Nephrogenic systemic fibrosis: A survey of the use of gadolinium-based contrast agents in Ghana

An audit of clinical practice, referral patterns, and appropriateness of clinical indications for brain MRI examinations: A single-centre study in Ghana

INTRODUCTION

The aim of this study was to investigate current brain MRI practice, pattern of brain MRI requests, and their appropriateness using the American College of Radiology (ACR) Appropriateness Criteria.

MATERIAL AND METHODS

We used direct observation and questionnaires to obtain data concerning routine brain MRI practice. We then retrospectively analyzed (i) demographic characteristics, (ii) clinical history, and (iii) appropriateness of brain MRI requests against published criteria.

RESULTS

All patients were administered the screening questionnaire; however, no reviews were undertaken directly with patients, and no signature of the radiographer was recorded. Apart from routine brain protocol, there were dedicated protocols for epilepsy and stroke. Brain MRI images from 161 patients (85 Males; 76 Females) were analyzed. The age group with most brain MRI requests were from 26 to 45 year olds. The commonest four clinical indications for imaging were brain tumour, headache, seizure, and stroke. Using the ACR Appropriateness Criteria, almost 43% of the brain MRI scans analyzed were found to be "usually appropriate", 38% were "maybe appropriate" and 19% were categorized as "usually not appropriate".

CONCLUSION

There was knowledge gap with regards to MRI safety in local practice, thus there is the utmost need for MRI safety training. Data on the commonest indications for performing brain MRI in this study should be used to inform local neuroradiological practice. Dedicated stroke and epilepsy MRI protocols require additional sequences i.e. MRA and 3D T1 volume acquisition, respectively. The ACR Appropriateness Criteria is recommended for use by the referring practitioners to improve appropriateness of brain MRI requests.

A national survey of MRI safety practices in Ghana

Objective

The aim of the present study was to assess current MRI safety practices among MRI facilities in Ghana, and their compliance with the 2013 American College of Radiology (ACR) guidance document on MR safe practices.

Material and methods

A questionnaire developed from the 2013 ACR Guidance Document was used to collect information on magnetic field strengths, MR safety policy and compliance, patient screening, emergency preparedness, infection control, MRI safety accessories, equipment safety, signage and barriers, report of adverse incidents, and access and communication.

Results

Out of the 13 MRI facilities identified, response rate of 92% was obtained. Six (50%) facilities indicated they have MRI safety policy and have it present and readily available to facility staff. Five (42%) facilities indicated they have handheld magnets, and 1(8%) has ferromagnetic detection system. Only one (8%) had crash carts. Seven (58%) facilities have zone 4 clearly marked with a red light and lighted sign stating “The Magnet is On”. One (8%) recorded projectile incident and fire outbreak. Eight (67%) facilities have direct visual observation of access corridors to zone IV.

Conclusion

There was compliance in some areas of MRI safety practice, however there were some shortfalls which need to be addressed. We therefore recommend improvement in the following areas: (1) establishment, implementation, and maintenance of current MRI safety policy, (2) patient screening, (3) provision of training and routine drills on emergency response protocols with documentations, (4) emergency preparedness, and (5) provision of colour codes for equipment used within MRI environment.