Conformity Assessment of Lead Aprons Used in Conventional Radiology: A Multi-Centre Survey in Togo

Aim: Lead aprons are used to protect against scattered radiation from the patient during interventional procedures and certain special conventional radiological examinations. Given the importance of the role lead aprons are supposed to play in radiation protection, we propose to assess their conformity in medical imaging departments in public and religious hospitals in Togo. Materials and method: A multi-centre survey conducted from 26 November to 06 December 2021 in the radiology departments of public and religious health facilities in Togo. All aprons in use were included. The evaluation criteria were physical (visual), quantitative (radiographic) and qualitative (dosimetric). Results: We had registred 43 aprons among wich 27 (62.79%) leaded aprons were labelled non-compliant and 16 (37.21%) were labelled compliant. Of the aprons judged to be non-compliant, 70.37% were more than 10 years old and 96.30% showed defects on the radiographic images. The most common defects were vampire marks (18.64%), multiple folds (16.96%), cracks (16.96%), multiple cracks (15.25%), tears (8.47%), absence of lead (5.08%), holes (3.39%) and lead corrosion (1.69%). Defective aprons (62.96%) had at least two defects. The defects were of thoraco-abdomino-pelvic (74.07%), thoracic (14.82%) and abdomino-pelvic (11.11%) topography. For indirect exposure at 50 and 70 kilovolts, all the aprons had an attenuation factor greater than 90%. After dosimetric measurement, 13.95% of aprons had attenuation factors below 90% for indirect exposure at 100 kilovolts. Conclusion: The compliance of the leaded decks is trifactorial (physical, radiographic and dosimetric). However, there is no significant difference in X-ray attenuation capacity between defective and normal decks.

Relevance of Medical Imaging in the Pre-Therapeutic Evaluation of Acute Intestinal Obstruction at CIMED

Objective: We initiated this work with the aim of studying the contribution of imaging in the diagnosis of acute intestinal obstruction at CIMED. Patients and methods: This was a prospective, descriptive and analytical study involving 96 patients collected at the radiology and medical imaging department of CIMED, from January 2022 to January 2023. Result: The age of our patients varied between 11 and 86 years with an average age of 36 years. There was a male predominance of 64.6% compared to 35.4% for women, i.e. a sex ratio of 1.82. The notion of previous surgery was found in 61.5% of our patients. Pain was present in all patients. Radiography of the ASP was performed in 89.6% of patients. It showed hydro-aerial levels in 96.5% of patients. Abdominopelvic CT was performed in 12 patients and made it possible to make the diagnosis of occlusion in all patients. The results of the positive diagnosis were concordant with those intraoperatively in 92% of cases. 8% of our patients, compared to the treatment, spontaneously resumed their transit, 91% benefited from surgical treatment and 1% died before surgery. The outcome was favorable in 80 patients or 83.3%, poor with death in 16 patients or 16.7% of cases. Conclusion: Acute intestinal obstruction remains a serious pathology for which ASP radiography often remains the only radiological examination performed urgently. However, abdominopelvic CT seems widely indicated thanks to its contribution both for the positive diagnosis and for the serious and etiological diagnoses. However, this imaging technique is largely underused in our practice due to its high cost and lack of availability.

Compliance of Magnetic Resonance Imaging Examination Requests at the Diagnostic Center of the National Social Security Fund of Conakry

Introduction: MRI is a rapidly growing technique with more and more indica-tions and requests in the Republic of Guinea. Its correct prescription is a guar-antee for the satisfaction of the actors, both prescribers, radiologists and pa-tients. The main objective of this study was to evaluate the compliance of MRI examination requests at the Diagnostic Center of the National Social Se-curity Fund (CNSS) in Conakry. Material and Methods: This was a descriptive cross-sectional study of MRI prescription forms sent to the MRI unit of the CNSS Diagnostic Center from February 1 to May 1, 2021. The 8 compliance criteria established by the French High Authority for Health were used to evaluate the compliance of the examination requests. Results: A total of 7003 examination forms were sent to the facility, including 7% (n = 468) of MRIs. 56.2% of MRI requests were performed by specialists. We observed an overall compliance of 10%. Administrative and clinical compliance were missing in 24% and 38%, respectively. More specifically, the purpose of the examination was not mentioned in 60%, followed by the requesting department in 48.1% and the patient’s age in 35.1%. Conclusion: This study allowed us to highlight the gaps in establishing MRI requests. It would be important to organize an awareness campaign for prescribers on the usefulness of correctly filling an MRI request and to design templates to be filled out by prescribers.

Post-COVID-19 Late Pulmonary Embolism in a Young Woman about a Case

COVID-19 appears to be associated with a disproportionate risk of thrombosis. The occurrence of thrombosis is a frequent complication of many medical and surgical conditions. Their prevention by LMWH is the option of choice as well as their early diagnosis in this pandemic context. In addition, several recent observations support that severe pulmonary embolism is very common in hospitalized patients with COVID-19. We report the case of late pulmonary embolism in a 26-year-old patient with a medical history of (SARS-CoV2) and newly discovered diabetes. The clinical examination found exertional dyspnea, intense chest pain, blood pressure at 145/85mmHg, heart rate at 129 bpm, respiratory rate at 25 cycles/min, blood sugar at 1.45 g/l, oxygen saturation at 92%. In front of this clinical picture, the thoracic CT angiography to ask shows a pulmonary embolism of the right segmental and sub-segmental branches less marked on the left, involving the lingular and basal branches; the management was limited to anticoagulation associated with rehabilitation sessions (respiratory physiotherapy).

Ectopic Pelvic Leiomyoma and Diagnostic Difficulty in Imaging: A Case Report from Conakry, Guinea

Introduction: Fibromyomas are benign tumours of frequent uterine location, most often found in black women, whose diagnosis of certainty is histological. The extra uterine location is rare and the physio-pathogenesis is poorly understood. This location poses diagnostic problems on imaging. Management is based on tumour resection. Observation: The authors report a clinical case of a 31-year-old woman who was seen for non-febrile hypogastric pain with a large abdominopelvic mass on physical examination. There was no particular history. The biology did not show any abnormality. Ultrasound with Doppler found a mass that was difficult to characterize, and was completed by a CT scan and a pelvic MRI. The management was surgical with an evolution marked by complications. Conclusion: Ectopic leiomyoma is a rare condition. This location poses diagnostic problems on imaging. Management depends on the type of extra uterine presentation of the myoma.