ER Magazine (Sept. - Dec. 2016) by Everything Radiography Ltd

EVERYTHING RADIOGRAPHY

INTERNATIONAL ...exposing the practice and lifestyle of radiography and medical imaging

VOLUME 6, ISSUE 3

September - December, 2016

WRITING FOR PUBLICATION By Prof. Richard Price

EXCLUSIVE INTERVIEW with the Managing Director Paramount Medical Services (ER Award Winning Diagnostic Center)

Mr Kenechukwu K. Obianodo

RADIATION PROTECTION

INTERVIEW with Dr. Mark C. Okeji

of the Patient during Computed Tomography Procedures

The President, ARN

THE SECRETS OF BUILDING SUCCESSFUL MEDICAL OUTFIT IN NIGERIA by Dr. Felix Erondu

INTERNATIONAL EFFORTS TO REDUCE MEDICAL IMAGING DOSE

NIGERIAN HEALTH EXCELLENCE AWARDS 2016 Prof. F. A. Durosinmi-Etti: The Journey of an Accomplished Radiation Oncologist

The West African Postgraduate College of Medical Imaging and Radiation Scientists and the Board – The Journey So Far

BY CHRIS STEELMAN

TIPS FOR WRITING RESUMES (Especially For Newly Qualiﬁed Radiographers)

a world class TOTAL MEDICAL IMAGING SOLUTION

FOREMOST RADIOLOGY

CONSULTANTS LTD.

www.foremost.com.ng MRI CT Scan X-Ray Imagin Fluoroscopy Ultrasound Imaging Mammography ECHO

ECG ENDOSCOPY

Plot 50/54, Ogunlana Drive, Surulere, Lagos I 0806 239 2299, 0816 744 4529

Biopsies + Drainage etc

Applications Training in Ultrasound , CT Scan and MRI Radiation Protection and Lead Lining Radiation Monitoring and Quality Control Design and Setup of Radiology Centers Installation and Maintenance of Medical Imaging Equipment Registration of Radiology Centers Specialist Training and Consultancy.

THE POWER OF GOAL-SETTING “And we are back”. This is a famous line used by Professor Pat Utomi of the now rested Patito's Gang. Just like Professor Utomi used to say, we at ER say “we are back” with another brand new edition of your favourite ER Intl'. Despite how easy this may seem, the journey path is never free of “bumps” but knowing that you are there keeps us running and reshaping this brand as expectations keep getting higher. Just like any other goal-oriented organisation, we at ER set out some specific aims and objectives for 2016 at the end of 2015. Having this edition in your hands now is an attestation that we are close to achieving those set-out annual plans. We are using this opportunity to say many thanks to individuals, corporate bodies and organisations who have partnered with ER or participated in one way or the other to make this feasible. The ER team is very proud to have you with us and always open to more cordial relationship with you! As we climb new levels, we are not forgetting our ardent readers and followers who are always waiting for the next edition. Your feedbacks are important to us as it helps us to serve you better. Let us keep them coming! And as the tradition is, we try to make the new edition more interesting than the immediate past one. This edition is not an exception. ER Intl' is debuting a new column called "the CEO Series". We will be celebrating CEOs who have left indelible marks in the healthcare sector. To this end, the ER team was recently with the MD/CEO of Paramount Diagnostic Centre Lagos, Mr. K. K. Obianodo who talked extensively on how the healthcare provider is setting a new standard in the diagnostics. In other categories, aspiring radiographer-entrepreneurs will find the tips for building a successful medical outfit by Dr. Erondu a very informative read. Professor Richard Price, a foremost professor of radiography and past editor of the popular journal of radiography in the UK, Radiography, teaches us on how to write academic articles for publication. Our readers who are also aspiring to publish articles especially in international journals, will find this very helpful. The ER team had an interview session with the current ARN president Dr. Mark Okeji (PhD) who has served the association for two tenures and will be handing over this November at Kano 2016 ARN annual conference with outstanding achievements for the next president to beat. Dr Okeji shares his experience in office as ARN president. In another column, Professor F.A. Durosinmi-Etti of the college of medicine university of Lagos and Former CMD National Hospital Abuja delivered his inaugural lecture recently at the University of Lagos and took us through his journey as a radiation oncologist. The award of the fellowship of the Nigerian Institute of Radiographers is something that has been “in the pipeline” since 2012. The registrar/CEO of the Radiographers' Registration Board of Nigeria (RRBN) Dr. M. S. Okpaleke expatiates more on this award. He also talks about the West Africa Post Graduate College of Medical Imaging and Radiation Scientist (WAPCMIRS). I trust you will find this particularly informative as radiographers have long awaited this career-redefining initiative. One of our own, Dr. Emmanuel Ehiwe, an advanced practitioner based in the UK takes our readers through an in-depth piece on musculo-sketetal ultrasound. The students are not left out of this edition as we had a student (now an intern) from the University of Maiduguri who shared her experience in school. Excerpts of an interview session with the president of the National Association of Radiography Students (NARS), University of Lagos chapter is also inside. Both the young and old in the profession will find the article on resume writing an interesting read as Faith Okwuosa gives us tips for writing resumes. This edition also sees the return of regular columns like Clinical Imaging with Anselm and CT Hub with Sidney while our very educative columns; healthcare research 101 with David and Health Alert are not left out. Like the saying goes, the proof of the pudding is in the eating. We can tell you that this pudding looks and smells good and the taste…your guess is as good as mine. From all of us at ER, do have an enjoyable reading. Victor Edeh For ER team

C O N T E N T PAGE 5

WRITING FOR PUBLICATION BY PROF. RICHARD PRICE

PAGE 7

REFLECTIVE PRACTICE IN RADIOGRAPHY: IMPROVING PROFESSIONALISM IN NIGERIA

PAGE 8

INTERVIEW WITH DR. MARK C. OKEJI, THE PRESIDENT, ARN

PAGE 12

THE WEST AFRICAN POSTGRADUATE COLLEGE OF MEDICAL IMAGING AND RADIATION SCIENTISTS AND THE BOARD – THE JOURNEY SO FAR

PAGE 13

NIGERIAN HEALTH EXCELLENCE AWARDS 2016

PAGE 15

EXCLUSIVE INTERVIEW WITH THE MANAGING DIRECTOR PARAMOUNT MEDICAL SERVICES (ER AWARD WINNING DIAGNOSTIC CENTER) - MR KENECHUKWU K. OBIANODO

PAGE 17

PROF. F. A. DUROSINMI-ETTI: THE JOURNEY OF AN ACCOMPLISHED RADIATION ONCOLOGIST

PAGE 21

THE SECRETS OF BUILDING SUCCESSFUL MEDICAL OUTFIT IN NIGERIA BY DR. FELIX ERONDU

PAGE 22

RADIATION PROTECTION OF THE PATIENT DURING COMPUTED TOMOGRAPHY PROCEDURES

PAGE 23

TIPS FOR WRITING RESUMES (ESPECIALLY FOR NEWLY QUALIFIED RADIOGRAPHERS)

PAGE 24

CT HUB WITH SIDNEY

PAGE 27

HEALTHCARE RESEARCH 101 WITH DAVID

PAGE 28

HEALTH ALERT

PAGE 29

CLINICAL IMAGING WITH ANSELM

PAGE 30

INTERNATIONAL EFFORTS TO REDUCE MEDICAL IMAGING DOSE BY CHRIS STEELMAN

Writing for Publication By Professor Richard Price PhD, MSc, FCR Short Proﬁle Dean of School of Health and Social Work University of Hertfordshire College Lane Hatﬁeld Hertfordshire UK Al10 9AB Prof Price is the senior manager and Dean of the School of Health and Social Work. He is also the academic and resource manager with responsibilities for Diagnostic Radiography, Midwifery, Nursing, Paramedic Sciences, Physiotherapy and Therapeutic Radiography. His research interests are radiographer role development and

ey words: Academic writing; manuscript preparation; publishing; ethical writing, peer review.

Abstract This article identifies the need of effectively sharing research data. It addresses the process of preparing a research article for submission to a journal that operates a peer review process. It discusses the preparatory steps that need to be taken before writing an academic or scholarly article. How to build and structure an article and ensuring the correct terminology and required manuscript language are considered. A structured and disciplined approach to writing has been considered which should assist authors in meeting their objectives of publishing their research in a peer reviewed journal. Introduction In an age of rapidly developing technology the evidence base of radiography has to be continually reevaluated if the best outcomes and service improvements are to be achieved for patients. The amount of research being undertaken by radiographers is increasing and driven by the objective of doing the best for our patients. Indeed, it is the duty of practitioners to undertake and to communicate their findings to peers and beyond to enable research data to be effectively shared for the common good. The main way of sharing effectively is by disseminating outcomes in the public domain via an article in a peer reviewed journal. Conference presentations and posters are other ways but do not carry the same weighting as a paper published in a peer reviewed journal. Writing an article for submission to a peer reviewed journal can seem daunting at the outset but very satisfying once the article has been published. To maximize the likelihood of your work being accepted there are a number of points to be considered at the outset. It will become apparent that there is a lot more to getting an article published than just sitting down to write and as a potential author something you need to appreciate. Writing for publication may be a new venture for a radiographer but the act of writing itself is not. As a student, you will surely have written essays or perhaps a dissertation. What you will have realised is that writing for a purpose is a disciplined activity and while it will not be marked, it will be scrutinised very closely when subjected to peer review. Peer review is the process used to screen and select submitted articles for publication. Articles are ‘refereed’ by experts in the same field who offer advice to editors and authors on the standard of the work submitted. Peer review is not fool proof as there are instances where fraudulent research has beaten the system but nevertheless the intention is that it should provide a robust scrutiny. Publications that have not been through peer review are likely to be regarded with some suspicion. Although this section will focus on preparing an article for submission to a peer reviewed journal, there are other types of writing. For a radiographer this could include writing a book chapter or a feature in a professional magazine but there is something that links all forms of writing; the need to communicate clearly and coherently to the readers. Authors will want readers to maintain their interest throughout the article. Think of reading a novel, and ask what readers want? A clear introduction setting out the context, who the main characters

Page 5

are and their relationships and a good structure which portrays a good story through to conclusion. This, in principle, is no different from writing an article. There will be sections to explain the background to the research, why and how the research was conducted, the results, the consequences and implications and finally conclusions and recommendations. Of course there are differences from a novel in style. Scholarly articles will normally be written in a scientific or formal style whereas a novel or magazine feature is likely to be freer and less constrained in approach. Type of article What type of article will you be writing? This can be divided into several categories; original full length research papers based on primary research, review articles, case reports, technical notes, guest editorials and letters to the editor. Each has its own approach and style. However, this article will focus on a full length empirical research paper where raw or primary data has to be collected. Such papers follow the standard scientific article format of introduction, method, results, discussion and conclusion and will consist of around 2,500 words. Qualitative research papers will have a greater allowance of up 4,000 words. Word allowance will not include reference lists. It is a key discipline of being able to present research within a given word allowance. Additionally, papers will be required to have an abstract usually not exceeding 250 words. Before looking at the structure of a full-length research paper it will be worth considering briefly on types of article. A review article (4,000 words) unlike the empirical research paper is a secondary source of research. Such articles are used to discuss and debate issues that have already been reported elsewhere. Typically an author will review several articles summarise under one title the outcomes of a number of studies on a particular topic. There are different levels of reviews which include systematic reviews or meta-analysis principles. As such there is some overlap with full length research papers. For a journal, 4,000 words are typically allowed. There is a strict methodology and sources that have been used, databases and publications have to be stated including the criteria used to select the article references. Case reports (800 words) are a useful starting point for the novice author. A report will describe an interesting case, which does not have to be a rarity but one that a radiographer might encounter in their practice. It could be a case in which there was some difficulty in reaching a diagnosis. Ideally, it should provide a teaching point. Preferably, the case should have one good illustration. Consent for publication of a medical image should comply with local hospital policy and as such takes into account any ethical and data protection constraints. Technical notes (1000 words) can be similar to a full length research paper, but with less data, or could also be a note on a piece of equipment. They describe issues of technical importance and can include the results of a small investigation. Preparing the article Let’s now focus on preparing a full length research article. Before putting pen to paper or fingers to keyboard, be sure that you target a publication which is relevant to the area of work and take note of the ‘instructions to authors’ that a journal will publish as these set out the ‘house’ style and its requirements. They will help you clarify your approach to presenting and formatting your article. The danger is if you do not present your

the impact of technology on practice. He has a number of publications in the ﬁeld. From 2011 to 2014, he was a member of the Sub-Panel 3 Allied Health Professions, Dentistry, Nursing and Pharmacy for the 2014 UK Research Excellence Framework. He was Editor-in-Chief, Radiography from 2008 to 2014. Radiography is aninternational, English language, peerreviewed journal of radiographic imaging and radiation therapy. It is the ofﬁcial professional journal of the Society and College of Radiographers (UK) and is published quarterly by Elsevier Ltd. He remains as a member of the Editorial Board for Radiography. O T H E R PA S T P O S I T I O N S A N D A W A R D S I N RADIOGRAPHY. 1990 Elected Fellow of the College of Radiographers 1995 Awarded Gold Medal of the Society of Radiographers, Röntgen Centenary Year (1 of 5 recipients) 1984-1993 Council Member of the Society & College of Radiographers 1989-1990 President of the Society & College of Radiographers

work in the format required, at the very least, you can expect to be required to revise your article. A golden rule is to maintain a clear focus on what you are writing, pay attention to detail, structure your sentences carefully, do not raise questions which you do not address; do not jump from idea to idea and do not make assumptions. A matter to which all authors will aspire is writing with confidence; but do not worry too much about this as that will develop in time. A first publication will certainly do wonders in that respect. There are steps that you can take to ensure your submission is a both well written and presented. The best approach in getting over your message is saying it simply; write clear sentences with one thought; build paragraphs with a number of associated thoughts; make effective use of punctuation and match the style of writing to the readership. This will be evident from the publisher’s instructions and scrutinising back copies of articles from your selected journal. A common factor in any profession is the technical language or jargon that inevitably develops. While this may be acceptable in conversation where terms are well understood that may not be the case with the written word. The best approach is to avoid jargon but if you do, make sure you have explained its meaning. Abbreviations and acronyms can be used for terms that are repeated but make sure that for the first time of use that they are written in full with the abbreviation or acronym in parenthesis e.g. CT (computed tomography); SSD (source to skin distance). There is a tendency for some to use upper case for common nouns e.g. “The Radiographers and Radiologists both use Ultrasound in this Department”. The words ‘radiographers, radiologists ultrasound’ and ‘department’ in this sense are common nouns not titles and therefore grammatically incorrect. Do not start a sentence with a number e.g. “12 respondents said yes” should be written as “Twelve respondents said yes.” Avoid using shortened forms such as ‘didn’t for ‘did not. Good English is very important in writing technical or scientific articles and the use of a spell check and someone to proof read your article before submission is advisable. The easier it is for the reviewer the easier it will be for you. Selecting a title is important; it needs to capture what your article is about and interesting enough to attract the attention of the reader. Take your time in deciding the title. A good approach is to have a working title which you can mull over while preparing the article. Bear in mind that you want to maintain the interest of your readers. Keep the article’s purpose to the forefront of your mind, be clear on what you are trying to communicate, digress at your peril. The journal’s instructions to authors will help authors maintain focus and will give guidance on the overall word length. The journal will invariably require you to provide an abstract; introduction, and sections on methodology and results; a discussion followed by conclusions; recommendations and references. Originality and Plagiarism The authors should ensure that they have written entirely original works, and if the authors have used the work and/or words of others, ensure that this has been appropriately cited or quoted. Abstract, Keywords and Highlights Although the abstract is likely to be read first, it is the last section to write. It should summarise the article i.e. what were

the objectives of the study; how the study was undertaken; what results were obtained and their signiﬁcance. It must make an impact because if it does not capture a reader’s interest then the full article may not be read. Just think of the situation when you are searching for an article in a data base, a distinctive title and abstract are vital. It must make an impact on potential readers. Also important for indexing are key words which you will be required to provide and directly relate to the topic of your article. A relatively new development is for authors to provide a number of highlights that are more explanatory than key words. But both serve the purpose of promoting your article and enabling readers to identify it.

Discussion This is where you have the opportunity to explain what the results mean or why they differ from what other studies. If necessary, note problems with the methodology and explain any anomalies in the data. You should interpret your results in the light of other published results, by adding additional information from sources you cited in the introductory section. Relate your discussion back to the aims and objectives and questions you raised in the introduction section but do not simply re-state the objectives and do not introduce new material or facts. Avoid making statements that are too broad or general in nature which your results do not support.

Introduction The introduction should explain the background to your study and provide the opportunity to discuss the results and conclusions of previously published work correctly referenced. The introduction has to include your aims and objectives plus any hypothesis.

Conclusions/Recommendations The conclusion serves two purposes, one is to summarise the main points of your article and two, to draw out your conclusions. Any recommendations should be set out along with future directions for on-going research.

Methodology This will provide all the details of your method including a description of statistical tests you may have used. It is essential that what you did is explained clearly so there is no ambiguity. Ensure that your methodology can be duplicated by another researcher. You must provide confirmation that the research complies with ethical principles and approval has been granted by an appropriate ethics committee if appropriate. This should include providing the ethics protocol number. Results There is no need to make any comment or interpret results in this section. You will have to decide however what information to include but it is not advisable or is there any need to present raw data. The approach should be to summarise data with text, tables or figures. Good advice is to only use a figure (e.g. graph) when the data lend themselves to a good visual representation. Also avoid using figures that show too many variables or trends at once, because they can be hard to understand. In other words aim to give your results visual impact. For example, consider the raw data presented in Figure 1. This table presents the cumulative raw data showing the adoption and diffusion of radiographer reporting in UK hospitals from 1994 to 2004. The number under each of the modalities shows the number of hospitals where radiographers were undertaking the activity and in the year column the year in which the activity commenced. A table such as this does present the requisite information but it is very plain and lacks impact. Table 1 Raw data illustrating the adoption and diffusion of radiographer reporting (cumulative)

Ba Enema

Ba Meal

Chest

Year

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Mamm ography 3

Nuc med

Paediatric

Muscul o skeletal

Axial

Ultrasound

103 110

126

131

135

136

138

146

153

156

How references are listed will depend upon the journal style. Medical publications tend to use a numerical or Vancouver system where citations are identiﬁed by a number in the text usually in superscript. The citations are then listed numerically in the order they appeared in the text, an advantage of this system is that a number of references to the same article use the same number. Alternatively, a journal may use a Harvard style citation which cites author(s) and date in the text and are listed alphabetically. Education and social science journals tend to use the author date style. A numerical system can be tricky to manage where there are multiple references but with software programmes available for managing this aspect the task should not be difﬁcult. Examples of referencing articles using a numerical and Harvard systems are as follows: 1. Price RC, Le Masurier, SB. (2007) Longitudinal changes in extended roles in radiography: A new perspective. Radiography 2007: 13, (1) 18-29 Price RC, Le Masurier, SB. (2007) Longitudinal changes in extended roles in radiography: A new perspective. Radiography13, (1) 18-29 Within each system there are different conventions for referencing books, conference papers, correspondence, websites etc and you should refer to the journal’s instructions to authors for guidance. However, from the author’s perspective, there is no choice, you have to comply with the journal’s style or you will be asked to revise your article.

Figure 1 Adoption and diffusion of radiographer reporting (cumulative) Although not using the exact data as Table 1 Figure 1 presents similar data in graphical format but giving a greater impact of the extending role of the radiographer in image reporting. This data is taken from the work of Price and Le Masurier (2007). Note also the convention of labelling. Tables are labelled above and left justiﬁed and Figures below and also left justiﬁed normally one font size less than that of the main article text.

Page 6

Reference list The reference list is extremely important for a number of reasons. It demonstrates that you have read around the topic which can strengthen your work; it acknowledges the work of other authors thus avoiding questions of plagiarism and readers may wish to may wish to access the articles themselves. Make sure you provide accurate references for the publications cited. It is worth noting that although you may have looked at a number of articles and books as background reading but if you did not cite them do not list them in your reference list. There is no need to produce a full bibliography for an article only the reference list.

Submission Before you submit make sure that your article has been spell checked. It is advisable to a colleague to read the article; it is so easy to overlook a typographical error. Also what may seem complete sense to you may not to another person. Most journals have an electronic submission system and the instructions will tell you how to register as an author and how to submit. It is a fairly straightforward process. Typically the information required will include the name of the author designated as the corresponding author (if there are joint authors), e-mail address, full postal address, and telephone and fax numbers. You will also be asked to give four or five keywords for search purposes and sometimes a classification code, for example, what the type of article are you submitting, original research, review or case study. Make sure you submit any prints, tables and figures in the format requested including instructions for colour reproduction and if you are using any copyrighted material such as photographs or research tools make sure you have the owner’s permission to do so. Once submitted, peer reviewers will be invited; the review process will take a number of weeks. Reviewers will report to the editor and make recommendations. There are four possible outcomes, rejection, major or minor revision or acceptance outright. A rejection means that the article may not be suitable for the journal but a matter you should have addressed before submission. Unfortunately, the article may be unsuitable because it is flawed such as inconsistencies in your method, ethical issues not considered or conclusion not supported by your results. If you are asked to make a major revision then the article will be returned for you to make the necessary amendments. Once the amendments have been completed

you will resubmit and your article be sent once again to the reviewers and the process repeated until the article is suitable for publication. In the case of a minor revision you will be requested to make these and resubmit but the article may not be sent to reviewers a second time. If your article is accepted outright then that is a marvellous achievement and you can look forward to seeing the fruits of your labour in print. Also do not expect that your article will be published immediately following submission. It could take several months before publication; the peer review process itself takes time to run its full course and will take longer if revisions are required. It also depends upon the frequency of journal publication. It is fairly common practice for articles once accepted to be published electronically prior to appearing in a bound paper volume. Note however that some journals are only published electronically and this is likely to be an increasing trend. In the worst case scenario your article may be rejected; it may be deemed unsuitable for publication in that particular journal or it is just flawed and not of the required standard. And Finally The achievements of seeing your work published in a peer reviewed journal or having presented at a conference are very rewarding. Both activities will be the result of hard work and commitment. What at first may seem daunting exercises appears less so if tasks are broken down into manageable parts. A structured and disciplined approach to writing has been considered which should assist authors in meeting their objectives. This means following a publisher’s instructions which are ignored at potential authors’ peril. There is, of course, further reading you may find helpful and a selection is listed below. Happy writing! Reference Price RC, Le Masurier, SB. (2007) Longitudinal changes in extended roles in radiography: A new perspective. Radiography13, (1) 18-29 Further Reading Kliewer MA. (2005) Writing It Up: A Step-by-Step Guide to Publication for Beginning Investigators. American Journal of Roentgenology.185 (3): 591 Epstein D. Kenway J. Boden R. (2005) Writing for Publication. London: Sage Publications ManningD, Hogg P. (2006) Writing for publication. Radiography, 12 (2) 77–78. Marshall G (2007) Writing review articles. Radiography, 13 (1)23

REFLECTIVE PRACTICE

IN RADIOGRAPHY: IMPROVING PROFESSIONALISM IN NIGERIA Reﬂective practice (RP) is deﬁned as the capacity to

reﬂection-before-action (planning before the incident),

think deeply and carefully on

reﬂection-in-action (thinking on your feet), and reﬂection-

one's actions and

on-action (retrospectively reviewing the incident). A

experiences as well as those

reﬂective radiographer will evaluate his own professional

of others so as to engage in a

practice in considerations of new conditions and

process of improved

knowledge. He will evaluate his actions and how they relate

continuous learning and

to internal beliefs and assumptions. He will create an action

consequently, improved

plan to work on bridging the gap between actions and

professionalism and patient

beliefs, thereby creating greater integrity and authenticity.

care. It is a skill to be

The focus on developing RP has increased across academic

possessed by both the

and practical ﬁelds in the last 25 years (Mann et al., 2009).

beginner level and advanced

At present, the work place has become more complex and

level practitioner.

RP is seen as a skill that enables practitioners manage

Reﬂection involves a

increasingly messy and confusing problems which defy

number of skills such as

technical and theoretical solutions (Schon, 1987). In

observation, self awareness,

academics, as a teacher or lecturer, RP is indispensable as

critical thinking, self

well. Questions like:

evaluation, as well as taking

audience)?, what am I teaching?, how will I teach it?, how

others perspectives, and it

will I know if the students understand me (comprehensibility)?, how will I improve my teaching next

integrating this

time?, etc. are effective in improving the intellectual base of

understanding into future

the lecturers as well as the students involved-which is the

planning and goal setting

idea behind schooling in the ﬁrst place. Beneﬁts of RP

(Mann et al., 2009).

therefore include: converting short-term memory to long-

Reﬂective medical practice

term, enhancement of better performance, provision of

which involves learning

best solutions for difﬁcult situations, prevention of loss of

through and from

resources/time wastage, and development of one's own

experiences tends to involve

unique way of patient management.

lose conﬁdence in one's self, succumb under the pressure

According to King (2009), experts learn experientially

being self aware and

through deliberate practice, feedback and reﬂection. The

critically evaluating their own responses to practical

need for this skill as an integral part of individual

situations. This practice exists because learning must not be

radiographic practice can therefore not be

s medical practitioners, especially in clinical

life-threatening situations. The tendencies to

who am I teaching (my target

has the outcome of

the individual practitioner in

settings, we are usually faced with challenging,

In the light of this, valuable reﬂection occurs in three stages;

absorbed by a process of osmosis when juniors work

overemphasized. Professionalism is not the job you do, it is

closely with seniors, and the medical educator must move

how you do it!

from work, make mistakes, seek help from senior

from that of “purveyor of information” to “facilitator of

colleagues, and watch them try to manage these situations

learning”.

In summary, knowledge is not something that is “out

Educators have always known that learning in theory

there” waiting to be discovered. Rather, knowledge

cannot entirely tell someone how to practice even in a

construction occurs as practitioners struggle to reconcile

are bound to happen. This is just an experience - we all go through this phase. What makes it a beneﬁcial experience

profession that is completely mediated by technology such

however, is the skill of “reﬂection”.

as radiography. That is why in the clinical setting especially,

As early as the 1930s, the educator Dewey stated that “there

juniors are encouraged to ask lots and lots of reasonable

can be no true growth by mere experience alone, but only

questions - why are we doing this?, if that isn't available how

engagement with the process of reﬂection that makes the

by reﬂecting on experience”. Therefore, in answering

can we improvise? etc., and seniors are expected to gladly

creation and integration of knowledge possible and opens

questions such as what happened (description)?, what

answer these questions rather than shutting them up and

the door for the development of a reﬂective radiographer.

were you thinking and feeling at the time (feelings)?, what

encouraging these “keep-quiet-and-do-only-as-I-do”

was good and bad about the experience (evaluation)?,

forms of practice. This is in the very least, not professional.

what sense can you make of the situation (analysis)?, what

One must not be a zombie in practice, and we should never

else could you have done (conclusion)?, and if it arose

hesitate to reﬂect on the practice of our seniors.

the theories and concepts found in text books with clinical realities and practical experiences. Ultimately, it is an

again what will you do (action plan)?, a radiographer would have successfully displayed the attributes of a reﬂective practitioner.

In practically difficult situations, the beauty of reflective practice comes to light because then, you are able to critically think and offer up well planned artistry in the form of problem framing, improvisation and implementation. You can do this basically because you have been or watched someone in a similar situation before, you reflected and you planned a way forward if the situation arose again. In doing this, you are not just unique, but consistently improving

RAJUNO ETENG

and performing at a level better than others. That is the

MEDIC AL RADIOGRAPHER,

mark of a true professional. Page 7

Interview with

Dr. Mark Chukwudi Okeji, The President, ARN

Dr. Mark ChukwudiOkeji, a native of Omasi in Ayamelum LGA of Anambra State, is currently the President of The Association of Radiographers of Nigeria (ARN). He holds a B.Sc, M.Sc and PhD in Radiography. It may interest you to know that he was the ﬁrst to obtain a PhD in Radiography from any department in Nigeria and indeed West Africa.

University of Nigeria as a Lecturer, he had worked as a clinical

Africa Radiography forum. This committee was

radiographer at National Orthopaedic Hospital Enugu where

charged with responsibility to create a professional

Radiographers, Radiologists, Medical Physicists and

and showcases all ARN activities including a link

Medical Radiography and Radiological Sciences,

Biomedical Engineers in Africa. I was also elected the

to ARN journal site.

University of Nigeria, Nsukka. Prior to joining

Steering Committee Chairman for the formation of

e is also a senior Lecturer in the Department of

he rose to the rank of Assistant Chief Radiographer.

addition, he is currently the Vice-President, Pan African

Employment of Administrative staff: During my tenure an administrative staff was employed

umbrella for Radiographers in Africa. We have done our

to run the Secretariat of ARN. This is a great departure

work and the launch will be in Kenya in October 2016.

from what we had in the past and it has made the work of the national Secretary a lot easier.

Congress of Radiology and Imaging (PACORI) 2015-2017,

ARN has never had it so good nationally and

Chairman Steering Committee for the formation of African

internationally. We are gradually taking our position as

Radiography Forum, to be inaugurated in Kenya in October

a Leader in Africa and a global player in Radiography.

Acquisition of ofﬁcial vehicle for ARN: A top of the line Sienna was acquired and inaugurated

2016. Acquisition of ARN land in Abuja:

in Asaba in 2015. This is the ﬁrst vehicle the Association

marriage is blessed four children.

This feat was achieved when I was the National

is acquiring since inception and we thank God for it.

His two-term tenure as ARN president will end by November

Secretary. During my Presidency, the land was

He is married to beautiful Barr (Mrs) Uzoamaka Okeji and the

We successfully organized fantastic conferences in

this year. Recently, ER had an opportunity to chat with him on

demarcated from others with L- piece corner blocks to

the journey over the years steering the profession.

safeguard it and all the accrued land dues were paid.

Minna, Abeokuta, Ilorin, Uyo and Asaba. This year we

We had thought that by now development of the

are taking it to Kano.

ER: Six years after your election as ARN president, how

land would have started but for paucity of funds. ER: Have you been able to meet the objectives you set

would you describe the journey so far? 3.

New scheme of service for Radiographers:

out to achieve at the beginning of your tenure?

A new scheme of service was achieved for

Dr. Okeji: My journey into ARN politics started in 2004 in Benin, Edo State, where I was elected National Secretary in a

radiographers in 2012 which elevated the post-NYSC

Dr. Okeji: With the above achievements and many more still

landslide election. I concluded a term as the National

entry point to Grade level 10(CONHESS 9). We

coming the target we set at the outset has been surpassed

Secretary and was elected Vice-President, which ended in

presented and defended the scheme of service at the

despite the lean resources of the association.

2010. Having been adjudged by my colleagues to have

National Council of Establishment. This circular also

performed creditably well, I was unanimously elected the

made it possible for our stagnated colleagues to be

ER: How best can the perennial problem of quackery in

President of ARN in Calabar, Cross River State in 2010.

promoted to Directors of Radiography since 2013 till

radiography are curbed?

Achievements during tenure

worked tirelessly to ensure the release of the circular.

date. The immediate past Registrar, Mr. R.S J. Babatunde 1.

international politics:

Dr. Okeji: Quackery has been there for a long time and has been a source of concern to me personally. When I came on

Elevation of ARN in the national and In Nigeria, I was a foundation member for the

Transformation of ARN journal to an

board in ARN politics, I made two submissions then as the

online journal: We met the journal only in hard copy

National Secretary which were:

formation of JOHESU and AHPA, the alliance that has

format and it was last produced in 2008. This journal

Establishment of more departments in the universities

transformed trade unionism for other healthcare

was updated, upgraded and moved from volume 19 to

ii.

Joint monitoring of radiography centres in Nigeria by

professionals. ARN has been playing active part till

volume 27 with both the online version and hard

ARN and RRBN. This is because ARN has the reach while

date. Internationally two of our own, Prince Ayo

copies. The online version can be accessed at

RRBN is legally empowered to conduct such exercises.

Okhiria and Mrs Ola Balogun were sponsored for ISSRT

www.jarnxray.org. The journal is now read and

The ﬁrst item had been pursued vigorously with huge

election in 2014 in Helsinki, Finland, where they were

referenced from across the world.

successes recorded. From the initial two departments,

Development of a new website for ARN:

them have been graduating radiographers. We now

A brand new interactive website has been hosted for

boast of a fairly good number of radiographers; though

we now have seven functional departments and six of

elected ISRRT Regional Coordinators for Public Relation and Professional Practice respectively, for the period 2014 to 2018. I was elected Vice-President

PACORI in 2014 in Nairobi, Kenya, for the period 2015

ARN and can be accessed at www.arn.org.ng. The site

more in the south than in the northern part of Nigeria.

to 2017. PACORI is an umbrella Association for

has an updated register of all radiographers in Nigeria

However there is need for more radiographers and

Page 8

· college/society of radiographers? Are there such plans in

· · · · ·

Member, Vice Chancellor's Committee on Review of

Member, Vice Chancellor's Standing Committee on

Member, University of Nigeria Committee on Global

Chairman, Transport Committee, University of Nigeria,

Member, Medical Advisory Committee, University of

Member, Prize Award Committee, University of Nigeria,

Postgraduate tuition and Sundry fees.

then Dr. Opoku who responded for Ghanaian society was

Foreign Students, 2015 to date.

several letters to the West African Societies since I became the President. Recently the ISRRT Regional Director for Africa

Visibility.

wrote a mail to me asking me to initiate the move and gladly we are working to actualize it. The West African College is not

Enugu Campus, 2016.

yet there for now. The Board in concert with the Association is organising a national fellowship which if ﬁrmly rooted may some universities are set to start the department of

form a framework for the eventual take off of the West

radiography soon. I have been actively involved in

African college if it is not yet on ground.

University of Nigeria Approved M.Sc and Ph.D Supervisor.

Societies sensitizing them towards the formation of the West

running a postgraduate program in UK then. We had written

Departmental Postgraduate coordinator, 2010 to 2014

Society ought to be a precursor to the West African College. I

African Society but only got a response from Ghana. Even

Member, Faculty of Health Sciences & Technology research group.

Dr. Okeji: This has been a dream I have been pursuing from

had as far back as 2005 written to all the West African

Faculty Representative: Library Committee, University of Nigeria, 2010- 2014.

place?

the time I was the National Secretary. The West African

Faculty Representative: Housing Committee, University of Nigeria, 2008 - 2010.

ER: What are the merits of developing a West African

Nigeria, Enugu Campus, 2016.

teaching in ﬁve of these departments at one time or the

Enugu Campus, 2016.

other sometimes at no cost. This shows my passion for

ER: Are there some honours or awards to show for your

the growth of the profession.

selﬂess service?

Academic awards ·

Distinction in PhD thesis, 2010

though occasionally the Board springs surprises and

Dr. Okeji: There are quite a number of them. They include:

Best Faculty PhD student, 2010

seals up some centres. My take is that until this synergy

The second item has not been as successful as the ﬁrst

is consistently achieved some gaps in monitoring will still be there. Also there is need for budgetary provisions

and Government assistance to achieve effective monitoring nationwide.

President, Association of Radiographers of Nigeria, Vice President, Pan African Congress of Radiology and Imaging, (PACORI) 2015 to 2017.

Best academic staff, Faculty of Health Sciences and Technology, 2013

(ARN) 2010 to Date. ·

Best academic staff, Faculty of Health Sciences and Technology, 2014

Council member, International Society of Radiographers and Radiologic Technologists (ISRRT)

ER: The annual ARN conference and scientiﬁc workshop

2014 to date.

tagged: Kano 2016 will be coming up in November

Chairman, African Radiography Forum 2015 to date.

which is an election year, what are the expectations of

Member, Governing Board, University of Uyo Teaching

Member, Governing Board, University of Nigeria

the delegates?

Hospital, AkwaIbom State: 2013 to 2015.

Dr. Okeji: This year'sannual conference and scientiﬁc

College of Medicine Board: 2014 – date

workshop will be held in the ancient city of Kano. This is particularly gratifying to me because I had assured our

colleagues in North-West Nigeria of hosting the conference before the expiration of my tenure and it has come to pass by

Investment Secretary, Academic Staff Union of

Member, ASUU National Committee on Science and

Member, RRBN Professional Accreditation Team to

the Grace of God. The last time a conference was held in Kano was in 1984 so you can see why I am happy.

Universities (ASUU), UNN branch, Jan 2013 to date.

This year is also an election year and this will help to mobilise our members to Kano. It is pertinent to note that I have been

Member, Governing Board, Radiographers Registration Board of Nigeria: 2008 - 2010

Technology (2012 to 2016)

able to engender competitive election into ARN ofﬁces.

Department of Medical Radiography, University of

Before now people were sometimes prevailed upon to take

Calabar, 2011.

up positions they were never prepared for. It is heart-

ARN president Dr. Mark Okeji with current ISRRT president Dr. Fozy Peer in Helsinki Finland.

Member, RRBN Professional Accreditation Team to

warming that available information shows that three

Department of Medical Radiography, Nnamdi Azikiwe

persons have indicated interest to run for the position of the

University Awka, Nnewi Campus, 2008.

ER: What has kept you motivated as a radiographer?

President. I am praying that all of them realize the enormity of work that is required. To the delegates I urge them to wish

Academic Positions in the University

away sentiments and choose for themselves whom they

consider capable of piloting the affairs of the Association. The candidates should also know that the stakes are now

Dr. Okeji: The driving force is my passion for the profession

Member: University of Nigeria Postgraduate Board,

and the desire to move radiography to an enviable height in

2011 to date

Nigeria as obtainable in some countries in Europe.

Examination Ofﬁcer: Department of Radiography &

high and their score cards would be presented at the end of

Radiological Sciences, University of Nigeria, Enugu

ER: Where do you see radiography in Nigeria in the next

their tenure.

Campus, 2006 - 2010.

decade? Dr. Okeji: We need to have a ﬁrm grip of all the imaging modalities and in therapy. Imaging is the most dynamic of all specialities in the medical ﬁeld and we must work hard to keep pace with the emerging modalities. ER: What is your advice to young radiographers looking up to you? Dr. Okeji: The younger ones should endeavour to undergo tutelage and embrace postgraduate studies to acquire adequate skills and knowledge to face the future. Hard work, diligence and commitment to good professional practice should be the watch word for young radiographers. They should grow to respect their senior colleagues and tap from their wealth of experience. ER: Thank you.

Page 9

Ultrasound Diagnosis and Management of Adductor Tendon Injuries Dr Emmanuel Ehiwe MBGCS, PhD, FRSPH BGGM Limited Market House Harlow Essex CM20 1BL

Abstract Adductor strain in the forms of twist, pull or tear is characterised by groin pain which are common occurrences in athletes. Clinically, it can be difficult to differentiate an adductor tendinopathy from an adductor strain. This paper examined the normal and pathological ultrasound appearances of adductor tendon insertion by looking at its heterogeneous muscular system. The morphological profile of tendon fibre with its ability to adapt depending on stressors and stimuli was also evaluated. The paper concludes by discussing conservative treatment with effects of groin strain and adaptive lifestyle choices for functional demands linked to physiological needs. Introduction The adductor muscles: adductor longus (lateral), the gracilis (medial), the intermediate to the adductor brevis and the deep adductor magnus adduct the thigh to the midline, aid in rotation and play a role in the flexion of the thigh (Fig 1). The pathogenesis of insertional tendinopathy in this musculature is related to functional overuse and repeated micro trauma of its muscle and tendon fibres. These are caused by torsion and traction of its musculotendinous insertion . It occurs mostly in sports involving sudden changes of direction and continuous motion. Symptoms of adductor strain include pain in the groin at the top of the adductor muscles which radiates down the leg. Such symptoms include pain on resisted hip flexion or pain when the legs are pressed in together against resistance as well as having difficulty in running especially sprinting. Weight training and agility exercises including football, ice hockey or gymnastics have resulted in a vast majority of partial tendon ruptures and tendinopathy . These injuries require clinical examination and diagnostic imaging to identify pathology, assess damage, estimate possible complications and predict recovery of the adductor tendons. This is significant as strain in the form of ruptures in the groin occur at the fastening of the adductor longus muscle. Groin strain occurs through a course of degenerative stages from normal tendon tissue to final rupture. This tendinopathic degeneration can be located anywhere between the myotendinous junction and muscular belly of the adductor musculature.

Fig 1

Stages of Adductor Tendinopathy The inability of the adductor tendon to adapt to the repetitive stress and micro trauma causes the tendon to progress through four phases of tendon injury . While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture . 1. Reactive Tendinopathy - Regular tissue adjustment stage - Prediction: Excellent. Normal Recovery!

2. Tendon Disorder - Damage rate > Restore rate - Prediction: Good. Tissue is attempting to heal. - It is vital that you prevent deterioration and progression to permanent cell death (phase 3). 3. Degenerative Tendinopathy - Cell fatality occurs - Prediction - Tendon cells are giving up! 4. Tendon Split or Rupture - Catastrophic tissue breakdown - Loss of utility. - Prediction: Poor. Due to the complexity of the groin and the difﬁculty to accurately diagnose pathological structures, it is important Page 10

to have ultrasound radiological evidence with clinical evaluation. Delay in diagnosis and treatment may result in undesired complications. The diagnosis of adductor tendinopathy through clinical assessment of groin pain along with weakness during isometric adduction of the hip muscles needs to be conﬁrmed by advanced imaging . During contraction of the muscles, tension is placed through the groin. The effect of this tension, when it is excessive may result in muscular strain which ranges from small partial tear where there is a minimal pain and minimal loss of function to a complete rupture resulting in severe pain and marked loss of function (see Table 1).

interrogation enhance clarity and ability to visualize flow in small vessels. These improve detection of low-volume blood flow in tendinopathic and inflammatory condition. This is because the spatial resolution of ultrasound in high frequency transducers is able to depict signs of reactive oedema and haematoma . In severe lesions (second and third degree) with involvement of a larger number of myofibrils, the lesions exhibit hypoechoic or anechoic haematoma appearance as shown in Fig 4 above. The true extent of a lesion after a trauma reveals hyperechoic haemorrhage. This appearance changes after 48 hours to reveal the true extent of the haematoma and morphology of the area affected. In cases of complete tear with a bell clapper appearance, the muscle bundle appears distinct showing evidence of retraction . Characterisation and diagnosis of these lesions are best demonstrated on dynamic examination particularly in first-degree strains. The table 1 below shows the different types of groin strains involving adductor musculature and heterogeneous tendon fibres. Table 1: Types of Groin Strains Grade 1

There is some pain with full function of the groin. Small numbers of muscle ﬁbres are torn.

Grade 2

There is a moderate loss of function. Signiﬁcant numbers of muscle ﬁbres are torn.

Grade 3

There is a major loss of function. All muscle ﬁbres are ruptured.

The majority of groin strains are grade 2. The most commonly affected muscle involved in a strained groin is the adductor longus muscle .

Fig 2 Patient supine and the thigh abducted to show the adductor muscle (www.sportsinjury.com)

Technique and Ultrasound Appearances The adductors musculature and tendon insertion are demonstrated with the patient supine and the thigh abducted, externally rotated and the knee bent . Examination of the iliopsoas tendon insertion on the lesser trochanter is done using long-axis planes. Placing the probe over the bulk of the adductor reveals the superﬁcial adductor longus (lateral), the gracilis (medial), the intermediate to the adductor brevis and the deep adductor magnus. The long-axis of these muscles is scanned up to reach the mons pubis to image the adductor insertion . This is seen with its triangular hypoechoic shape (Fig 3).

Fig 3 : Right adductor strain with grade 1 strain

Normal Left groin

Ultrasound spatial resolution helps with the identiﬁcation of second and third degree muscle strains. This resolution enables visualization of insertional tendinopathy of the adductor muscles (gracilis, pectineus, long adductor, adductor magnus). Fig 4 & 5 below show areas of degenerative rupture from repetitive injury of the adductor longus and deeply sited adductor magnus muscles of the groin.

Treatment The initial management of an adductor injury include protection, rest, ice, compression, and elevation of the affected limb. Painful activities should be avoided with the use of crutches during the first few days encouraged to relieve pain. This conservative treatment for the groin injury is meant to encourage adaptive lifestyle and prevent deterioration of the groin strain. It is advisable that to maintain overall health and fitness, continuous exercise in ways that do not stress the affected area by any aggravating activity be undertaken. This is because tendons require considerable length of time to heal . Long-term changes in the types of activities one does or how they are done should help in the recuperative repair process. This conventional management pathway can be also combined with heat pads along with analgesics and non-steroidal anti-inflammatory drugs such as ibuprofen or naproxen to manage the inflammatory pain experienced. Oral and topical NSAIDs creams can also be used to reduce inflammation in or around the tendon injury. The use of steroid injections is controversial in adductor strains without a tear. There is a potential for the tendon to rupture if the steroid is injected into the tendon itself. Conclusion Adductor strain in the form of tendinopathy and tear is characterised by groin pain along the adductor tendon. This is reflected by the morphological profile of the tendon fibres and its ability to adapt on stressors and stimuli. Conservative treatment and management helps to limit haemorrhage and soft tissue swelling. The objective is to help ensure adaptive lifestyle choices which meet the physical and functional demands linked to physiological needs. Reference 1 2

3 4 5

6 7

Fig 4 showing degenerative tear and rupture of the adductor longus tendon

Fig 5 Further degenerative adductor rupture

8 9

Gray scale ultrasound allows visualization of the heterogeneous and continuous tertiary bundles of the adductor musculature. Using compound imaging and beam-steering in real time b-mode gray scale examination, ultrasound helps to decrease anisotropy in tendons and ligaments, which are less well depicted due to their oblique course . Micro bubble contrast agents with Doppler

Bradshaw C, Hölmich P. Longstanding groin pain. In: Brukner P, Khan K (eds) Clinical sports medicine, 3rd edn. McGraw-Hill, Sydney, Australia. 2006. . Biedert RM, Warnke K, Meyer S. Symphysis syndrome in athletes: surgical treatment for chronic lower abdominal, groin, and adductor pain in athletes. Clin J Sport Med. 2003;13:278–284. Brukner P, Khan K. Clinical sports medicine. 2007. 3rd edn. McGraw-Hill, Sydney, Australia. Miller.J. http://www.physioworks.com.au/FAQRetrieve.aspx?ID=38256 Access : 07/07/16. Fowlkes JB, Averkiou M. Contrast and tissue harmonic imaging. In: Goldman LW, Fowlkes JB,eds. Categorical Courses in Diagnostic Radiology Physics: CT and US Cross-Sectional Imaging. Oak Brook: Radiological Society of North America; 2000:77–95. Jarvinen TA, Jarvinen TL, Kaariainen M, Kalimo H, Jarvinen M. Muscle injuries: biology and treatment. Am J Sports Med. 2005;33:745–764. MaVey L,Emery C. What are the risk factors for groin strain injury in sport? A systematic review of the literature. Sports Med. 2007. 37:881–894. Lawrence JP. Physics and instrumentation of ultrasound. Crit Care Med. 2007;35:S314–S322. Mens J, Inklaar H, Koes BW, Stam HJ. A new view on adduction-related groin pain. Clin J Sport Med. 2006;16:15–19. Schilders E, Bismil Q, Robinson P, O’Connor PJ, Gibbon WW, Talbot JC. Adductorrelated groin pain in competitive athletes. Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2007;89:2173–2178. Weaver JS, Jacobson JA, Jamadar DA, Hayes CW. Sonographic ﬁndings of adductor insertion avulsion syndrome with magnetic resonance imaging correlation. J Ultrasound Med 2003; 22:403–407. Tyler TF, Nicholas SJ, Campbell RJ, Donellan S, McHugh MP. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. Am J Sports Med. 2002. 30:680–683.

A SHORT PROFILE Dr Ehiwe began his career in 1994 when he qualiﬁed as a radiographer from the defunct School of Radiography now Department of Radiography, University of Lagos. He is an Advanced Ultrasound Practitioner and a Consultant Public Health Practitioner with radiography as his core profession. Dr Ehiwe is a Fellow of the Royal Society of Public Health United Kingdom and a member of European Association of Cancer Research. He holds a Doctor of Philosophy Degree in Public Health Medicine and a member of the British Gynaecology Cancer Society. Dr Ehiwe currently work as a Consultant Musculoskeletal Sonographer with BGGM Healthcare Limited practising across NHS Hospital Trusts in West Midlands, East Midlands and Leicestershire in the United Kingdom. He is currently a Journal Reviewer for the International Journal of Human Rights in Healthcare, England and the South African Journal of Radiography. Until recently, he was a Clinical Instructor for AECC Bournemouth UK and Associate Editorial Board Member of the Professional Radiography Journal: Synergy Imaging & Therapy Practice. This role involved evaluating the patterns and causes of ill-health among patients. He regularly seeks to produce empirical research outcomes which inform policy decisions through evidencebased practice that identify risk factors for disease and targets for preventative healthcare. Dr Ehiwe holds professional memberships with the following professional bodies: the Irish Institute of Radiography, the Health and Care Professions Council (UK) and the Society of Radiographers London. On the home front, he is registered with the Radiographers Registration Board of Nigeria (RRBN) as well as the Association of Radiographers of Nigeria. Dr Ehiwe has the following specialist training from University of Bournemouth: Musculoskeletal Ultrasound; Anglia Ruskin University Cambridge: Healthcare Research and the Federal University of Technology Minna Nigeria: Science Education and Curriculum Development. He is an author of several international peer reviewed publications including:

Dr. EMMANUEL EHIWE MBGCS, PhD, FRSPH

Advanced Practitioner Ultrasound / Consultant Public Health Practitioner

Ehiwe E, Ohuegbe C (2011). A case of: Imaging peri-urethral abscess of the Skene's duct using endovaginal sonography. Synergy Imaging & Therapy Practice, January 2011, 28-29. England Ehiwe E, Buckingham S, Ohuegbe C, Odeleye K. (2010). “Magnetic Resonance Imaging of Endometrial Carcinoma Invasion of the Myometrium: A Case Report”. New Zealand Journal of Medical Radiation Technology. Vol 53 issue 1. March 2010. pp5-7.

Diary of a Radiography Student in Northern Nigeria Going down memory lane of the past 5 years, and finally graduating, it's has been a bitter-sweet experience but definitely more sweet than bitter. No doubt time has flown really fast. It feels just like yesterday, I received the news of my admission into medical radiography. Nevertheless, the experiences I gained over the years as a student has had a great impact on me and has moulded me into the person I am today. It all started in May 2011. As expected, the first year was when I really got to know what the course was all about. An orientation lecture was organized at the beginning of the semester where we were taught and also allowed to ask questions about the course in its entirety. I can still remember those JJC questions that we asked like "what is the difference between a radiographer and a radiologist?" "Is it true that radiographers might not give birth?" Lol. There our HOD, Mr. ChigozieNwobi, took his time to enlighten us about who a radiographer is and the world of opportunities that await us. After the talk, I doubt if any of us remembered the initial course we might had applied for. Someone I know even went on to use the course name (radiography) as her password. We were also taken to the Teaching Hospital (University of Maiduguri Teaching Hospital) where we were shown the many big and beautiful machines (that was all they were to us at that time) they had and we were told more about the radiographer's role in the hospital. All the courses we offered were basically an extension of our basic science subjects and so they weren't tough, only bulky. The tough part was finding a good seat in a lecture room full of students from different departments. But it was also there that I got to meet a lot of people; everyone coming from totally different backgrounds and having different characters; and also made some very good friends. I remember seating next to someone once whom I told what I was studying and immediately jolted and she exclaimed "Do you want to die young?!"lol. It was also there I met my two closest friends; Saratu and Maryam. Second year was really the storm before the calm (third year). We had series of lectures and practical sections, (sometimes even on Saturdays) which only ended because the semester had to end. But it was also the year that we began the interesting college courses; physiology, anatomy and biochemistry. Physiology lectures were the most interesting. We had Dr Habib 'the coolest lecturer of all times'. He taught us how to pronounce medical terms. He gave Page 11

practical examples by demonstrations for almost everything and really broke down physiology into very simple bits. We had all kinds of lecturers really; the ones that teach you at the slowest of paces, the one that teaches you what seems like Greek and then says with a straight face "You just have to know this.", lol and the ones that give you note till your hands feel like they're about to give way. Physiology laboratory postings were also the best. We had a lot of interesting experiments and taught how to measure important parameters like blood pressure, pressure and pulse rate and that made us to start to feel like little professionals. With that enthusiasm, I went home to try some of the things I had learnt, but I was never given consent. Another highpoint of that year were the exams. We got introduced to MCQs for the ﬁrst time along with the usual essay part. Some of the papers were okay but others were so indescribably hard that we couldn't source for the answers even after the exams (though, we made good grades s u r p r i s i n g l y, a l l t h a n k s to t h e A l m i g h t y ) . Third year, we had only 10 courses between the two semesters so we had a lot of time to ourselves. It was the time I got to attend other extracurricular classes to improve on my knowledge. We also started the core radiography courses that year. I liked radiographic imaging the most. The lecturer really knew how to teach and made all the physics and chemistry behind image formation to really stick to my head till one of my friends began calling me 'haly imaging' lol. That year we also moved a step further and started going for clinical postings.Hmm, those fateful days when we endured a lot of 'shakara' because we wanted to touch the x-ray machine. "Don't touch that. You'll spoil it" "You can only touch it when you are asked to" "Don't you know you are not supposed to lean on the couch"? These were some of the things we were told when we started. Little did we know that barely 2 years down the line, we'll be doing almost all procedures on our own and only summon the radiographer at the time of exposure. The much frightening viva voce exams came at the end of the semester where we were tested on both our practical and oral explanatory skills. Surprisingly, I found mine to be very simple, all thanks to Him. Fourth year was another storm. Not only because of the amount of lectures, but also because they were getting a lot tougher. We were told we are going to be treated like ﬁnal year students because that would have been the case in other departments. And to make matters worse, we had the Boko haram issues that made everyone lose sleep. Some of

my friends even had to leave the school at the request of their parents. Others like me had to plead to be left to continue schooling here. Another notoriety was the introduction of e-exams (online exams). At first I was over the moon with joy as I was better at grabbing concepts than cramming loads of stuff. But unfortunately the state of our results compared to the previous years was disheartening. And we were told the culprit was the negative marking applied. I can say the good part of that year was the chance to start having class presentations for us to get accustomed to it, having an actual 4 months only semester, and also the fact that we were nearer to our goal of becoming radiographers. Fifth year is surely the straw that is breaking the camel's back. Only that the camels will soon have their back in good shape again, God willing. Between projects, lectures, clinical Postings and presentations, we barely have time to call our own. But smelling the fragrance of graduation so near makes one to carry on with a cheerful face. I'm happy that I'm working on a project I've always wanted to 'knowledge and practice of justification of medical exposures by Referring Physicians' in Northern Nigeria, under the careful supervision of Mr. Nkubli B. Flavious, a specialist in radiation protection. That was because I've once been and have seen victims of unjustified practices too many times. We only had proposal and seminar presentations which I found really enjoyable. We also had some new lecturers whom we are learning a lot from at this our prime stage. For a change, we had a combination of online and written exams in our first semester, and as usual the e-exams proved to be quite peppery. But it was our oral exams that was something else. I still cherish the moment when my class members gathered in a circle the next day after the exams and everyone was relating the extra-ordinary hard questions our lecturers and clinicians decided to ask us because we are in final year. Till this day, I still laugh when I remember some of the questions we were asked. How they expect us to know the answers is one mystery I'm yet to unravel. It was all really one great ride. For the most, I'm grateful for my teachers, who taught me the value of knowledge and that leniency is not cowardice. I'm grateful for the modern and easy to learn methods used in our departments, and lastly for my classmates who taught me the spirit of togetherness. Indeed, it was a bitter-sweet experience, but definitely more sweet than bitter. Halima Damagum, B.Rad, Medical Radiography, University of Maiduguri. Intern Radiographer

THE WEST AFRICAN POSTGRADUATE COLLEGE OF MEDICAL IMAGING AND RADIATION SCIENTISTS AND THE BOARD – THE JOURNEY SO FAR.

chedule 1 of the Act establishing the Radiographers Registration Board of Nigeria (RRBN) Board, states inter alia that among other duties of the Board is to determine the standard of knowledge and skill to be attained by persons seeking to become members of the profession. The section under reference went further to state that such body and standard of knowledge to be possessed by members is to be improved from time to time indicating that radiographers must be updated regularly by the board on the latest techniques, protocols, skills and research works in the field of radiography. We shall not proceed further without an understanding of what is meant by knowledge and skill. Knowledge is defined by the Cambridge Dictionary as understanding of or information about a subject that you get by experience or study either known by one person or by people generally while the oxford dictionary puts it more aptly as “facts, information, and skills acquired through experience or education; the theoretical or practical understanding of a subject. Going further, skill refers to the ability to do something well i.e. expertise. Thus to practice a profession well or be referred to as an expert in that field, you need a good understanding of the body of knowledge (facts, information) about that profession. Acquisition of knowledge and skill is very important to drive healthcare but the need to acquire this knowledge, skill and competence is more germane in the radiography profession unlike other professions. This is because of the changing dynamics in radiography equipment design, architecture and operations which oftentimes leads to modifications of conventional procedures and protocols in order to produce optimal diagnostic yield/images for diagnosis or treatment of patients as the case may apply. Suffice it to say therefore that professions are founded on body of knowledge and sometimes is a vocation meant to satisfy specific needs in the society. The quest to satisfy these specific needs in patient management and care is what

drives innovation and creativity which form the pillars of the ever changing dynamics of today's radiography equipment designs. Sometimes people confuse the meaning of a profession and job or use same interchangeably. A job can be performed by anybody including artisans and may not require specific regular training. In fact, most menial jobs are executed without any formal training. However, a profession is something a little more than a job. Members of every profession become competent in their chosen sector through regular training and retraining programs. They are committed to behaving ethically to protect the interest of the public and those of their members. The skill they have acquired over the years are further sharpened through continuous professional developments. Consequently, the board has instituted the fellowship award as a way to shore up the clinical knowledge of our colleagues in clinical practice and elsewhere to the standard of those with academic Msc and/or PhD. This mean that even in the clinical setting one can acquire Msc and PhD while performing his clinical duties in the hospital and become consultants. This will go a long way to broaden their clinical knowledge and sharpened their skills in what they know to do best in the healthcare settings. Over the years, the current board administration has foreseen the need for radiographers to become distinguished fellows in their chosen field like their colleagues in similar professions. We have midwifed several meeting beginning from 2012 to 2016 to birth the fellowship programme. Such meetings created the avenue for galvanizing ideas among academics and seasoned professional colleagues. The likes of incumbent Registrar / CEO, Prof. Agwu, Associate Prof. Nzotta, Dr. Egbe, Dr. C Okeji, V.C Ikamaise, Dr. P. Okoye, Chief E.J Akpan, Dr. A.C Ugwu, L.C Abonyi, Chigozie .I. Nwobi, Emmanuel Odumeru, Dr. Erondu, Dr. Chyke Ohugbe, Mrs. Animasaun Moji, Dike Uche, Nwodo Chinedu, Chris Ishikwen, Dambele Musa, Ugwuja Marbel, and a few others met severally at various locations to fine tune the various aspects of this professional fellowship award. These distinguished gentlemen and ladies, served in different committees and subcommittees in various capacities with respect to their expertise and prowess. The professional fellowship award of the Institute of Radiographers is to be awarded in the various disciplines of radiography namely: 1. Faculty of Medical Ultrasonography. 2. Faculty of Computerized Tomography 3. Faculty of Magnetic Resonance Imaging. 4. Faculty of Nuclear Medicine. 5. Faculty of General Radiography 6. Faculty of Radiography and Radiation protection The criteria for the award has been carefully selected by a group of experts to accommodate seasoned and experience radiographers with at least 12 years post graduate

experience but with a minimum of a master's degrees. Also to benefit from the professional fellowship award are those radiographers who have a minimum of 20 years post qualification experience and whose contributions to the radiography profession can be verified. The body of experience and skill possessed by the last group of prospective awardees cannot be equated by MSc or PhD and so deserved to be so honoured as fellows. The preinduction seminar will take place on 7th November 2016 in Abuja while the ceremony for the investiture of fellows will take place on 8th November 2016 after a brief ceremony to make the world Radiography day. The same day the (8th November 2016), a cross section of radiographers with PG qualification in MRI, ultrasound etc will be issued their certificates in a colourful graduation ceremony. Notable dignitaries invited for these cascade of memorable occasions include but not limited to the Hon. Minister of health, other Principal officers of the FMoH, Rt. Gen Ike Nwachukwu, Senators, amongst others. This glorious occasion which is the first in the annals of the Board and the profession of radiography in Nigeria is an ambient déjà vu reminiscent of the much desired dreams of our elders. The radiography family introduced the birth of the much awaited West Africa College of Medical Imaging and Radiation Scientists. Further to several meetings of radiographers/imaging scientists within the west Africa sub region held before now and anchored by the RRBN, delegates from Ghana, Nigeria, Burkina Faso, Senegal etc met and agreed to establish a professional college to be known and called the West Africa Post Graduate College of Medical Imaging and Radiation Scientists (WAPCMIRS) herein referred to as the ”College” to among other things to promote and improve imaging and radiation services in the west Africa sub-region. The interim President of the college is Dr. S.Y Opoku (from Ghana), Mrs. Cissokho Mariana as vice President (for Senegal) and Mr. Nado Yeye as Treasurer (Burkina Faso). The headquarters of the college is in Lagos Nigeria. The postgraduate college is a dream come true meant to deepen the standard of professionalism in research in the field of radiography and radiation sciences. With this, radiography has been placed on a pivotal lampstand to give light to medical practice in Nigeria and in West Africa just like related allied health professions. Indeed, the fellowship award will revolutionize the way and manner radiography is practiced in Nigeria and in the sub region. Dr. M.S. Okpaleke. FCIDA, FIHIMN Registrar/CEO

APPLICATION FOR AWARD OF FELLOWSHIP OF THE NIGERIAN INSTITUTE OF RADIOGRAPHERS (Established by section 18, Radiographers (Registration, etc) Act CAP RI LFN 2004) Applications are hereby invited from suitably qualiﬁed members of the Radiography Profession for the award of the Fellowship of the Nigerian Institute of Radiographers. Radiographers /Medical Imaging Scientists with a minimum of twelve(12) years post graduate experience plus Master's degree Or with twenty (20) years post graduate experience should visit www.rrbn.gov.ng/fellowship to ﬁll the application form and for further enquires. ses on Application clo th , 2016. 30 September Signed: Dr. M.S. Okpaleke Registrar/CEO (RRBN) Page 12

NHEA AWARDS 2016 About Nigerian Healthcare Excellence Awards n Friday June 24th,2016, all roads led to the Eko Hotel and Suites, Victoria Island, Lagos where the third annual edition of the Nigerian Healthcare Excellence Awards was held in a ballroom ceremony.

NHEA is aimed at recognizing and celebrating the achievements of personalities and organizations who have contributed immensely to the growth and development of the Nigerian health sector.

Nigerian Healthcare Excellence Awards, the Oscar of Nigerian Healthcare is an annual event where we recognize and celebrate outstanding personalities for their extraordinary contributions to healthcare. The eminent team of the Nigerian Healthcare Excellence Awards has created a paradigm in Nigerian health care sector through continuous Research, Innovation and Excellence.

The award focuses on the following; · Outstanding Performances · The Creation of new Business Models · Recognising and Embracing New Trends · Market Leadership · Inspirational Performance amongst others. In addition it will recognize the rapid growth of Nigeria's Healthcare sector, the role of Technology and the capacity of organizations and individuals to inﬂuence and set new performance standards in Nigeria and beyond.

NHEA is an initiative of Global Health Project and Resources (GHPR) in collaboration with Anadach Group USA. GHPRis one of West Africa's leading Healthcare Management and Consultancy Company, involved in the promotion of healthcare business in West Africa. The company has amassed a wealth of experience from managing various healthcare Projects from Trainings, Exhibitions, Awards and Surveys to deployment of Information Technology Solutions.

Since inception, NHEA has presented 90 awards and we have continued to receive avalanche of commendations for the event, which has hosted over 500 healthcare Stakeholders as well as Dignitaries from afﬁliate sectors within Nigeria and abroad.

NHEA 2016 WINNERS 1.

Lifetime Achievement Award · Prince Julius Adelusi-Adeluyi, OFR,mni · Professor Olu Akinyanju (OON)

Outstanding CSR Health Project of the year · Dangote Foundation

Outstanding State Healthcare Programme of the year · Ondo State Trauma and Surgical Centre (OSTSC)

Healthcare Media Excellence Award – Print 1. Iﬁjeh Martins (This Day)

Healthcare Media Excellence Award – Electronic 1. Habibat Basanya (TVC)

Healthcare Friendly Financial Institution of the year · Diamond Bank Plc

7. ·

Special Recognition Award - Service to Humanity. Medecins Sans Frontieres (Doctors without Borders)

Private Healthcare Provider of the year · Reddington Hospital

Private Laboratory Service Provider of the year · Pathcare Laboratories

10. Radiology Service Provider of the year · Clinix Healthcare 11. Health Maintenance Organisation of the year · Total Health Trust (A Member of Liberty Holdings South Africa) 12. Innovative Healthcare Service Provider of the year · Sproxil Nig. Ltd 13. IVF Service Provider of the year · Bridge Clinic DR. SHOLA ALABI, DR. WALE ALABI, DR. JIDE IDRIS, COMMISSIONER OF HEALTH, LAGOS STATE AND DR. TUNDE OLUJOBI. PHOTO COURTESY NHEA.

CLINIX HEALTHCARE RECEIVES AWARD FOR BEST RADIOLOGY SERVICE PROVIDER OF THE YEAR

14. Dialysis Service Provider of the year · Zenith Medical & Kidney Centre 15. Eye care Service Provider of the year · Eye Foundation Hospital 16. Dental Service Provider of the year · Smile360 Dental 17. Physiotherapy Service Provider of the year · Ageless Physiotherapy 18. Tertiary Healthcare provider of the year · Lagos State University Teaching Hospital

SPECIAL GUESTS AT THE NHEA AWARDS 2016

THE ONDO STATE TRAUMA AND SURGICAL CENTRE WENT HOME WITH THE OUTSTANDING STATE HEALTHCARE PROGRAMME OF THE YEAR AWARD.

19. Healthcare information Technology Provider of the year · Realms Healthcare Services Consulting Ltd 20. Nursing and Midwifery Excellence Award of the year · Nwaobi Jude Chiedu (Nursing world Nigeria) 21. Biomedical Engineering Service Provider of the year · JNC International Limited 22. Laboratory equipment Marketing Company of the year. · DCL Laboratory Product Ltd 23. Hospital Equipment Marketing Company of the year · Swiss Biostadt Limited

JNC INTERNATIONAL BAGGED THE AWARD FOR BIOMEDICAL ENGINEERING SERVICE PROVIDER OF THE YEAR

MR ANIL GROVER (CONSULTANT DIAGNOSTIC HEALTHCARE EXPERT) PRESENTING AN AWARD TO MARTINS IFIJEH OF THISDAY NEWSPAPER

24. Pharmaceutical Retail Outlet of the year · Healthplus Pharmacy 25. Pharmaceutical Operation Excellence (Manufacturing Companies) · Mopson Pharmaceuticals Ltd 26. Excellence in Pharmaceutical Research and Development · May and Baker

PATHCARE LABORATORIES HAS SET THE STANDARD IN LAB SERVICES FOR THREE YEARS IN A ROW AT THE NHE AWARDS

Page 13

History of the

ifteen national societies formed the International Society of Radiographers and Radiological Technologist (ISRRT) in 1962. In 2006 it has grown to 80 member societies. The idea of an International Society was proposed at a meeting during the 1959 International Congress of Radiology held in Munich where 24 countries were represented. The objectives were to assist the education of radiographers and to support the development of medical radiation technology world wide. Membership would be open to any national society that included radiographers or radiological technologists within its membership. By the time of the next World Congress in 1962, the Society was ofﬁcially founded with Miss D. van Dijk of the Netherlands as the ﬁrst President. Each of the 15 founder member societies nominated one person from its country to be their Council Member, thus forming the governing body of the

ISRRT MISS K.C. CLARK

During the early 1960's, Miss K.C. Clark, a radiographer of great international esteem, established a working party to concentrate on the needs for education and training, thus inaugurating the work of the Education Committee. Compiled by: Mrs. O. Balogun The regional co-ordinator for professional practice ISRRT Africa kanmibalo@yahoo.com

MR E.R, HUTCHINSON Ofﬁcial recognition as a Non-Governmental Organization in Ofﬁcial Relations with The United Nations was granted in 1967 in acknowledgement of the Society's work and its co-operation with the World Health Organization. As a result of this, the ISRRT is rostered with the ECOSC (Economic and Social Council) of the United Nations for appropriate meetings.

At the World Congress in 1965, the Board of Management founded the "World Radiography

Hutchinson Book Fund" was

To promote further exchange of information, Regional Conferences were held in each of the three years between World Congresses from 1992 to 2001. Since 1962. Commencing in 2002 a World Congress will be held once every two years. The important role of the ISRRT in education led to the ﬁrst International Teachers Seminar being held in 1966. These Seminars and Workshops Conferences are organised as required, particularly in developing countries. These countries are nominated by the Council, and the event take place in the years between the World Congresses.

created by the WRET in 1981.

The ofﬁcial language of the ISRRT is English.

Educational Trust Fund" to assist projects of educational value. The fund is managed by an independent Board of Trustees and the "E.R.

Initial Secretariat of the ISRRT

International Society. Mr E.R. Hutchinson of the United Kingdom was appointed as the ﬁrst Secretary General. Statutes were established and a Board of Management appointed. It was decided that the future pattern of activities would be focused on a World congress every 4 years, to coincide with the International Congress of Radiology.

Past Presidents of the ISRRT

Lisa Falk, Scandinavia Miss D van Dijk 1962

Miss L Falk 1965

Mr M V Allen 1969

Mr K C Denley 1973

K C Clark, Australasia

Mr T J D West 1977

Mr K Vauthilingam 1981 Mr G Ryan 1985

Mr P Akpan 1989

Dr M Nakamura 1994

D van Dijk, Holland

K C Denley, UK Above: excerpt taken from the report document produced for the World Congress in Rio in 1977

Mrs G van der Heide-Schoon 1998

Page 14

Dr T Goh 2002

Mr R George 2006

Dr M Ward, President 2010

EXCLUSIVE INTERVIEW

•

With the Managing Director Paramount Medical Services (ER Award Winning Diagnostic Center)

•

Mr Kenechukwu K. Obianodo

•

medical diagnostic ﬁeld of practice and also enhancing CT image quality to a high level. Magnetic Resonance Imaging (MRI 1.5Tesla): PMS is also offering the latest in MRI technology, the 1.5 tesla resolutions with a high quality Siemens machine to give the patient; comfort, the best in image quality and report. Mammogram: PMS also offers an exceptional image quality of mammograms to enable the smallest detection of any cancerous lump in the breast so that breast cancer can be battled early. Fluoroscopy: PMS offers a fully digital ﬂuoroscopy machine dedicated to all special contrast studies of Xrays to deliver the best images in the shortest possible time without causing much discomfort to patients. Digital X-ray: With the latest in digital X-ray technology we offer x-ray services in safest way possible combined with the best in image quality and reports Also introducing the latest innovation in Ultrasound, the 4D Ultrasound Scan with digital pictures and Color Doppler Studies. Endoscopy Services: This is the latest addition to our retinue of services with perhaps the best in class setup in the industry at the moment where we offer Gastroscopy and Colonoscopy. Our Cardiology Department is led by a consultant Cardiologist with a wealth of experience to handle ECG, Stress Test (Treadmill Test) and 2D ECHO for both Adult/Paediatric procedures and report. 4D Ultrasonography / Color Doppler Studies are also available at PMS. We have well experienced sonologist heading our ultrasound unit.

What are the value added offerings you render in the diagnostic healthcare industry that makes you stand out?

an you tell us how Paramount Medical Services all started?

Paramount Medical Services (PMS) was founded in 2014 by the Chairman of YSG Group (Chief Dr. Vincent A. Obianodo), as a best-in-class indigenous centre of its kind to offer a comprehensive range of medical diagnostic modalities in imaging and laboratory investigations. PMS which offers “World Class Care For Everyone” officially commenced operations to the public in mid-September, 2015 and in this short period has emerged as one of the leaders in the very competitive medical diagnostic and healthcare industry in Nigeria. The diagnostic center is managed by competent and well experienced professionals of international repute and recognition. Our commitment to quality and our philosophy of always putting the patient first has ensured that over the past year, we have established a reputation for excellence and reliability and have become a household name for quality diagnostic services. We have a vision to provide a medical platform where healthcare professionals and health planners use the latest high end diagnostic medical equipments to proffer solutions to patients thereby creating choices that are wellinformed while restoring confidence, hope and healing to all and sundry. Our mission is to provide crucial diagnostic information that supports and enhances decisions healthcare practitioners make to improve patients' health. With our team certified consultants in Radiology, Cardiology, Gastroenterology and Pathology, we are fully committed in ensuring our clients get a full range of diagnostic services spanning Imaging, Conventional and Special Laboratory Services that are qualitative, reliable and affordable. Our passion for delivering quality and accurate results using the latest in technology for all our clientele has made us a convenient medical provider of choice. What unique innovation in technology have you brought to diagnostics healthcare in Nigeria? Our pool of equipment, which are from renowned and leading global manufacturers, are notable brands and a combination of a good blend of high-technology and expertise to ensure excellent services. PMS Laboratoryparades the latest range of high end Page 15

equipmentwhich are fully automated to meet the pathology needs of our prospective clients in all capacities ranging from haematology, clinical chemistry, immunoassays, bacteriology, parasitology, serology to histopathology. We have the latest equipments in biomedical technology necessary for accurate reporting, patient’s safety and quick turnaround time. Our Radiology Department offers no less innovation and we parade the very best in the industr y with a team of experienced radiographers, imaging scientists and consultant radiologists covering the practice effectively including special contrast studies such as barium meal, barium enema, IVU, HSG, etc. Our equipment listing in Imaging includes: • Computed Tomography (CT – 128 slices): PMS is proud to be the ﬁrst to launch the CT 128 slices machine in Nigeria, thereby bringing about revolution in the

At Paramount Medical Services, we are very mindful that there is no substitute for accurate and reliable diagnostic medicine to ensure the good health and wellness of all and sundry. Our cutting edge is borne out of the value added services we offer: One-stop diagnostic medicine mega centre Health-friendly environment, exquisite ambience First class / world class service delivery Qualiﬁed and dedicated professionals Reliable and trusted results State-of-the-art and fully automated equipment and machines that gives the best turnaround time (TAT) Barcoding of all test samples which eliminates mix-ups and human error Affordable pricing On-line payment with credit cards option On-line reporting Free ambulance services Emergency services available 24/7

How is Paramount Medical positioned in making diagnostic healthcare ser vices accessible and affordable?

What is your ﬁnal message to our readers? Try to live a healthy life for the sake of your loved ones and for the good of what your life is worth.

At PMS our pricing policy is pocket friendly to ensure a lot more Nigerians have access to the best healthcare service delivery we profess and champion. We have even gone further to offer heavily discounted pricing at different times to promote health awareness and timely checkups eg Cancer screening (cervical & breast) for women and Prostrate test (PSA) for men as well as other investigations. Do you have plans to replicate more of this model? Certainly yes we do have plans to replicate our services

Page 16

across the length and breadth of Nigeria. This has been programmed in phases and we are already on the drawing boards to make this a reality. Already within our ﬁrst year we have established two collection centers within Lagos (in Surulere and Ajamgbadi respectively) to complement our pilot centre located in Festac Town and also plan to have three more before this year runs out in strategic locations as we are encouraged by the patronage we have been receiving from all our clients – individual, family, corporate, etc – since we came on board.

PROF. F. A. DUROSINMI-ETTI:

THE JOURNEY OF AN

ACCOMPLISHED RADIATION ONCOLOGIST I had my medical training at the College of Medicine, University of Lagos between September 1967 and June 1972 when I graduated. During my Clinical years, I observed that virtually all the patients I saw with Cancer had advanced disease and many of them died in rather painful and undigni ed ways.

y young mind registered this and I knew since

1971 that “Overcoming Cancer” would be my

dream. On completion of my Housemanship

in June 1973, I was accepted in July 1973 as a Senior House Officer at the Radiotherapy Unit of the then Department of Radiation Biology and Radiotherapy. The Compulsory NYSC had not started at that time and my colleagues and I missed all the fun and excitement associated with NYSC which started with the 1973 set. I started work on 1st July 1973 as Senior House Officer in Radiotherapy at the Department of Radiation Biology and Radiotherapy. There were three Units: 1. Radiation Biology Unit based at the College of Medicine under the late Prof Kurt Solomon PhD. He was interested in cancer cell cultures and the radiation effect on them. He was the overall Head of Department. 2. Medical Physics Unit: headed by Dr, later Professor Fregene PhD who later succeeded Prof Solomon as the Head of Department. Prof Fregene was interested in aspects of Nuclear Medicine using radio isotopes based scans using a Rectilinear Scanner. Indeed the first Nuclear Medicine centre in Nigeria started at the College of Medicine, University of Lagos. The original basic Infrastructures- laboratories etc are still in place and I suggest that the University through the College of Medicine should consider resuscitating the service thus regaining our original status as the pioneers in Nuclear Medicine field in Nigeria. This is possible, feasible and sustainable based on the current increasing clinical needs. I know there are International funding and technical cooperation support available for such projects. 3. Radiotherapy Unit: This closely knit Unit was under Dr and now Professor JT Kofi Duncan.- the Pioneer and Grandfather of Radiation Oncology in Nigeria and West Africa. The Unit consisted between 1973 and 1976 of very dedicated staff including the following: Dr and later Ass. Prof DOS Ajayi who joined the Department in 1975 on his return from Postgraduate studies in the UK - Dr Mrs Tsereje Oteri whom I met in the Unit/Department as a Senior House Officer - Dr now Professor FA Durosinmi-Etti who joined in July 1973 as Senior House Officer. - Dr - now Professor KK Ketiku who was working at St Nicholas Hospital and was invited by me. He joined the Department in 1975 also as a Senior House Officer. - Dr - now Professor OB Campbell joined the Department in 1976 on the invitation of Dr. Ketiku . - Mr, -now Dr Ogunleye – a Medical Physicist now based in USA.

Page 17

Matron Ibironke Sappeh – a Royal Marsden Hospital, London trained Oncology Nurse. - Mrs Ekanem also a UK trained Therapy Radiographer - Mr Francis Idehen, also a UK trained Therapy Radiographer. It is noteworthy that most of us listed above actually occupied a very small building as shown below which today ought to be preserved and recorded as being the FIRST Radiotherapy centre in Nigeria. The Building is sandwiched between the Mortuary and the LUTH Petrol Station. Incidentally, I have noticed that many Radiotherapy Centres elsewhere are usually located close to the Morgue!!! Perhaps to remind us of the Myth that Cancer is synonymous with DEATH Mr Vice Chancellor Sir, I am pleased to announce that –Things are changing for the better and Cancer no longer needed to be seen as a death sentence especially when diagnosed and treated early.

Some of the items of Equipment in those early days were - RT 50 - A 50KV MACHINE FOR KELOIDS - RT 305 - A 300KV ORTHOVLTAGE MACHINE FOR DEEPER TUMOURS. - CAESIUM-137 MANUAL AFTER LOADING BRACHYTHERAPY MACHINE. The Radiotherapy Unit under Prof. Duncan moved into our current larger premises in 1975 following the installation of a more sophisticated Theratron-780C, Cobalt-60 Teletherapy machine donated in 1973 by the Canadian Government. We also had Dosimetry and other items of

equipment which guaranteed radiation safety and improved treatment of our cancer patients. The Department continued to grow with the addition of more staff including the following who joined at various times: 1. Dr now Professor AT Ajekigbe, current Head of the Department, (2016). 2. Dr now Professor Moses A. Aweda, a French trained Medical Physicist 3. Dr now Associate Professor AT Olasinde – currently Head of Radiotherapy Department at ABUTH Zaria (2016) 4. Dr Festus Igbinoba – now Head of Radiotherapy Department at National Hospital, Abuja (2016) 5. Nursing Sister Aiyela who retired as a Matron many years later. 6. Nursing Sister Tina Olumese (later Matron) – She sponsored her Oncology Nursing Training programme herself at the Royal Marsden Hospital, London. 7. Sister Taiye Ijandipe (now Mrs Salawu) – who as will be mentioned later was among many others whose training at the Royal Marsden, London was facilitated by me during my tenure at the IAEA. Vienna. 8. Sister Moji Okanlawon of Blessed memory- was sent for training at Shefﬁeld 9. Sister Owolabi who was sent to Sweden for her Oncology Nursing Training 10. Mr Oladeji a very experienced Physicist was also assisted to do a Masters programme at Hammersmith Hospital London. He recently retired from service at LUTH. 11. Mr Olusoji Ojebode, a British trained Radiographer also joined the Department. I also facilitated his specialized training in Quality Control at Vienna, Mould Room Techniques and Maintenance of the Cobalt machine at Russia; He currently works at the

National Hospital, Abuja.. 12. Mr M. Olaniwun, another British trained Radiographer currently working at the National Hospital. 13. Mr Nerius Okoye – Joined the Radiotherapy Unit and he also beneﬁtted from overseas training as a Therapy Radiographer . 14. Mr Odu like the above also had his training in the UK as a therapy radiographer.

MODERN COMPUTERIZED TREATMENT PLANNING SYSTEM

THE RADIOTHERAPY DEPARTMENT TODAY. The Department is known today as the 4Rs: Department of Radiation Biology, Radiotherapy, Radiodiagnosis and Radiology following a merger of all Departments that have Radioxxxx in their names even though their operational areas and functions are dissimilar in many aspects. Apart from the administrative convenience from the forced marriage the merger indeed deserves to be reviewed and I hope that the University management is looking into this .

MY TRAINING IN RADIATION ONCOLOGY AND NUCLEAR MEDICINE AT THE CHRISTIE HOSPITAL, UNIVERSITY OF MANCHESTER, ENGLAND. However the Radiotherapy and Oncology section continues to make modest progress. We now have many young doctors who are Residents, many young Consultants and Lecturers gradually making their ways up the Professional ladder as Clinical Oncologists. Medical Physicists, Oncology Nurses, Dosimetrists, Therapy Radiographers. Other members of the Clinical Oncology team are also in the Department contributing their quota to the cause of overcoming Cancer. Although we lack the necessary functional equipment for overcoming Cancer, I am aware that the Government of the day through the Honourable Minister of health, has declared that overcoming Cancer is a priority in this administration.

THE NEW RADIOTHERAPY SECTION TODAY THE NEW LINEAR ACCELERATOR

THE CT SIMULATOR

Through the Grace of God and the help of Prof. Duncan, my professional father and Mentor, I secured a training position at the Christies Hospital and Holt Radium Institute, University of Manchester, England. This is one of the oldest and world renowned Cancer Institute in the world. Most other Cancer centres all over the world would often refer to 'Manchester techniques' which they adapt for use in their various hospitals. I was granted a 3-year study leave with pay by LUTH and left for Manchester, England together with my wife and two children on 22nd September 1975. Economy Air passage for us was paid for by LUTH and I was also entitled to daily travel allowance and other allowances as were in practice in those days. I was a very comfortable student just ready to face my studies and return home as early as possible. As it were, my Supervisor, Dr Sherrah-Davies of Blessed memory insisted that having passed PLAB- the eligibility examination for practice in the UK by overseas trained doctors- I must be offered a paid job to enable me benefit from full training like their home students and be held accountable for my actions like any of their nationals. After much persuasion I accepted a job as a Senior House Officer rising over the years to the level of Registrar and Senior Registrar at Cookridge Regional Hospital, Leeds and Merseyside Regional Hospital, Clatterbridge, Liverpool, England where I worked to gain more Clinical experience before returning to Nigeria in 1980. I was tempted to stay back in England but for the fact that I just believed that Nigeria needed people like me to join Prof. Duncan and our other colleagues to clinically fight and overcome Cancer in Nigeria. The decision to pack and return home was made easier for me when I received a phone call from Prof. Elebute who as CMD and Provost asked when I would be back home having completed my training. He assured me that I would get my appointment as Lecturer and Consultant as soon as possible following my return. I was then not sure whether or not he knew I was considering staying back in England with offers for consultant post in England. His phone call and my loyalty to my country in addition to the contract I signed all helped me make up my mind and was back home to LUTH in late 1980. I was soon appointed Consultant and Lecturer 1 early 1981. Research and Some Publications on Basic Cancer Problems In Nigeria. I remember one day soon after my return from Manchester, one of my revered teachers and a great mentor, Prof Deji Femi-Pearse said to me ”Youngman, you are sitting on gold with your area of specialization as an oncologist. I hope you will make the best of it” He said there are opportunities for me to define the actual status, demography and other issues as regards cancer in Nigeria for which information were still lacking.

Page 18

Over 80% of cancer patients in Nigeria often present with late and advanced stages 3 and 4 diseases. The reasons for this avoidable delays were analyzed and solutions proffered in my publication titled Cancer patients in Nigeria- Causes of delay before diagnosis and treatment.(4). Another joint publication- Nnatu SNN and Durosinmi-Etti (1985): The problems with the management of carcinoma of the cervix in Nigeria(5) looked into the basic issues affecting the inefficient management of this lesion in Nigeria and proffered solutions. Durosinmi-Etti FA and Ajekigbe R (1984) also looked into the reasons for the apparent rising incidence of Cancer of the Cervix in the younger generation of Nigerians (6). Durosinmi-Etti, FA and Ketiku,KK (1984) examined the beneficial role of radiotherapy over surgery in the management of Chemodectomas in Nigeria. It is now the preferred choice of treatment for this condition,(7). Kaposi Sarcoma is a malignant lesion which hitherto has been treated with radiotherapy in many cases. The joint study by Ketiku KK and Durosinmi-Etti,FA (1984): The treatment of Kaposi Sarcoma by combination chemotherapy in Nigeria demonstrated the superiority of this approach over radiotherapy in the management of this condition (8). Global Activities at the United Nation's International Atomic Energy Agency Between 1984 and 1988 while serving as Head of the Radiotherapy Unit of LUTH and Ag. Head of Department, I had various opportunities to attend and present papers at many International Conferences. After my presentation at one of such meetings in Japan in 1987, a Senior official from the International Atomic Energy Agency, (IAEA) Vienna approached me and told me the IAEA would be very happy to appoint me as a Staff Member and the Radiotherapy Specialist in charge of all the Agency's activities in Radiotherapy all over the world. He stated that the IAEA would request my formal nomination by the Federal Government of Nigeria. My duties included initiation and conduct of multi institutional and international coordinated research projects in the management of Cancer par ticularly using Radiotherapy; Establishment of new Radiotherapy services including Equipment, Manpower and Experts especially in the developing countries in Africa, Asia and Pacific region, Latin America, Eastern Europe and other parts of the world. Organisation of various training courses, Conferences and Symposia in Radiotherapy all over the world. Training of Radiation Oncologists, Medical Physicists; Oncology Nurses; at various institutions.

SOME SUPPORT FOR NIGERIA. TRAINING

LUTH

UCH

NHA

Radiation Oncologists

Medical Physicists

Radiographers

Oncology Nurses

Cobalt Machine

LDR BRT machine

MouldRoom /Dosimetryfacilities

Yes

1 1

2 1

2 Yes

ABUTH

Yes

MY INVOLVEMENT IN RADIOTHERAPY AND ONCOLOGY SERVICES IN THE FOLLOWING COUNTRIES BOLIVIA:

CAMEROON:

DEM. REP.OF KOREA:

ECUADOR:

Establishment of brachytherapy facilities at Teaching Hospitals at LaPaz, Cochabamba, Santa Cruz and Sucre. 1992. Establishment of low dose rate brachytherapy services at the General hospital at Yaounde and Douala.1992-93. Improvement of radiotherapy services for Teletherapy and brachytherapy at Pyongyang. North Korea. 1992 Establishment of remote

EGYPT:

ETHIOPIA:

GUATEMALA:

GHANA:

HAITI: INDONESIA:

JORDAN:

KENYA:

NICARAGUA: NIGERIA:

PAKISTAN:

SRI-LANKA:

UGANDA:

VENEZUELA:

ZIMBABWE:

ROMANIA:

URUGUAY:

VIETNAM:

COLOMBIA:

TANZANIA:

afterloading high dose rate brachytherapy facilities at Quito. 1992. Pilot project on Brachytherapy for carcinoma of the cervix. Included coordination of the training programme for 120 specialists. 1988-92. Coordination of a new project aimed at the manufacture of a simple Cobalt-60 teletherapy machine in Cairo.1993. Establishment of a new department or radiotherapy at the University of Addis Ababa.1992. Establishment of high dose rate remote after loading brachytherapy facilities 1992. Establishment of the National Radiotherapy and Nuclear Medicine Network at Korle-Bu Teaching Hospital. Accra. 1997-1998 Improvement of radiation protection and radiotherapy services 1992. Establishment of new Teletherapy facility at Pershabatanhospital. Jakarta.1991. Development of postgraduate training programme in Medical Physics.1993. Upgrading of radiotherapy and medical physics at Al-Bashir Hospital. Amman. Jordan.1991. Introduction of high dose rate remote after loading technique for treatment of carcinoma of the cervix and oesophagus at the Kenyatta National Hospital. Establishment of a modern radiotherapy centre. Managua.1990. Resuscitation of radiotherapy facilities (Brachytherapy andTeletherapy) at the Lagos University Teaching Hospital. 1992 Establishment of Brachytherapy service at the new radiotherapy department of Ahmadu Bello University Teaching hospital Zaria. 1993. Establishment of a new Radiotherapy Service with a Linear Accelerator in Nigeria at the National Hospital for Women and Children. Abuja. 1997 Establishment of new Cobalt-60 teletherapy unit at Jamshoro Medical centre 1990. Introduction of remote high dose rate brachytherapy and computerised planning. Cancer Institute. Colombo. 1989. Development of a new radiotherapy department at Mulago hospital. Kampala.1993. Introduction of high dose rate remote after loading brachytherapy techniques at the Central University, Caracas 1989. Establishment of a postgraduate training programme in radiotherapy and medical physics.1988. Introduction of remote after loading brachytherapy techniques at Coltea Hospital. Bucharest.1993. Introduction of remote after loading brachytherapy techniques and computerised treatment planning. 1993. Upgrading of radiotherapy facilities for Teletherapy and Brachytherapy at the Tumour Centre. Ho Chi Minh city 1993. Introduction of remote after loading brachytherapy techniques at the National Cancer Institute. Bogota1993. Improvement of Radiotherapy services and Dosimetry at Muhimbili Medical Centre. Dar essalam. 1993.

My Role in Cancer Advocacy. A sure route to overcoming cancer is through prevention. However there is the need to reach the people by getting involved in Cancer Advocacy. In this regard I have made the following contributions among others: ·

Founded the Cancer Aid Foundation, in 1981 and is the first Registered Cancer Charity in Nigeria by the Corporate Affairs Commission. The older Nigerian Cancer Society of which I was a past National Treasurer and currently Member of the Board of Trustees was founded in 1968 but only got officially registered recently. The Cancer Aid Foundation continues to promote cancer awareness, diagnosis, treatment and cancer survivorship. Originated and was Pioneer Secretary-General of the African Radiation Oncology (AFROG) which is still being supported by the IAEA and WHO. Pioneer President of Cancer Education and Advocacy Foundation of Nigeria (CEAFON) which hosted a highly successful cancer summit in October2015 supported by various Cancer Stakeholders such as the Federal Ministry of Health, Pharmaceutical Companies: Roche, Astra Zeneca etc. It has also just produced about three weeks ago, the National Guidelines for Multidisciplinary Management of Breast Cancer in Nigeria which will help Assure the Quality of Breast Cancer treatment in Nigeria.. As Chairman National Consultative Committee on Cancer Control, we developed the first ever National Cancer Control Plan for Nigeria which covered prevention, early detection and management of cancer including terminal care for cancer patients in Nigeria.

WITH WIFE AND GRANDCHILDREN

THE WHOLE CLANTHREE GENERATIONS

Some Academic International Radiotherapy Related Activities I was the coordinator of international research project on computer assisted planning and dosimetry in radiotherapy of carcinoma of the cervix in Asia and Paciﬁc regions. Participating institutions from India, Indonesia, Japan, Korea, Philippines, Pakistan, Malaysia, Sri-Lanka and Thailand. 1989-93. Coordinator of global research project on radiotherapy of head and neck cancer. Participants from England, Cuba, Bulgaria, Austria, Cameroon, Nigeria, Pakistan and Turkey. 1990-93. Coordinator of research project on "Advanced brachytherapy techniques" for malignant tumours at various anatomical sites. 1993-1994. Coordinator of research project on Use of radiotherapy in advanced cancer. April 1995 - January 1996. Examiner in Radiotherapy and Oncology for the Postgraduate Medical College of Nigeria. and West African College of Surgeons. 1994 till date IAEA Expert/Lecturer at the Postgraduate Radiotherapy Training Programme at the University of Zimbabwe, Harare, Zimbabwe January -March 1995. Organisation and conduct of a Regional Training course for senior Radiotherapists and Medical Physicists from Africa. September 25 - October 6. 1995. Lagos. Nigeria. IAEA Expert/Lecturer in Radiotherapy at the Makerere University, Mulago Hospital. Uganda. April - May 1996.

Scientiﬁc Secretary for the Following International Cancer Conferences. IAEA/WHO First research coordination meeting on computer assisted planning and dosimetry in carcinoma of the cervix. Bangkok. Thailand. October 30-November 2. 1990. IAEA/WHO First research coordination meeting on computer assistedplanning and dosimetry in radiotherapy of Head and Necktumours. Manchester. England. June 1-5. 1991. Regional training course for Medical physicists on recent advances in Radiotherapy. Lahore, Pakistan. 16-27 October 1989. IAEA/WHO seminar for Africa on "Organisation and training inradiotherapy". Cairo, Egypt. 1-5 December 1989. Workshop for Physicists and radiation technologists on "Introduction ofcomputers and database in radiotherapy of carcinoma of the cervix".Bombay, India.1-5 June 1992. Second research coordination meeting on "Computer assisted planning and dosimetry in radiotherapy of carcinoma of the cervix" Jarkata. Indonesia. November 30 December 2 1992. International Consultants meeting to design a new global coordinatedresearch project on "Advanced brachytherapy

Page 19

techniques." Vienna. Austria December 7-9 1992. Final research coordination meeting on computer assisted planning and dosimetry in head and neck cancers. Vienna. Austria September 20-22. 1993. Final research coordination meeting on Computer assisted planning and dosimetry in radiotherapy of carcinoma of the cervix in Asia and Paciﬁc region. Seoul Korea, March 28-30 1994. Regional Training Course on modern techniques and QA in radiotherapy. Sept 25-Oct.6. 1995. Lagos. Nigeria.

IMAGING ACCESSORIES MEDICAL EQUIPMENT INSTALLATIONS RADIATION PROTECTION DIAGNOSTICS CENTER DESIGN AND LAYOUT

Email: Najishasengineering@gmail.com Twitter: @najishasengineering Phone: 08027967930, 08071099744

ARN CONFERENCE

KANO2016 22nd - 26th November, 2016

19 ISSRT WORLD CONGRESS 23RD EACRT & 51ST KRTA Annual Meeting October 20-22, 2016 Seoul, Korea

6 REASONS WHY YOU MUST BE IN KANO THIS NOVEMBER

ano is the treasure of the northern pearl in Nigeria. It is a city that is packed with ancient civilization relics, home to some forefathers of the country. It has this unchanged allure that is seen resonating through the city walls. The commercial activities vibrate all through the streets and have become one of the largest market place in Sub-Sahara Africa. There are many ways you can explore Kano. The City Walls The Kano Walls is a must visit in the city. It stands at 18 meters tall covering a radius of about 14km. It is over seven-century old and still tells the ancient tale that a lot of people may have forgotten. GidanMakama Museum Initially, the GidanMakama Museum was the Emir’s Palace before it was converted to this museum that now showcases Kano’s history from the pre-colonial times to our present. There are different sections that have housed arts and crafts. It was constructed in 15th century. Today, it has become a National Monument. The Emir’s Palace The natives called it the GidanRumfa that has become the home of the Emir of Kano. It was Emir MuhammedRumfa who built it in the 13thcentury. It has been renovated over the years and seats comfortable on 33 acres of land. The place is asite to see both inside and within. The Local Restaurants You may not expect to be handed over a bottle of beer in any of the restaurants in Kano because it is prohibited. However, the local foods are healthy and affordable. You can be served different cuisines in any of the eateries in the city. The Markets One of the markets in Kano is the Kurmi Market that is affordable for you to get a lot of items for yourself including souvenirs. Shop some of the ﬁnest items in the country when you are in Kano. Hotels There are different hotels that range from budget to luxury hotels. We would not forget chalets, motels and hostels that you can still make use of when you are in Kano. Durbar Festival Every year, people from different parts of the world come to Kano to witness the Durbar Festival. This festival is colourful and amazing to see horse riders and their horses beautifully dressed for your delight.

Page 20

THE SECRETS OF BUILDING A SUCCESSFUL MEDICAL OUTFIT IN NIGERIA

FELIX ERONDU BS.c, MS.c, MHA, Ph.D

Corporate Governance This involves collective decision making by a board of directors who may not necessarily be medical practitioners but are experienced in business strategy. The presence ofa board of directors ensures continuity and succession planning in the event of retirement, incapacitation or death of the original owner. Many private health institutions often die with their medical directors or proprietors. This is because most health care organization's are built around the original owner, with no plans for continuity or succession planning. Forecasting: This is done to achieve future key performance indices, using current statistics and data. This allows the projection into the future business direction of the company. This can include capital investment decision as well as ﬁnancial decisions.

uilding a successful medical diagnostics business starts with recognizing what a business actually is. Healthcare is a “commodity”. It has a price. It has producers, suppliers and consumers. It can therefore be rightly said to be a business. Like any other business, a health care organization passes through a definite route or stages of development: (a) Source for capital in a market place (b) Use the funds to acquire assets such as land, lease or buy buildings, and equipment. (C) Use the assets to generate products or services (d) Sell those products or services and generate revenue (e) Pay back the source of capital and reinvest the excess Some basic understanding of the concepts of demand and supply are critical in making decisions regarding health care services. The demand for health care is purely a derived demand. Whether a patient would demand for care is a function of many factors, some of which are outside the control of the patient. Genetic make-up, type of environment, public health policy, lifecycle and availability of right technology are all such factors. For the patient, the decision is mainly on two fronts – whether to visit a hospital and which one to go. To run a successful medical business in Nigeria, one has to be mindful of the following: (a) Variable and inconsistent health policies (b) Poor strategic health plan (c) Poorly implemented public health policy (d) Multiple taxation (e) High cost of capital funds (f) Epileptic power supply (g) Inadequate infrastructure to support high end technologies (h) Insufficient manpower for repair and preventive maintenance (I) Low affordability (j) Poor re-imbursement modal by * and insurance (k) Poor inter-professional relationship among healthcare providers (l) Poor regulatory framework to check mediocrity and mockery. (m) No social security and poor implementation of health insurance and managed care options Basic Steps That Guarantee Success Strategic Business planning Strategic planning is an indispensable part of any successful medical business. The leaders of an organization must think strategically by viewing the organization's issues, problems and operations from a broad and futuristic perspective, taking into cognizance its environment and situations. The medical organization may be involved in a variety of activities such as treating patients (hospitals), filling of prescriptions and drug sales(pharmacies), performing tests (Diagnostic centers) or drug and equipment research and production ( pharmaceuticals and medical technology companies). Whatever the goal, strategic thinking prepares the organization towards performing its roles on a long term basis. A typical strategic plan would include defining the mission and vision, values, objectives, specific plans and targets and benchmark to measure such targets. Finally, a programme that allows selfmonitoring and evaluation must be put in place. Planning and Budgeting: This will allow the CEO or MD to evaluate the financial activities emanating from its operations and to plan for the future. Financial Reporting This takes the form of internal as well as external audits, providing an unbiased report of the results of operations and exact financial state of the organization. Page 21

Working Capital Management There should be adequate control and management of the organizations short term assets including inventions, cash, securities, resources to ensure cost efficiency and operational efficiency. Contract Management Health care managers should understand and acquire negotiation skills. This allows proper initiation, negotiation and monitoring of contracts especially with HMO, through party payers and corporate entities. Customer care management The customer is key to the success of every business strategy. A good understanding of whom the customer is, what he wants and how to meet the needs is a critical part of any successful business. The customer includes the patient who receives the service or care, those who take decisions on his/her behalf, third party payers including HMO, insurance companies and employers and even the care providers who are responsible for delivering the care. Building Partnerships It is important to build partnerships and relationships which can provide some leverage to enhance business success. Some critical partnerships include stakeholders such as government agencies and regulatory organs, professional bodies in the health care sector, business partners, equipment and technology vendors, banks and financial institutions, training facilities, physicians and other health care givers. Brand Marketing This is simply defining the identity of an organization using some unique service or product and promoting such identity. A brand could therefore be a product, service, or concept that is unique and clearly distinguishes one organization from others. A brand name is the name of the distinctive product, service, or concept. Branding is the process of creating and disseminating the brand name. The popularity of a product is judged by the public perception of its brand. Succesful organizations are known for their strong brands, and most spend millions of dollars in building and sustaining their brand. Some specific components of a strong brand include the promise to the customer (for example low price or quick turn around), the perceptions of these customers regarding the supposed brand, the specific expectations of customers and the personality behind the brand. Brands are usually protected from use by others by securing a trademark or service mark from an authorized agency, usually a government agency. Health care organizations should try to carve a niche in an area of specialization or service profile. Summary The survival and success of private health institutions is hinged on a number of factors. To be successful, would-be entrepreneurs need to understand the peculiarity of the Nigerian business environment. It is important that the individual should have both clinical and managerial skills. While the former is not a critical necessity, the latter is extremely important. The use of board of directors, ensures a balance of opinions and experiences that can impact positively on the growth of the company. Financial discipline, good investment ideas, a well articulated strategic plan and leveraging on viable partnerships are ingredients that can guarantee success. References Berkowitz E.N (2011). Essential of Health care Marketing. 3rd Ed. Jones and Bartlett Pub. Sudbury MA. Moseley G.B (2009). Managing Health care Business Strategy. Jones and Bartlett Pub. Sudbury MA.

Sualata A ﬁlm by fast rising Nollywood Director “Edward Uka” debut for International ﬁlm festival. This movie was shot in North Nigeria and studded with notable Nollywood casts, looking forward to various AWARDS…

CEO Series

Kunle Afolayan's movies are always eagerly anticipated – “The CEO” is no exception. Set mainly on a beautiful beach resort on the outskirts of Lagos in Nigeria, “The CEO” is a mystery-thriller surrounding five top executives from across Africa who are despatched on a 1-week leadership retreat by a multinational telecommunications firm, to determine which one to appoint as the firm's new CEO. Things go awry when one-by-one the executives are eliminated in sudden death circumstances, and the finger falls on the last two remaining executive as prime suspects.

After the mega success of his movie “30 Days in Atlanta”, Enterprising star comedian AY Makun is set to release a new project titled “A Trip to Jamaica – Another Akpos Adventure” soon. The official release tells us, “The movie which is the second installment of the Akpos franchise is billed to raise the comedic bar set by the hilarious '30 Days In Atlanta' which set the record as the highest grossing cinema movie in Nigeria till date.” Shot in Nigeria, the United States of America and Jamaica, the film showcases Akpos (AY) and his fiancée Bola (Funke Akindele) as they travel across the Atlantic to visit family, they unexpectedly end up on an adventure. From Nigeria to America to the beautiful island of Jamaica, this is a movie that is both designed to keep viewers reeling with laughter as well as bridge the gap between Hollywood, Nollywood and Jamaica's film industry. “A Trip to Jamaica” features Hollywood actors including Eric Roberts and Dan Davies while the Jamaica cast includes Paul Campbell (of 3rd World Cup) and Rebecca Silvera (Former Miss Jamaica). Ghanaian and Nigerian stars Chris Attoh, AY, Funke Akindele, Nse Ikpe Etim, Patoranking, Cynthia Morgan and Ras Kimono shine brightly. The movie which will surely appeal to the teeming international 'Akpos' fanbase is directed by Robert Peters, and written by Dianne Diaz andAY.

RADIATION

PROTECTION

OF THE PATIENT

DURING COMPUTED TOMOGRAPHY PROCEDURES

Adejoh, Tom; Ogbonna, K. Joshua; Onuegbu, C. Nnamdi; Nwefuru, O. Stanley Radiology Department, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria; adtoms@yahoo.com; joshuakayceogbonna@gmail.com; nwefurustanley@gmail.com; onuegbun@gmail.com

Introduction Over the past two decades, there has been a marked growth in the absolute number of diagnostic medical procedures that utilize ionizing radiation. In addition, there has also been an increasing frequency of relatively high-dose procedures like computed tomographic (CT) scanning (Mettler, 2008), a modality considered in medical imaging as the most important contributor to patient exposures (Van da Molen, 2013). Patient exposure is critical in CT because, aside using ionizing radiation, the doses are typically much higher than for radiographic or fluoroscopic procedures (Stephen, 2007). Furthermore, the introduction of multi-section CT scanners has resulted in relatively large dose increases compared with doses from single-section scanners (Wall, 1995). This increase in CT investigations may eventually result in an increased incidence of cancer (Stephen, 2007), hereditary diseases in descendants of the exposed persons and the possibility of induced deterministic effects (Olarinoye, 2010). Therefore, sensible use of the CT modality requires strict adherence to the principles of radiation protection to ensure that the risk to patients does not outweigh the benefit gained from the technique (Foley, 2012). Every modality in radiology has a dual goal: acceptable image quality with reasonable radiation dose. Therefore, radiologists, medical physicists and radiographers must be attentive to their responsibility to maintain an appropriate balance between diagnostic image quality and radiation dose. Image quality must be adequate for diagnosis and obtained with reasonable patient doses. (Mayo, 2003; Vano, 2007). Radiation protection of the patient Although dose limits do not apply to medical exposures of patients, nevertheless radiation protection measures to prevent unnecessarily high doses should be undertaken (European Commission, 2000). The emphasis on radiation protection has been on stochastic effects, an effect where the probability, rather than its severity, increases with dose (Mahadeveppa, 2001). The main tools to achieve radiation protection are justification of practices, optimization of protection and the use of dose limits for personnel (European Commission, 1999; ICRP, 1991). The International Commission on Radiological Protection (ICRP) has been involved in radiation protection for more than 80 years and in 1990, as well as in subsequent years, recommended that all medical exposures should be subjected to radiation safety principles of justification, optimization and limitation of protection (Omar, 2015; Ujah et al 2012; Sharifat and Olarinoye, 2010). 'All medical exposures' include computed tomography. Computed tomography mapping in Nigeria In Nigeria, aside the multiplication of CT scanners, the number of CT examinations has shown a steady increase (Ogbole, 2014) and globally, this rate can be expected to increase on the basis of the higher number of examinations performed today. The first CT scanner was installed on November 19, 1987 at the University College Hospital (UCH) Ibadan, in Southwest Nigeria while the first in Southeast Nigeria was installed at the University of Nigeria Teaching Hospital (UNTH), Enugu around 1996-1998 (Eze, 2012). For 29 years Nigeria and Nigerians have benefitted from CT technology. However, statistics on the total number of CT scanners in Nigeria is not accessible as revealed by online search of literature and government websites. Although the total number of CT scanners in Nigeria are not handy, an unpublished survey carried out by the lead author in the Southeast geopolitical zone in 2015 revealed that from the single scanner at UNTH eighteen years ago, there are currently eighteen CT centres distributed as follows: Anambra: 7 (39%); Enugu: 4 (22%); Abia: 3 (17%); Imo: 3 (17%); and Ebonyi: 1 (5%). Seven (39%) are privately-owned, four (22%) belong to the Federal Government, three (17%) each are owned by faithbased organizations and public-private partnership (PPP) respectively while one (5%) is owned by a State Page 22

government. Of the seven privately-owned centres, two in Anambra and one in Imo are manned by non-radiographers in synergy with some young radiographers. A survey of CT doses in four continents and covering forty countries revealed that head CT is the most common CT examination, and amounting to nearly 75% of all pediatric CT examinations (Vassilever, 2012). Current works on CT doses in Nigeria are focused specifically on the head, which is also adjudged the most common procedure in Nigeria (Adejoh 2015; Garba 2015; Mundi 2015; and Ogbole 2014). The implication is that there shall be more cases of CT of the head nationwide than of any other anatomical area. The lacuna in knowledge on CT dose The ability to use the computed tomography (CT) scanner to acquire images that will aid in diagnosis is an exciting and rewarding experience (O'Sullivan & Goergen, 2015). However, from the anecdotal evidence of the writers, what is being learnt and done in Nigeria is basically image acquisition with little or no consideration for radiation dose. 'International experts' who were contracted to give hands-on training when equipment were installed were silent on CT dosimetrics. Even the CT update course for interns and radiographers organized by the Radiographers Registration Board of Nigeria (RRBN) lacks meaningful course content on dose management. There are also no policies by the RRBN on threshold dose in computed tomography so, dose administration in CT appears arbitrary. In addition, radiation protection in computed tomography is grossly missing from undergraduate and postgraduate radiography curriculum and that of the National and West African College of Surgeons (radiology subspecialty) respectively. Even in the four years of active CT practice by the lead author, no physician or radiologist has ever requested for dose information about any patient. It was also noticed that not many CT radiographers were familiar with or interested in 'series 999' which represents dose information after a CT scan. This obvious scenario leads to the logical conclusion that there is a lacuna in knowledge on CT dose. CT dose-influencing parameters Unlike conventional X-Ray where tube potential (kVp), tube current (mA), time (second), focus-film-distance (centimeter), are major influences on dose, there are much more parameters that influence dose in CT. Some of these include: azimuth, pitch, automatic tube current modulation, manual tube current and tube potential manipulations, gantry rotation time (seconds), scan duration (seconds), data channel maximization, exam mode (axial, helical, cine), aperture diameter, focus-subjectdistance (FSD) and scan range (cm). One may also say that the possession of a 16, 32, 64, 128, 256 or 512 slice scanner is not an advantage in dose optimization if the radiographer is ignorant about CT dosimetrics; the computed tomography dose index (volume) CTDIvol and dose-length product (DLP). A CT scanner without CTDI (vol) and DLP is either old, poorly installed or the operators are thoroughly ignorant.

2012). Our obligation therefore, as radiographers, is to be the watchdog against high and unnecessary radiation dose from CT. This we must do by understanding the concept of diagnostic reference levels. Diagnostic reference levels Computed tomography delivers higher radiation doses to patients of up to 20 mSv than radiographic or ﬂuoroscopic procedures (Stephen, 2007). As a result of wide variations in patient dose levels for the same examinations up to a factor of 100 (Faulkner & Corbelt, 1990), both the International Commission on Radiological Protection (ICRP) and International Atomic Energy Agency (IAEA) recommended the use diagnostic reference levels (DRLs) in radiology (IAEA, 1998; ICRP, 1990). These reference levels were intended to act as thresholds to trigger investigations or corrective action in ensuring optimized protection of patients and maintaining appropriate levels of good practice. This according to European Commission (EC) is to encourage departments to investigate their patient radiation levels (Olowokere, 2012). The DRLs is not universal but speciﬁc to a country, region, equipment and procedure. Unfortunately, in Nigeria, there are neither diagnostic reference levels nor working documents or legislation for CT procedures. This has the potential to create room for misuse of radiation. The obligation for the legislation and regulation for CT operation lies with the RRBN. To guarantee radiation protection of the patient during CT examinations, in addition to the policy documents, there ought to be proper training on dose optimization as well as strict regulations by the RRBN.

Diagnostic reference levels in Nigeria Preliminary attempts at bridging

the gap in establishing

diagnostic reference levels have produced wide intraRadiographer and inter-centre dose variations as revealed by some isolated studies by radiologists in Ibadan and radiographers from the North and Southeast Nigeria respectively (Adejoh et al, 2015; Mundi et al, 2015; Garba 2015; Ogbole and Obed, 2014). These observed variations in Nigeria in the local surveys have presented the need for the establishment of standards (Sharifat

and Olarinoye, 2010).

Interestingly, there is progress being made in that regard as Garba Idris (Kano), Joseph Dlama (Bauchi) and Adejoh Thomas (Nnewi), who are PhD radiographers working independently, are determined to give the country DRLs. In the absence of a national diagnostic reference level, the values from EC (table 1) have been popularly used as standards and are therefore recommended for Nigeria pro tempore

Table 1: Typical CT dose output/DRL from different countries and Nigeria

How enormous is CT dose?

Exam

A simple arithmetic will give an idea of the quantity of radiation

Head

Chest

X-ray of acceptable optical density, spatial and contrast resolutions can be produced using any static or mobile unit. The mAs is 12.5 because the time is too short, about 0.05 seconds (50 milliseconds). In CT, gantry rotation times are given in seconds and to only one decimal point of seconds (and not in milliseconds). It is therefore usual to see gantry rotation times of 0.5s, 0.7s, 1s, 2s, etc. To acquire axial scans in CT, 100 kVp, 250 mA and a gantry rotation time of 1s will produce a mAs of 250! Compare the 12.5 mAs of conventional X-ray with 250 mAs of CT. The difference is clear. But the story does not end there. This 250 mAs may be dispensed for 30 seconds or more depending on the entire duration of the particular series in question. Let us assume it is 250 mAs * 30 seconds. That will give us 7,500 mAs for just a head CT scan. It is this 7,500 mAs that will be transformed into the XRay photons to examine the patient. If a mere 12.5 mAs can do it in conventional X-Ray, why use 7,500 mAs in CT? Can it be justiﬁed? No, it can not. It can not because, no matter the scanner, less than 120 kVp and less than 250 mA on a much lesser series duration can achieve the same result. The right attitude is to experiment with lower scan parameters while watching out for image noise. Also, the secret is to understand how to steer off from dose creep, which is a gradual increase in x-ray exposures over time that results in increased radiation dose to the patient. This occurs where judgment to determine the correct radiographic exposure factors is needed when taking into account a large range of patient sizes (Gibson,

European

Commision

(Wall 1995)

Australia

Sweden

Germany

Nigeria, Ibadan

Nigeria, Nnewi

ARPANSA

SRPA, 2002

Brix 2003

Ogbole 2014

Adejoh 2015

Adult 60

Children 35

Adult 75

Adult 61

1200

1016

1898

CTDI(mGy)

40-70

DLP (mGy-

300-750

1050

1000

600

20-50

200-600

650

450

110

20-30

170-800

780

700

390

cm)

CTDI (mGy) DLP (mGycm)

Abdo men

Australia

(Wall 1995) Adult 60

Children

involved in CT procedure. Recall that with a tube potential of 100 kVp, tube current of 250 mA and an mAs of 12.5, a skull

Dosimetrics

CTDI (mGy) DLP (mGycm)

Nigeria, NE

Nigeria,Abuja

Garba 2015

Mundi 2015

Nigeria; adult 59 77 1301

985

38 1477

Figure i: A predictive dose information before the actual exam. This gives an idea of the dose to be applied for the exam as a result of the protocol being used. Note the CTDIvol and DLP in the instance above

Figure ii: An actual dose chart after the exam. This gives an idea of the dose applied for the exam as a result of the protocol used. Note the CTDIvol and DLP Figure iii: Typical example of azimuth for head scanogram. 180 degrees for supine position represents postero-anterior beam direction which minimizes dose to the lens. Cervical spine & chest also need 180 degrees azimuth to minimize dose to the thyroid and mammary glands respectively. Figure iv: An interface for dose optimization. Select axial mode if movement of patients is not of concern. At all times, aim for least gantry rotation times.

S/No 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.

PARAMETERS

INCREASE

mA kVp Azimuth

Yes Yes

Gantry rotation time

Pitch Scan range Slices/rotation Aperture diameter

FSD Gantry tilt Contrast

CTDI Up Up

DLP Up Up

ADVICE

REMARK

Use auto mA

Dose will change with anatomical density

Avoid minimum & max

Too little kVp will introduces noise

Position supine and use azimuth that is opposite to radiosensitive organs e.g eyes, thyroid, breast, gonads, etc

Yes Yes Yes Yes Yes Yes Yes Given

Up Down Up Down Down Down Up Up

Use smaller time

Tomography.” EUR 16262 EN. Luxembourg: European Commission; 2000 Eze K.C. and Eze E.U. Brain computed tomography of patients with HIV/AIDS before the advent of subsidized treatment program in Nigeria. Nigerian Medical Journal, 2012; 53 (4): 231-235

Image quality will remain adequate

Dose will crash Manipulate other parameters Duration + dose will crash The wider the better It will increase FSD (better) Position at isocentre Uniform FSD (better) Aim for pitch ≥ 1

Be in agreement with physician

Maximize your data channels

Minimize tilt to ≤ 10

Less tissue distance traversed by photon

Crash meticulously

There will be inevitable increase in dose

Conclusion: In medical imaging CT is the most important contributor to patient exposures. Radiographers must therefore, be attentive to their responsibility to maintain an appropriate balance between diagnostic image quality and radiation dose. 60 mGy (CTDIvol) and 1050 mGy-cm (DLP) are Caucasian diagnostic reference levels for head CT examinations, yet recommended, pro tempore, for Nigeria. Radiographers should therefore ensure that they work hard to acquire images with dose levels ≤ 60 mGy and 1050 mGy-cm respectively. Recommendations: The CT update course by RRBN should be enriched with CT dose optimization to ensure that our interns start with the right dose orientation early enough in practice. Furthermore, RRBN may wish to adopt diagnostic reference levels from the ongoing works of Nigerian Radiographers in that regard. Also, a document giving speciﬁc guide on dose optimization should be produced and distributed to Radiographers who attend CT update courses. Reference Adejoh, T., and Nzotta, C.C. Head Computed Tomography: Dose Output and Relationship with Anthropotechnical Parameters. West African Journal of Radiology, 23(2):64-68 (ahead of print) European Commission, “European Guidelines for Quality Criteria for Computed

Faulkner K , Chappie CL, Hedley P, Kotre CJ and Harrison RM. Automated quality assurance and patient dosimetry in diagnostic radiology. Journal. Biomed. Eng,.1990; 12:228-232 Foley S.J., M F McEntee M.F., and Rainford L.A. Establishment of CT diagnostic reference levels in Ireland. British Journal of Radiology, 2012; 85(1018): 1390–1397 Gibson D.J. and Davidson R.A. “Exposure Creep in Computed Radiography. A Longitudinal Study.” Acad Radiol,2012; 19(4): 458-462 Garba I., Engel-Hills P., Davidson F. and Tabari A.M. Computed Tomography Dose Index For Head CT in Northern Nigeria. Radiation Protection Dosimetry, 2015; 1–4 doi:10.1093 International Atomic Energy Agency . IAEA; Vienna: 1998. Diagnosis and treatment of radiation injuries. Safety reports series 2. Mettler A. Fred, Huda Walter, Yoshizumi T. Terry and Mahesh Mahadevappa. Effective doses in radiology and diagnostic Nuclear Medicine: A Catalog. Radiology, 2008;248(1):254-63

Page 23

Ogbole, G.I.. Radiation dose in paediatric computed tomography: risks and beneﬁts. Ann Ib Postgrad Med. 2010 Dec; 8(2): 118–126. Stephen Amis E. Jr, Priscilla F. Butler, Kimberly E. Applegate, Steven B. Birnbaum, Libby F. Brateman, James M. Hevezi, Fred A. Mettler, Richard L. Morin, Michael J. Pentecost, Geoffrey G. Smith, Keith J. Strauss, Robert K. Zeman. American College of Radiology White Paper on Radiation Dose in Medicine. Journal of American College of Radiology, 2007;4:272-284

Mundi Abdullahi, Hammed Shittu, Dlama Joseph, Abdul-Jamiu Aribisala, Eshiett Peter Eshiett, Itopa Richard and Goriya Kpaku. Diagnostic Reference Level for Adult Brain Computed Tomography Scans: A Case Study of a Tertiary Health Care Center in Nigeria. IOSR Journal of Dental and Medical Sciences, 2015;14 (1):66-75

Vassileva J, Rehani M.M., Al-Dhuhli H., Al-Naemi H.M., Al-Suwaidi J.S., Appelgate K. et al. IAEA survey of pediatric CT practice in 40 countries in Asia, Europe, Latin America, and Africa: Part 1, frequency and appropriateness. American Journal of Roentgenoly, 2012; 198(5):1021-31. doi: 10.2214/AJR.11.7273.

Mayo J.R, Aldrich J., and Müller N.L. Radiation Exposure at Chest CT: A Statement of the Fleischner Society. 2003; 228 (1): 15-21

Vano, E and Fernandez Soto, JM . Patient dose management in digital radiography. Biomed Imaging Interv J. , 2007; 3(2): e26.

Mahadevappa Mahesh. Fluoroscopy: Patient Radiation Exposure Issues. RadioGraphics, 2001;21(4): Ogbole G.I. and Obed R. Radiation doses in computed tomography:Need for optimization and application of dose reference levels in Nigeria. West African Journal of Radiology, 2014; 21(1):1-6

Wall B.F and Shrimpton P.C. Patient dose protocol and trend in the U.K. Radiation protection Dosimetry, 1995; 57:359-362. www.arpansa.gov.au/services * accessed 10-04-2016

Olarinoye, I. O., and Sharifat, I. A protocol for setting dose reference level for medical radiography in Nigeria: a review. Bayero Journal of Pure and Applied Sciences, 2010; 3(1):138–141

just recently completed a degree, your high school results are probably not necessary. Since most newly qualiﬁed radiographers completed high school reasonably recently, it is worth putting it in. Mention any notable achievements such as awards or particular high marks (e.g. high GPA or high averages across subjects).

Career Objective This is probably the hardest part of the resume to write. Do not be afraid to tailor this to each job you apply for. Examples: I am a graduate of ….. I would like to obtain a position where I can continue to develop my skills in general radiography, ﬂuoroscopy, theatre and mobiles I would like the opportunity to train in modalities such as CT and MRI so as that I can develop a well rounded skill base and be a valuable team member Obviously if you are applying for a position where they for example don't have CT and MRI, it probably is not worth mentioning that you would like training there as it may make you look like you don't really want the job there. I also wouldn't recommend writing something like “I hope to study medicine and become a doctor” because it makes you seem like you only have short term ambitions for the job, whereas most workplaces are looking for a more long term employee. Education How far back you go probably depends on how old you are. If you have been out of the work force for 20 years and have

O'Sullivan, B and Prof Stacy Goergen. The Radiographer (Medical Imaging Technologist). pages/view. php?T_id=9#.V0IVWCGmrMw. Accessed 22 May, 2016.

Molen A. J. van der, Schilham A, Stoop P, Prokop M. and Geleijns J. A national survey on radiation dose in CT in The Netherlands. Insights Imaging, 2013; 4:383–390

By Faith Okwuosa

Omar Desouky a,*, Nan Ding b, Guangming Zhou b. Targeted and non-targeted effects of ionizing radiation. Journal of Radiation Research and Applied Sciences, 2015;): 247–254.

Ujah F.O, Akaagerger N.B, Agba E.H. and Iortile T.J. A comparative study of patients radiation levels with standard diagnostic reference levels in federal medical centre and bishop murray hospitals in Makurdi. Archives of Applied Science Research, 2012, 4 (2):800-804

TIPS FOR WRITING RESUMES (ESPECIALLY FOR NEWLY QUALIFIED RADIOGRAPHERS)

he most important thing you can do when applying for a job, especially your ﬁrst radiography job out of university, is to have a strong resume. When you consider that everyone applying for a Professional Developmental Year or Internship year (whatever you call it, wherever you are) Radiographer position has the same amount of clinical experience and effectively the same skills then what will set you apart is a great resume. Which is easier said than done. Here are some recommended tips. There is obviously no one correct way to write a resume, but there are certainly a lot of wrong ways.

Olowookere C.J; Babalola I.A.; Jibiri N.N.; Obed R.I.; Bamidele L.; and Ajetumobi E.O. A Preliminary Radiation Dose Audit in some Nigerian Hospitals: Need for Determination of National Diagnostic Reference Levels (NDRLs). The Paciﬁc Journal of Science and Technology, 2012; 13(1): 487-495

Clinical Experience I have found the best way to set this out is to mention responsibilities you have had across all clinical placements. E.g. use of CR/DR systems (Kodak, AGFA, Fugi etc) performing examinations on wide range of patient presentations from ambulatory to non responsive working independently and as part of a multidisciplinary team It is also good to mention where you have had clinical experience as this gives an indication of what skills you have developed. With each clinical setting, mention what specific skills you learned there. E.g. final clinical placement at …. Hospital had extensive CT training and performed … procedures independently. This gives you the opportunity to demonstrate all the training in different modalities you have gained. Skills Summary This is your chance to demonstrate all the key capabilities you possess which have been developed not only through clinical experiences but any other jobs you have had. A lot of job applications will mention certain skills you should have, so you should consider tailoring your resume to include these skills. May include: Clinical Reasoning Skills questioning/assessing patients, identifying issues with requests, modifying examinations/techniques for patient presentation, evaluating radiographers Practical Skills experience in general, theatre, mobiles etc trauma or paediatric experience image interpretation Professional Conduct awareness of patient confidentiality, OH&S, non discrimination etc.

Communication and Teamwork make mention of other jobs/activities where you have demonstrated this as well as clinical settings communication and teamwork with radiographers, nurses, radiologists, referring doctors, other health care professionals Other Skills CPR/First Aid Other languages spoken Possession of a driver's license Employment This is obviously where you can demonstrate other responsibilities you have had. It is especially important to demonstrate skills, which are transferrable to radiography (e.g. communication, teamwork, organisation etc. Interests You do not have to go into too much details. But it is important to show that you have a life outside of work. Mention a couple of interests you have and do not be surprised if they are mentioned in an interview. Transcripts/Clinical Reports This will be expected to be included so their absence will look like there is something you do not want them to know! General “Don'ts” For Resumes Don't: Include a photo of yourself. I'm not sure why but employers generally don't like this. They won't hire you because you have a nice photo and it is generally unnecessary Make spelling/grammatical mistakes. Have as many people as possible read and correct your resume. Constant spelling or grammatical mistakes will be a deﬁnite turn off Talk yourself up to much. Find the line between demonstrating your skills and blatantly talking yourself up. You cannot be the best at everything, you can't perform every possible examination and procedure perfectly so claiming it will only make you seem arrogant and complacent. I once read a resume which said exactly that but clinical reports said clearly the opposite! Make it unnecessarily long. Use bullet points and get to the point quickly as most employers will skim it quickly for the main facts. If it takes too long to read they will not read it. Use a crazy font or colours. They won't like it and it won't help. Stick to the basics. I hope this few basic points assist you in putting up a resume. Ensure you update your resume occasionally with each newly acquired skill or certiﬁcation and engage in relevant Continuous Professional Development programs. Reference http://blogxrayvision.blogspot.com/

CT HUB WITH SIDNEY

www.cthub.blogspot.com

PRACTICAL STEPS TO LEARNING CT SCANNING PROCEDURES

In the last edition, CT Hub was absent. This was because of some technical issues that have now been resolved. In the edition before last, we did not complete our discussion due to lack of space. I had promised to continue that discussion in the next edition which was not possible. In this edition, We are also not able to continue that discussion but you can read it up in on my blog (www.cthub.blogspot.com). In this edition, let take a redirection and discus some practical approach to learning CT scans. This is very necessary because most of us might spend a longer time trying to ﬁgure out all that is involved in understanding CT scanning except if a more organized practical approach is followed.

understand that it can be very intimidating to face a CT scanner for the ver y first time. I was also intimidated…very intimidated. It's easier if as a student you were introduced to practical CT procedures. But if you were unfortunate to meet a CT scanner for the first time as an intern, it's pretty tasking to learn it under so much pressure. I am going to share with us practical steps to learning CT scanning procedures. It could be that simple if you follow it sequentially than trying to learn everything at the same time. Scanning a patient using a computed tomography scanner requires the following 1. Knowledge of patient surface anatomy. You will need this in patient positioning and centering. Surface anatomies like vertex of skull, glabella, sternal notch, external auditory meatus, midline mid axilliary line, etc 2. Knowledge of anatomical coordinates. You will be hearing lots of stuffs on axial, sagittal, coronal, craniocaudal, caudo-cranial, prone, supine etc. It will help you a lot also in patient positioning and the actual scanning. 3. Theoretical knowledge of the basic concepts of CT scans. we have discussed about the physical properties of CT technology. You need to understand how CT images are formed and the principles behind the production of CT images, the different component parts of a CT scanner, the different generations of CT scanners etc. 4. And every other relevant knowledge you can get. CT scan procedures can be divided into these steps: STEP 1: PATIENT'S PREPARATION: This is the very first thing you do before you put the patient on the couch. Information about the scan is usually given to (booked) patients prior to the scan. Most patients however are walk-in patients. You ask the patient questions regarding what they ate and how best they adhered to instructions given earlier (if any). This is the right time to look at the request of the patient *again and review the clinical notes/ history. The patient is given appropriate clothing for the procedure. You explain the procedure (and what to expect during the procedure) to the patient and take vitals (blood pressure, temperature etc.). There is usually a departmental protocol for patient preparation. Patients requiring oral contrast are given instructions on how to drink it and the duration. For patients requiring IV injections, it's better to cannulate the patient at this point before positioning. I have omitted patient registration and documentation pre and post scanning because it is mostly handled by medical records personnel or other designated persons; but where it is the responsibility of the medical radiographer, you will need to fully understand the procedure. What to learn: · How the patient request is reviewed; what important information to look at and how that information guides the scanning. · How the patient is prepared; what you explain to the Page 24

patient about the scanning procedures, what the patient should eat and not eat. · What patient requires oral contrast and why and how do they take it. Note: in most departments, it's the job of the radiologist or medical officer to cannulate the patient and the radiology nurses take vital signs. It's very important to understand the departmental protocol on patient preparations. Step 2: PATIENT POSITIONING: Bad CT technique starts from bad patient positioning skills. What to learn: · How the patient is supposed to lie; supine/ face up, prone/ face down, lateral/ on the sides, hands by the sides, hands above the head etc? · What buttons on the CT gantry moves the table up, down, in and out, angulates the gantry and other motions. · Where the centering for each examination is. How to properly use the beam lights/coordinates in centering the patient. What buttons you need to press to centre a patient and so on. Step 3 SCANNING: This is where the images are obtained. To do this, you will need to put in patient data, select the appropriate protocol, obtain the scout/topogram images, plan the locations of scan images and the region of interest, confirm and scan and repeat scan (for contrast phase if needed). What to learn · How to input patient data · How to select the appropriate protocol. · How the scout image(s) is obtained. · How you plan/ plot the locations of scan images and the region of interest · How to confirm and scan. · H o w t o repeat scan for contrast phase. N OT E : I h a v e omitted how to adjust protocols and parameters. The simply reason is that the CT scanner has so many settings in it. From exposure factors through slice thickness/ inter val, pitch a n d t a b l e increment to

dose reconstructions, these figures are standardized for specific protocols. So brain protocol is already set for CT brain scans, Abdomen protocols for CT abdomen and so on. Most protocols also include thin slices/ volume image recons. It is not your business at this stage to worry about adjusting protocols and parameter. You will have enough time to learn that as you progress. However, the supervising radiographer will tell you what is necessary to adjust especially when you need bone windows and for other cases requiring any adjustments. Step 4: REVIEWING THE IMAGES: This helps you to better appreciate the images and the quality of the work you have done. At this stage of learning, you are to learn how the body organs/tissues appear on axial, coronal and sagittal images. You will be guided to know how the normal appears and how the abnormal are different. Text books on sectional anatomy will help you learn faster. But don't sweat yourself out. You have enough time to learn while you practice. Step 5: IMAGE REFORMATION: CT images are typically acquired in axial planes. You are going to need to learn how to reformat images into coronal and sagittal planes. These plans are very essential for a more comprehensive diagnosis by the radiologist. Some machines can produce reformatted plane images automatically. You will learn 3D/ Volume rendering reformations but this is when you have learnt how to scan properly. STEP 6: PRINTING AND ARCHIVING IMAGES: This is the final step involving producing the images on film and storing the images in the departments PACS/ Picture Archiving and Communication System. In summary · 1. Learn how to prepare the patient · 2. Learn how to position the patient · 3. Learn how to type in patient details · 4. Learn how to obtain scout/ topogram image(s) · 5. Learn how to plan/ plot locations for slices · 6. Learn how to confirm and scan · 7. Learn how to repeat scan for contrast administration. · 8. Learn how to reformat images into coronal and sagittal planes · 9. Learn how to print and archive images. Like I said earlier, learning CT can become very challenging when you have to learn so many things at the same time when in fact CT scan is very easy...at least the basic ones. it is best to develop a timetable to guide you in learning. 1 and 2 can be learnt in a day or 2; 3,4,5, 6 and 7 can be learnt over 2 weeks to 1 month; 8 and 9 can be learnt over 1 week. so in all, within 1-2 months, you are good to go. It is best to start learning CT scan with CT brain. After that, focus on CT chest and then CT abdomen. Don't rush to learn CT angiography and the rest. You will end up being confused. Refer to my post on CT Brain: a preview of practice. It will help you. Good luck

ADVANCED SUBSPECIALTY TRAINING ON CT AND MRI COMING SOON

ENQUIRIES: SIDNEY 08034635555 cseiroegbu@yahoo.com

Students' Corner

AN INTERACTION WITH THE PRESIDENT OF

NARS UNILAG CHAPTER MAY WE KNOW YOU? I'm Ogunyemi Israel Babatunde. I had my primary education in Lagos and an alumnus of CMS grammar school, Bariga, Lagos. Subsequently, I began studying radiography at the University of Lagos in 2011 and hope to finish this year 2016. I am currently the president of NARS UNILAG Chapter. I'm also an entrepreneur and produce African customized souvenirs like wristwatches, necklaces, beads and bracelet. You can connect @Afriklilobracelets on Instagram to learn more. WHAT IS NARS UNILAG ALL ABOUT AND HOW DID IT COME TO BE? NARS stands for "Nigerian Association of Radiography Students". Radiography first started in Nigeria at the School of Radiography, Yaba issuing diploma certificates in radiography. A bold step was later taken by the authorities and it was restructured into the present B.sc programme in the prestigious University of Lagos. NARS Unilag chapter's secretariat is located at former school of radiography, Yaba. WHAT MADE YOU SEEK TO BECOME THE PRESIDENT? When I came into the department, I realized we were faced with numerous challenges which I felt by the virtue of experiences I garnered over the years, I should be able to contribute my quota towards making NARS Unilag chapter a glorious one to behold. I have been for eight years, a volunteer for "The Future Awards" a yearly event organized by The Future project Africa aimed at eradicating unemployment in Africa and celebrating young achievers, I saw to its logistics, research and planning of the nominees' reception and award night. I am also among the National executive of Pastors seed

family and the student president of Christ redeemers' ministry. All this enabled me to meet people and acquire skills required to serve. WHAT IDEAS DID YOUR TEAM BRING ON BOARD? I am blessed with a wonderful team who seems to have the same intent and zeal as I do. This helps us to work relentlessly to make sure our plans would be executed, some of which includes: Renovation of our Secretariat, Organizing students training forums, Industrial visits, Raising entrepreneurs and talented members in areas such as music, Male cooking competition aimed at encouraging males to assist their mothers and wives in the kitchen, Also, our biggest idea "The Project", aimed at raising funds for the support of the radiodiagnosis department in Lagos University Teaching Hospital and also to ensure the welfare of students by sponsoring bright students in radiography to international conferences. WHAT ARE YOUR ACHIEVEMENTS, AND CHALLENGES SO FAR? The first is "CODE 2 EARN" - a program organized in partnership with Microsoft to train students on coding and software development which can go a long way in helping diagnostic and industrial radiography. Also a female football match was organized to encourage ladies to always keep fit. Due to our cordial relationship with our members, our 300 level class saw to it that a tennis table and its accessories were provided. Tutorials were also organized which ensured our 200 level students who just crossed over to the college of medicine come out in flying colors. "The project "also had a conference which reached out to notable alumni and lecturers and it's promising to ensure a yield.

We also will soon organize our health week which will include a symposium and other educative and fun ﬁlled activities. Some of the challenges we are facing includes: nonresponse of some companies we reached out to for support, presumably because of the present economic climate and also there is the challenge of effectively combining school work with executive duties. By God's grace we shall succeed. WHAT ADVICE DO YOU HAVE FOR YOUR FELLOW STUDENTS? I appeal that they should come out to support NARS, their little will go long way in assisting NARS. The future is nothing but bright, let's wake up and take our rightful position on the seat of glory, every opportunity counts. WHAT DO YOU HAVE TO TELL THE PUBLIC ABOUT RADIOGRAPHY? Radiography is a beautiful ﬁeld and one of the core areas of modern medicine - helps in the treatment and diagnosis of various medical conditions that cut across specialties.

TEAM PROACTIVE

PRESIDENT: OGUNYEMI ISRAEL BABATUNDE

VICE PRESIDENT: OKE BAYODE THOMAS

GENERAL SECRETARY: OGUNBELA RIDWAN

DEPUTY GENERAL SECRETARY: HASSAN ABDUL-MUIZ AKINFOLARIN

PUBLIC RELATIONS OFFICER: OLASOPE AYODEJI OLUFEMI

FINANCIAL SECRETARY: WELFARE SECRETARY: OBALOLA KHALID OJEDOKUN BUKOLA BEATRICE

SOCIAL SECRETARY: ADENIJI ADETUNJI TIMOTHY

SPORT SECRETARY: GBOGBOADE OLUWATOBILOBA OLADAPO

GE Healthcare launches new MR products into the Nigerian market It was a learning session at the GE MRI 1.5T PRODUCT LAUNCH which took place in Lagos and Abuja recently. The SIGNA Series of MRI comes with super value applications that meet diagnostic expectations. It is affordable, durable and user-friendly. In attendance was the Africa Marketing Director for MRI, Serge Moubarak in the company of other Africa MR team. Also present were Mrs. Okubadejo (Deputy Director of Radiography) LUTH, the Registrar of the RRBN, Dr. Okpaleke amongst others.

Professionals listening to presentations

Cross section of Medical Imaging Professionals

Page 25

Cross section of Healthcare Professionals

TREASURER: UGWU JUDE EMEKA

DERMATOPATHOLOGY

By Dr. Dolamu Jawando MBBS, PgDHM

ermatopathology is a subspecialty of pathology, which has to do with the study of skin diseases. It includes the study of the causes, course, progression and the complications that arise from different skin diseases. Dermatopathology as a specialty dates as far back as 1792 when Henry Seguin Jackson coined the name Dermatopathologia; and the first real text book on dermatopathology was written by Karl Gustav Theodor Simon a German pathologist in 1848. In 1903 the first English language dermatology text book was written by Macleod, John Hendrie. Dermatopathology as a joint specialty had its first breakthrough in 1913, due to efforts of Dr Wise Fred; a Dermatologist and Dr. S Pollitzer; a Histopathologist. Their efforts lead to the institutionalization of the American Society for Dermatopathology in 1962, the British Society for Dermatopathology in 1977 and the International Society for Dermatopathology, which was formed in 1978. Looking back at the long journey this specialty has undertaken gives one the understanding of how important the field is. Anatomic pathology, or histopathology, refers to the study of the structural and compositional changes that occur in organs and tissues as a result of disease. A pathologist is a doctor trained in anatomic pathology that examines, describes and interprets pathological specimens to arrive at a specific finding or diagnosis. Dermatopathology is the study and description of structural and compositional changes that occur in skin diseases. From a practical point of view, dermatopathology involves the microscopic examination, description and interpretation of biopsy specimens obtained from the skin. This is usually carried out by a general pathologist (who may or may not have had specific training in dermatopathology) or by a dermatopathologist (a doctor trained specifically in dermatopathology, but who may not have fully trained in anatomic pathology). Dermatopathologists often have training in clinical dermatology. Dermatopathology is an essential component of American College of Graduate Medical Education (ACGME) and Royal College of Physician and Surgeons of Canada (RCPSC) approved dermatology residencies. Twenty-five percent of the dermatology residency curriculum is devoted to dermatopathology, with a similar emphasis in the dermatology board-certifying examination. Residents routinely examine stained histologic sections from the full spectrum of dermatologic diseases. Training includes education relating to interpretation of direct immunofluorescence specimens, appropriate use and interpretation of immunohistochemistry (special stains, including immunoperoxidase) and electron microscopy. A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neo-plastic diseases. This entails the examination and interpretation of specially prepared tissue sections, skin scrapings and smears of skin lesions by means of routine and special(electron and fluorescent) microscopes. Dermatopathologists are referred to as the Physician's Physician, because of their commitment to patients' care by

Page 26

providing support and diagnostic information quickly and accurately, written in the language of clinical dermatology. Most dermatopathologists engage relevant technologies to provide diagnostic and prognostic information needed to provide the best possible patient outcome. The interpretation of skin specimens can be complicated and difficult, as many diverse inflammatory skin diseases share the same basic inflammatory process or pattern. The final diagnosis requires clinical input and clinicopathological correlation. Dermatologists, physicians and leading dermatology centers will benefit from excellent dermatopathological services, and dermatologists stand a chance of making more accurate and evidence based diagnosis. Dermatopathology is a consultative service to the referring physicians and not just a laboratory test. This increases efficiency, help build capacity and create platforms for robust discussions between the two professionals thereby increasing the chances of better outcome for patient management. One of the greatest challenges of dermatopathology is the ever increasing number of different skin diseases. There's an estimated 1500 different rashes and skin tumors including variants. Therefore dermatology and dermatopathology are among the most complex specialties in medicine. The dermatopathology laboratory is able, therefore, to produce slides of better quality and diagnose more accurately and quickly. Accurate interpretation of skin biopsies requires the ability to recognize and record the details of the specimen, and to synthesize these findings with the clinical situation. Failure to interpret skin biopsy specimens correctly can lead to misdiagnosis, co-morbidity, and fatality.

disorders such as: Cutaneous vasculitis, Connective tissue diseases (Cutaneous lupus erythematosus) and Blistering diseases (Pemphigus vulgaris). Today in Nigeria, very few centers offer dermatopathology services but the demand for these services far outweighs the available expertise. This very interesting and challenging specialty is recommended for Anatomic/Histopathologist and Dermatologists across the nation. Firmcare Diagnostics is one of the few laboratories in Nigeria rendering dermatopathological services wherein all cases processed are examined by a board certified dermatopathologist. We provide a holistic approach to our physician partnerships providing a wide range of specialized services, support services and innovative technology solutions to enhance their dermatology practices. As your partner, referring physicians receive more than just pathology services. Our commitment to ser ving the unique needs of dermatologists and their patients has made Firmcare Diagnostics one of the fastest growing dermatopathology organizations in the Nigeria. Our practice include some of the most renowned dermatopathology experts in the field known for their clinical contributions and dedication to physician education to further the field of dermatology. We are dedicated to providing exceptional personalized and unmatched dermatopathology services to patients, dermatologists, and other physicians specializing in skin disease. Firmcare Diagnostics is fully dedicated to continuing education by providing comprehensive training in forms of webinars to residents in different locations across the country. Firmcare Diagnostics provides high quality, customized dermatopathology and immunofluorescence services. Our services include processing and analysis of cysts, biopsies, excisions and Cone biopsy/LLLETZ. We offer second opinion for slides, blocks and complex(3+ blocks or/immunostains). Others are immunofluorescence including Panel 1 IgG, IgA, C3, immunofluorescence Lupus panel and Gene Rearrangement T cell. In Abuja we offer daily sample pick up and have special arrangement for sample pick up outside Abuja. Call for pick up procedures in all other states in Nigeria. We assure you of accurate, concise reporting with histology correlation. All reports have pathological images. Our turn around time is usually 4-5 days with direct communication with our experts and monthly post payment services available. DrDolamuJawandoMBBS, PgDHM is the CEO of Firmcare Diagnostics and Medical Services Ltd. www.firmcare.com.ng, facebook.com/firmcaredx, twitter.com@firmcarelab twitter.com@DrJawando 08081499391 08091064763

Skin biopsy specimen is processed and then stained with Haematoxylin and Eosin (H&E). Eosin is acidic in nature and stains basic / alkaline structures red/pink. Haematoxylin is alkaline, and stains acidic structures (e.g. deoxynucleic acid, ribonucleic acid within cell nuclei) blue. Depending on the observed dermatopathological pattern present and/or the clinical features, special stains may be requested to identify agents causing the condition (e.g. bacteria or fungi), specific substances deposited in the skin (e.g. amyloid, iron or melanin) or specific markers to identify the origin, nature and distribution of cells in the specimen under review. The specimen is systematically examined by looking at the structure of the epidermis, dermis, subcutis, fascia and underlying structures. Based on the findings, the dermatopathologist may come up with a definitive diagnosis, or list several possible explanations, creating a differential diagnosis. The integration of clinical information in conjunction with the pathological findings generates the final diagnosis. It is in this correlation of clinical and pathologic findings that experience in clinical dermatology can be very helpful.

Dermatopathology and Immunofluorescence studies are crucial for the diagnosis and classification of immunologic disorders, allowing optimal patient care. Immunofluorescence studies play an important ancillary role in the diagnosis of autoimmune and inflammatory skin

An advocate for innovation in medicine, passionate about pathology and a believer in the use of quality at the centre of all activities in medicine.

By Dr. Dolamu Jawando MBBS, PgDHM

HEALTHCARE RESEARCH 101 with David

TYPES OF RESEARCH DESIGN

IN HEALTH SCIENCES

except it is not feasible and unethical to randomise. Non-Experimental Designs A good number of research studies conducted in health sciences are non-experimental, because there is no formal intervention. These include all qualitative studies, and many quantitative studies. Many non-experimental

n our last edition we saw how quantitative and

Let us now use an example of the experimental design in

studies are simply descriptive, as they do not test a

qualitative designs provide two different approaches to

healthcare research. Imagine you are a researcher wanting

hypothesis. For this edition we will focus on quantitative

answering a research question. However, just choosing

to investigate whether eating a low fat diet reduces

research design that comes under this category. While those

one of these, or a combination of both of these approaches

cholesterol. You decide that an experimental design would

of qualitative will be treated in other editions.

to carry out your research will not get you far in doing the

be the best design to answer this research question. You

Non-experimental research designs can be categorised as

research. This is because you also need to decide how the

then recruit patients from a general practice in Abuja and

follows:

research is going to be carried out. This is known as the

ﬁnd that there are 100 patients who have high cholesterol.

methodology or research design. This should not be

The patients' cholesterol levels are measured at baseline.

· Retrospective or Prospective Design

confused with the research methods, which concerns the

These are then randomly assigned to either eating low fat

· Case study

· Cross-Sectional or Longitudinal

nuts and bolts of how data is collected and analysed.

diet (experimental group) or continuing on their normal diet

In this edition, we will consider in more details the main

(control group) for the next four months. After the four

Cross-Sectional and Longitudinal Designs

designs for research in healthcare. We will create typologies

months have been completed the cholesterol levels of the

The distinction between cross-sectional and longitudinal

of research designs to differentiate the main methodologies

patient are taken again and compared to see if there are any

designs is an important one. This is a basic distinction used

that can be applied to research.

differences between those who have received the

in both quantitative and qualitative research. A cross-

intervention (experimental group) and the control group.

sectional study provides a measure of things as they are at a

We will look at three types:

This example can be shown diagrammatically in ﬁgure 1.0

point in time, equivalent to a snapshot. A longitudinal study

below:

in contrast is more equivalent to a ﬁlm, in that information is

· Experimental, quasi-experimental and non-experimental designs

Group 1 (n=50) (Experimental group)

· Cross-sectional and longitudinal designs · Prospective and retrospective designs

collected from individuals over a period of time, sometimes Receives low fat diet Post test

demonstrate change over time.

Pre-test

Experimental, Quasi-experimental and non experimental designs

Cross-sectional design The typical quantitative research design that uses a cross-

100 patients with Randomised0 high cholesterol allocation

Experimental Designs

more than twice. Longitudinal studies therefore can

section is the social survey. Cross-sectional studies are

An experimental design allows the researcher to quantify

usually ﬁxed in time and data is collected from two or more

the effects of an intervention. In health research, an

cases. It is worth noting that the cases in a cross-sectional

surgical approach, or even a different type of service

Group 2 (n=50) (Control group)

delivery. For example, does poor ergonomics in

Pre test

intervention could be a new drug, a new treatment or a

design are not always individuals. Cities, households and Receives normal diet

Post test

ultrasonography practice increase repetitive stress injury?

schools are just some other examples of cases that are studied in a cross-sectional design. They can take many forms but in health research they are particularly useful in

Does antispasmodic drug relieve pain during

Figure 1.0: The Experimental Design

hysterosalpingography?

The most rigorous form of experimental design in research

Whatevertype intervention is being considered, an

the following areas: ·

Provide a description of a disease and its

is the randomised controlled trial or RCT. This is generally

treatment. A particular disease is chosen and

experimental research project is designed to enable a

regarded as the 'gold-standard' of quantitative clinical trials

observation/ interviews are conducted with the

researcher to assess whether the inter vention A

and consequently is known as the classic experimental

sufferers. All of the subjects will necessarily be at a

(independent variable) causes some kind of change in B

design. We will consider the RCT in more depth in later

different stage of their disease process and a

editions.

comprehensive description of the disease may be

(dependent variable). To enable you to make this statement, the experimental

obtained.

design has to rule out the likelihood that variables other

Quasi-Experimental Designs

than A could lead to a change in B. For instance, if the

Essentially, the quasi-experimental designs is one in which

intervention A is a treatment for a disease, and B is the

Describing the diagnosis and staging of disease whereby the range of abnormality and the severity

the researcher has no control over who receives the

of the disease can be used to develop a predictive

outcome following this treatment, then other variables that

intervention and who does what. While mimicking an

tool for clinicians.

could lead to a change in B could be diet, length of bed rest

experiment, because there is not a control group, the quasi-

In quantitative research, data collection under a cross-

or the amount of social support that a patient receives

experimental design is considered less powerful than the

sectional sur vey design is usually carried out by

during the treatment.

classic experimental design.

administering a questionnaire or carrying out a structured

There may be a number of reasons why it is not possible to

interview at one point in time from which the data can be

The classic experiment

randomly allocate subjects to each group, for example in

quantiﬁed and analysed using inferential statistics.

In simple terms, a classic experimental design enables the

caseswhere there may be ethical problems in withholding

However, it is worth mentioning that the cross-sectional

researcher to measure the effect of the intervention

drug treatments. Early drug trials of treatments for AIDS

research design can also be employed in qualitative

(independent) variable on the effect (dependent)

encountered these problems in the USA. However, it is still

research. Under this research method data is usually

variable against a comparator both before and after the

possible to attempt to replicate an experimental design as

collected using focus groups or qualitative interviews at

intervention. The researcher will measure the baseline

closely as possible be controlling for extraneous variables.

on single time point and analysed using different qualitative

before the intervention and the outcome after the

An example of this approach is the use of matching, as

data analysis techniques such as content or discourse

intervention. To ensure that the difference identiﬁed is not

opposed to randomisation, in order to compare two groups.

analysis.

due to some other external factor, the experimental design

Matching is a common way of allocating subjects to groups,

will contain a control group for comparison with the

selecting for certain characteristics such as age and gender.

Longitudinal Designs

intervention group. A control group is a group of subjects

This can be carried out on a group bias or on a paired basis.

As mentioned above thelongitudinal design is more

who receive no intervention or sometimes a different

By matching a researcher can hold all known independent

equivalent to a ﬁlm in that information is collected from

variables constant, although obviously the more variables

individuals over a period of time, sometimes more than

that are selected for the matching process, the more

twice. Longitudinal studies can therefore demonstrate

intervention (for example the standard treatment). An experimental design is claimed to be the most powerful

complicated and difﬁcult it becomes to achieve equivalent

change over time. However, due to the time and cost that are

way of demonstrating the causal effect of an intervention.

groups. In addition, unknown factors cannot be matched. If

involved in using this research design, it is not often used in

This is because of randomisation. Randomisation within

signiﬁcant differences are detected between groups, in

social research. As for the cross-sectional research design,

an experimental design is a way of ensuring control over

terms of other independent variables, then these can be

data for longitudinal research is typically collected using

confounding variables as it involves the random

held constant and allowed for in the analysis process.

structured interviews and questionnaire, the only difference

assignment of subjects to either group. This process should

Another form of quasi-experimental design occurs when

being that it is collected from the sample on at least two time

result in an equal distribution of characteristics in each of the

subjects are assigned to treatment groups on a systematic

points.

two groups, for example in terms of age, gender and

basis, for example, selecting every other patient, or selecting

There are two main types of longitudinal survey; a cohort

ethnicity. As such randomisation allows the researcher to

on every other day. Obviously this type of selection is more

study and a panel study that can be used to collect data

have a greater conﬁdence in identifying real association

open to abuse, but it is easier to implement than full

from a sample on more than one occasion.

between an independent variable (the cause) and a

randomisation. Wherever possible it is preferable to select

For Longitudinal qualitative research design, data is typically

an experimental design than a quasi-experimental design

collected using qualitative interviews which are carried out

dependent variable (the effect or outcome measure). Page 27

on at least more than one occasion. Ethnographic research

found that daily variations in air pollution in London may

interviews, ethnography and documentary analysis, which

which is carried out over a long period of time would also be

have an adverse effect on daily mortality, in particular, ozone

are predominantly followed under a qualitative research

a method of collecting qualitative data using a longitudinal

levels and black smoke concentrations were both

strategy or using structured questionnaire and interviews

design.

signiﬁcantly associated with all causes of mortality

within a quantitative research strategy.

There is one other distinction that is typically made about

(excluding accidents). This type of design is also known as

Case studies may be cross sectional, prospective or

longitudinal studies and this is that they can take either a

time-series analysis. Time series analysis is the analysis of

retrospective. It is also feasible to intervene in a case,

prospective or a retrospective design.

large-scale quantitative data which is plotted over time to

creating a kind of experimental situation, although this will

illustrate the causal relationship between two variables and

not be amendable to inferential statistics to generalise from

Retrospective and Prospective design

the time lag between them.

the case. This latter kind of case study is known as action research in which the intention is to change (for the better) a

All longitudinal designs can be categorised as either prospective or retrospective.

Prospective Design

Retrospective Design

Prospective designs are forward looking in that the

A retrospective design is one that looks backwards in time.

researcher can have complete control over who receives the

The case control study is the classic example of a

intervention, if any, and over the data collected. This means

retrospective longitudinal study. Other types of

that the researcher can deﬁne the outcome measure and

retrospective designs could involve analysing secondary

some level of quantity can be applied to the data collection

data gathered previously to identify the factors that may

process. A prospective study begins at zero time and any

have inﬂuenced changes over time. It could even include a

interventions or observations are made in the following

survey of individuals who are asked about their experiences

months/ years. It is worth noting that all experimental

some time earlier.

designs are prospective in nature.

An interesting example of a retrospective design using secondary data is the area of epidemiology. Epidemiology

Case Study

is the study of the patterns of diseases in human

The case study research design is concerned with collecting

populations. By analysing secondary data retrospectively,

detailed and intensive data on one single subject or 'case'.

researchers have been able to examine the relationship

The case could be an organisation such as a hospice, a ward

between daily variations in air pollution in London and the

or a general practice, or it could be a unit of people such as a

daily mortality between April 1987 and March 1992. They

family. The case study approach can include in-depth

situation that one is researching. Conclusion We have examined the main research designs that are used in healthcare research. In addition to the experimental design, we have also covered the quasi-experimental design, longitudinal designs, cross-sectional design and the case study design. We have introduced you to the terms retrospective and prospective, that refer to whether the study is looking backwards or forward in time respectively. The main point to note is that the design selected should be appropriate for the research question and the research design should always be decided on before you decide what method you are going to use. Many of the designs are mutually exclusive and sometimes a research question can be answered by several different designs.

HYPERTENSION – PRECAUTIONS TO PROTECT YOURSELF

n the last edition we discussed the Lassa fever scourge (which at the time of writing this article is still very much in existence as three people were reported dead in Edo state). Well, we would not be doing a sequel to that particular public health menace. Rather we would be looking at continuing on another subject which is of great importance and still concerns us very much as a people. The purpose of this column is not to cause fear or panic but to bring some kind of awareness on health issues we may be taking lightly. We had discussed in the past the kidneys and what we can do to protect them. One of the things we touched on in that particular article is what we would be touching on today. This is because of the health burden involved more so amongst young people who previously have not been thought to have this health challenge. Hypertension is what we want to touch on in this particular edition. “Why hypertension?” you may ask. We will ﬁnd out shortly. In a 2013 brief by the World Health Organisation, it was stated that cardiovascular disease accounts for approximately 17 million deaths a year and of these, 9.4 million deaths are as a result of complications of hypertension globally. It went further to state that hypertension is responsible for at least 45% of deaths due to heart disease and 51% of deaths due to stroke. You guess is as good as mine why this is a global health burden more so to us in Nigeria as we would see later on. Some would erroneously assume again that it does not concern young people (just like renal impairment) but statistics show otherwise. In 2008, approximately 40% of adults aged 25 and above had been diagnosed with hypertension. In fact, there has a been a global rise in the number of people with hypertension. According to the World Health Organisation (WHO), the number of people with hypertension has risen from 600 million in 1980 to 1 billion in 2008. Not surprisingly, the statistics on prevalence shows that it is high in the African region. To be more exact, 46% of adults aged 25 and above in the African region have hypertension. This is according to WHO's Global Status report on non-communicable diseases, 2010. One of the reasons for this may not be unrelated to the population in the African region. In the 2013 brief by WHO,we understand that the prevalence in the Americas is the lowest, standing at 35%. It also showed that the prevalence is higher in lowincome countries compared to high-income countries (40% compared to 35%). And we already know there are quite a number of low-income countries in Africa. Page 28

Let us bring this home. In an article by Ogahet al (2012), it was showed that the overall prevalence of hypertension in Nigeria ranged between 8 to 46%. According to the publication, prevalence in men ranged between 7.9 to 50.2% while that of women was between 3.5 and 68.8%. In urban areas, there was a prevalence range of 8.1 to 42% while for rural areas, it was 13.5 to 46.4%. According to another research (Adeloyeet al, 2015), there is an overall prevalence of 28.69%of hypertension with the men showing a prevalence of 29.5% and the women 25%. This tells us that prevalence is higher in men compared to women. This research also corroborated the fact that hypertension is more prevalent amongst urban dwellers as compared to rural dwellers with prevalence rates of 30.6% and 26.4% respectively. A more worrying data according to this article is the fact that it states that there are 20.8 million cases of hypertension among people that are at least 20 years old (again looking at the fact that it has always been thought to be a disease or health condition that affects only older people). In fact, it is projected that by 2030, the prevalence would have hit 30.8% and there would be 39.1 million people with hypertension. By extrapolation you can tell what that already means for the prevalence amongst men and women. We can go on and on about the statistics. Again, the essence of this is to bring to the fore this health challenge as most of the people living with this condition are not even aware as it is mostly asymptomatic. This makes it more worrisome. In addition, our health system is still developing. The World Health Organisation has attributed weak health systems to high number of undiagnosed, uncontrolled and untreated cases of high blood pressure. Before we get into what the risk factors for hypertension are, let us briefly have a look at what the disease is. It is important to state that blood pressure is measured in mmHg (millimeter of mercury) and is usually recorded as two numbers with one written above the other. The one above is the systolic blood pressure which is taken when the heart contracts or beats. It is usually higher than the lower one which is the diastolic blood pressure (taken when the heart relaxes). Thus normal blood pressure is 120/80 mmHg. However, according to WHO, the cardiovascular benefits of normal blood pressure extend to lower systolic (105mmHg) and lower diastolic (60mmHg) pressure levels. Hypertension according to WHO is thus defined systolic blood pressure of at least 140mmHg and/or diastolic blood pressure of at least 90mmHg. What then is responsible for the increasing prevalence of the disease? According to WHO (2013), population growth, ageing and behavioural risks such as unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight and exposure to persistent stress are responsible for the increasing prevalence of hypertension. According to WHO, there are three different factors that are responsible for hypertension. The first we already looked at which is behavioural risk factor. The second one is socioeconomic factor. There is no gainsaying that one's socioeconomic status inadvertently affects one's lifestyle. In other words, a person's income, education or housing will certainly have an impact on the person's choice of lifestyle in terms of behavioural risks like diet, stress management and so on. A

very typical example will be folks who live in cities like Lagos. It goes without saying that a person who lives in Lagos is faced with more stress; traffic, waking up early to beat traffic and as such having less sleep and all. Thus, urban dwellers have to find a way of better managing stress. Because of this time factor as well, they are prone to eating unhealthy diets-lots of fast food. Of course this cannot be compared to the lifestyle choices people who are rural dwellers have to make as they are not faced with the same challenges. They eat healthier food and sleep well. This probably explains why the prevalence of high blood pressure in urban areas is higher than what obtains in the rural areas. But then, rural dwelling comes with its own challenge. Because they have lower earning power, they are not able to visit the hospital as regularly as they should, thus adding to the number of undiagnosed cases of hypertension. Suffice to say, socioeconomic factors also play a role in hypertension development, diagnosis and management. Other factors may include things like genetic factors (for people below the age of 40), preeclampsia, endocrine and kidney diseases as well as blood vessel malformation. These factors are by no means exhaustive. What are the symptoms of hypertension? According to the World Health Organisation, most hypertensive people are asymptomatic i.e. they have no symptoms and therein lies the danger. However, some people can be symptomatic. These symptoms include headaches, chest pain, palpitations, dizziness, shortness of breath and nose bleeds. But we cannot rely on these symptoms as being a case of hypertension. So how do we then diagnose hypertension? WHO recommends that blood pressure be recorded for several days before a diagnosis of hypertension can be made. Readings should be taken twice a day usually in the morning and in the evening. They also recommend the use of affordable electronic devices that have the option of manual readings. An early detection of hypertension reduces the risk of heart attack, heart failure, stroke and kidney failure (WHO, 2013). A diagnosis of hypertension requires a significant change in lifestyle- a reduction of salt intake, low cholesterol consumption, getting involved in physical activities, avoiding dangerous consumption of alcohol and tobacco. Sometimes, this is not always enough for some people and they may thus require the help of medication. All adults should therefore check their blood pressure regularly, keeping a closer monitoring when it may be increasing. If you have not been doing, take some break today, visit your healthcare provider, measure your blood pressure and know your values. That stitch in time can save nine!

REFERENCES Okechukwu S Ogah,IkechiOkpechi, Innocent I Chukwuonye, Joshua O Akinyemi, Basden JC Onwubere, Ayodele O Falase, Simon Stewart, and Karen Sliwa. Blood pressure, prevalence of hypertension and hypertension related complications in Nigerian Africans: A review. World journal of Cardiology. 2012 Dec 26; 4(12): 327–340 Adeloye D, Basquill C, Aderemi AV, Thompson JY, Obi FA.An estimate of the prevalence of hypertension in Nigeria: a systematic review and metaanalysis.J Hypertens. 2015 Feb;33(2):230-42. A Global Brief on Hypertension. Silent Killer, global public health crisis. World HelathOrganisation, 2013.

CLINICAL IMAGING WITH ANSELM health have also been reported. Some studies have obser ved a decrease in length of hospital stay and therefore the cost of individual medical visits and fewer referrals. A more patient-centered encounter results in better patient as well as radiographer satisfaction. Satisfied patients are less likely to lodge formal complaints or initiate malpractice complaints. Satisfied patients are advantageous for radiographers in terms of greater job satisfaction, less work-related stress, and reduced burnout. Why the Need for Radiographers' Adequate Communication Skills? Radiographers are not born with excellent communication skills, as they have different innate talents. More sadly, our present undergraduate radiography curriculum used for basic training of imaging professionals overtly lacks clear-cut provision for education in communication skills. In postgraduate level, communication skills is examined but as an advanced concept. This shouldn't be case because communication constitutes core aspect of the radiographer's roles in his entire professional life. All these necessitate the call for radiographers to understand the theory and practice of good radiographer-patient communication, learn and practice the skills, and be capable of modifying their communication style given sufficient motivation and incentive for self-awareness, self-monitoring, and training. We will now examine the impact radiographer-patient communication has on patients and their families from the perspectives of the two domains of communication in healthcare.

ACHIEVING EFFECTIVE RADIOGRAPHER-PATIENT COMMUNICATION IN THE CLINICAL IMAGING SETTING

roadly, communication can be defined as the transmission of a message from a sender to a receiver in an understandable manner. Communication is a major component of the process of health care. An example of communication in healthcare is between clinical professionals and patients, staff and their relatives. For communication to be effective, each participant needs to put the responsibility for clear communication on himself which means that each of them should endeavour to send clear messages and to receive messages with as little distortion as possible. Health experts believes that effective communication is essential for high quality service and care, and to avoid communication breakdown complaints and problems such as ill-informed patients, worried relatives and bad publicity. To avoid communication breakdown, regulatory bodies requires radiographers to be able to use appropriate verbal and non-verbal communication and to use an appropriate interpreter if necessary when communicating with service users and others. It is clear that one of the many radiographer responsibilities is to communicate with patients. After all, patients are the reason imaging professionals are employed. Radiographer-patient relationships can be strengthened and patient outcomes improved through effective communication. Imaging professionals have the responsibility to provide the best possible patient care, and proper communication plays a large role in successful imaging interactions. Using open and honest communication, the radiographer can form a trusting relationship with patients and their families. Benefits of Effective Radiographer-Patient Communication Effective radiographer-patient communication has the potential to help regulate patients' emotions, facilitate comprehension of information, and allow for better identification of patients' needs, perceptions, and expectations. Patients reporting good communication with their caregivers are more likely to be satisfied with their care, and especially to share pertinent information for accurate diagnosis of their problems. Studies have shown correlations between a sense of control and the ability to tolerate pain, recovery from illness, decreased tumor growth, and daily functioning. Enhanced psychological adjustments and better mental

Approaches to Radiographer-Patient Communication First, why is it important that we understand the different approaches to communication? When two people communicate they form perceptions of each other. When they differ in terms of how they are communicating (and why), there is a risk that each will perceive the other as obstructive or difficult, not because they are difficult but because they are communicating to different purposes. Hence, you can have conflict that comes, not from disagreement about the issues, but simply because of communication style or purpose differences.

In a clinical setting, the radiographer-patient communication approach can be task-oriented or emotion-oriented. Both are valid and equally useful ways of interacting, but serve different purposes. They are not mutually exclusive, and people can shift from one to the other, although people have a tendency to go one way or another. Ta s k - o r i e n t e d c o m m u n i c a t i o n - s o m e o n e u s i n g a t a s k orientedcommunication focuses on "getting things done" efﬁciently, and is less focused on developing and maintaining good interpersonal relationships with the other person. In a clinical imaging setting, a sonographer asks an expectant mother about her LMP while a radiographer gives the patient preparation instructions for HSG

(hystero-salpingography). Both scenarios constitutes task-oriented communication. Often, task-oriented communication is perceived rigid by the patients due to the approach radiographers tend to give it. When a radiographer simply feed the patient breathing instructions for chest xray without explaining the rationale for those instructions, radiographerpatient interaction might become rigid and the patient might not fully co-operate. Consequently, the goal of communication will be defeated in such scenario. However, if the radiographer adds that breathing instructions must be observed in order to get full inspiration of the lungs which will in turn facilitate optimal diagnosis, the patient will be more likely to observe the breathing instructions fully. To achieve an effective task-oriented communication, the radiographer must be ready to go the extra mile of providing more information on examinations and their aims including routines because no matter how familiar the examinations may seem to you, they will look strange to many patients coming into the unit for various investigations. At the end of each task-oriented interaction session, always ask the patient if they have any questions so that you get feedback and determine the effectiveness of communication. Repeat the whole process again before you finally discharge the patient from the department. That way, you ensure the patient doesn't go home with doubts, misconceptions, worries or opinions that can be easily be set straight by mere conversation! Emotion-orientedcommunication– someone using this approach is less concerned with getting things done, but more interested in building and maintaining good relationships with people and ensuring others are comfortable with the interactions. In a clinical imaging setting, our sonographer now provides a listening ear to the expectant mother who is sharing her experience with the unborn fetus while our radiographer consoles the female patient experiencing pelvic pain following an HSG exam. Both scenarios portray semotion-oriented communication. It actively promotes patient's wellness, satisfaction and positive outcome. In a maternal-fetal setting, it helps the sonographer to facilitate better maternal-fetal well-being and bonding. Unfortunately, this communication approach is rarely employed in the imaging setting though it has been argued to be the most beneficial communication style to the patient. Evidence abounds to show that patients' perceptions of the quality of the care they received are dependent on the quality of the emotional interactions with their clinician amongst other factors. However, they are some guidelines the radiographer must have at the back of the mind when utilizing this communication approach. First, the patient's concerns and needs must be centre of interaction in this approach. The imaging professional must also be able to clearly demarcate the boundaries of interaction in order not to become emotionally-tangled with the patient in an unprofessional manner. Nonetheless, it is important to note that the benefits of emotionoriented communication in the imaging setting far outweigh the possible attendant drawbacks. Conclusion As Chairman Mao said, the first step in solving a problem is calling it by its right name. Only then can it be discussed and its particular features in a given site identified. It is no news that many imaging professionals lack the needed skills for effective communication in the imaging setting. This exposure is just an attempt to bring this challenge on to the table for redress. This is urgent need to train professionals in effective communication skills. Until then, imaging professionals need to learn to take that extra mile for their patients, interact more effectively and get feedback as appropriate before discharging the patient from the imaging unit. After all, it's all about patient!

fferent Services Limited.

CONNECTED RADIOLOGY MADE SIMPLE We provide the most cost-effective and efﬁcient teleradiology solution for single or multi-facility practices with a unique design for low-bandwidth environments and resilient to regular power outages.

Simplicity Plug-and-Play set up takes less than 1 hour No maintenance fees or set-upcosts Intuitive user interface and one-click routing means less training time and fewer mistakes You choose where images are sent, your specialist network or ours

Cost 90% Lower data cost than Fibre, using consumer3G/4G connection Pay-as-you-go service means you only pay for what you use Increase patient volume through our marketing and physician awareness efforts

Performance 40% better compression than traditional JPEG DICOM Fewer dropped studies and faster transmission than VSAT connections Quality assurance at every stage Battery backup to transfer images on our network even when power is not available

Powered by Alemhealth To request a demo or learn more Contact us, Efferent Services Limited, in Lagos Nigeria www.efferentservices.com info@efferentservices.com +234 902 437 2353, +234 909 049 4606 +234 1 632 4634

International Efforts to Reduce Medical Imaging Dose Corresponding Author: Chris Steelman MS, RT(R)(CI), RCIS, RCSA +1.843.290.5404 csteelman@x-rayintl.org Skype: c.steelman

he application of ionizing radiation and r a d i oa c t i v e m a t e r i a l s i n d i a g n o s t i c , interventional and therapeutic procedures is essential to the practice of modern medicine. In fact, the editors of the New England Journal of Medicine named medical imaging one of the most important medical developments of the past millennium. But the average radiation dose to which persons are exposed has increased dramatically. In the United States, for example, it has doubled over the past 30 years. And although the average dose from natural background sources remains unchanged, the average dose from medical imaging has increased more than sixfold.Medical imaging now contributes 50% of the overall radiation dose to the U.S. population compared with 15% in 1980.For example, interventional transcatheter procedures dependent upon fluoroscopy continue to become more sophisticated. However, many ofthese procedures require more time and as a result more radiation exposure. Consider this, entrance exposure to patients in diagnostic and therapeutic angiography has been estimated to be hundreds to a thousand times more than a chest radiograph.The International Atomic Energy Agency provides some startling numbers that compare exposure in terms of PA chest radiographs. Assuming the Mean Effective dose of a PA chest radiograph is 0.02 mSv, the IAEA reports that coronary angiography is equivalent to 155 PA chest radiographs. An interventional procedure may increase that number to 755 PA chest radiographs. Emerging radiographic imaging modalities such as positron-emission tomography CT (PET/CT), single photon emission CT (SPECT/CT) are expected to increase exposure even further. The increased use of radiation is not limited to the United States. The radiologic community worldwide shares a responsibility; we must be ever mindful of the delicate equilibrium that exists between capturing information-rich images and the risks of exposing patients to radiation. As medical uses of radiation multiply, so too have the concerns of the medical community and an increasingly informed public. Professional organizations are responding to these concerns. Various countries have professional societies who, thanks to global connectivity, have the ability to share knowledge beyond their borders. The American Society of Radiologic Technology, a leader in the advancement of the radiologic technology, produces exceptional educational content that addresses dose reduction. One such example is the publication of Best Practices in Digital Radiography (2012). This authoritative report, written by many of this country's thought- leaders provides a concise overview of this complex issue. As evidenced by a growing number of citations, this document is a significant contribution to the science of radiography. But while most imaging and therapy professionals are aware of the domestic organizations dedicated to setting standards and disseminating data related to the optimum utilization of radiation, an increased awareness of international organizations provides us with additional channels of information that may benefit patients and their families.

It is beyond the scope of this article to provide details on each organization. However, the international community of organizations dedicated to dose reduction is easily accessed online: the International Commission on Radiological Protection, International Society of Radiology, the International Radiation Protection Association and the United Nations Scientific Committee on the Effects of Atomic Radiation. Each website contains a wealth of information. While each makes significant contributions to dose reduction efforts, it's the collaborative efforts of the world's organizations that yield the greatest contributions. A joint position statement by the IAEA and WHO states: “There is a need for a holistic approach which includes partnership of national governments, civil society, international agencies, researchers, educators, institutions and professional associations aiming at identifying, advocating and implementing solutions to address existing and emerging challenges; and leadership, harmonization and co-ordination of activities and procedures at an international level.” Some say the best example of this holistic approach is the Bonn Call-for-Action. The IAEA held the “International Conference on Radiation Protection in Medicine: Setting the Scene for the Next Decade” in Bonn, Germany in 2012. The conference was co-sponsored by the WHO, hosted by the Government of Germany through the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety. The conference was attended by 536 participants and observers from 77 countries and 16 organizations. Those who attended expressed the need for a joint statement to be issued by the IAEA and the WHO. The result was the Bonn Call-for-Action, a statement that identifies the actions considered essential for the strengthening of radiation protection in medicine over the next decade. A more recent example of this approach is Eurosafe Imaging. The European Society of Radiology (ESR) is the world's largest radiological society, with more than 60,000 individual members from 155 countries, 43 institutional member societies across Europe, 15 European subspecialty and allied sciences member societies and 41 non-European associate institutional members. Euro Safe Imaging, is the ESR's flagship initiative to promote quality and safety in medical imaging. Officially introduced at the European Congress of Radiology in March 2014, the mission of EuroSafe Imaging is to “support and strengthen medical radiation protection across Europe following a holistic, inclusive approach.” CHRISTOPHER STEELMAN works for Medical University of South Carolina Children's Hospital in Charleston, South Carolina. Christopher is the chairman of the ASRT CardiovascularInterventional Chapter, vice-chairman of the ASRT Practice Standards Council, a Trustee of the World Radiography Education Trust Foundation and is the ISRRT Regional Coordinator for Professional Practice for The Americas. Mr. Steelman welcomes comments and can be reached at csteelman@xrayintl.org.

The International Society of Radiographers and Radiological Technologists (ISRRT) is a global organization representing over 500,000 medical imaging and radiation therapists in more than 90 countries. It provides guidelines for safe practice and dose reduction through its far -reaching educational programs. The ISRRT's World Congresses are held every two years and are attended by over 50 countries. The Society collaborates with and provides the radiologic technologist's perspective to organizations such as the International Commission on Radiological Quality and Safety (ICRQS) and the Heads of the European Radiological Protection Competent Authorities (HERCA) International Atomic Energy Agency (IAEA)and the World Health Organization (WHO). Twice yearly the ISRRT newsletter, News & Views, offers unparalleled insight into the world of radiologic technology. Bonn Call-for-Action http://www.who.int/ionizing_radiation/medical_expos ure/bonncallforaction2014.pdf Heads of the European Radiological Protection Competent Authorities (HERCA) www.herca.org International Atomic Energy Agency www.iaea.org International Commission on Radiological Protection www.icrp.org International Commission on Radiological Quality and Safety (ICRQS) http://www.isradiology.org/isr/quality.php

International Radiation Protection Association www.irpa.net International Society of Radiology http://www.isradiology.org/ International Society of Radiographers and Radiological Technologists www.isrrt.org United Nations Scientiﬁc Committee on the Effects of Atomic Radiation www.unscear.org World Health Organization http://www.who.int

Special Offer Swiss Biostadt Limited with the Support of its Partner Siemens Healthcare is offering a special package on Medical Equipment to Private Medical Practitioners through the platforms of AGPMPN/NMA/GMD