climate hazards such as heatwaves and floods (1). These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality. To avoid these catastrophic health effects across all regions of the globe, there is broad agreement—as 231 health journals argued together in 2021—that the rise in global temperature must be limited to less than 1.5oC compared with pre-industrial levels.
RADIOGRAPHIC DETERMINATION OF NORMAL RANGE VALUES OF ACROMIOCLAVICULAR JOINT SPACE IN NIGERIAN POPULATION
Background: Acromioclavicular joint space is one of the most common injuries of the shoulder region. Accurate diagnosis of most acromioclavicular (AC) joint pathologies depends on the knowledge of the normal range values of acromioclavicular joint space. The variation in the normal AC joint spaces among the studied population points to the need to have population-specific reference range values of acromioclavicular joint space while the paucity of data on normal acromioclavicular joint space diameter in our locality necessitated this study. Objective: This study was, therefore, aimed at radiographically determining the normal reference range values of acromioclavicular joint space diameter with age in adult Nigerian and also to find its variation with sex. Methods: This retrospective study was conducted in three tertiary hospitals in Enugu from January 2019 to July 2019. It involved digital anteroposterior shoulder radiographs of 628 adults (18 – 80 years) obtained using Zanca’s view and reported as normal by four consultant radiologists. The acromioclavicular joint space diameter is calculated as an integral of the distances between the superior and inferior borders of the acromioclavicular joint space. Data were analyzed using a linear regression model, Pearson product-moment correlation coefficient, and independent sample t-test. Results: The mean AC joint space diameter ranged from 3.63 mm at ≤ 20 years to 1.14 mm at 76-80 years of age. Acromioclavicular joint space diameter correlated strongly but negatively with age with correlation coefficients of -0.785, -.839, -.797, and -.780. There was a significant difference between the acromioclavicular joint space diameter of males and females (p = 0.000). Conclusion: This study has generated a reference range value of normal acromioclavicular joint space diameter with age in our locality while there is a difference in acromioclavicular joint space between male and female adult Nigerians.
QUALITY ASSURANCE OF PERSONAL PROTECTIVE APPAREL AT TERTIARY HOSPITALS IN YOLA, ADAMAWA STATE
Background: Exposure to ionizing radiations is hazardous to radiological workers, patient’s relatives and patients. The effect may be stochastic or deterministic. Protective apparel keeps the radiation dose received by hospital workers, patients and patient relatives as low as reasonable achievable (ALARA) under normal working conditions. Protective apparels are frequently mishandled in the diagnostic room after use leading to damage. Objective: This study aimed at assessing integrity of the protective apparel used at the radiology department of a tertiary health institution in Adamawa State of Nigeria. Methods: From three different hospitals in Yola, 26 pieces of protective apparels were identified, inspected and classified by the hospital, type, manufacturer's name, years it had been used, and the thickness of the lead. With 17 x 14-inch cassette two exposures were made on each the garment with 70 kVp and 10 mAs with a film focal distance (FFD) of 100cm with a conventional x-ray unit.. Results: The result showed 12 (46.0 %) of the protective apparel studied were defective with split 5 (42.0%), crack 4(33.0%) and hole 3(25.0%) as the most common defect. Correlation of the apparels age and the number of defective protective apparels were statistically not significant (p = 0.166). Conclusion: In order ensure protective garments provide the best protection possible; there is a need for proper storage and regular quality assurance on the apparels in the radiology departments to ensure radiation protection.
CLINICAL DATA, PATHOLOGICAL FINDINGS, AND IMAGING FEATURES OF FOLLICULAR DENDRITIC CELL SARCOMA IN THE MEDIASTINUM: CASE REPORT AND LITERATURE REVIEW
Follicular dendritic cells sarcoma (FDC sarcoma) are mesenchymal-derived dendritic cells located in B-follicles, where they play a pivotal role in triggering and maintaining B-cell adaptive immune response. It is an uncommon tumor with few reported cases. Using pathological tests, we investigated the computed tomography (CT) appearance, positron emission tomography-computed tomography (PET-CT), and pathological findings in a 43-year-old woman diagnosed with mediastinal FDC sarcoma which usually overlaps with lymphoma. Previous literature reports on FDC sarcoma were reviewed. FDC sarcoma should be considered in asymptomatic patients with mediastinal lymph node lesions with a diameter of more than 1cm and appears as an illdefined mass with an arborising pattern of necrosis. The complement receptor CD21(+) is an immunohistochemically specific marker for determining the pathological diagnosis of FDC sarcoma. This case report aims to highlight imaging features to facilitate this rare entity’s diagnosis and treatment options.
Positron Emission Tomography-Computed Tomography
Situs solitus refers to a normal visceral structure, whereas situs ambiguous refers to a situation in which the pattern of arrangement cannot be determined. Major visceral organs are reversed from their natural locations in situs inversus, a congenital variation. It's called situs inversus totalis when it is associated with dextrocardia. We present a case of situs inversus totalis in a 43-year-old immunocompromised female patient referred to the Radiology Department of a military hospital in Makurdi, Benue State, in the North Central region of Nigeria. The patient was referred for a chest x-ray on suspicion of mitotic disease, but an abdominal ultrasound was done in addition after the discovery of dextrocardia. Abdominal ultrasound and chest radiographs revealed transposition of major visceral organs and dextrocardia, respectively. In this present case study, abdominal structures revealed reversed anatomy of visceral organs. The liver and gallbladder were found on the left side of the abdomen, while the stomach and spleen were found on the right side. An additional abdominal radiograph was obtained to further clarify organ distribution in the abdomen. This case demonstrates a typical case of situs inversus totalis and further underlines the relevance of multiple medical imaging techniques in diagnosis. An early identification of this condition has profound implications for the future care and comparative imaging of patients. Most individuals with situs inversus can live a normal life without symptoms or disability. Finally, the authors suggest that radio diagnostic professionals employ consistent use of universally accepted imaging protocols, annotations, and image orientation as an important means of correctly identifying situs inversus totalis.
REDUCING THE RISKS OF NUCLEAR WAR - THE ROLE OF HEALTH PROFESSIONALS
In January, 2023, the Science and Security Board of the Bulletin of the Atomic Scientists moved the hands of the Doomsday Clock forward to 90 s before midnight, reflecting the growing risk of nuclear war.1 In August, 2022, the UN Secretary-General António Guterres warned that the world is now in “a time of nuclear danger not seen since the height of the Cold War. 2 The danger has been underlined by growing tensions between many nuclear armed states. 1,3 As editors of health and medical journals worldwide, we call on health professionals to alert the public and our leaders to this major danger to public health and the essential life support systems of the planet—and urge action to prevent it.
EVALUATION OF X-RAY EQUIPMENT PERFORMANCE IN SOME GOVERNMENT HOSPITALS IN KADUNA CITY, KADUNA, NIGERIA
Background: In low- and middle-income countries, imaging equipment is frequently left unmonitored for extended periods of time, and only during inspections for licensing purposes is its quality assessed in terms of performance evaluation and quality control Objective: The objective of this study was to conduct an evaluation of X-ray equipment performance in some government hospitals in Kaduna city, Kaduna state, Nigeria Method: In this investigation, three (3) facilities were deliberately visited. At each hospital, Xray equipment was subjected to quality control (QC) testing, and the X-ray rooms were physically inspected. Hospitals execute the following quality control tests: radiation dosage levels, radiation leakage, half value layer, beam alignment, peak tube voltage, mA linearity, and entrance skin dose. Using a survey meter (RADOS model RDS-120), the radiation dose levels in each X-ray room were measured. Results: The acquired data revealed that only Hospital 1 and Hospital 2 exhibited a high level of compliance. Hospital 1 and Hospital 2 passed the radiation leakage test with results below the tolerance limit of 1.0 mSv/hr, demonstrating compliance with the norm. Hospital 3 passed the Half-value layer test, and all three hospitals passed the beam alignment test. Hospitals 1 and 2 passed the peak tube voltage (kVp) test because the co-efficient of variation between the set kVp and measured kVp was less than 0.05. Only Hospital 2 passed the mA linearity test, since its coefficient of linearity was 0.08, which is below the permitted level of 0.1. The outcome of the entrance skin dose (ESD) test revealed that all of the hospitals fell under the international and national tolerance limits, which is deemed safe for both patients and employees. Conclusion: Based on the findings of this study, it can be concluded that the government hospitals in the Kaduna city are slightly in compliance with national and international standards. The visual inspection performed on the hospitals revealed that they retain a high degree of compliance to the standard.
INDOOR AND OUTDOOR BACKGROUND EXPOSURE LEVEL ASSESSMENT OF SOME LOCATIONS IN NATIONAL YOUTH SERVICE CORPS ORIENTATION CAMP, KEFFI, NASARAWA STATE, NIGERIA
Background: Human activities have increased the relative concentration of the radionuclides, referred to as the technologically enhanced naturally occurring radioactive materials (TENORMS) in our society. Aim: To assess the indoor and outdoor background exposure level of some selected locations in National Youth Service Corp Orientation camp, Keffi, Nasarawa state, Nigeria. Methodology: A total of ten halls were selected and the exposure rate for four sampling points (two indoor and two outdoor) for each of the hall were measured using a handheld Inspector Alert Nuclear Radiation Monitor. The Radiation Monitor was held at an elevation of 1.0m above ground level and a geographical positioning system (GPS) was used to record the location. The absorbed dose rate, annual effective dose rate, excess lifetime cancer risk and organ doses were calculated. Results: The result obtained are in the range of 0.16 – 0.36 mR/h, 0.016 - 0.026 μSv/h, 0.11- 0.25 mSv/y, and 0.39- 0.88 for ER, ADR, AEDR, and ELCR respectively. The calculated mean organ dose is 0.122, 0.110, 0.131, 0.156, 0.118, 0.087, and 0.129 for lungs, ovaries, bone marrow, testes, kidney, liver, and whole body respectively. Conclusion: The obtained values of AEDR and organ doses are lower than the recommended dose limit by ICRP and UNSCEAR. This indicates that the inhabitant of the orientation camp is safe of radiation hazards. Recommendation: It is recommended that this same study be done at other NYSC camp sites in the country.
NIGERIAN RADIOGRAPHY STUDENTS’ CLINICAL EXPERIENCE: WHY VIRTUAL RADIOGRAPHY SIMULATION SHOULD BE INTRODUCED AS AN ADJUNCT TO CLINICAL TRAINING
Objective: To evaluate the clinical training experience of radiography students and their tutors and assess their attitude towards the use of virtual simulation as an adjunct to clinical postings. Methods: A survey was conducted on third- to fifth-year radiography students in five universities offering radiography as a five-year degree programme and on radiographers involved in students training. Data was collected and analysed using SPSS v 21. Results were displayed using tables and figures. Results: A total of 276 students (169 males and 107 females) and thirty-six radiographers (24 males and 13 females) responded. The students were exposed to a wide range of modalities, but most of them (78.3%, n = 216) reported that they had issues with overcrowding and were not allowed to attend to patients (60.1%, n = 166). 55.8%, n = 154) classified themselves as “static observers” as opposed to “passive” (20.7%, n = 57) and “active” (23.6%, n = 65) observers. They rated themselves “average” in clinical practise but were equally divided on their levels of satisfaction with their clinical experience, with 52.9% (n = 146) expressing dissatisfaction against the 47.1% (n = 130) that expressed satisfaction. Few of the radiographers who have used VR software before responded that they were open to newer and better methods of clinical training. Conclusion: Based on the findings of this study, the learning environment for clinical procedures for the students is not conducive. The introduction and use of virtual simulation will be a welcome development, as it will improve the clinical training of radiography students.
EVALUATION OF LEAD APRON AS A POTENTIAL SOURCE OF NOSOCOMIAL INFECTION IN OPERATING THEATER
Background: For radiation protection, lead aprons are often carried into the operating theater from the radiology department, where there are few or no dedicated lead aprons for the operating theater and can be a potential source of nosocomial infection. Objective: The main objective of this research is to evaluate the presence of microorganisms on the lead aprons and devising a simple method of cleaning to lower the risk of contamination in the operating room. Methods: A total of 64 swabs were taken in two regions of the lead apron, the shoulders (inner and outer) and secondly, the front middle part of the apron (inner and outer). 40 samples were collected before cleaning, while 24 post-cleaning swabs was also taken from areas where growth were isolated using three different agents routinely used in our hospital: (cetrimide and chlorohexidine gluconate (savlon), isopropyl alcohol (methylated spirit) and sodium hydrochloride (Hypo/bleach). The samples collected were cultured on plates of Blood Agar, chocolate Agar, and MacConkey Agar and incubated at 37o c for 48h. The data was analysed using SPSS version 16.0, using descriptive statistics such as frequency and percentage. Result: Growth was observed on 72.5% (n = 29) of X-ray aprons, and Staphylococcus aureus 69% (n = 20) and Staphylococcus epidermidis 31% (n= 9), were the pathogens observed on the lead apron, mostly on the outer part of the lead apron at the level of the patients and bed, followed by the inner part at the same level. The least noticeable area of growth is the inner part of the shoulder. After cleaning, no growth was detected in the 24 samples collected. Conclusion: Lead aprons can be a potential source of nosocomial infections in the operating theater and cleaning them with any of the available disinfectants in the hospital before taking them to the room will significantly reduce the bacteria load.
PHOTON AND NEUTRON SHIELDING COMPETENCE OF SnO2 – REINFORCED WITH 22Na2O – 15B2O3 – 45P2O5 – (18 - X) K2O BIOACTIVE GLASSES.
Background: Tin(IV) oxide (SnO2) has favorable photon shielding properties due to its high atomic number (Z), which enables effective attenuation of gamma rays and X-rays. When incorporated into bioactive glasses, SnO2 dopants enhance the overall photon shielding performance of the composite material. The high Z of Sn (Z=50) assists in attenuating the photons through photoelectric effect, Compton scattering, and pair production mechanisms. Objective: The research is to assess photon and neutron shielding competence of SnO2- reinforced 22Na2O –15B2O3 –45P2O5 – (18 – x) K2O – xSnO2 (NBPK) (x = 0, 2, 4, 6, 8, and 10 Mol% ) bioactive glasses for better radiation shielding. Methods: In this study, the melt quenching process is assumed in making the glass system 22Na2O –15B2O3 – 45P2O5 – (18 – x) K2O – xSnO2, x = 0, 2, 4, 6, 8 and 10 mol %) using NH4H2PO4, H3BO4, Na2CO3, K2CO3 [12]. Computational approach was applied to estimate for each value of x. The nominal compositions of the prepared glasses were given as S1-S6 and was run in the WinXCOM software. The XCOM code is a database for calculating mass attenuation coefficients at different photon energies [11, 13].The obtained value from WinXCOM (S1-S6) were transported to excel for further calculations and thereby taken to the origin software for graph plotting. Results: The result of the simulation shows that as energy changes, the Mass attenuation coefficient (MAC) values of all the glass samples change in a similar way. As a result, the MAC values tend to be in the order of S1 < S2 < S3 < S4 < S5 < S6 for the majority of the energy spectrum. S1-S6's LAC maximums were 0.08, 0.45, 0.59, 0.71, 0.80, and 0.92, respectively. The greatest HVT was acquired for all glass tests with values 65.56, 13.28, 11.18, 10.26, 9.81, and 9.16 cm for S1-S6 accordingly. Conclusion: The calculated radiation interaction parameters revealed that S6 outperformed the other five bioactive glasses in this study as a photon, proton, and neutron absorber. In general, photon shielding applications may benefit more from the studied bioactive glasses than conventional concrete.
EVALUATING OCCUPATIONAL DOSE MONITORING IN RADIOLOGY: A CASE STUDY OF RADIOGRAPHERS AT FEDERAL MEDICAL CENTRE JALINGO
Background: One essential component of radiological safety is occupational dose monitoring (ODM), which shields radiation workers from any radiation health-related concerns. Radiographers are frequently exposed to different radiation levels, which calls for strict monitoring and control procedures to guarantee their safety. This study aims to assess the level of Radiographers' occupational dose level (ODL). It will also assess whether the current dose limits are effective and in line with international radiation safety standards. Methods: This was a questionnaire-based study. Ethical approval was sought from the institution’s ethics committee. Participants were only Radiographers and were actively involved in routine Departmental activities within the last 12 months at the study site. Consented Radiographers were recruited and issued a validated questionnaire. The questionnaire contains closed-ended questions on demography, personnel radiation dose level, and their perceived effectiveness of institutional radiation protection practices. Data was processed and expressed in terms of frequency and proportions. Results: A total of 26 responses were collected, with 79.9% (n=20) being male and 23.1% (n=6) being female. Radiographers with B. Rad. degrees were the highest with 34.6% (n=9). About 66.4% (n=17) of Radiographers operate within safe dose limits, while 34.6% (9) are within the maximum permissible dose of 20mSv. There was effective implementation of safety measures and adherence to radiation protection guidelines as 81% (n=25) of respondents were satisfied with the effectiveness of ODM at the study center. Key radiation protection practices such as the presence of lead lining walls, use of TLDs, and working closely with regulated authorities among others. Conclusion: Primary radiation workers are conscious of ODL and working within the recommendations. The institutionalized radiation protection measures are effective and they closely collaborate with relevant authorities on best radiation protection practices at the study site.
ASSESSMENT OF RADIATION PROTECTION STATUS OF THE RADIOLOGY DEPARTMENTS OF TWO SELECTED SECONDARY HOSPITALS IN KANO METROPOLIS, KANO STATE, NIGERIA
Background: During the operation of X-ray machines, radiology personnel and individuals in adjacent areas may inadvertently be exposed to harmful doses of ionizing radiation. Objective: This study examines the levels of secondary radiation in two busy radiology departments of secondary health facilities in Kano metropolis. Methods: Radiation doses were measured using a Radiation Alert Ranger MultiPurpose Digital Survey Meter at various locations by taken first the background radiation, including the control panel, changing room, patient waiting area, protected cubicle, dark room/digitizer, and radiographer’s office. Results: The highest measurement was 22.653 μSv/h in the changing room at Hospital 'B', and the lowest was 0.011 μSv/h in the patient waiting area at Hospital 'A'. Background radiation levels ranged from 0.077 to 0.203 μSv/h, with the highest levels recorded in the CT unit at Hospital 'B'. Conclusion: The study emphasizes the need for continuous monitoring and stringent control of radiation exposure to ensure the safety of medical staff and the general public.