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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 3  |  Issue : 2  |  Page : 45-49

Knowledge and perception of the practice of nuclear medicine among physicians in Usmanu Danfodiyo University Teaching Hospital, Sokoto


1 Department of Nuclear Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
2 Department of Haematology and Blood Transfusion, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
3 Department of Community Health, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
4 Radiotherapy, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
5 Department of Nuclear Medicine, Sultan Qaboos University Hospital, Muscat, Oman

Date of Submission09-Sep-2021
Date of Decision06-Jan-2022
Date of Acceptance15-Sep-2022
Date of Web Publication17-Dec-2022

Correspondence Address:
Ahmed Rufai Isah
Departments of Nuclear Medicine, Usmanu Danfodiyo University Teaching Hospital, Sokoto
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jrmt.jrmt_19_21

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  Abstract 


Background: The management of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, since the year 2011 set the machinery to establish a Department of Nuclear Medicine (NM). The objective of this study is to evaluate the physicians' knowledge and perception of the practice of NM, with a view of improving these when NM services commence at UDUTH, Sokoto. Methods: An anonymized electronic questionnaire was used to conduct this cross-sectional study. The questionnaire had three sections, comprising responders' demography, basic knowledge of NM, and physicians' perception of the practice of NM. The data were collated in an Excel spreadsheet (version 16.53, 2019), and the IBM SPSS package (version 27, 2020) was used to conduct the descriptive statistical tests. Results: Seventy-six doctors participated in the study. Of this figure, females were 19 (24.7%), whereas 57 (75.3%) were males. In terms of designation, there were 2 (2.6%) house officers, 22 (28.6%) registrars, 25 (32.5%) senior registrars, and 27 (35.1%) consultants. Fifty-one (67.1%) respondents clearly understand what NM is, while 18 (23.7%) wrongly identified NM as the field of medicine that uses machines that produces radiation to diagnose and treat certain illnesses, 2 (2.6%) respondents did not respond, while 5 (6.6%) were not sure. Only three (2.6%) physicians were able to correctly identify the rays/particles that are used in NM (beta rays, gamma rays, alpha rays, and positron), the majority of 25 (32.9%) identified gamma rays as the only rays used in NM. Conclusion: The study shows low awareness on what NM is about and the perception on the role of NM in clinical practice is also poor. This has demonstrated the need to enlighten them through lecture and seminar presentations. There is a need for the NM centers in the country to collaborate with the referring clinicians with a view to create awareness on the role of NM services and where these services can be accessed.

Keywords: Knowledge, perception of practice, nuclear medicine


How to cite this article:
Isah AR, Abdulqadir I, Adamu H, Aliyu UM, Abubakar S, Yunusa GH, Jawa ZM. Knowledge and perception of the practice of nuclear medicine among physicians in Usmanu Danfodiyo University Teaching Hospital, Sokoto. J Radiat Med Trop 2022;3:45-9

How to cite this URL:
Isah AR, Abdulqadir I, Adamu H, Aliyu UM, Abubakar S, Yunusa GH, Jawa ZM. Knowledge and perception of the practice of nuclear medicine among physicians in Usmanu Danfodiyo University Teaching Hospital, Sokoto. J Radiat Med Trop [serial online] 2022 [cited 2023 Feb 5];3:45-9. Available from: http://www.jrmt.org/text.asp?2022/3/2/45/364177




  Introduction Top


Nuclear medicine (NM) is a field of medicine that utilizes radioisotopes in the diagnosis and treatment of certain disease conditions. This field is of tremendous help in the management of patients as it images physiological changes which are often the earliest changes to occur in the pathophysiology of the disease.[1] This enables NM physicians to correctly diagnose diseases much earlier, compared to anatomical imaging which provides information on morphology that is present at a later stage of the disease.[2]

The field mainly utilizes unstable atoms (radionuclides) that produce either gamma rays or positrons to acquire images using a gamma camera and positron emission tomography camera, (PET camera), respectively.[3] It also utilizes beta or alpha rays emitting radionuclides, whereby the radionuclides are tagged with pharmaceuticals, to enhance delivery to the site of action, to treat certain illnesses — both benign (hyperthyroidism)[4] and malignant for example, well-differentiated thyroid cancer, neuroendocrine tumors, and advanced prostate cancers.[5]

In Nigeria, three functioning NM centers exist; one each in National Hospital Abuja (NHA),[6] Evercare Hospital, Lagos, and University College Hospital, Ibadan (UCH).[7]

The management of Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto, since the year 2011 set the machinery to establish a Department of NM by way of training of staff and procurement of NM equipment. This preparation has reached an advanced stage and hence the need to create awareness among the hospital community.

The objective of this study is to evaluate the referring physicians' knowledge and perception of the practice of NM, with a view to improving these when NM services commence.


  Research Methodology Top


Design and data collection

It was a cross-sectional study that was conducted in UDUTH, the center that provides tertiary services to all the neighboring states of Kano, Katsina, Zamfara, Kebbi, Niger, and Kwara States. The study utilized an anonymous questionnaire which was administered electronically (https://forms.gle/kxL1DyVi9fhBiF7T7) through Google Forms to clinicians in all medical and surgical specialties at UDUTH. This questionnaire was divided into three parts: the first section includes questions about the responders' age, gender, level of qualification, medical specialty, and years of practice; the second section includes multi-structured questions evaluating the basic knowledge of NM; and the third section asks questions assessing the perception of NM practice among the respondents. The questionnaire was initially tested in University of Ilorin Teaching Hospital to check for any ambiguity.

Data processing

The data were entered into the Excel spreadsheet (version 16.53, 2019). Excel and SPSS packages (version 27, 2020, IBM, Chicago, IL, USA) were used for descriptive statistical tests.

Research limitations

Low response by the responders was the only limitation we encountered during the study.

Ethical issues

No respondents' detail was used in the final report. Confidentiality was maintained throughout the study in line with the Helsinki declaration.[8]

Ethical clearance was obtained from the Health Research and Ethical Committee of UDUTH, Sokoto.

Funding

This was a cross-sectional study; a self-administered questionnaire was used. The cost of stationaries, photocopying, and printing was borne by the researchers.


  Results Top


Demographics

Seventy-six doctors participated in the study. The demographic of the participants for the gender showed that females were 19 (24.7%), whereas 57 (75.3%) were males. In terms of designation, there were 2 (2.6%) house officers, 22 (28.6%) registrars, 25 (32.5%) senior registrars, and 27 (35.1%) consultants. Of the 76 respondents, 54.5% were between 30 and 39 years of age, 31.2% were between 40 and 49 years, and 6.5% were between 20–29 and 50–59 years of age. The largest group of respondents (18%) was from the radiology department, while the distribution of the rest of the respondents is shown in [Table 1]. Forty respondents have between 10 and 19 years of practice, 28 respondents have between 0 and 9 years, 7 respondents have between 20 and 29, and 1 respondent has more than 30 years of practice.
Table 1: Distribution of frequencies of respondent's department

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Fifty-one (67.1%) respondents clearly understand NM is a field of medicine that uses unsealed radioactive sources to diagnose and treat certain illnesses, while 18 (23.7%) wrongly identified NM as the field of medicine that uses machines that produce radiation to diagnose and treat certain illnesses, 2 (2.6%) respondents did not respond, while 5 (6.6%) were not sure. Sixty-nine (90.8%) respondents knew there is a difference between nuclear imaging and radiological imaging, six (7.9%) were not sure, while only one (1.3%) did not respond. Of these 69 respondents that knew NM imaging is different from radiological imaging, 64 (92.8%) respondents correctly identified radiological imaging provides information on anatomy and morphology while nuclear imaging provides information on physiology and metabolism, and the remaining 5 (7.2%) were not sure.

Only 8 (10.5%) respondents were fully aware of functioning NM centers in Nigeria as UCH, Ibadan, National Hospital Abuja (NHA), and Evercare Hospital Lagos, the rest of the respondents showed variable responses as shown in [Figure 1].
Figure 1: Respondents' awareness on nuclear medicine centers in Nigeria

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Nineteen (24.7%) doctors responded that textbooks were the main source of knowledge of NM while the remaining showed various responses as shown in the pie chart [Figure 2].
Figure 2: Pie chart showing distribution of respondents' source of NM knowledge. NM: Nuclear Medicine

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Only 3 (2.6%) physicians were able to correctly identify the rays/particles that are used in NM (beta rays, gamma rays, alpha rays, and positron), the majority of 25 (32.9%) identified gamma rays as the only rays used in NM. The remaining participants had various responses as shown in [Figure 3]. Majority of the respondents 29 (38.2%) correctly identified the machines used in NM, the remaining participants' responses are shown in [Figure 4].
Figure 3: Respondents' response to: Can you identify rays/particles used in NM?. NM: Nuclear Medicine

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Figure 4: Respondents' response to: Which of the following equipment is (are) used for imaging in Nuclear Medicine Department?

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Of all the participants, only 11 (14.5%) knew that the radiological images have better resolution compared to the NM images, 52 (68.4%) of the participants thought otherwise, while 13 (17.1%) were not sure of the answer.

Twenty-five (32.9%) respondents have been to NM before, while 49 (64.5%) have not, and the remaining 2 (2.6%) were not sure. The majority of our respondents 63 (82.9) did not access the services of NM before, only 13 (17.1%) had. Of the 13 that have accessed the services, 12 (92.3%) were in their practice, while 1 (7.7%) was a patient's relative.

Sixty-eight (89.5%) of the participants believe their patients may require the services of NM in UDUTH when it becomes available while 2 (2.6%) of the respondents believe otherwise. However, five (6.6%) were not sure and only one participant did not respond to the question.

The two questions asked to assess the participants' knowledge on the role of NM in both diagnosis and therapy showed that the majority had partial knowledge and their responses were incomplete as shown in the two bar charts [Figure 5] and [Figure 6].
Figure 5: Bar chart showing respondents' response to: Nuclear Medicine has diagnostic role in which of the following disease conditions: (a) Differentiating osteomyelitis and cellulitis (b) Detection of parathyroid adenoma, (c) Assessment of skeletal metastases, (d) Assessment of renal function

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Figure 6: Bar chart showing distribution of respondents' response to: Nuclear medicine has a therapeutic role in which of the following disease conditions? (a) Follicular thyroid cancer, (b) Hyperthyroidism, (c) Prostate cancer

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A comparison made between respondents' departments and knowledge of NM showed radiology and surgery departments have the highest respondents with good knowledge of NM as shown in [Figure 7]. Respondents with between 10 and 19 years of practice showed the highest knowledge of NM [Figure 8].
Figure 7: Comparison of respondents' department and knowledge of NM. NM: Nuclear Medicine

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Figure 8: Comparison of years of practice of respondents and knowledge of NM. NM: Nuclear Medicine

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  Discussion Top


This study to assess the knowledge and perception of the practice of NM among doctors in UDUTH was the second of its kind in the country. A similar survey was done in UCH Ibadan.[9] Only 76 doctors among all the cadres in the hospital responded to our electronic questionnaire sent out over 8-month period. The low response rate may adversely affect the conclusions that would be drawn from this study.

Allowing for the low response rate, of the 76 doctors that responded, house officers had the least participants, and only 2 responded. This has shown the area that our emphasis on awareness should focus. Of the 76 that responded, there was a huge gender difference, with 57 male respondents.

The majority of our participants were between 30 and 39 years and in their early years of practice (10–19 years). The radiology department has the highest number with a total of 19 participants.

Our study has clearly identified that there is a clear awareness of NM among the physicians in UDUTH, 67.1% of the respondents correctly identified the definition provided by the researchers. This could be as a result of efforts put in place by the first nuclear physician in the hospital. Only 12 respondents were not able to differentiate nuclear imaging from radiological imaging. The majority stated that textbooks were their main source of this information. This is no different from what Alonge et al. got from UCH Ibadan, this is likely because the availability of NM in Nigeria has remained unchanged. Only 8% knew how many functioning NM centers exist in Nigeria, this has clearly shown that most of our doctors have not been referring their patients to access these services possibly because of the problem of availability or the pioneer centers have done little to raise awareness. This has clearly demonstrated the need to create more awareness of the role NM has in clinical practice and advocate the opening of many more NM centers in the country.

In general, our respondents have little knowledge on the type of rays that are being used in NM practice, only 3% correctly identified them. About 25% of them thought it is only gamma rays that are used. This is possible because we only have gamma cameras in the country. Similarly, the finding of only third of the respondents indicating that gamma cameras and PET scanners are NM equipment is consistent with the low knowledge of NM among respondents. Unfortunately, a similar study conducted in UCH Ibadan did not include this question in their questionnaire.

Only 32.9% of our doctors in UDUTH have been to functional NM centers either within or outside the country. Twelve of our respondents ever referred the patient for NM services while one respondent visited the center as a patient relative. This is possible because of the unavailability and inaccessibility of these services in the country.

While the majority (89.5%) agreed that their patients would benefit from the new NM center in UDUTH, a lot of them did not know the role of NM in both diagnostic and therapy as shown by the two questions the researchers asked one each for diagnosis and therapy. Only about 10% of them were able to identify complete answers. This is similar to what Dasgupta and Ryan found in their study before intervention.[10] This again has further reiterated the need to enlighten them on the role of NM in both diagnosis and treatment of a lot of sicknesses, and inform them where such services are available in Nigeria.

There was no significant difference in awareness of NM among the designation of house officer, registrar, senior registrar, and consultant in UDUTH, only two house officers responded and both were able to give correct responses in assessing their knowledge. However, our analysis showed a majority (40%) of the respondents that were able to give correct responses in assessing their knowledge had between 10 and 19 years of practice [Figure 5], this likely showed younger doctors irrespective of their designation are better informed.


  Conclusion Top


This study shows low awareness on what NM is about and the perception on the role of NM in clinical practice is also poor. This has demonstrated the need to enlighten them through lecture and seminar presentations.

There is a need for the NM centers in the country to collaborate with the referring clinicians with a view to create awareness on the role of NM services and where these services can be accessed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Joint I, Organization WH. The medical uses of ionizing radiation and radioisotopes: Report of a Joint IAEA. Geneva, Switzerland: World Health Organization; 1972.  Back to cited text no. 1
    
2.
Pomper M, VanBrocklin H, Anderson C. What is molecular imaging? Virginia, USA: Soc Nuclear Med; 2008.  Back to cited text no. 2
    
3.
Ziessman HA, O'Malley JP, Thrall JH. Nuclear Medicine: The Requisites E-Book. Philadelphia, USA: Elsevier Health Sciences; 2013.  Back to cited text no. 3
    
4.
Isah AR, Kotze T. Efficacy of single fixed dose of radioiodine (I 131) therapy in patients treated for hyperthyroidism at nuclear medicine department of Groote Schuur Hospital (GSH). West Afr J Med 2020;37:349-54.  Back to cited text no. 4
    
5.
Assadi M, Pirayesh E, Rekabpour SJ, Zohrabi F, Jafari E, Nabipour I, et al. 177Lu-PSMA and 177Lu-DOTATATE therapy in a patient with metastatic castration-resistant prostate cancer and neuroendocrine differentiation. Clin Nucl Med 2019;44:978-80.  Back to cited text no. 5
    
6.
Jawa ZM, Ahmed RI, Oniyangi O, Ononiwu UN. Renography in children seen at national hospital, Abuja. Afr J Paediatr Nephrol 2016;3:65-9.  Back to cited text no. 6
    
7.
Orunmuyi AT, Lawal IO, Omofuma OO, Taiwo OJ, Sathekge MM. Underutilisation of nuclear medicine scans at a regional hospital in Nigeria: Need for implementation research. Ecancermedicalscience 2020;14:1093.  Back to cited text no. 7
    
8.
World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. J Am Coll Dent 2014;81:14-8.  Back to cited text no. 8
    
9.
Alonge TO, Okoje VN. Perception of the role of nuclear medicine in clinical practice in Nigeria. J Nucl Med 2008;49:15N-6N.  Back to cited text no. 9
    
10.
Dasgupta DJ, Ryan PJ. Awareness and understanding of nuclear medicine among junior doctors in a district general hospital setting: An audit and personal experiences. Nucl Med Commun 2010;31:1004-7.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1]



 

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