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BACKGROUND: Radiation from CT (computerized tomography), poses risk of radiation associated cancer. Studies indicate a cumulative dose of 50mGy triples the risk of leukemia and a dose of 60mGy triples the risk of brain tumors in children. This study aimed to assess the application of “Justification and Optimization Principles of ALARA (As Low As Reasonably Achievable)” in pediatric CT.METHOD: A prospective cross-sectional study was conducted from December 2017 to July 2018 G.C at Tikur Anbessa Specialized Hospital. CT request forms were reviewed. All pediatric patients listed for CT were included. The collected data were analyzed using SPSS version 25.RESULTS: Four hundred and twenty nine CT requests were reviewed, 246 (57.3%) were males and 183(42.7%) were females; 52(12.1%) were less than 1 year old, 153(35.7%) between 1 to 5 years, 113(26.3%) between 5 to 10 years and 111(25.8%) 10 to 14 years old. On the other hand, 28(6.5%) scan requests were rejected based on the ALARA justification principle, and from these, in 11(39.2%) MRI was recommended instead of CT, in 6(21.42%) US was recommended. Review of previous CT helped to reject 4(14.28%). Review of prior chest radiographs helped in rejecting 2(7.14%) requests. For 5(17.8%) and 19(4.4%), requests were optimized by applying principles of optimization to reduce received dose from CT.CONCLUSION: Overall, 47(11%) patients were protected from unnecessary radiation exposure by applying the principles of ALARA. The use of other alternating imaging modalities is vital in pediatric patients who are more radiosensitive and have longer time to manifest radiation induced injury.

Neurosurgeons often neglect the sphenoid sinus due to its deep location and difficulties in accessing during surgical interventions. Disease of the sphenoid sinus is difficult to diagnose since its presenting symptoms are difficult to recognize. Moreover, compared with other paranasal sinuses, the sphenoid sinus is considered the most variable air sinus in terms of its degree of pneumatization, number and position of inter-sinus septa, and its relationship with the surrounding anatomical structures. Anatomical variations of the sphenoid sinus are significant from a neurosurgical point of view. Understanding of these variations and its relationships with surrounding structures such as the internal carotid artery, optic nerve, and pituitary gland are clinically relevant to minimize injuries associated with surgical procedures that involve sphenoid sinus. We implemented principles of imaging using computed tomography to elucidate any anatomical variations of the sphenoid sinus in the Ethiopian population. We conducted a prospective study in 200 patients with ages 18&ndash, 79, who underwent scans of the sphenoid sinus at the Tikur Anbessa Referral Teaching Hospital in 2017&ndash, 2018. Our findings revealed an incidence of anatomographical variations in terms of pneumatization that varied between 2&ndash, 50%. These variants include 2% conchal, 25.5% presellar, 50% sellar, and 22.5% postsellar pneumatization. We also demonstrated anatomographic variants in terms of septation, 77.5% single complete septa, 11.5% single incomplete, 10% double septa, and 1% absence of septa. In summary, the sellar pneumatization was found to be the most clinically relevant anatomographic variant among Ethiopians participating in the study, of which 90% were tomographically single septated. These variants must be taken into consideration during trans-sphenoidal surgery and knowledge of the variations has clinical implication in minimizing injuries during invasive surgical procedures involving the sphenoid sinus.

BACKGROUND: The international literature on physicians’ knowledge regarding radiation dosages and risks due to computed tomography showed a widespread underestimation of diagnostic radiation doses. Hence, the objective of this work is to assess the awareness of pediatric residents and medical interns about pediatric CT dose and possible risks.METHODS: A cross-sectional study was conducted on May/2016 among year I to year III pediatric residents and 2015/2016 year medical interns attaching Pediatrics Department during the study period in Tikur Anbessa Specialized Referral and Teaching Hospital. Data was collected by distributing standardized structured questionnaires. Finally, after the data was checked for clarity and completeness, it was analyzed by using SPSS software.RESULT: While the majority (76.3%) of the residents and interns knew that children were more sensitive to radiation than adults, 93.7% did not know that there is currently no annual dose limit set for medical exposure of patients. The majority of the respondents (81.3%) know the risk of cancer from CT scan, but most (60%) of the respondents did not know that many imaging facilities still use adult doses for pediatric patients. Furthermore, 18.8% thought that magnetic resonance imaging involves ionizing radiation, and 8.9% of the physicians associated ultrasound examinations with ionizingradiation.CONCLUSION : Within resident group, since the level of clinical experience did not affect the outcome, we recommend that formal education and training on awareness of radiation with special concern on pediatric population is mandatory especially for pediatric residents and pediatricians who are major caretakers of children.KEYWORDS: Computed tomography, radiation exposure, awareness of radiation, pediatric CT dose, possible risks of radiation.

Objectives. To evaluate the level of knowledge about the radiation exposure to diagnostic imaging procedures among the final-year medical students and interns and to suggest how education could be improved. Material and Methods. All 355 final-year medical students and interns from Tikur Anbessa Teaching Hospital in Addis Ababa were included in the study. Participants were asked to complete a questionnaire consisting of their actual knowledge on ionizing radiation and on their preferred method of learning. All questions were in multiple choice formats ranging from 4 to 7 choices. The obtained data were analyzed using statistical software. Results. A total of 343 completed questionnaires were received. Up to 78.9% of respondents underestimated or do not know the radiation dose from commonly requested radiological procedures. Surprisingly, 245 (71.4%) and 254 (79.3%) students incorrectly believed that ultrasound and MRI, respectively, emit ionizing radiation or they do not know if they emit radiation or not. Both interns and medical students did not have significant difference (P=0.56) in their knowledge of ionizing radiation. A combination of tutorials or workshops (29.7%) and learning modules (19.8%) combined were their first and last preferred methods of teaching for future radiation awareness, respectively. Conclusion. This study has clearly shown that awareness of ionizing radiation from diagnostic imaging is lacking among senior medical students and interns. The results highlight the need for improved education to minimize unnecessary exposure of patients.

Breast cancer in women is a major health burden both in developed and developing countries. Although there is no cancer registry in Ethiopia cervical and breast cancers are the top two cancer types having a lion's share for the high maternal deaths in the country. Stratified random sampling with proportional allocation and systematic random sampling techniques were employed to assess the knowledge of breast cancer risk factors and practice of breast cancer screening methods among female healthcare professionals in governmental hospitals of Addis Ababa, Ethiopia. Data was analyzed using SPSS version 16 in bivariate analysis. In bivariate analysis age, marital status work experience and educational level had association with study participants' practice of the three breast cancer screening methods. These female health workers who were expected to act as role models and educate the public had adequate knowledge of breast cancer risk factors (85.0%)), BSE (77.6%), CBE (71.4%), and mammography (81.4%) but poor practice of BSE (35.5%), CBE (32.5%) and mammography (16%).Considering their leading role in breast cancer awareness and information dissemination, efforts should be made by Government to improve practice of breast cancer screening methods among female healthcare professionals.

Increasing concern has recently been expressed in the literature that the referring doctor's knowledge of radiation doses incurred during radiological procedures is inadequate. Such information may be particularly relevant when the expansion of imaging technology is considered. Hence the objective of this work is to assess the awareness of physicians about radiation dose and hazards of radiation. The study was performed among medical doctors at Tikur Anbessa Specialized Referral Teaching Hospital, the largest medical school in the country. A 135 self administered questionnaire was circulated randomly from a range of specialties; out of which 114 questionnaires were completed and used in the study giving a response rate of 85%. Participants were asked about the radiation dose from a chest radiograph, the annual dose from background radiation, and cancer risk from several common radiological procedures. A mean score of 7.1 out of 19 was achieved. 12 doctors had received formal training about ionizing radiation, and these participants scored higher than those with no previous training in this area. Our survey suggested that clinicians' awareness of radiation doses imparted during common radiological procedures, and the consequent risk to the individual patient is poor. A major curriculum revision of both undergraduate and graduate medical education regarding awareness on radiation is mandatory to improve this deficiency.

Background: A mammography examination facilitates the early detection of breast cancer. However, the potential risk of radiation-induced carcinogenesis is also increased with such a procedure. Thus assessment of the breast dose is important. Objectives: The objectives of this study were to investigate the techniques currently used for diagnostic mammography in Ethiopia, thereby to estimate the mean glandular dose (MGD) for Ethiopian women. Materials and methods: A cross-sectional study was conducted on breast cancer patients between 40-64 years of age having compressed breast thickness (CBT) greater than 2 cm. Five mammographic units and 386 women having a total of 1463 mammograms were included in the study period from April 2011-February 2012 in Addis Ababa, Ethiopia.The characteristics of the radiographic equipment and the exposure data of each patient were recorded using designed format. The MGD was calculated from the measured Entrance Surface Air Kerma (ESAK) using appropriate conversion coefficients. The obtained data were analyzed using statistical software. Results: The range of CBT was 2.2-7.5 cm for CC mammograms with mean ± SD of 4.24 ± 1.1 cm and 2.3-8.0 cm in MLO projection with mean ± SD of 4.64 ± 1.1 cm. The average MGD per exposure was 2.57 ± 2.1 mGy while the respective averages separately for the CC and MLO projections were 2.58 ± 2.2 mGy and 2.57 ± 2.1 mGy, respectively. Conclusion: The average MGD values recorded in this study were between the limiting value of the Institute of Physical Sciences in Medicine (2.0 mGy) and American College of Radiology (3.0 mGy) recommendation. These ensure that the mammography examination performed in Ethiopia was capable of achieving acceptable dose levels for patient safety.

Background: Medical x-ray exposures have the largest man made source of population exposure to ionizing radiation in different countries. Recent developments in medical imaging have led to rapid increases in a number of high dose xray examinations performed with significant consequences for individual patient doses and for collective dose to the population as a whole. It is therefore important in each country to make regular assessments of the magnitude of these large doses. Objectives: To calculate collective dose of the population as a result of radiation dose from diagnostic x-rays, thereby to estimate the annual incidence of cancer which would be reduced by the use of rare earth intensifying screen. Methods: Data on the number of diagnostic procedures using x-ray examination in year 2007 in nine governmental hospitals, excluding military hospitals, by body site were collected in Addis Ababa. The number of examinations of specific body site was multiplied by the average effective dose per examination to get the collective dose over the population. Based on International Commission on Radiological Protection (ICRP) the fatality risk of fatal cancers (5% per Sv) was estimated. Results: In this study, the annual collective dose over the population is 31.21manSv (0.0.42mSv per person). Based on ICRP fatality risk of 500 fatal cancers per 10,000 man-sieverts (5% per Sv), estimation of incidence of fatal cancers cases in year 2007 was 2 cases half of which can be reduced by adoption of rare earth screens. Conclusion: Although the use of ionizing radiation for diagnostic medical procedures is an acceptable part of modern medicine, there is also the potential for inappropriate use and unnecessary radiation dose to the patient, so the request of radiography must be justified. It is estimated that the adoption of rare earth screen technology might reduce the annual incidence of cancer which would be fatal after an average latency period of 18.4 years by half, hence this research recommended adopting rare earth screen technology in Ethiopia. [Ethiop. J. Health Dev. 2010;24(2):140-144]

Background: It is not uncommon to encounter patients undergo repeat x-ray examinations after their initial x-rays are rejected for poor image quality thereby subjecting them to excess radiation exposure and avoidable extra cost. This creates a situation which necessitates the need to explore causes of reject and repeat of x-ray examinations. The employment of reject analysis as part of overall Quality Assurance (QA) programmes in clinical radiography and radiology services in the evaluation of image quality is a well established practice. The role of reject analysis in providing relevant information that would help achieve sound reduction in radiation exposure and cost as well as develop acceptable image quality was explored in this study. Objective: To assess the reject rate of x-ray films and obtain information for further recommendation on quality, cost, and radiation exposure in the two hospitals. Methods: Prospective and cross-sectional study approaches were employed. Reject rate was measured for two x-ray departments (one from public and the other from private) across all plain x-ray films examinations using a structured format on which relevant data for reject were recorded by investigators (radiologists and a medical physicist). Results were then collected and entered into a database for analysis. Results: Reject rate along with exposure rate was measured across all plain film exams for the hospitals. Analysis has shown that the overall reject rate was 4.94% in 4470 and 0.83% in 1870 exposed films for the public and private hospitals, respectively. Conclusion: The study has shown the highest reject to be that of chest x-ray in both adults and children with overexposure and patient motion, respectively being the major causes. Although the overall reject rate is well within the accepted range, individual causes of reject have given light into some of the most common problems of quality of radiography service and we recommend that regular and cyclic QA programmes should be instituted at all levels of the x-ray department and that of hospital management for effective and sustained service delivery, x-ray dose reduction to patients and personnel as well as economic management of scarce resource. [Ethiop.J.Health Dev. 2008;22