Maternal geophagy remains a common cultural and behavioural practice among pregnant women in Ghana, representing a potential pathway for various concurrent exposures, including toxicological, microbial, nutritional, and radiological. This Mini Review synthesises evidence from a wide range of multidisciplinary literature, encompassing mineralogy, toxicology, parasitology, microbiology, nutrition, and radiological science, to provide a comprehensive assessment of maternal geophagy in the Ghanaian context. The reviewed literature consistently indicates that geophagic clays contain elevated concentrations of toxic metals, such as lead, arsenic, cadmium, chromium, and mercury, which often exceed international safety limits. Bioaccessibility studies further demonstrate that metal solubility increases under gastric conditions, suggesting that actual maternal exposure may be underestimated when only considering total concentrations. In addition to chemical hazards, microbial contamination and the presence of geohelminths in commercially sold clays pose infection risks, exacerbated by informal extraction, processing, and handling practices. Emerging evidence specific to Ghana also shows that commonly consumed clays contain naturally occurring radionuclides, such as potassium-40, uranium-238, and thorium-232, which contribute to measurable internal doses that warrant closer examination, especially with repeated ingestion during pregnancy. Overall, these findings highlight maternal geophagy as a multi-hazard exposure pathway involving toxicological, microbial, nutritional, and radiological risks. Significant knowledge gaps remain, including the lack of bioavailability-adjusted radiological dose modelling and limited longitudinal evidence linking geophagy to foetal outcomes. This review highlights the importance of developing integrated exposure assessment frameworks, enhancing regulatory oversight, and implementing targeted public health interventions to address the multifaceted risks associated with maternal geophagy in Ghana.

The study employed high-resolution gamma-ray spectrometry with a p-type extended range germanium coaxial detector to determine the activity concentrations of 40K, 238U, and 232Th in coastal sand samples collected along the western coast of Ghana. The evaluated mean activity concentrations of 40K, 238U, and 232Th in the beach sand were 349.5 +/- 92.8 Bq kg-1, 21.7 +/- 4.4 Bq kg-1 and 19.7 +/- 4.3 Bq kg-1 respectively. The measured mean concentrations of radionuclide levels were then used to estimate radiological hazard indices to assess the potential radiological hazards associated with the measured radionuclide activity levels in the study as well as the excess lifetime cancer risk. The estimated radiological hazard indices and corresponding effective dose indicated that the beach does not pose a significant radiological risk to the public. The average Excess Lifetime Cancer Risk value was 0.2 x 10-3, within the range of 0.074 x 10-3 to 0.958 x 10-3, which is within the globally accepted limit. The Pearson's correlation analysis established a significant contribution of 232Th and 40K to the radiological hazards of the coastal area, whereas 238U showed a negative or weak correlation with the hazard parameters, suggesting its minimal impact. Support Vector Machine with Radial Basis Function Kernel (SVM-RBF) models outperformed Random Forest in predicting radiation-induced cancer risk (RMSE = 0.038, R2 = 0.91), with Annual gonadal dose (AGD) as the dominant predictor. Findings highlight the importance of external exposure monitoring and warrant validation in expanded cohorts. Continued monitoring is recommended to track the possible changes in radionuclide contamination due to agricultural and industrial activities. This study provides baseline data for future research and regulatory purposes within the study area and other coastal regions in Ghana.

In this study, a comprehensive investigation was conducted to determine the radioactivity levels of naturally occurring radioactive materials (NORMs) in heap pads/soil and water samples within and around the operational area of Tarkwa Gold Mine in Ghana. Gamma-ray spectrometry was used to determine the activity concentrations of 238U, 232Th, and 40K in heap pads/soil, and 226Ra, 228Th, and 40K in water samples. The average activity concentrations of 226Ra and 228Th in all water samples were below the World Health Organisation (WHO) recommended guidelines for drinking water. Similarly, the average activity concentrations of measured radionuclides in heap pads/soil samples taken from depths of 0–20 cm and 20–50 cm were found to be below the worldwide average reported values. The annual effective dose to the public was estimated to be around 0.16 mSv, which is below the recommended limit. The values of the hazard indices are also below the recommended limits, implying that if heap pads/soils are used for building purposes and construction, they will not pose any significant radiation hazard. The results of this study indicate that radiation levels are within the natural background radiation levels reported in the literature and are consistent with findings from similar studies conducted in Ghana.

This study provides a general observation of the status of naturally occurring radioactive materials (NORMs) distribution in mining and industrial areas of Ghana in order to establish regional and national data on NORMs. The study includes data on radioactivity concentrations of U-238, Th-232, and K-40 in soils and for water concentrations of Ra-226, Th-228, and K-40 from various mining, oil, and gas communities, as well as water sources used for crop farming and farmlands. The average activity concentrations of U-238, Th-232, and K-40 in the soil samples were found to be 59 ± 16 Bq/kg, 48 ± 15 Bq/kg, and 286 ± 57 Bq/kg, respectively. The average concentration of Ra-226, Th-228, and K-40 in the water samples were found to be 1.62 ± 0.33 Bq/L, 2.08 ± 0.53 Bq/L, and 22.36 ± 3.44 Bq/L, respectively. The estimated average annual effective doses from external and internal exposure pathways in soil and water samples were 0.09 mSv/y and 0.54 mSv/y, respectively. The total annual effective dose resulting from both exposure pathways was calculated to be 0.63 mSv/y, which is below the 1 mSv/y dose limit recommended by the International Commission on Radiological Protection (ICRP) for controlling public radiation exposure. Based on the radiological hazard indices, the majority of the soil samples were found to be suitable as building materials as their respective indices were below the limits except for two sample locations and the sludge and scale samples. The average Excess Lifetime Cancer Risk (ELCR) value of the water samples was 1.6 times greater than the recommended value of 1.16 × 10−3, presenting a relatively higher risk to the public of developing cancer. No significant regional differences in the levels of radioactive elements. The regression models demonstrate strong interrelationships between the studied elements, with high R-squared values suggesting a predictable nature of one element’s concentration based on others.

INTRODUCTION:There is a paucity of large-scale studies reporting organ doses and cancer risks in patients who undergo indication-specific CT examinations. This study estimated organ-specific lifetime attributable risk (LAR) of cancer incidence and mortality among patients who underwent indication-based computed tomography (CT) examinations [(involving abdominopelvic lesion, kidney stones and computed tomography-intravenous urography (CT-IVU)] in about 70% of the functioning CT facilities in Ghana.METHODS:With a total of 1,100 data sets, organ doses were first determined using the National Cancer Institute Dosimetry System for CT (NCICTX) software version 2.1, and LAR values were predicted using the BEIR VII model.RESULTS:The estimated radiation-induced colon cancer risks were likely in 39.4-59.8 out of 100,000 patients who underwent CT because of abdominopelvic lesion. The risk was even higher in CT-IVU examinations (53.3-66.4 patients in 100,000 procedures) but was relatively less (16.8-26.3 patients) in kidney stone procedures. Accordingly, the risk of radiation-induced colon mortality was more common in CT-IVU than in kidney stone procedures (22.7-28.2 versus 7.2-12.5 patients in 100,000 procedures).CONCLUSION:These results call for further optimisation actions for indication-specific CT examinations to appropriately reduce the potential risk levels for patients' protection and safety.

Introduction:to address the challenge of inadequate and non-equitable distribution of diagnostic imaging equipment, countries are encouraged to evaluate the distribution of installed systems and undertake adequate monitoring to ensure equitability. Ghana´s medical imaging resources have been analyzed in this study and evaluated against the status in other countries.Methods:data on registered medical imaging equipment were retrieved from the database of the Nuclear Regulatory Authority and analyzed. The equipment/population ratio was mapped out graphically for the 16 regions of Ghana. Comparison of the equipment/population ratio was made with the situation in other countries.Results:six hundred and seventy-four diagnostic imaging equipment units from 266 medical imaging facilities (2.5 units/facility), comprising computed tomography (CT), general X-ray, dental X-ray, single-photon emission computed tomography (SPECT) gamma camera, fluoroscopy, mammography and magnetic resonance imaging (MRI) were surveyed nationally. None of the imaging systems measured above the Organization for Economic Co-operation and Development (OECD) average imaging units per million populations (u/mp). The overall equipment/population ratio estimated nationally was 21.4 u/mp. Majority of the imaging systems were general X-ray, installed in the Greater Accra and Ashanti regions. The regional estimates of equipment/population ratios were Greater Accra (49.6 u/mp), Ashanti (22.4 u/mp), Western (21.4 u/mp), Eastern (20.6 u/mp), Bono East (20.0 u/mp), Bono (19.2 u/mp), Volta (17.9 u/mp), Upper West (16.7 u/mp), Oti (12.5 u/mp), Central (11.9 u/mp), Northern (8.9 u/mp), Ahafo (8.9 u/mp), Upper East (6.9 u/mp), Western North (6.7 u/mp), Savannah (5.5 u/mp) and North-East (1.7 u/mp).Conclusion:medical imaging equipment shortfall exist across all imaging modalities in Ghana. A wide inter-regional disparity in the distribution of medical imaging equipment exists contrary to WHO´s recommendation for equitable distribution. A concerted national plan will be needed to address the disparity.

BACKGROUND:There is a need to harmonize imaging practices in computed tomography (CT) imaging. This study, therefore, investigated the variability of the basic imaging protocols used for CT imaging of common indications in Ghana in order to generate recommendations for the development of national imaging practice guidelines in CT imaging.METHOD:A cross-sectional study, utilizing a structured online questionnaire, was undertaken (between December 2018 to March 2019) to collect indication-based imaging protocol data (scan coverage, scan series, image quality requirement, slice thickness, reconstruction, scan mode and orientation, required window, AEC usage, scan and breath hold techniques etc.,) across the various CT facilities in the country. Data were analysed and with experts' input, recommendations were made.RESULTS:The imaging protocols used across the CT facilities in the country were largely similar, with a few variabilities for similar examinations. These variabilities were found in scan coverages, series and slice thicknesses. In particular, for a brain tumour examination, 92% of the 25 facilities used both non-contrast and contrast phases while 8% preferred only the IV contrast phase. Seventy percent of all the facilities (n=10) performing pulmonary angiograms in the country also used a two-sequence scan, and others (30%) worked with only the angiogram phase. A majority (89%) of the 19 facilities that were engaged in CT-IVU procedures also used 3-4 scan phases, while 11% preferred a split-bolus technique. None of the facilities employed the low-dose or ultra-low dose protocol for kidney stone examination.CONCLUSIONS:The study's outcome provides an important preliminary roadmap that could lead to the development of imaging practice guidelines to ensure harmonization of imaging practices to improve the protection and safety of patients across the CT facilities.

BACKGROUND:Scan length optimization is a method of optimization which ensures that, imaging is performed to cover just the area of interest without unnecessarily exposing structures that would not add value to answer a given clinical question. PURPOSE:This study assessed the variability and degree of redundant scan coverages along the z-axis of CT examinations of common indications and the associated radiation dose implications in CT facilities in Ghana for optimization measures to be recommended. METHODS:On reconstructed acquired CT images, the study measured extra distances covered above and below anatomical targets for common indications with calibrated calipers across 25 CT facilities. The National Cancer Institute Dosimetry System for CT (NCICT) (Monte Carlo-based-software) was used to simulate the scanning situations and organ dose implications for scans with and without the inclusion of the redundant scan areas. RESULTS:A total of 1,640 patients' CT data sets were used in this study. The results demonstrated that CT imaging utilized varying scan lengths (16.45±21.0-45.99±4.3 cm), and 70.6% of the scans exceeded their pre-defined anatomic boundaries by a mean range of 2.86±1.07-5.81±1.66 cm, thereby resulting in extra patient radiation dose. Hence, scanning without the redundant coverages could generate a dose length product (DLP) reduction of 17.5%, 18.8%, 15.5% and 9.0% without degrading image quality for brain lesion, lung lesion, pulmonary embolism and abdominopelvic lesion CT imaging, respectively, whilst ensuring organ dose reduction of0.8%-79.1%. CONCLUSION:The study strongly recommends that radiographers should avoid the inclusion of redundant areas in CT examinations to reduce organ doses.

Purpose This study was conducted to develop national indication-based DRL values for common indications of adult computed tomography (CT) examinations for clinical application in Ghana. Materials and methods The methodological approach recommended by the International Commission on Radiological Protection (ICRP), Publication 135, for the development of DRLs, was employed. Studies on CT infrastructure, common indications and quality control tests were first undertaken. A sample of 20 CT dose descriptor/quantity data sets were collected from each centre for each indication. Overall, 3960 data sets were collected for all identified common indications from 71.4% of the total CT scanners in Ghana (25/35). The data were collected from image folders reported and accepted by radiologists. The objective image quality was assessed through a signal to noise ratio (SNR) analysis prior to using the data and extracting DRL values. Results Clinical indications and their respective DRL values in terms of volume weighted CT dose index (CTDIvol) and dose length product (DLP) were cerebrovascular accident (CVA)/stroke (77 mGy; 1313 mGy.cm), head trauma/injury (76 mGy; 1596 mGy.cm), brain tumour/space occupying lesion (SOL) (77 mGy; 2696 mGy.cm), lung tumour/cancer (12 mGy; 828 mGy.cm) and chest lesion with chronic kidney disease (CKD) (13 mGy; 467 mGy.cm). Others were abdominopelvic lesion (17 mGy; 1299 mGy.cm), kidney stones (15 mGy; 731 mGy.cm), urothelial malignancy/CT-intravenous urogram (CT-IVU) (11 mGy; 1449 mGy.cm) and pulmonary embolism (PE) (14 mGy; 942 mGy.cm). Conclusion National Indication-based DRL values developed in this study are recommended to be used to manage CT radiation dose in Ghana.

Purpose To assess the status of quality management systems in computed tomography (CT) facilities in Ghana. Methods A questionnaire and quality control measurements were used to assess the status of quality management systems in CT facilities in Ghana. Thirty-one CT facilities took part in the study. The evaluation included quality assurance (QA), quality control (QC), and quality improvement (QI). Results Seventeen (54.8%) of the 31 CT facilities had a QA-QC committee in place to ensure patient protection. Fifteen facilities (48.4%) had documented protocols for CT scanning. Ten facilities (32.3%) lacked QC assessment and recordkeeping after notable repairs. Regular QC check records were available in 20 (64.5%) facilities. All scanners passed the QC assessments; however, none of the facilities had established local diagnostic reference levels. Discussion Quality management systems in some Ghanian CT facilities are unsatisfactory; not all facilities have the needed infrastructure in place for quality management system purposes. Conclusion Quality management systems in Ghanaian CT facilities should be strengthened to optimize patient protection and safety with acceptable image quality.

INTRODUCTION:In Ghana, there is a need to document computed tomography (CT) infrastructure and management systems for the development of interventions to promote CT practices while ensuring patient protection through the establishment of diagnostic reference levels and improved dose management systems.METHODS:A quantitative inquiry using a descriptive, cross-sectional approach was used to collect data, using a semistructured questionnaire related to CT infrastructure and management from the technical heads responsible for CT scanners. Data collected included the scanner characteristics, basic management system and organizational arrangements, number of attending practitioners, clinical indications for CT examinations, and the operation of CT facilities in Ghana.RESULTS:Of the 35 CT scanners installed across the country, 31 were involved in the study. The majority (29%) were Toshiba models. Equipment slices ranged from 1 to 640, of which 45.2% were 16-slice scanners. Many (n = 28, 90.3%) were functioning, and most were installed in the capital city, Accra. The equipment mean age was 7.3 ± 4.4 years, and 25.6% were 10 or more years old. There were 107 operating radiographers, 60 reporting radiologists, and 10 medical physicists employed across the facilities. A total of 204,760 CT examinations were performed yearly (6.8 CT procedures per 1000 people in Ghana). Head CT procedures were the most common, and suspicion of cerebrovascular accident or stroke (32.8%) was the most common indication. Some basic quality management system and policy driving CT infrastructure in Ghana were lacking.CONCLUSION:The results have provided essential information on the status of CT infrastructure and management systems for policy development and planning in CT facilities in Ghana. This study provides those interested in CT services, jobs, or medical equipment investment in Ghana the information needed to make appropriate decisions.

Knowledge of accurate radio-isotopic signatures and chemical constituents is essential in assessing potential radiological hazards to the public and workers from exposure to NORM waste. For that reason, scale and sludge samples from Ghanaian oilfields were assessed using alpha spectrometry, gamma spectrometry, radon monitoring and scanning electron microscope techniques. Activity concentration of 238U, 232Th-series and 40K radionuclides for NORM residues have been evaluated. Fourteen trace elements were also identified and semi-qualitatively quantified. The obtained results clearly reflect that scale and sludge may present radiological risk for workers, public and environment.

Baseline radioactivity levels of naturally occurring radioactive materials within the operational area and surrounding communities of Akyem Gold Mine of Newmont Golden Ridge Limited of Ghana were determined based on direct gamma-ray spectrometry to quantify the radionuclides of interest, namely,238 U,232 Th, and 40 K in soil samples. The average activity concentrations of 238 U,232 Th, and 40 K in the soil samples were 11.90, 11.39, and 139.71 Bq/kg, respectively. For the water samples, the concentration values of gross-alpha and gross-beta for all the water samples were below the Ghana Standards Board (now Ghana Standards Authority) and World Health Organization recommended guideline values for drinking water quality. The annual average effective dose to the public due to gamma ray exposures from the soil samples was estimated to be 0.03 mSv which is below the UNSCEAR 2000 average reference level of 0.07 mSv for public exposure control. The results obtained in this study also show that radiation levels are within the natural background radiation levels found in literature and compare well with the results of similar studies in Ghana.

Studies have been carried out to assess the radiological exposure to the general public from small-scale mining activities in Dunkwa-on-Offin and its surrounding communities. Direct gamma spectrometry was used to determine the concentration of naturally occurring radionuclides 226 Ra (238 U),232 Th, and 40 K in the soil samples. The mean activity concentrations measured for 226 Ra (238 U),232 Th, and 40 K in the soil samples were 25.4 ± 11.1, 29.4 ± 15.6, and 225.9 ± 93.8 Bq/kg, respectively. The total annual effective dose to the public was estimated to be 0.05 mSv. The results, thus, indicate an insignificant exposure of the general public. The radiological parameters assessment as a result of 226 Ra (238 U),232 Th, and 40 K was also carried out. Data established from the study could aid in formulating guidelines, to educate and create awareness on the levels of naturally occurring radionuclides resulting from small-scale mining activities in Dunkwa-on-Offin and Ghana as a whole.

Activity concentrations of radionuclides in water, soil and tuber crops of a major food-producing area in Ghana were investigated. The average gross alpha and beta activities were 0.021 and 0.094 Bq/L, respectively, and are below the guidelines for drinking water and therefore not expected to pose any significant health risk. The average annual effective dose due to ingestion of radionuclide in water ranged from 20.08 to 53.45 μSv/year. The average activity concentration of (238)U, (232)Th, (40)K and (137)Cs in the soil from different farmlands in the study area was 23.19, 31.10, 143.78 and 2.88 Bq/kg, respectively, which is lower than world averages. The determined absorbed dose rate for the farmlands ranged from 23.63 to 50.51 nGy/year, which is within worldwide range of 18 to 93 nGy/year. The activity concentration of (238)U, (232)Th, (40)K and (137)Cs in cassava ranges from 0.38 to 6.73, 1.82 to 10.32, 17.65 to 41.01 and 0.38 to 1.02 Bq/kg, respectively. Additionally, the activity concentration of (238)U, (232)Th, (40)K and (137)Cs in yam also ranges from 0.47 to 4.89, 0.93 to 5.03, 14.19 to 35.07 and 0.34 to 0.89 Bq/kg, respectively. The average concentration ratio for (238)U, (232)Th and (40)K in yam was 0.12, 0.11 and 0.17, respectively, and in cassava was 0.11, 0.12 and 0.2, respectively. None of the radioactivity is expected to cause significant health problems to human beings.

The gross α–β activities of 226Ra, 232Th and 40K in underground water samples were determined and γ spectroscopy measurements made as well. The gross α–β concentrations were measured using a low background gasless automatic α–β counting system calibrated with 241Am and 90Sr standards for α and β, respectively, while γ analyses were carried out using γ spectrometry system coupled to a NaI (TI) detector and measuring assembly. Gross α activities in the water samples varied from 15.7 to 142.7 mBq/L, registering an average value of 40.7 ± 12 mBq/L, whereas gross β activities ranged from 89.3 to 400 mBq/L. The activities of 226Ra, 232Th and 40K were 22.41 ± 6.07, 114.62 ± 13.01 and 227.38 ± 12.16 mBq/L, respectively. The mean annual effective dose due to water consumption was determined to be 7.00 ± 0.86 µSv/year per inhabitant. The gross α–β levels, the activities obtained for the three radionuclides and the annual effective dose were all within the WHO safe limits. This study indicates that underground water in the areas sampled is radiologically safe for consumption.

Studies have been carried out to assess exposure of the public due to natural radioactivity associated with soil, tailing and water at the Bibiani gold mine in Ghana. Concentrations of radionuclides in samples were determined by γ-ray spectrometry using high purity germanium detector. Gross-α and gross-β activity concentrations were also determined for the water samples using a low background gas-less automatic α/β counter. The mean activity concentrations of 238U, 232Th and 40K in soil/tailing samples were 16.1 ± 3.6, 16.6 ± 6.0 and 380 ± 15 bq/kg, respectively. The mean activity concentrations in water samples were 0.20 ± 0.04, 0.38 ± 0.03 and 3.05 ± 0.11 Bq/L for 226Ra, 232Th and 40K respectively. The total annual effective dose to the public was estimated to be 0.125 mSv. The radium equivalent activity, internal hazard index, and external hazard index for all soil/tailing samples are lower than the accepted safety limit value of 370 Bq/kg and 1.0 respectively. The gross-α and gross-β activity concentrations for the water samples were below the World Health Organisation recommended guideline values for drinking water quality. The results indicate an insignificant radiation exposure to the public.

The International Basic Safety Standards requires that all personnel on whom protection and safety depends be trained and qualified. The Radiation Protection Institute of the Ghana Atomic Energy Commission has adopted a systematic approach to training those occupationally exposed to ionizing radiation in the course of their work. In collaboration with the International Atomic Energy Agency several training courses have been implemented at the national level and in the African region. From 1993 to 2008, more than 400 occupationally exposed workers in Ghana were trained on radiation safety. Several African regional training events on radiation safety have also been executed with a total participation number of 583 individuals. The training events have contributed towards upgrading the safety culture within institutions that have participated.

Studies have been carried out in a Goldmine in Ghana to determine the exposure of the public to naturally occurring radioactive materials from processing of gold ore. Direct gamma spectrometry and neutron activation analysis techniques were used to analyse soil, rock, water and dust samples from the mining environment. The mean activity concentrations measured for 238U, 232Th and 40K in the soil/rock samples were 15.2, 26.9 and 157.1 Bq kg − 1, respectively. For the water samples, the mean activity concentrations were 0.54 and 0.41 Bq l − 1) and 7.76 Bq l − 1 for 226Ra, 232Th and 40K, respectively. The mean activity concentrations measured in the dust samples were 4.90 and 2.75 μBq m − 3 for 238U and 232Th, respectively. The total annual effective dose to the public was estimated to be 0.69 mSv. The results in this study compared well with typical world average values. The results indicate an insignificant exposure of the public from the activities of the Goldmine.