Establishment and utilisation of national diagnostic reference level for adult computed tomography examinations in Ghana.

The International Atomic Energy Agency, as part of the new regional project (RAF/9/059), recommend the establishment of diagnostic reference levels (DRLs) in Africa. In response to this recommendation, this project was designed to establish and utilise national DRLs of routine computed tomography (CT) examinations. These were done by estimating CT dose index and dose length product (DLP) from a minimum of 20 patient dose report of the most frequently used procedures using 75th percentile distribution of the median values. In all, 22 centres that formed 54% of all CT equipment in the country took part in this study. Additionally, a total of 2156 adult patients dose report were randomly selected, with a percentage distribution of 60, 12, 21 and 7% for head, chest, abdomen-pelvis and lumber spine, respectively. The established DRL for volume CT dose index were 60.0, 15.7, 20.5 and 23.8 mGy for head, chest, abdomen-pelvis and lumber spine, respectively. While the established DRL for DLP were 962.9, 1102.8, 1393.5 and 824.6 mGy-cm for head, chest, abdomen-pelvis, and lumber spine, respectively. These preliminary results were comparable with data from 16 other African countries, European Commission and the International Commission on Radiological Protection. Hence, this study would serve as a baseline for the establishment of a more generalised regional and national adult DRLs for Africa and other developing countries.

The influence of artificial intelligence on the work of the medical physicist in radiotherapy practice: a short review.

There have been many applications and influences of Artificial intelligence (AI) in many sectors and its professionals, that of radiotherapy and the medical physicist is no different. AI and technological advances have necessitated changing roles of medical physicists due to the development of modernized technology with image-guided accessories for the radiotherapy treatment of cancer patients. Given the changing role of medical physicists in ensuring patient safety and optimal care, AI can reshape radiotherapy practice now and in some years to come. Medical physicists' roles in radiotherapy practice have evolved to meet technology for the management of better patient care in the age of modern radiotherapy. This short review provides an insight into the influence of AI on the changing role of medical physicists in each specific chain of the workflow in radiotherapy in which they are involved.

Africa's readiness for artificial intelligence in clinical radiotherapy delivery: Medical physicists to lead the way.

BACKGROUND: There have been several proposals by researchers for the introduction of Artificial Intelligence (AI) technology due to its promising role in radiotherapy practice. However, prior to the introduction of the technology, there are certain general recommendations that must be achieved. Also, the current challenges of AI must be addressed. In this review, we assess how Africa is prepared for the integration of AI technology into radiotherapy service delivery. METHODS: To assess the readiness of Africa for integration of AI in radiotherapy services delivery, a narrative review of the available literature from PubMed, Science Direct, Google Scholar, and Scopus was conducted in the English language using search terms such as Artificial Intelligence, Radiotherapy in Africa, Machine Learning, Deep Learning, and Quality Assurance. RESULTS: We identified a number of issues that could limit the successful integration of AI technology into radiotherapy practice. The major issues include insufficient data for training and validation of AI models, lack of educational curriculum for AI radiotherapy-related courses, no/limited AI teaching professionals, funding, and lack of AI technology and resources. Solutions identified to facilitate smooth implementation of the technology into radiotherapy practices within the region include: creating an accessible national data bank, integrating AI radiotherapy training programs into Africa's educational curriculum, investing in AI technology and resources such as electronic health records and cloud storage, and creation of legal laws and policies to support the use of the technology. These identified solutions need to be implemented on the background of creating awareness among health workers within the radiotherapy space. CONCLUSION: The challenges identified in this review are common among all the geographical regions in the African continent. Therefore, all institutions offering radiotherapy education and training programs, management of the medical centers for radiotherapy and oncology, national and regional professional bodies for medical physics, ministries of health, governments, and relevant stakeholders must take keen interest and work together to achieve this goal.

Patient skin dose measurement and risk of deterministic effect during fluoroscopy cardiac procedures.

This study aimed at assessing patient's peak skin doses (PSD) during fluoroscopy cardiac procedures and proposed a look up table to enhance patient's dose management. Perspex phantom and thermoluminescent dosemeters (TLD) were irradiated for different dose levels with X-ray equipment (Philips Azurion 7). It was found that PSD measures were higher than the kerma at the interventional reference point [K (IRP)] reported with factors 1.55, 1.75 and 2.88 for anterior posterior (AP0o), left anterior oblique (LAO45o) and right anterior oblique (RAO45o), respectively. The equations describing the correlation between the PSD measured kerma area product and cumulative air kerma were found with R-square values of 0.98 and 0.99, respectively. The statistical analysis shows a strong linear correlation between PSD and K (IRP) (P-value = 0.05). It was also found that 27% of the patients population considered in this work, received a skin dose higher than the threshold of deterministic effect of 2 Gy and a look up table with the equation of fitness were proposed to be implemented in the facility for K (IRP) higher than 500 mGy.

Science diplomacy in medical physics - an international perspective.

Purpose: Science diplomacy in medical physics is a relatively young research field and translational practice that focuses on establishing international collaborations to address some of the questions biomedical professionals face globally. This paper aims to present an overview of science diplomacy in medical physics, from an international perspective, illustrating the ways collaborations within and across continents can lead to scientific and professional achievements that advance scientific growth and improve patients care. Methods: Science diplomacy actions were sought that promote collaborations in medical physics across the continents, related to professional and scientific aspects alike. Results: Several science diplomacy actions have been identified to promote education and training, to facilitate research and development, to effectively communicate science to the public, to enable equitable access of patients to healthcare and to focus on gender equity within the profession as well as healthcare provision. Scientific and professional organizations in the field of medical physics across all continents have adopted a number of efforts in their aims, many of them with great success, to promote science diplomacy and to foster international collaborations. Conclusions: Professionals in medical physics can advance through international cooperation, by building strong communication across scientific communities, addressing rising demands, exchange scientific information and knowledge.

A review of MRI studies in Africa with special focus on quantitative MRI: Historical development, current status and the role of medical physicists.

This scoping review provides overview on the historical and major developments, current status, quantitative magnetic resonance (MR) studies and the role of medical physics bodies in MR imaging in Africa. The study analyzed MRI availability in 32 (59 %) of the 54 African countries. South Africa and Egypt have the most dominant MR systems. Number of MR systems in the 4 northern countries (Egypt, Morocco, Algeria and Libya) alone constitute 53 % of the total number of machines in the studied countries. Less than one-third of the countries have 1 MR system serving less than a million population. Libya recorded the most MR systems per million population. The studied countries altogether have an average of 1 machine per million population. The private sector far dominates number of installed MR systems across the region, making up two-thirds of the distribution. A major challenge was revealed where less than 3 % of Medical Physicists in the studied countries are engaged in MRI facilities. Review of MRI published studies in the last 5 years indicates dominance of literature on brain studies and most of such published works coming from Nigeria. Only 7 out of 27 published studies reviewed were quantitative. The African region has no dedicated MRI physics societies; however, the regional medical physics body and national associations have big roles to play in developing MRI through education, research, training and leveraging on awareness creation. Thisreview is the first of such wide scale study on MRI availability and quantitative studies in the African region.

National inventory of authorized diagnostic imaging equipment in Ghana: data as of September 2020.

Introduction: to address the challenge of inadequate and non-equitable distribution of diagnostic imaging equipment, countries are encouraged to evaluate the distribution of installed systems and undertake adequate monitoring to ensure equitability. Ghana´s medical imaging resources have been analyzed in this study and evaluated against the status in other countries. Methods: data on registered medical imaging equipment were retrieved from the database of the Nuclear Regulatory Authority and analyzed. The equipment/population ratio was mapped out graphically for the 16 regions of Ghana. Comparison of the equipment/population ratio was made with the situation in other countries. Results: six hundred and seventy-four diagnostic imaging equipment units from 266 medical imaging facilities (2.5 units/facility), comprising computed tomography (CT), general X-ray, dental X-ray, single-photon emission computed tomography (SPECT) gamma camera, fluoroscopy, mammography and magnetic resonance imaging (MRI) were surveyed nationally. None of the imaging systems measured above the Organization for Economic Co-operation and Development (OECD) average imaging units per million populations (u/mp). The overall equipment/population ratio estimated nationally was 21.4 u/mp. Majority of the imaging systems were general X-ray, installed in the Greater Accra and Ashanti regions. The regional estimates of equipment/population ratios were Greater Accra (49.6 u/mp), Ashanti (22.4 u/mp), Western (21.4 u/mp), Eastern (20.6 u/mp), Bono East (20.0 u/mp), Bono (19.2 u/mp), Volta (17.9 u/mp), Upper West (16.7 u/mp), Oti (12.5 u/mp), Central (11.9 u/mp), Northern (8.9 u/mp), Ahafo (8.9 u/mp), Upper East (6.9 u/mp), Western North (6.7 u/mp), Savannah (5.5 u/mp) and North-East (1.7 u/mp). Conclusion: medical imaging equipment shortfall exist across all imaging modalities in Ghana. A wide inter-regional disparity in the distribution of medical imaging equipment exists contrary to WHO´s recommendation for equitable distribution. A concerted national plan will be needed to address the disparity.

Critical Appraisal of Radionuclide Calibrators and Gamma Cameras Prior to Lutetium-177 Internal Dosimetry at Two South African Hospitals.

Introduction The functionality of radionuclide dose calibrator and nuclear medicine imaging systems hasa direct effect on the accuracy and preciseness of internal dosimetry evaluations. Our study, therefore, aimed to critically appraise the radionuclide calibrators and gamma cameras prior to Lutetium-177 ( 177 Lu) internal dosimetry in a developing country. Materials and Methods Two radionuclide calibrators' and three gamma cameras at two South African hospitals were critically appraised in preparation for internal dosimetry of 177 Lu. The radionuclide calibrators' accuracy, linearity, and sample volume abilities were appraised. For the three gamma cameras, the uniformity, energy resolution, center of rotation, and collimator sensitivity were appraised. These appraisals were performed between the years 2014 and 2019. Results The radionuclide calibrators' constancy, accuracy, linearity, and sample volume were within ± 5%. We also integrated a 177 Lu calibration factor into one radionuclide calibrator's library. The three gamma cameras' uniformity was within 2 to 5%, energy resolution within 11%, center of rotation within 2 mm, and the sensitivity recorded for all low energy high resolution collimator. Conclusion Our radionuclide calibrators passed the critical appraisal and may be confidently used for assaying 177 Lu. All three cameras also passed critical appraisal and may be used to assess organ absorbed dose.

An image-based notion for therapeuticplanar organ activity dosimetry in a developing country: Masterdose software.

OBJECTIVE: Planar dosimetry is often performed in developing countries due to its simplicity during basic quantitative dosimetry. The geometric mean method is often used during planar dosimetry and imaging counts can be corrected for background, attenuation and scatter. The aim of our study was to develop computerized software called Masterdose that may be used for therapeutic isotope planar organ personalized dosimetry. MATERIALS AND METHODS: Masterdose software uses various methods to correct for background, scatter and attenuation.We also introduced a method to convert imaging counts to activity on the software,which is Java based and runs on Windows, Linux and Macintosh platforms. RESULTS: Three user interfaces named image processing, quantification and dosimetry were developed for the software. Masterdose could quantify kidney and liver doses of lutetium-177-DOTA-0-Tyr3-octreotate (177Lu-DOTATATE) patients. The software was validated throughcalculation of the kidney and liver doses of ten neuroendocrine tumour patients (NET) treated with 177Lu-DOTATATE. CONCLUSION: Masterdose presents an option for planar quantification that can be used as a quality control tool to verify imaging counts and perform dosimetry in particular organs.

ESTABLISHMENT OF REGIONAL DIAGNOSTIC REFERENCE LEVELS IN ADULT COMPUTED TOMOGRAPHY FOR FOUR AFRICAN COUNTRIES: A PRELIMINARY SURVEY.

This preliminary study aims towards the establishment of regional diagnostic reference levels (DRLs) for routine adult computed tomography (CT) examinations. The study was performed on 54 CT facilities from four African countries (Ghana, Kenya, Namibia and Senegal) and the results compared with international DRLs. Data were collected from facilities using a structured questionnaire provided by the International Atomic Energy Agency. Dose descriptors (volume computed tomography dose index [CTDIvol] and dose length product [DLP]) evaluations were performed on CT head and body phantoms for head, chest and abdomen CT examination protocols using standard methods. The estimated dose indices were compared with console-displayed dose values. Experienced radiologists accepted the diagnostic image quality of the images as per departmental imaging requirements. Median CTDIvol and DLP data from each facility were compiled to estimate the typical dose in each country. National DRLs were established based on the 75th percentile of median values, whereas the regional DRLs were based on the median of the national DRLs. Comparison of measured CTDIvol with console values of all facilities in all four countries was within 20% as recommended. The established CTDIvol DRLs for head CT, chest CT and abdomen CT were 60.9 mGy, 15.2 mGy and 15.7 mGy, respectively. Similarly, that of DLP, DRLs were 1259 mGy.cm, 544 mGy.cm and 737 mGy.cm, respectively for head CT, chest CT and abdomen CT. The established DRLs from this study were comparable to DRLs from other countries with some variations. This study would serve as baseline for establishment of a more generalized regional adult CT DRLs for Africa.

An Africa point of view on quality and safety in imaging.

Africa has seen an upsurge in diagnostic imaging utilization, with benefits of efficient and accurate diagnosis, but these could easily be offset by undesirable effects attributed to unjustified, unoptimized imaging and poor quality examinations. This paper aims to present Africa's position regarding quality and safety in imaging, give reasons for the rising interest in quality and safety, define quality and safety from an African context, list drivers for quality and safety in Africa, discuss the impact of COVID-19 on quality and safety, and review Africa's progress using the Bonn Call for Action framework while proposing a way forward for imaging quality and safety in Africa. In spite of a healthcare setting characterized by meagre financial, human and technology resources, a rapidly widening disease-burden spectrum, growing proportion of non-communicable diseases and resurgence of tropical and global infections, Africa has over the last ten years made significant strides in quality and safety for imaging. These include raising radiation-safety awareness, interest and application of evidence-based radiation safety recommendations and guidance tools, establishing facility and national diagnostic reference levels (DRLs) and strengthening end-user education and training. Major challenges are: limited human resource, low prioritization of imaging in relation to other health services, low level of integration of imaging into the entire health service delivery, insufficient awareness for radiation safety awareness, a radiation safety culture which is emerging, insufficient facilities and opportunities for education and training. Solutions to these challenges should target the entire hierarchy of health service delivery from prioritization, policy, planning, processes to procedures.

Knowledge and perception on the transmission and control of SARS-COV-2 infection among allied radiation medicine professionals in Ghana.

Knowledge and perception on transmission and control of SARS-COV-2 infection are key to preventing outbreak of the disease in healthcare settings and in dealing with the COVID-19 pandemic. This study assessed the level of knowledge on SARS-COV-2 infection prevention, transmission and symptoms of COVID-19, as well as perceptions regarding prevention of SARS-COV-2 infection among allied radiation medicine professionals. Cross-sectional descriptive survey was carried out among 145 radiation medicine professionals in Ghana using facts on COVID-19 as presented on the website of the World Health Organization and data was analyzed based on weighted average indices. Overall, the extent of knowledge among allied radiation medicine professionals on the symptoms of COVID-19, transmission and control of SARS-COV-2 infection in radiation medicine facilities were all adequate, with weighted average indices of 3.8, 4.1 and 4.4 respectively. However, overall perception of the respondents regarding the use of radiation medicine procedures in management of COVID-19 was diverse, with weighted index of 3.5. The facts about COVID-19 that were identified to be most known were shortness of breath being a serious symptom of the disease and fever being a common symptom. The extent of knowledge on the fact that "SARS-COV-2 infection can be transmitted through small droplets from the nose or mouth of an infected person" was almost excellent, with weighted average index of 4.9. Also, the thinking that provision of hand washing and sanitizing facilities is a measure for controlling the infection was almost perfectly shared among the respondents. Computed tomography was perceived by majority of the respondents as the most preferred imaging modality for screening patients for COVID-19. The study shows that some aspects of the awareness of radiation medicine professionals on COVID-19 pandemic are adequate and others need critical improvement to help reduce spread of the disease.

BENCHMARKING OF A NEW AUTOMATIC CT RADIATION DOSE CALCULATOR.

Information on patient radiation dose is essential to meet the radiation protection regulations and the demands of dose optimization. Vendors have developed different tools for patient dose assessment for radiological purposes. In this study, estimated effective doses derived from a new image-based software tool (DoseWatch, GE Healthcare) was benchmarked against the corresponding doses from a dose calculator (CT-Expo, SASCRAD) and a conversion coefficient method. Dose data from 150 adult patients (66 male and 84 female), who underwent CT head, abdominopelvic or chest examinations, were retrospectively collected using DoseWatch. Effective dose estimated by DoseWatch was significantly lower than that of CT-Expo and DLP-E (k) (p ≤ 0.001). For the organ doses, DoseWatch resulted in lower dose than CT-Expo for all the organs with the exception of testis (p ≤ 001) and eye lenses (p ≤ 0.026).

Safety measures in selected radiotherapy centres within Africa in the face of Covid-19.

Radiotherapy is life-saving treatment which ought to be guaranteed for all cancer patients who are indicated. While this is so, it is incumbent on the management of radiotherapy centres to ensure that patients, patient care-givers and radiotherapy personnel are at all times safe within the radiotherapy facility. Cancer patients are known to have increased risk for respiratory viruses like Covid-19 due to the compromised immune state of such persons. It is thus important to institute adequate safety measures in radiotherapy centres to prevent infection of cancer patients during the global Covid-19 pandemic. A survey conducted in 12 radiotherapy centres in 8 African countries has highlighted key measures needing implementation to ensure safety against Covid-19 infections. The safety measures were indexed on a 16-point questionnaire covering 5 main areas of staffing, radiotherapy environment, equipment and treatment protocols, patient condition and scheduling, and education/sensitization. The study shows that use of personal protective equipment, provision of hand washing and sanitizing facilities, social distance observance, restrictions for patient care-givers, provision of isolation unit meant for holding suspected Covid-19 cases, existence of working protocols, and Covid-19 safety education for staff are fully complied with by the surveyed radiotherapy centres. A greater portion of the centres, are however, without radiotherapy facilities solely dedicated for suspicious and confirmed Covid-19 cases. Strict adherence of the safety measures is highly essential to contain the spread and prevent infection of the disease to patients, care-givers and staff of the radiotherapy departments.

Physics in Africa.

Africa tends to be isolated and sometimes forgotten when it comes to scientific research and in particular physics. But the region has great potential, being home to the youngest population in the world, and despite a variety of issues, there has been steady, albeit uneven progress towards establishing a scientific infrastructure. Ten African researchers discuss the diverse challenges and opportunities faced by physicists across the continent.

Radiation Protection, Safety and Security Issues in Ghana.

Although the use of radioisotopes in Ghana began in 1952, the Radiation Protection Board of Ghana was established in 1993 and served as the national competent authority for authorization and inspection of practices and activities involving radiation sources until 2015. The law has been superseded by an Act of Parliament, Act 895 of 2015, mandating the Nuclear Regulatory Authority of Ghana to take charge of the regulation of radiation sources and their applications. The Radiation Protection Institute in Ghana provided technical support to the regulatory authority. Regulatory and service activities that were undertaken by the Institute include issuance of permits for handling of a radiation sources, authorization and inspection of radiation sources, radiation safety assessment, safety assessment of cellular signal towers, and calibration of radiation-emitting equipment. Practices and activities involving application of radiation are brought under regulatory control in the country through supervision by the national competent authority.

Effect of Radionuclide Activity Concentration on PET-CT Image Uniformity.

Assessment of radionuclide activity concentration on positron emission tomography-computedr tomography (PET-CT) image uniformity has been carried out quantitatively. Tomographic PET-CT images of cylindrical phantom containing F-18 fluorodeoxyglucose (FDG) activity concentration was acquired and used for the assessment. Activity concentrations were varied and PET-CT images were acquired at the constant acquisition parameters of time, matrix size, and reconstruction algorithm, respectively. Using midtransaxial image slices, quantitative index of nonuniformity (NU), and coefficient of uniformity variation were estimated for the different activity concentrations. Maximum NUs of 17.6%, 26.3%, 32.7%, 36.2%, and 38.5% were estimated for activity concentrations of 16.87 kBq/mL, 14.06 kBq/mL, 11.25 kBq/mL, 8.43 kBq/mL, and 5.62 kBq/mL, respectively. The coefficient of uniformity variation established an inverse quadratic relationship with activity concentration. Activity concentrations of 16.87 kBq/mL, 14.06 kBq/mL, 11.25 kBq/mL, 8.43 kBq/mL, and 5.62 kBq/mL produced uniformity variations of 1.47%, 2.52%, 4.23%, 5.12%, and 4.98%, respectively. Increasing activity concentration resulted in decreasing coefficient of uniformity and hence, an increase in image uniformity. The uniformity estimates compared well with the standards set internationally.

Medical physics practice and training in Ghana.

Medical physics has been an indispensable and strategic stakeholder in the delivery of radiological services to the healthcare system of Ghana. The practice has immensely supported radiation oncology and medical imaging facilities over the years, while the locally established training programme continues to produce human resource to feed these facilities. The training programme has grown to receive students from other African countries in addition to local students. Ghana has been recognised by the International Atomic Energy Agency as Regional Designated Centre for Academic Training of Medical Physicists in Africa. The Ghana Society for Medical Physics collaborates with the School of Nuclear and Allied Sciences of the University of Ghana to ensure that training offered to medical physicists meet international standards, making them clinically qualified. The Society has also worked together with other bodies for the passage of the Health Profession's Regulatory Bodies Act, giving legal backing to the practice of medical physics and other allied health professions in Ghana. The country has participated in a number of International Atomic Energy Agency's projects on medical physics and has benefited from its training courses, fellowships and workshops, as well as those of other agencies such as International Organization for Medical Physics. This has placed Ghana's medical physicists in good position to practice competently and improve healthcare.