To X-ray or not to X-ray?

Safety campaign reduces medical radiation risks in Africa

April 2016

Billington Jesse Semwogerere and his mom Victoria Nandagire have a conversation with Dr. Deborah Babirye at Ecurei-Mengo Hospital (Kampala, Uganda) about the risk of radiation during diagnostic testing, such as a CT scan.
Miss Elizabeth Nabunya Kawooya

When Dr Michael Kawooya, a radiologist at Mengo Hospital in Kampala, Uganda, performs an ultrasonography on pregnant patients he’s often asked, “Doctor, is this dangerous?”

His answer is always “No”.

“Ultrasonographies do not use ionizing radiation, so they aren’t dangerous,” says Dr Kawooya, who is also Director of Ernest Cook Ultrasound Research and Education Institute in Kampala.

Yet many of the procedures his patients do have or ask for, including X-rays, CT-scans and fluoroscopy-guided interventions, do use ionizing radiation. These have the potential to cause cancer and skin injuries, particularly in children. Many referrers, patients and caregivers are unaware of these risks.

“Often patients think that an X-ray is part of a cure without any knowledge of the risks involved,” explains Dr Kawooya. “This is our opportunity to educate them.”

Improving radiation safety

Worldwide, an estimated 3.6 billion diagnostic medical examinations, such as X-rays, are performed every year. This number continues to grow as more people access medical care. About 350 million of these are performed on children under 15 years of age.

“If patients and families are not properly informed about the risks and benefits of an imaging procedure, they may make choices that are more harmful rather than beneficial to their health, such as refusing a CT that is needed or demanding a CT that is not justified,”

Dr Maria del Rosario Perez, scientist with WHO’s Department of Public Health

Using radiation in medical imaging can save lives and prevent the need for more invasive procedures, but inappropriate use may lead to unnecessary and unintended radiation doses for patients. Because children are smaller and have a longer lifespan than adults their risk of developing radiation-induced effects is greater.

“If patients and families are not properly informed about the risks and benefits of an imaging procedure, they may make choices that are more harmful rather than beneficial to their health, such as refusing a CT that is needed or demanding a CT that is not justified,” says Dr Maria del Rosario Perez, a scientist with WHO’s Department of Public Health.

To improve safety WHO launched a Global Initiative on Radiation Safety in Health Care Settings in 2008 with the aim to mobilize the health sector towards safe and effective use of radiation in medicine.

One key priority is to improve the communication of radiation risk in paediatric imaging to ensure an effective and balanced benefit-risk dialogue between health care providers, families and patients.

A new WHO publication, “Communicating radiation risks in paediatric imaging”, helps health-care providers communicate known or potential radiation risks associated with paediatric imaging procedures. The document provides several approaches to help medical professionals answer questions, like “How much radiation will my child receive?” and “How much medical radiation is too much?”

In Uganda, Dr Kawooya and other medical professionals are using the new publication as part of a regional campaign to improve radiation safety and raise awareness to develop national radiation policies and regulations.

A campaign for Africa

In many parts of Africa protecting patients from radiation risks can be a challenge. Radiation guidelines are often inadequate and rarely adhered to. Training for medical professionals is unregulated, and procedures for maintenance, decommissioning and disposal of radiology equipment are not always followed.

In February 2015, the Pan African Congress of Radiology and Imaging launched AFROSAFE, a campaign to ensure all radiation-based medical procedures in Africa are necessary and performed safely. As part of the campaign, medical professionals are learning to conduct risk-benefit discussions about paediatric imaging with patients and families utilizing WHO’s new risk communications tool.

“AFROSAFE is bringing the African medical community together in the struggle to ensure radiation safety,” says Dr Kawooya. “WHO’s new tool will help us create more awareness about the risks associated with radiation exposure, and help use develop communication skills needed to pass on the messages.”

Through AFROSAFE Uganda, Dr Kawooya is teaching doctors and technicians in his country to enhance the safety and quality of radiology. In November 2015, he helped organize the first training session, which was attended by more than 100 Ugandan medical professionals and patient advocates.

On of the training sessions, “To X-ray or not to X-ray,” presented different patient scenarios and asked participants to discuss whether they would refer the patient to medical imaging or not. This scenario reminded medical professionals of the guidelines they should be following to protect all patients.

“We are encouraging radiologists at hospitals throughout Uganda to use referral guidelines when making decisions about using radiation on children and their families,” says Dr Kawooya. “It is our responsibility to help our patients make informed decisions while keeping them safe.”

The new communication tool will serve as a basis to further develop training packages to improve communication skills of health care workers, as well as advocacy and information materials targeting patients, parents, family members, and the community.