What Nigerians must know about CT scans, mammograms —Adekanmi

In this interview, President, Society of Cardiovascular Radiology in Nigeria and the acting head of the department of Radiology at the University College Hospital (UCH), Ibadan, Dr Ademola Adekanmi, speaks with Sade Oguntola about CT scans and mammography, and why it is better for Nigerians to have the tests conducted in Federal Government’s facilities.

PEOPLE always talk about getting a CT scan or a mammogram. What are these tests?

These are radiological investigations that help detect diseases affecting different parts of the body and the breasts. Computed Tomography (CT) shows disease processes ongoing in the body. Mammography on the other hand is simply a test to detect or confirm suspected breast diseases. CT and mammography equipment are high-end imaging modalities to make diagnosis of different diseases that may affect the body. And, in some instances, they are used to guide some interventional procedures.

A CT scan uses X-ray and a computer to create detailed images of any body part. CT scans help detect various injuries and diseases, including certain cancers and tumours, broken bones, blood clots in the lung vessels, heart diseases, lung diseases, liver diseases, kidney diseases and bowel disorders such as bowel inflammation and bowel tumours. The CT is also very useful in detecting brain infections, tumours or vessel diseases in the brain, kidney stones, spinal injury, spinal infection and masses, e.t.c. For example, it can show the extent of injuries and bleeding in the brain, skull fractures in patients that suffer road traffic accidents or from blunt trauma or fall from a height. It can also differentiate what type of stroke an individual may have.

In addition, CT scans can also be used for guiding biopsies (taking tissue samples for tests) in preparation for surgery or other treatment and also to guide pathological fluid drainage. Contrast agents (medical dye) are frequently used during CT examinations to improve the detection/visibility of abnormalities.

On the other hand, a mammogram is an X-ray picture of the breast. Doctors use a mammogram to look for early signs of breast cancer. If there is auspicious mass within the breast, some tissue will be removed (biopsy) and examined under a microscope to determine if it is cancerous or not. The procedure also detects breast problems like benign tumours and cysts. A major advantage of a mammogram is that it can detect early breast cancers before they can be felt or show any clinical symptoms. In the developed world, there are many breast cancer survivors because of mammography, which ensures early detection of breast cancer cases and prompt commencement of appropriate treatment.

 

Facilities for CT scans and mammograms are everywhere in Nigeria. How can patients identify the centre to patronise for the best imaging results?

It might be difficult for patients to identify centres with facilities for CT scans and mammography to go to for imaging. However, I will say that attending physicians in and outside UCH are aware of centres that have the high-end CT scan and mammography equipment. In UCH for example, these high-end equipment are available. A major advantage of seeking medical treatment in UCH, a federal tertiary and referral hospital, is the availability of highly specialised and experienced doctors in various subspecialties of Medicine and Surgery as well as researchers of high repute. There are highly specialised doctors that accurately interpret the images from these tests, thereby helping the managing physicians in instituting prompt and appropriate treatment.

Also, UCH is one of Nigeria’s few centres with such sophisticated machines. Our CT scanner can check the bowel to see if there are masses or polyps within it (CT colonography); check the blood vessels that supply the heart for blockages. For instance, a CT angiography is very useful to rule out a blood clot in the blood vessel supplying the lungs, what is medically called pulmonary embolism. Sometimes we hear that some people that are apparently healthy suddenly collapse and die, probably from a heart attack. A cardiac CT scan screening, in adults above 40 years, would have detected narrowing of the blood vessels supplying the heart from atherosclerosis, in appropriate cases or show other cardiac lesions at an early stage. These heart conditions, if detected early and appropriately managed, could prevent the worsening of the condition and the possible sudden collapse and death. Cardiac CT is one test the CT machine at the UCH Ibadan can do.

Of course, our mammography machine does three-dimensional breast imaging; most of the ones available around can only do two-dimensional imaging of the breast. It can also do tomosynthesis, meaning that it can show pictures of the breast in many thin sections, making it easier to pick extremely small or hidden lesions within the breast.

In addition, the digital breast tomosynthesis helps to pinpoint the area(s) that looks suspicious for breast masses. The doctor can then take a critical look at it so that no lesion is missed.

With contrast enhanced mammography, a particular area within the breast under study will be seen more clearly. Contrast refers to a dye substance injected into a vein, in this case. If it is a malignant tissue/mass, it will show brighter due to contrast enhancement. Such patients would be referred to surgeons who can take the appropriate steps at the right time. So basically, our CT scan and mammography units can do more tests and see diseases more clearly than conventional machines around.

 

Are these facilities also available for non-patients of UCH, who come in with request forms from their physicians?

Yes, we also attend to walk-in patients referred to UCH for such imaging, in addition to patients treated in UCH and referred for these tests. In the case of mammography, any woman can walk in for a screening mammogram. Women above the age of 40 should have screening mammography for the detection of early breast cancer signs just as we encourage women to have a PAP smear for early cervical cancer detection.

 

Are these tests risky, given that they make use of X-rays for imaging?

The mammography uses a very low dose of X-ray for imaging. Also, a CT scan uses X-ray, although the doses are higher than that of mammography. However, CT tests are only carried out if there is a clear medical reason to do so, so the merits of these tests far outweigh the demerits. For example, if a patient comes for screening mammography and a mass is detected in the breast, and the physicians can manage this condition on time and the patient will be breast cancer-free. It is the same with CT scans as they detect various injuries and diseases, including certain cancers, broken bones, brain injuries, kidney stones, spinal cord injuries and internal bleeding. However, the serious side effects from a mammogram or CT scan due to the use of X-ray are rare, as the doses used for medical imaging are within acceptable limits.

Again, CT and mammography have been in use for decades and, in the past decade, newer technical advancements have greatly improved both the technique and the images, while various dose reduction methods have been developed and are used by these equipment. Nowadays, the radiation risks are negligible, when the right protocol is followed.

 

What are basic preparations to make when coming for these investigations?

For CT scan, it is important to arrive early; no meal before the CT scan, remove any metallic jewellery or clothing. Other specific preparation may be required in some special examinations or in patients on some specific medication. For mammography, no special preparation is required before the test.

 

How cheap are these facilities for individuals that require or want to have either a CT scan or mammogram?

A major goal of the UCH management is to make health accessible at an affordable cost. For example, the cost of mammograms is very minimal and almost free, because of the drive of the UCH Ibadan to make this test accessible to our women, in order to stem the tide of late presentation of breast masses/cancer and the associated mortality in our environment. Also, the cost of CT scan is comparatively cheaper than in other facilities outside the hospital, even with lesser quality machines.

Currently, NHIS covers all ranges of CT examinations. But when it comes to mammography, it only covers mammograms for diagnostic purposes. Screening mammography is not covered yet. Government needs to put screening mammography on NHIS so that many of our women can have access to this examination to pick up suspicious masses early at a time the condition could be adequately treated. In this regard, the government should look more into preventive care rather than curative care, which is comparatively costlier and may not bring about the desired cure.

 

Nobody likes going to government hospitals for care because of the long waiting time. What is like coming for these facilities at UCH?

There are many steps that have been put in place to reduce the waiting time. In addition, the UCH management is constantly improving on making services easily accessible. We have information centres and many staff (service managers) that will enthusiastically direct one to the CT and Mammography suites or any other place you might want to go to in the hospital. Those with request forms for CT scan should just go straight to the CT site and they will be attended to promptly. Those coming for mammography at the two mammography suites will also be attended to promptly. A lot of effort has been directed at and has significantly removed the bureaucracy that could happen in other comparatively big hospitals.