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 handle by the imaging team to advance a better understanding of the complex practices and protocols behind each image.
The team comprises; Radiologist, Medical Physicists, Biomedical Engineers, Radiation Technologists and other supporting staff, who collaborate to advance the course of the imaging process to the benefits of patients. Interestingly, there have been an increase used of medical imaging in Ghana, mainly for staging and localizing tumours and cancer diagnoses, as well as detecting anatomical and physiological problems. The success of this increased will depends on effective medical imaging team, with well-trained clinical Medical Physicist 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 make 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 in the country of which 62% are in Greater Accra region, 11% in Ashanti region and the rest of the 27% are doted across the country. This in balance is a major challenge to health care delivery in the country. According to internationally standard, 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 this reality. Apart from this inadequate imaging equipment, there is also an issue of frequent break down of this equipment. This may be attributed to several factors among them is the lack of expertise in these centres. This I found an unacceptable since these experts are available and the International Atomic Energy Agency Basic Safety Standard, which Ghana is a signatory says they must be employ 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 Medical Physicist, Radiologist, Radiographers and Biomedical Engineers. Of these number, only just about 50% are employed, who are most Radiologist and the Radiographers. These is because the Radiographers take the images and the Radiologist report and interprets those images. Their absence will mean no imaging process, hence the system is forced to employ them. However, the other core members of this team namely the Medical Physicist and the Biomedical Engineers, whose job is more essential not only for the quality assurance and optimisation of the processes and protocols but for the safety of both patients and users of these facilities. In other words the risk associated in the use of these machines are extremely high in Ghana to both patients, users and the general public. As to why this persist it’s only the authorities and owners of these facilities who can explain. It is of interest to note that several attempt by Ghana Society for Medical Physics and other related health professionals to resolve these issues felt on death ears. The politicians are not interested and to make maters worst the technocrats in the field who should know better tend their blind eyes on this extremely risky and danger to the citizens. I intend to leave this for another discussion, however what the general public should know is that all is not well with the diagnostic imaging process in Ghana and the earlier something is done about this the better 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 proper and correct diagnosis of diseases as a necessity before treatment. The more sophisticate 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 realised 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 plays an important role in clinical diagnosis and therapy of various diagnose 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 computer and image technology, medical imaging has greatly influenced medical field. As the quality of medical imaging affects diagnosis the medical image processing has become a hotspot and the clinical applications wanting to store and retrieve images for future purpose needs some convenient process to store those images in details.
Generally, there are three form of medical imaging; first by the use of X-ray as in Conventional X-ray popular refers to as X-ray, Computed Tomography refers to as CT, Mammography, and Fluoroscopy. Secondly by the use of waves (electromagnetic and sound) as in Magnetic resonance Imaging refers to as MRI and Ultrasound refers to as scan (in Ghana) and third by Nuclear Medicine Techniques, where radioactive substance is inhaled or injected into a patients and a camera is made to detect the radiation from the tissues of 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 patients tissues based on its health state.
Though the final images obtained from many techniques have similarities but 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 have been 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 then to produce 3D images many scans are made and then produced a 3D model which can 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, and microwaves are types of radiation that are called nonionizing. 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 cause serious irreparable damage to tissues. However, experts in the field like Medical Physicist are trained with tax payers’ money to offer services in this regard, in other to ensure safe use of these equipment. Unfortunately, those who matter refused to employ these professionals despite signing to International Atomic Energy Agency Basic Safety Standard (BSS) documents which demands that these professionals are employ to offer services for the well-being of all Ghanaians.
I have the following questions for the authorities and owners of imaging facilities;
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 these equipment?
Why are you ignoring the danger pose to the citizens by inuring your responsibility of protecting the general public and the sick as enshrined in article 30 of the constitution of Ghana.
I leave this to the conscience of those responsibility to do the right. And I shall be back if nothing is done.
By Dr Shiraz Issahaku
The writer is a medical consultant and an imaging expert.