Establishing the quality management baseline in the use of computed tomography machines in Kenya

The objective of this study was to assess the level of compliance to quality assurance and image quality standards in computed tomography facilities in Kenyan hospitals. A quality assurance inspection and physical image quality assessment in eighteen representative computed tomography facilities were completed. A quantitative method was developed and used to score the results obtained from the physical image quality measurements using the American Association of Physicists in Medicine (AAPM) water phantom. Inspection was done in order to establish the level of compliance with internationally recognized standards such as those stipulated in the European Guidelines Quality Criteria for Computed Tomography and the International Basic Safety Standards for Protection against Ionizing Radiation. The overall findings placed the national quality management performance at 50± 3%, while image quality and quality assurance performance were 61 ± 3% and 37 ± 3%, respectively. The quality assurance assessment benchmarked the country’s level of quality management system compliance in diagnostic radiology. During accreditation appraisal, the scrutiny of scores from each stage in the medical imaging chain per facility will encourage continual implementation of the quality improvement process

Establishing a quality assurance baseline for radiological protection of patients undergoing diagnostic radiology

Background. The wide use of ionising radiation in medical care has resulted in the largest man-made cause of radiation exposure. In recent years, diagnostic departments in Kenya have adapted the high-speed film/screen combination without well-established quality control, objective image quality criteria, and assessment of patient dose. The safety of patients in terms of justification and the as-low-as-reasonably-achievable (ALARA) principle is inadequate without quality assurance measures. Aim. This study assessed the level of film rejects, device performance, image quality and patient dose in 4 representative hospitals using high-speed film/screen combination. Results. The X-ray equipment quality control tests performance range was 67% to 90%, and 63% of the radiographs were of good diagnostic value. The measured prevalent chest examination entrance surface dose (ESD) showed levels above the international diagnostic reference levels (DRLs), while lumbar spine and pelvis examination was the largest source of radiation exposure to patients. Conclusion. The optimisation of patient protection can be achieved with optimally performing X-ray equipment, the application of good radiographic technique, and continuous assessment of radiographic image quality

Estimation of annual occupational effective doses from external ionising radiation at medical institutions in Kenya

This study details the distribution and trends of doses from occupational radiation exposure among radiation workers from participating medical institutions in Kenya, where monthly dose measurements were collected for a period of one year (January to December 2007) using thermoluminescent dosimeters. A total of 367 medical radiation workers were monitored, comprising 27% radiologists, 2% oncologists, 4% dentists, 5% physicists, 45% technologists, 4% nurses, 3% film processor technicians, 4% auxiliary staff, and 5% radiology office staff. The average annual effective dose for all subjects ranged from 1.19 to 2.52 mSv. Among these workers, technologists received the largest annual effective dose. The study forms the initiation stage of wider, comprehensive and more frequent monitoring of occupational radiation exposures and long-term investigations into its accumulation patterns, which could form the basis of future records on the detrimental effects of radiation, characteristic of workers in the medical sector, and other co-factors in a developing country such as Kenya

NATIONAL DIAGNOSTIC REFERENCE LEVEL INITIATIVE FOR COMPUTED TOMOGRAPHY EXAMINATIONS IN KENYA

This study is 2nd year research of its 3 years research project on utility evaluation of private certifications. This utility evaluation is performed by using most of the evaluation system proposed on the 1st year research. The targets of this evaluation are private certifications authorized by the state on May, 2016, which were wiling to participate on this utility survey. Overall summary on the evaluation research is as follows: First, the satisfaction value on authorized private certifications by ministries are 3.58, which is higher than the median value of 3. As the common satisfaction value result is way beyond the median value, the absolute value is not a high level. Second, classifying the vocational certifications and basic vocational certifications, the result shows that the utility of vocational certifications have higher utility value than basic vocational certifications in every respect. Third, in terms of the areal utility of state authorized private certifications, non-economic utility and management operation of private certifications show high utility value than average value. This indicates that existing private certification market is more focused on improving the individual competency not on entering into the job market. Fourth, in terms of the infrastructure of state authorized private certifications, hardware-wise infrastructure has higher value than the software-wise one. This means that certification system shows lower average value than that of the organization’s management operation capability. This demonstrates that state authorized test agencies are not fully displaying its ability. This is because many of certifications’ test subject and test methods, which are the core of the certification system, are inadequately designed. Fifth, the correspondence value of private certifications is also shown as below average value. This attributes to the fact that the existing state authorized private certification does not fulfil the improvement of lifelong vocational competency of people, which is the purpose of establishing the system. Sixth, although some of state authorized private certifications claim to advocate vocational qualification-test, they did not properly function, and some other basic vocation related authorized private certification functioned as vocational qualification-test. According to its evaluation result, this study would like to suggest a policy recommendation. First, classifying vocational qualification- test and basic vocational qualification-test when it comes to authorizing the private certifications. Second, simplifying the re-authorizing procedure for the certifications with high utility value. Third, reinforcing the inspection regarding non-participating agency and test subject. Fourth, reinforcing the management of certification quality through feedback on evaluation result. Fifth, granting incentive to already registered private certification when it’s newly authorized

Quality management systems in radiology

Background: The use of X-ray imaging is ever increasing in proportion to the need for radiological services and technological capabilities. Quality management that includes patient radiation dose monitoring is fundamental to safety and quality improvement of radiological services. Objective: To assess the level of quality management systems in X-ray medical facilities in Kenya. Methods: Quality management inspection, quality control performance tests and patient radiation exposure were assessed in 54 representative X-ray medical facilities. Additionally, a survey of X-ray examination frequency was conducted in 140 hospitals across the country. Results: The overall findings placed the country’s X-ray imaging quality management systems at 61±3% out of a possible 100%. The most and the least quality assurance performance indicators were general radiography X-ray equipment quality control tests at 88±4%, and the interventional cardiology adult examinations below diagnostic reference level at 25±1%, respectively. Conclusions: The study used a systematic evidence-based approach for the assessment of national quality management systems in radiological practice in clinical application, technical conduct of the procedure, image quality criteria, and patient characteristics as part of the quality management programme