MEDICAL IMAGING- THE GHANA SITUATION

Diagnostic Medical imaging is the technique and process of creating visual representations of the interior of a body (Anatomical) for clinical analysis and medical intervention, as well as visual representation of the function of organs or tissues (Physiological). All these procedures are handled by the imaging team to advance a better understanding of the complex practices and protocols behind each image.

The team comprises; Radiologists, Medical Physicists, Biomedical Engineers, Radiation Technologists and other supporting staff, who collaborate to advance the course of the imaging process to the benefit of patients. Interestingly, there have been an increased use of medical imaging in Ghana, mainly for staging and localizing tumors and cancer diagnoses, as well as detecting anatomical and physiological problems. The success of this increase will depend on an effective medical imaging team, with well-trained clinical Medical Physicists and Biomedical Engineers, who are key members of a well-defined imaging team.

The absence of this imaging team hinder the expansion and the development of precision medicine through integrated decision support application software and effective use of medical imaging equipment and devices in Ghana. This is because, the absence has affected the realization and transformation of medical imaging, which would have made medical equipment smarter, imaging results faster and examinations more precise, to obtain effective diagnoses outcomes and above all prevent the constant break down of these equipment.

In Ghana, there are about 500 imaging equipment country-wide, of which 62% are in Greater Accra region, 11% in Ashanti region and the rest of the 27% are dotted across the country. This in balance is a major challenge to health care delivery in the country. According to internationally accepted standards, this is really inadequate to serve the population of about 30 million and use for proper diagnoses of diseases. Unfortunately, this is the stuck reality and we currently have no option but to accept it. Apart from the inadequate imaging equipment, there is also an issue of frequent break down of these equipment. This may be attributed to several factors, among them being the lack of expertise in these centers. This I found as unacceptable since these experts are available in the country and the International Atomic Energy Agency’s Basic Safety Standards, of which Ghana is a signatory, says they must be employed by the authorities and owners of these facilities, unfortunately, not much has been done in this regard.

Annually, an average of 250 imaging experts are trained in Ghana, which are made up of Medical Physicists, Radiologists, Radiographers, and Biomedical Engineers. Of this number, just about 50% are employed, who are mostly Radiologists Radiographers. This is because the Radiographers take the images and the Radiologist report and interprets those images. The absence of these professionals will mean no imaging process, hence the system is forced to employ them. However, the other core members of this team namely the Medical Physicists and the Biomedical Engineers, whose jobs are very essential not only for the quality assurance and optimization of the processes and protocols but for the safety of both patients and users of these facilities. In other words, the risks associated with the use of these machines are extremely high in Ghana to both patients, users and the general public when these additional professionals are not involved. As to why this persists it’s only the authorities and owners of these facilities who can explain. It is of interest to note that several attempts by the Ghana Society for Medical Physics and other related health professionals to resolve these issues fell on deaf ears. The politicians are not interested and to make matters worse the technocrats in the field who should know better turn a blind eye, exposing citizens to extreme risk and danger. I intend to leave this aspect for another discussion, however, what the general public should know is that all is not well with the diagnostic imaging processes in Ghana and the earlier something is done about it the better, for the safety of the patients, users, and the general public.

The rapid progress of medical imaging and the invention of various medical imaging equipment have benefited mankind in the developed world. However, this seems to be the reverse in the developing world, including Ghana. I have visited a number of facilities in Europe and had the opportunity of seeing the wonders in using this equipment in the proper and correct diagnosis of diseases as a necessity before treatment. The more sophisticated these bio-instruments are, the better the diagnosis. Unfortunately, I weep for mother Ghana any time I visit these facilities across the country. It is time the general public realized that we are all at high risk for lack of action by our leaders in ensuring that Medical Physicist and Biomedical engineers are employed in all imaging facilities in the country.

Even though medical images play an important role in clinical diagnosis and therapy of various diseases. It is often thought of as a way to represent anatomical structures of the body with the help of X-ray, Sound waves and electromagnetic wave. But often it is more useful for physiologic function in addition to the determination of anatomical structures. With the growth of computers and image technologies, medical imaging has greatly influenced the medical field. As the quality of medical imaging affects diagnosis, medical image processing has become a hotspot and the clinical applications wanting to store and retrieve images for future purposes need some convenient process to store those images in detail.

Generally, there are three forms of medical imaging; first by the use of X-ray as in Conventional X-ray, popularly referred to as X-ray, Computed Tomography referred to as CT, Mammography, and Fluoroscopy. Secondly, the use of waves (electromagnetic and sound) as in Magnetic resonance Imaging, referred to as MRI and Ultrasound, referred to as scan (in Ghana) and thirdly by Nuclear Medicine Techniques, where a radioactive substance is inhaled or injected into a patient and a camera is made to detect the radiation from the tissues of the patient. The difference between the first two imaging processes (X-ray and electromagnetic and sound wave) and the third process (Nuclear Medicine Techniques) is that in the case of the first two cases, the X-ray and the electromagnetic and sound waves are generated from a source and made to pass through the human tissues and a picture of the internal tissues or organs are drawn. However, in the third case (Nuclear Medicine Technique), the source of the radiation is the radioactive substance inhaled or injected into the patient and the camera is made to detect the source of the radiation which is defined by the metabolic activities of the patient’s tissues based on their health state.

Though the final images obtained from many techniques have similarities, the technologies used and the parameters represented in the images are very different in characteristics as well as in medical usefulness, even different mathematical and statistical models are used. Several techniques have been developed to enable CT, MRI and ultrasound scanning software to produce 3D images for interpretation and diagnoses. Traditionally, CT and MRI scans produced 2D static output on film. Therefore to produce 3D images, many scans were made and then used to produce a 3D model which can then be manipulated for the purpose it was taken to answer clinical questions.

Despite all these benefits, medical imaging also poses danger to the users, patients and the general public, based on the use of radiation in acquiring these images if the right care is not taken by the experts in the field. Radiation is energy that comes from a source and travels through space and may be able to penetrate various materials including human tissues. Light, radio waves, and microwaves are types of radiation that are called nonionizing radiation. The kind of radiation discussed in most of these imaging equipment is called ionizing radiation because it can produce charged particles (ions) in matter which can cause serious irreparable damage to tissues. However, experts in the field like Medical Physicists are trained with taxpayers’ monies to offer services in this regard, in order to ensure the safe use of these equipment. Unfortunately, those who matter have refused to employ these professionals despite Ghana signing on to the International Atomic Energy Agency’s Basic Safety Standard (BSS) documents which demands that these professionals are employed to offer services for the well-being of all Ghanaians.

I have the following questions for the authorities and owners of imaging facilities;

  1. What will it take to ensure that all hospitals in Ghana are made to employ at least one Medical Physicist and a Biomedical engineer each, to ensure the safety and proper functioning of this equipment?
  1. Why are you ignoring the danger posed to the citizens by ignoring your responsibility of protecting the general public and the sick as enshrined in article 30 of the 1992 constitution of the Republic of Ghana.

I leave these questions to the conscience of those responsible to do the right thing and I will be back if nothing is done.

Shiraz Issahaku (Ph.D.)

Imaging Expert/Consultant