Mammography Diagnostic Reference Levels (DRLs) in Ghana.

INTRODUCTION: Diagnostic Reference Levels (DRLs) are essential for optimisation in mammography. A local DRL for screen-film mammography has been established in Ghana but none exists for the digital mammography systems. Furthermore, technological advancement is phasing out the use of screen-film mammography and replacing it with digital mammography systems. This study aims to establish the local DRLs used in digital mammography across three institutions in Ghana to guide mammography practice. METHODS: Average glandular dose (AGD), compressed breast thickness (CBT), age of patients, entrance surface exposure (ESE), kVp, and mAs were retrospectively extracted from three digital mammography systems. The 75th and 95th percentile values were obtained for the AGD of each mammography projection and at CBT of 60 ± 5 mm. The correlation between the AGD and CBT, kVp, mAs, and ESE were investigated. RESULTS: The 75th percentile for the AGD at CBT of 60 ± 5 mm for Centres 1, 2, 3, and all centres were 2.3, 1.8, 2.1, and 2.0 mGy respectively. The DRLs obtained were comparably higher than international studies except those of the United Kingdom. The AGD showed a strong positive correlation with the CBT, kVp, mAs, and ESE. There was variability in the AGD applied across the three centres for the craniocaudal (CC) and mediolateral oblique (MLO) projections. The mean AGD, mAs, and ESE for all the three centres and per centre recorded were higher than previous studies, but the mean kVp and CBT were lower than previous studies. CONCLUSION: The higher DRLs estimated in this preliminary study indicates that there is a need for dose optimisation in digital mammography practice in Ghana to improve radiation protection. IMPLICATIONS FOR PRACTICE: The findings will guide the process of optimisation and limit the variations in the radiation dose during mammography practice.

Compression force variability in mammography in Ghana - A baseline study.

INTRODUCTION: Breast compression during mammographic examinations improves image quality and patient management. Several studies have been conducted to assess compression force variability among practitioners in order to establish compression guidelines. However, no such study has been conducted in Ghana. This study aims to investigate the compression force variability in mammography in Ghana. METHODS: This retrospective study used data gathered from 1071 screening and diagnostic mammography patients from January, 2018-December, 2019. Data were gathered by seven radiographers at three centers. Compression force, breast thickness and practitioners' years of work experience were recorded. Compression force variability among practitioners and the correlation between compression force and breast thickness were investigated. RESULTS: Mean compression force values recorded for craniocaudal (CC) (17.2 daN) and mediolateral oblique (MLO) (18.2 daN), were within the recommended values used by western countries. Most of the mammograms performed - 80% - were within the National Health Service Breast Screening Programme (NHSBSP) range. However, 65% were above the Norwegian Breast Cancer Screening Programme (NBCSP) range. Compression forces varied significantly (p = 0.0001) among practitioners. Compression forces increased significantly (p = 0.0001) with the years of work experience. A weak negative correlation (r = -0.144) and a weak positive correlation (r = 0.142) were established between compression force and breast thickness for CC and MLO projections respectively. CONCLUSION: This initial study confirmed that although wide variations in compression force exist among practitioners in Ghana, most practitioners used compression forces broadly within the range set by the NHSBSP. As no national guidelines for compression force currently exist in Ghana, provision of these may help to reduce the range of variations recorded. IMPLICATIONS FOR PRACTICE: Confirmation of variations in compression will guide future practice to minimize image quality disparities and improve quality of care.

Accuracy of appendicular radiographic image interpretation by radiographers and junior doctors in Ghana: Can this be improved by training?

INTRODUCTION: Access to image interpretation in Ghana remains a challenge with the limited number of radiologists. Radiographers with the right skills and knowledge in image interpretation could help address this challenge. The aims of the study were to determine and compare the ability (accuracy, sensitivity and specificity) of radiographers and junior doctors in interpreting appendicular trauma radiographs both before and after training. METHODS: An action research study involving a pre and post training test was carried out to determine the level of accuracy, sensitivity and specificity in abnormality detection by radiographers after undergoing training when compared to junior doctors. Eight radiographers and twelve junior doctors were invited to interpret an image bank of 30 skeletal radiographs, both before and upon completion of an educational program. The participants' tests were scored against a reference standard provided by an experienced radiologist. Pre and post-test analysis were carried out for comparison. RESULTS: Post training mean accuracy (radiographers 83.3% vs 68.8%, p = 0.017; doctors 81.9% vs 71.6%, p = 0.003), sensitivity (radiographers 83.3% vs 69.2%, p = 0.042; doctors 77.2% vs 67.8% p = 0.025) and specificity (radiographers 83.3% vs 68.3%, p = 0.011; doctors 86.7% vs 75.6% p = 0.005) of both groups significantly improved. No significant differences were recorded between the radiographers and doctors after the training event. CONCLUSION: The study revealed that, with a well-structured training program, radiographers and junior doctors could improve on their accuracies in radiographic abnormality detection and commenting on trauma radiographs.