Advancing Radiographic Quality in Resource-Limited Countries: An Audit of Quality Assurance Practices in Ghana

To assess the quality of clinical radiography systems by auditing quality assurance (QA) and radiation protection compliance in Ghanaian diagnostic imaging facilities and by evaluating x-ray exposure indicator (EI) metrics through quality control (QC) testing to assess equipment performance.

An empirical audit assessed QA and radiation protection compliance using internationally harmonized guidelines. Experimental QC tests measured EI metrics using a solid-state x-ray multimeter based on the International Atomic Energy Agency Technical Cooperation Regional Project RAF6/053 protocols. Deviations from standard EI metrics were analyzed to determine compliance.

This study evaluated 43 radiography systems used throughout 41 facilities. One facility had an established QA program with periodic QC measurements. Radiation protection compliance was satisfactory concerning aprons, barriers, and waiting areas; however, no facility had infant immobilization devices. EI deviations were within acceptable tolerances, except the half-value layer, which fell below recommended limits (, 2.9 mm aluminum [Al] but . 2.3 mm Al) in 11 facilities.

Although compliance was high for certain QA and radiation protection guidelines, deficiencies were noted. Lack of QA documentation and essential radiation protection accessories necessitates increased regulatory enforcement, structured training programs, and standardized nationwide QA implementation.

Gaps exist in QA and radiation protection implementation in some Ghanaian radiography facilities. Strengthened regulatory oversight, comprehensive QA and QC practices, and improved radiation protection compliance are essential for enhancing radiographic quality and safety.