Ghana, with a population of 26 million, has three radiotherapy centres, one nuclear medicine centre, and several hundreds of diagnostic radiology centres. At present, over 7,000 new and follow-up cancer cases are recorded at the radiotherapy centres annually. Most of these patients are referred to undergo medical imaging procedures as part of the overall management of the diseases.
The National Programme in Medical Physics Audits was instituted in 2016 based on recommendations of the IAEA publications on QA audits in radiotherapy (QUATRO), diagnostic radiology (QUAADRIL) and nuclear medicine (QUANUM) to cover local and international needs of Ghana. The project is spearheaded by the Ghana Society for Medical Physics (GSMP) and the Radiological and Medical Sciences Research Institute (RAMSRI) of the Ghana Atomic Energy Commission, and with the support of the International Atomic Energy Agency (IAEA). It aims to implement a national QA audit network programme for coordinated and sustainable audits of Radiotherapy, Diagnostic Radiology and Nuclear Medicine practices in Ghana. The programme is sectioned into three parts (i.e. Radiotherapy, Diagnostic Radiology and Nuclear Medicine), with Radiotherapy being rolled out first followed by Diagnostic Radiology.
The programme started in the third quarter of 2016 with an audit of all three radiotherapy centres by teams of carefully selected senior Medical Physics auditors. Selected junior physicists were also added to shadow the senior colleagues as a means of receiving training. The teams audited the Radiotherapy Centres at Korle-Bu Teaching Hospital, Komfo Anokye Teaching Hospital and the Sweden Ghana Medical Centre. The audit exercise covered the evaluation of elements such as staffing, equipment and procedures, patient protection, safety, and the general performance of the various radiotherapy departments. Reports from the audits have been submitted to management of the radiotherapy centres and recommendations made for improvement of procedures. Follow-ups are planned to be undertaken at the centres to assess the implementation of recommendations.
Audit of Diagnostic Radiology Centres are planned to commence in 2017 with Nuclear Medicine following in 2018. The audit exercises are instituted to ensure credibility of the quality of diagnosis and radiation treatment being offered to patients who patronize the radiological health facilities. It is expected to lead to an improved patient care with the objective of maximizing the effect of clinical outcomes and minimizing harm to the patient, staff and society as a whole. The radiotherapy audits have so far received great interest from management of the centres. Some areas have been identified by the audit teams for improvement.
The audit programmes is not designed for regulatory or inspection purposes, investigation of accidents or reporting medical events. Audits under the programme are purely voluntary, with the audit request(s) originating from the radiological department to be audited. This ensures maximum cooperation of the audited centres. The audit programme comprises both internal and external audits of facilities. Participating facilities are encouraged to undergo regular internal audits within good quality systems, while external audits are conducted to serve as peer review assessment of facilities by qualified personnel of other institutions. The value of external audits lies mainly in providing the audit with a broader perspective. This removes the possible inability of internal auditors to recognize, in their own environment, the weaknesses and limitations which may involve long-standing or routine practices. The external auditors are able to better judge the consistency of procedures from one health care service to another and from one user to another.