Experiences of in-field and remote monitoring of diagnostic radiological quality in Ghana using an equipment and patient dosimetry database

Abstract

A review of diagnostic radiological equipment performance and resultant patient dose values in Ghana has been undertaken. Equipment survey data was taken from 10 x-ray rooms across 7 individual hospitals in southern and central Ghana in order to establish basic equipment performance levels against IPEM standards. The x-ray kerma output data for a range of kVp values was transferred to an online relational database in order that a comprehensive dose audit could be undertaken using exposure factors emailed back to the UK using conventional data entry forms. Analysis was undertaken of the key tube performance parameters. This established a baseline level of equipment acceptability and allowed entrance surface dose values to be verified and calculated using proprietary software.

Data was collected on 1968 patients who underwent a total of 2838 radiographic projections comprising chest, pelvis, lumbar spine (AP and lateral), abdomen and skull (PA and lateral). Entrance surface doses were calculated by operators and analysts inputting the data into the database containing basic output data which then corrected for the applied kVp, mAs, focus-to-skin distance and backscatter variables. The results have been analyzed and compared with IAEA Basic Safety, European and UK quality standards in patient dosimetry. Chest PA and lumbar spine lateral results are presented.

A narrow range of performance variation between the radiographic equipment in the sample was found. The tube and generator performance is acceptable. However, the wide range of ESD values presented highlights that a prioritized approach is needed to address areas of investigation and noncompliance, especially where values exceed basic safety standards. The Chest PA results serve as an example of how standardization of technique could contribute to optimization. A program of patient dose monitoring is proposed, provided that a basic level of practical, cost-effective, ongoing routine equipment quality control can be undertaken.