CHAPTER ONE

1.0 INTRODUCTION
1.1 BACKGROUND
Radiography is a science, which integrates scientific knowledge and technical sk
ills with effective patient interaction to provide quality patient care and usef
ul diagnostic information (Council for the Professions Complementary to Medicine
(CPCM), 2006). This then requires the services of a radiographer who may be def
ined as a practitioner and or prescriber, who performs the radiographic examinat
ions that creates the images needed for diagnosis in accordance with established
protocols and guidelines (CPCM, 2006). Thus radiographers shall maintain knowle
dge about radiation protection and safety principles, implement these principles
and use professional and ethical judgment when performing their duties (CPCM, 2
006)
For many years, the search and ultimate realization of quality diagnostic radiog
raphs which do not compromise on the vested interest and total safety of the pat
ient has been echoed repeatedly with a unified call for best professional and et
hical practices to be observed in the practice of diagnostic radiography. These
ethical practices concern the professional’s conduct or behaviour and practice whe
n carrying out professional work. The introduction of codes of conduct and codes
of practice is common with many professional bodies for their members to observ
e, and to enhance the image of the profession they practice (http://www.is.cityu
.edu.hk. Accessed 15th November 2006).
Radiographers’ specific expertise is related to imaging (X-rays, nuclear medicine,
ultrasound and MRI examinations), radiation protection as well as radiation sur
veillance (Society of Radiographers in Finland, 2000). Some basic ethical princi
ples observed in the practice of radiography, includes beneficence, which requir
es that people are treated in an ethical manner by respecting their decisions, p
rotecting them from harm, and making efforts to secure their well-being (Barron
and Kim, 2003), and also balancing treatment against the risks and costs that th
e patient may incur (The Ethox Centre, 2004). Radiographers, thus have a duty of
care towards patients they accept for imaging procedures and must act in a mann
er appropriate to the standards of care imposed by law (College of Radiographers
(CoR), 2002), and strictly ensuring that they act in a way that ultimately benef
its the patient (The Ethox Centre, 2004).
The standards of care in the profession of radiography, also requires radiograph
ers to ensure the highest quality of service at their practice to their patients
(Sherer, et al, 2002).

1.2 STATEMENT OF PROBLEM

Presently there has not been any published study, specifically carried out to fo
cus on the practice of professional ethics among radiographers in Ghana. Current
ly, the unknown status of the level of practiced professional ethics, coupled wi
th the unavailability of a clearly defined code of Professional conduct for the
practice of radiography in Ghana is likely to create a situation which could pos
sibly cause a high level of unrivalled legal and administrative actions being ta
ken against radiographers, if left unchecked.

1.3 AIM
This research aims to investigate the extent to which best professional ethics a
re applied in the practice of radiography in Ghana.
1.4 SPECIFIC OBJECTIVES
1To verify the extent to which professionally ethical practices are applied in t
he radiography practice in Ghana.
2To establish the possible medico-legal liabilities which radiographers could be
exposed to in the course of their clinical duties
1.5 JUSTIFICATION
Presently no published studies have specifically been carried out to focus on th
e practice of professional ethics among radiographers in Ghana and therefore the
results of this study may serve as a reliable source of reference for informati
on in this regard and for the purpose of general administrative management. The
research would also serve to help readers and colleague radiographers in their e
ndeavour to understand medico-legal issues which would lead to the avoidance of
any potential legal liability with respect to malpractice and patients’ bill of ri
ghts in the practice of radiography.

CHAPTER TWO
2.0 LITERATURE REVIEW
2.1 INTRODUCTION TO PROFESSIONAL ETHICS
World Health Organization (WHO) reports that appropriate diagnosis requires appr
opriate health care infrastructure, equipment and health professional education
and training (WHO, 2001a), aimed at achieving the set diagnostic goal.
The status of health care worldwide has increased in recent times, and this has
also translated into positive developments in facilities and services rendered.
These developments notwithstanding also come with its own measure of responsibil
ities that is required of professional players in the medical field. These measu
res of responsibilities are as a result of expectations that come with the intro
duction of professionalism in any industry. Ehrlich, McCloskey and Daly (2004) d
efined professionalism with respect to radiography as “A system, organized to gove
rn itself and to effectively set standards of professional behaviour, education,
and qualification to practice and to enforce those standards within its ranks”.
In the practice of ones professional duties, a lot of issues arise, which someti
mes lead to confrontations between staff and patients. Such confrontations could
be physical or verbal at the hospitals, or through law suit at law courts, the
latter being a situation gradually gaining grounds in Ghana, as patients begin t
o demand good services from providers in exchange for fees charged at such facil
ities, as in the case of the law suit brought against Korle Bu Teaching Hospital
and three of its doctors for negligence by 14 year old Master Frank Darko, an a
ggrieved patient (Ghana News Agency (GNA), 2006a ), it has been realised that n
o matter how small or large the amount charged, collection of such fees is assum
ed to be acceptance of responsibilities towards the total wellbeing of the patie
nt. In order to avert such legal tussles, it is important that radiographers ar
e assured that medical imaging procedures are performed following the receipt of
appropriate request and only where appropriate patient consent has been obtaine
d be it written, verbal or implied (CoR, 2002)
It is worth noting that, certain unethical practices might be carried out agains
t patients by some professionals, with the aim of cutting cost and saving time.
This may however introduce compromises on the part of the radiographer which cou
ld affect patient satisfaction and comfort, and may lead to varying medico-legal
implications.
It is basic requirement that, patients, should not only be made aware of what th
e specific procedure they will be undergoing and what it involves, but also they
must be informed of what needs to be done, if anything, as a follow-up to their
examination (Sherer et al,2002).
Radiographers are expected to respect the rights of patients, and act in coopera
tion with the patients and their relatives when required (Society of Radiographe
rs in Finland, 2000). According to the society, the relation between radiographe
rs and their patients should be based on an open interaction and mutual trust, w
ithout compromising the confidentiality regarding the patient’s person, life or tr
eatment. This then requires that the consent of the patient is sort in all cases
be it verbal or written, and it also relies on the radiographer to ensure the s
afety of such patients and their relatives that might be called in to assist. Fa
ilure to observe such protocols, can lead to several unfavourable responses from
patients who may carry negative impressions about the departments they visit, a
nd such impressions might just fall short of legal or administrative actions bei
ng taken by the patients against radiographers or their departments. To avert su
ch situations it is recommended that the radiographer adequately educates the pa
tient prior to the radiographic procedure, on what the patient might be undergoi
ng as part of the whole exercise (Sherer, et al, 2002).
Sherer et al,(2002) further states that when patients have the right understandi
ng of the potential medical benefit from the imaging procedure, they are more li
kely to overcome any radiation phobia and be willing to assume a small risk of p
ossible biologic damage.
Through appropriate communication, patients can be made to feel that they are ac
tive participants in their own healthcare (Sherer, et al, 2002).
Although some practices could be allowed in certain units as protocol, the inter
est of the patient should be considered paramount. This then requires that the u
nethical radiographer be called to book, since failure to do this, may have the
potential of taking away the tint of nobility in the profession, and replacing t
hat with a negatively tagged profession with no compassion for patients, fellow
healthcare staff and visitors to the department.
“Radiographers are legally responsible and accountable for the result of their Pro
fessional actions caused by act, negligence, omission, or injury” (CoR, 2002, pg 1
5)
While a minimum standard of acceptable performance is appropriate and should be
followed by all Radiographers (diagnostic) in a specific area, it is unrealistic
and highly inappropriate to assume that professional practice is the same in al
l hospitals (CPCM, 2006)
WHO has again stated that, in clinic and hospital settings, to be saved or cured
, one in four patients will need some sort of diagnostic imaging procedures. Ove
r 90% of diagnoses requiring diagnostic imaging can be satisfied if there is a b
asic, general all purpose X-ray and ultrasound equipment in place (WHO, 2001a).
This then requires that training of healthcare professionals should be tailor-ma
de to meet local needs and should include medical, technical and managerial skil
ls. (WHO, 2001a)
The rights of the patient, as captured in the Ghana Health Service (GHS) Patient’s
Charter, as a guide for health professionals to protect the rights of the patie
nt states that “The patient has the right to Quality basic healthcare irrespective
of his/her geographical location” (Ghana Health Service (GHS), 2002a).
Again it is stated that the patient is entitled to full information on his/her c
ondition and management and the possible risks involved except in emergency situ
ations when the patient is unable to make a decision and the need for treatment
is urgent (GHS, 2002a).
Whilst in the care of the radiographer, the safety of the patient is wholly the
responsibility of the radiographer. This includes radiation protection and prote
ction from physical harm, as well as other forms of protection such as in the ca
se of privileged information and the protection of the vested interest of the pa
tient.
It is known that exposure to X-rays creates some risk for both the patient and R
adiographers. It is therefore an essential part of the Radiographer’s ethical resp
onsibility to be knowledgeable about radiation safety and to use this knowledge
to avoid all unnecessary radiation exposure to patients, self and co-workers (Eh
rlich, et al, 2004).
The rightful application of the knowledge of radiation protection protects the p
atient and all others from exposure to unnecessary irradiation, and this is effe
ctively achieved in several ways, but primarily through the application of time
tested radiation protection principles; that is, the time, distance and shieldin
g principles.
These principles state that
1.Provide shielding for gonads, eyes, breast and thyroid, as appropriate
2.Use the fastest films and screens consistent with the necessary film Quality
3.Use at least 100cm SID to limit patient’s exposure from the tube housing leakage
and collimator scatter (Ehrlich, et al, 2004).
These principles allow for greater protection of the patient, whilst ensuring th
at the Radiographer and others around are adequately protected.
Apart from the radiation protection, another, vital form of protection is the pr
otection of privilege information on patient, which is mostly acquired during th
e course of services rendered.
The Code of Ethics of the Ghana Health Service, states that: “All service personne
l shall respect confidential information obtained in the course of their duties.
They shall not disclose such information without the consent of the patient/cli
ent, or person(s) entitled to act on their behalf, except where the disclosure o
f information is required by law or is necessary in the public interest as may b
e required by law” (GHS,2002b).
The Code further states that: “All service personnel shall treat official discussi
ons, correspondence or reports obtained during official duties as confidential e
xcept where disclosure is required by law” (GHS, 2002b).
The vested interest of patients is given a further boost of protection in the GH
S code of Ethics, which clearly states that “no service personnel shall discrimina
te against patients/clients on the grounds of the nature of illness, political a
ffiliation, occupation, disability, culture, ethnicity, language, race, age, gen
der, religion, etc. in the course of performing their duties” (GHS, 2002b). The pa
tient is therefore assured of fair treatment when medical services are required
by such patients.

2.2 NEED FOR KNOWLEDGE AND PRACTICE OF RADIATION PROTECTION

Health problems, causing disability and death, can be avoided or better Controll
ed through early and appropriate diagnosis using X-rays and/or ultrasound imagin
g (WHO, 2001a).
Though the benefits to be derived from the use of such diagnostic equipments men
tioned are enormous for the patient, care should also be taken to ensure that th
e patient is adequately protected from the harmful effect of radiation exposure.
Clearly, exposure to X-rays creates some risk for both the patient and Radiograp
hers. It is therefore an essential part of the Radiographer’s ethical responsibili
ty to be knowledgeable about radiation safety and to use this knowledge to avoid
all unnecessary radiation exposure to patients, self and co-workers (Ehrlich, e
t al, 2004).
This is supported by findings and the now generally accepted No-Threshold princi
ple which indicates that no dose exists below which the risk of damage to cells
does not exist, no dose is considered permissible (Alder and Carlton, 2003).
In applying basic radiation protection and also having in hindsight the No-thres
hold principle, the primary concern, when exposing individuals to radiation, mus
t be for females, especially, those of reproductive or child bearing age, as it
has been recognized for some time that radiation exposure poses specific risks t
o the developing embryo or foetus. (Ehrlich, et al, 2004).
It is now known that irradiation during pregnancy may result in spontaneous abor
tion, congenital defects in the child, increased risk of malignant disease in ch
ildhood, and an increase in significant genetic abnormalities in the children of
parents who were exposed in utero (Ehrlich, et al, 2004).
For this reason, it is essential that the Radiographer considers the possibility
of pregnancy in any female of childbearing age (Ehrlich, et al, 2004).
Radiation Control regulations require that females of child bearing age are advi
sed of the potential radiation hazards before X-ray examinations (Ehrlich, et al
, 2004).
The patient’s history may indicate the possibility of a pregnancy, and specific qu
estion to rule out pregnancy should be a part of any medical history that preced
es the ordering of pelvic or lower abdominal X-ray examinations (Ehrlich, et al,
2004). It is also essential that the radiographer personally clears all doubt o
f pregnancy even when it is apparent that the chances of such occurrence may be
very remote. The Radiographer may confirm this further by verbally asking the fe
male patient of her last menstrual period (LMP).
Some radiology departments still use the 10 day rule, which provides that “non-eme
rgency X-ray examinations of the female abdomen and pelvis are done only during
the first 10 days of the menstrual cycle, the onset of menstruation being consid
ered as day 1” is strictly adhered to, and used as a means of screening potentiall
y pregnant patients before radiographic examinations (Ehrlich, et al, 2004).
It is worth noting that, though the application of the 10day rule is proper, nei
ther the 10 day rule nor an early pregnancy test can guarantee that the patient
is not pregnant, but then, these methods can greatly decrease the likelihood of
irradiating an otherwise unsuspected embryo (Ehrlich, et al, 2004).
If the part to be examined is not the abdomen or pelvis, this area can be shield
ed with a lead apron. Where it is very necessary to examine the abdomen or the p
elvis, the number of projections and /or the size of the radiation field may be
minimized, resulting in less radiation exposure than that required for a routine
procedure (Ehrlich, et al, 2004).
Genetic damage results from irradiation of the reproductive cells and consequent
ly as a rule, the most important dose to consider in diagnostic Radiography is t
hat received by the gonads of the subject (Chesney and Chesney, 1986).
As a result of the above effect, it is advised that where practicable, direct sh
ielding of the gonads with a lead apron sheet is clearly an efficient means of r
educing radiation dosage (Chesney and Chesney, 1986).
Gonad shielding, which is a very reliable form of lead shielding prevents unnece
ssary radiation to the reproductive organs and is especially required when the p
atient is of reproductive age or younger, or whenever the gonads are within the
primary radiation field, particularly where there has been enough provision to e
nsure that the shield will not interfere with the examination (Ehrlich, et al, 2
004).

2.3 PROFESSIONAL ETHICS ISSUES

Ethics is defined as a “system of moral principles or rules of behaviour or moral
principles that govern or influences a person’s behaviour” (Oxford advanced learner’s
Dictionary, 1999).
With this definition in mind, it is evident that the day-to-day ethical problems
faced by the healthcare practitioner have as high a percentage of legal consequ
ences as ethical ones, thus Problems related to negligence, informed consent, an
d malpractices are ethical as well as legal issues (Wilson, 1997).
Ehrlich, et al (2004) defined Ethical actions as behaviour that is within the ac
cepted principle of right and wrong, and stated that Group ethical behaviour inc
ludes duties and obligations placed on us by our profession and these essential
principles of ethical behaviour for the group are stated in a document called a
code of Ethics.
Thus since Professionals have important moral duties as captured in the code of
Ethics, they are responsible for knowing and honouring the principles of Ethics
that govern their Professional activities, in order not to fallout with their pr
ofessional bodies (Ehrlich, et al, 2004).
Most individuals outside Professional settings (patients and their relations) ar
e now becoming aware of their legal rights as enshrined in these Professional co
des of Ethics, it has thus become necessary for Professionals to be abreast with
current trends in their practice.
Patterson and Vitello (1993) discussed societal trends that have resulted in a r
enewed emphasis on the study of Ethics. They further stated that Society is aski
ng for greater accountability from all health professions, including Radiography
.
Dowd (1993), in supporting calls for students to study medical law stated that: “R
adiographers must have a basic knowledge of medical law in today’s health care env
ironment. Today, Radiographers are recognized as health care Professionals. Ther
e is an increased responsibility that goes along with this recognition. Today’s pa
tients are customers and expect high levels of service. In past years, physician
s and/or the hospital were solely responsible for the care they delivered, but n
ow the story is different.”
Ehrlich, et al, (2004) emphasized that a code of ethics is a hallmark of any pro
fession because it signifies high principles of professional behaviours and will
ingness by the profession to control its own conduct and that of individual memb
ers.
However a breach of professional confidence is an issue that most professional c
odes speak against.
The Radiographers’ Board of the Council for Professions Supplementary to Medicine
now Health Professions Council (HPC) of the United Kingdom, specifically states
concerning matters of privilege information that “one of the acts of infamous cond
uct by a Radiographer would be to knowingly ‘disclose to any patient, or to any ot
her unauthorized person, the result of any investigations or any other investiga
tion of a personal or confidential nature gained in the course of practice’ of the
Radiographer’s profession (Chesney and Chesney, 1984)
It has been realized that health professionals in the course of their work are g
iven knowledge concerning the personal history of those who consult them, and th
at they must regard such knowledge as strictly confidential, thus developing a b
ond of secrecy between the radiographer and the patient (Chesney and Chesney, 19
84).
This bond of secrecy as suggested by Chesney and Chesney, (1984) applies not onl
y to medical details but to anything which may be discovered about the patient i
n the process of diagnosis or treatment.
Strictly there are only two people with whom Radiographers may freely discuss a
patient and the details of his condition and case history; these two people are
referring clinician and the radiologist to whom the patient has been referred.
In practice however, some discussions of patients must fairly and necessarily ta
ke place between other various members of the hospital staff; for example betwee
n Radiographers and other nursing staff in whose charge the patients rest. These
are legitimate extensions of the triangle of confidence (clinician, patient and
Radiographer) (Chesney and Chesney, 1984), but then the consent of the patient
must be sought if the patient’s identity would be revealed during the discussion.

Radiographers must recognize that, in their work they are certainly placed in th
e category of those who of necessity submit others to procedures which are intri
nsically dangerous, furthermore, the people who suffer these procedures have kno
wn characteristics (fear and discomfort) and as such demands a higher degree of
care (Chesney and Chesney, 1984), and may arrive in altered states of consciousn
ess, in an unfamiliar environment where they have no complete control (Alder and
Carlton, 2003).
In carrying out professional duties, it is the duty of the radiographer to ensur
e the safety of patients, colleagues and self .
It is thus very important as provided by the International Basic Safety Standard
s for Protection against Ionizing Radiation and for the Safety of Radiation Sour
ces (BSS) that “all personnel on whom protection and safety depend, be appropriate
ly trained and qualified so that they understand their responsibilities and perf
orm their duties with appropriate judgement and according to defined procedures” (
International Atomic Energy Agency (IAEA), 2006).

2.4 QUALITY ASSURANCE AND SAFETY MECHANISMS

Quality Assurance is a plan of action to ensure that a diagnostic X-Ray facility
will produce consistent, high-Quality images with a minimum of exposure to pati
ents and personnel (http://www.kodakdental.com – accessed 9th May 2007)
The International Organization for Standardization (ISO) also defines Quality As
surance as well planned and systematic actions needed to provide confidence that
a structure, system or component will perform satisfactorily in service(IAEA, 2
006). Applying these definitions to diagnostic imaging, the World Health Organiz
ation then states that “satisfactory performance in service implies the optimum qu
ality of the entire process, i.e., the consistent production of adequate diagnos
tic information with minimum exposure of both patient and personnel” (IAEA, 2006).

The WHO (2001b) stated in its publication that health and safety issues in any w
ork environment are very important, and thus it is the responsibility of all Hea
ds of Departments to ensure that injuries and sickness due to working conditions
, is kept to a minimum. This can well be achieved if a simple quality assurance.

The benefits derived from a quality assurance and quality control program far ou
tweigh implementation efforts and costs (http://www.kodakdental.com – accessed 9th
May 2007).
The implications of non application of a quality assurance program, may be of va
rying consequences. This may include injury to staff and or patients, absenteeis
m of staff from work, and general reduced efficiency (WHO, 2001b).
Though quality assurance and control is internationally prescribed, it is the ma
in responsibility of the Radiographer to determine an acceptable performance lev
el which is necessary for the provision of safe and effective services and ensur
e that services are performed in a safe environment in accordance with establish
ed guidelines (Ehrlich, et al, 2004)
The Quality Assurance program, apart from aiding diagnosis, when well-executed,
can result in minimized dosage to patients, because radiographs are produced und
er the most favourable conditions (http://www.kodakdental.com – accessed 9th May 2
007)
The above assertions about the positive aspects of Quality Assurance and Control
notwithstanding, Quality Assurance and Control appears to be the weakest link i
n the Radiology department (Boone, 2001).
According to Ehrlich, et al (2004), Quality Assurance can be accomplished in sev
eral stages captured as part of basic standards of good professional practice, b
y the radiographer performing such activities or acquiring information on equipm
ents and materials. These activities provide valid and reliable information rega
rding the performance of materials and equipments (http://www.kodakdental.com -
accessed 9th May 2007).
Though some equipment, by their design may function optimally, it is proper prof
essional practice that Quality Assurance and Control is maintained to safeguard
the continual performance of such systems. Historical instances, such as the int
roduction of the more versatile computed radiography into the domain of diagnost
ic radiography some few years back, came to gain a lot of successes and general
acceptance, which led to the misconception that Quality Control (QC) processes w
ere no longer necessary, especially as early adopters of the system claimed that
repeat rates decreased to zero (Willis, 2004).
It is however now evident that even the computed radiography system is not error
- proof, giving way to the general recognition that QC processes for such system
s are no less important than they are for the conventional screen-film radiograp
hy systems (Willis, 2004).
Willis (2004) further wrote that there are a variety of errors that can result i
n bad computed radiography images, and this means that departments must institut
e QC processes to detect and correct these errors before images are released to
physicians for interpretation.
Since no body can guarantee the efficiency of any equipment or material, the Qua
lity Assurance activities helps to assure the Radiographer that the equipment wo
uld function safely to a large extent (Ehrlich, et al, 2004).
It is a basic understanding of hospital care that equipment used for, and by, pa
tients should be safe and function properly (Parelli, 1994). Accordingly the hos
pital must have some type of system, such as a Quality Control program, to check
equipment and supplies routinely so that all are maintained in proper working o
rder. It is evident that any reasonably prudent Professional Radiographer could
foresee that harm could come to a patient if equipment is not checked and tested
properly (Parelli, 1994), and this could eventually open doors of litigations b
etween patients and Radiographers.
The doctrine of ‘Foreseeability’ is a principle of law that holds an individual liab
le for all the natural and proximate consequences of any negligent acts (actions
or inactions that could result in injury to others) to another individual to wh
om a duty is owed and which could, or should, have been reasonably foreseen unde
r the circumstances, meaning injury actually suffered is related to the foreseea
ble injury, and routine equipment check is important in overcoming this doctrine
(Parelli, 1994).
Documentation of Quality Assurance activities and results is very essential as i
t provides evidence of Quality Assurance activities designed to enhance the safe
ty of patients, the public and health care providers during the diagnostic and t
herapeutic services (Ehrlich, et al, 2004).
It also provides enough legal evidence in resolving any law suit as a result of
an equipment failure leading to patient injury.
There are a minimum number of program elements addressed in a basic Quality Assu
rance program. The first is documentation or records to demonstrate compliance,
which is important because, there must be a written description of the Quality A
ssurance program, as well as test results, observations and associated Quality C
ontrol activities (Commonwealth of Pennsylvania Department of Environmental Prot
ection (DEP), 2006).
Based on documentation, the Radiographer compares and verifies Quality Assurance
 results and testing conditions to established acceptable values and then formul
ates an action plan following verification of testing, evaluate Quality Assuranc
e results and establish an appropriate action plan because, as emphasized by Ehr
lich, et al (2004) materials, equipment and procedure safety depends on ongoing
Quality Assurance activities that evaluate performance based on established guid
elines.
Next are the standards or action levels used to assess Quality and trigger any n
ecessary corrective action, which may call for several aspects of the image and
imaging media to be evaluated: these may include contrast, density, fog, artefac
ts and coverage of the clinical area (DEP, 2006). This is done in order to ident
ify problems associated with the image recording media, image processing or the
x-ray equipment operation (DEP, 2006).
The DEP (2006) advises that for safety, Radiographers must establish and adhere
to optimum exposure technique settings, so as to detect quickly when these setti
ngs no longer yield clinical Quality images, which may give rise for an investig
ation and attempt at resolving the cause.
The final stage involves the implementation of a Quality Assurance action plan s
ince this is imperative for Quality diagnostic, therapeutic procedures and gener
al patient care and safety (Ehrlich, et al, 2004). This may involve putting equi
pment off use indefinitely or getting the problem fixed as soon as possible. Thi
s is done bearing in mind that: “the Quality of images (clinical value) and patien
t safety are most important in Diagnostic Radiography” (DEP, 2006).
It is worth noting that even practitioners of advanced imaging modalities as com
puted radiography, are cognizant of the fact that a Quality Assurance program is
more than a collection of tests and measurements, but an ongoing process that e
ncompasses all activities that affect the Quality and efficiency of the imaging
operation (Willis, 2004).
This, Willis (2004) stated, is a program which includes installation, configurat
ion, calibration, maintenance, and operation of the entire system, and for the p
rogram to be effective, then it requires active participation by all concerned w
ith the usage of the system, example radiologists, radiology administrators, tec
hnologists, clinical engineers, informatics personnel, medical physicists, as we
ll as vendor applications and service personnel.

2.5 MEDICO-LEGAL ISSUES

While Radiographers do their best to give patients the very best in diagnostic a
nd therapeutic services, there is the need to observe some general ethical princ
iples in relation to the work done and the parties involved. This is aimed at av
oiding the several legal tussles commonly associated with unsatisfied clients.
The respect for patient autonomy is generally regarded as one of the central eth
ical principles in medical practice, of which the first is to do with consent, a
nd the second with confidentiality (Hood,€Hope and Dove, 1998).
Informed consent is the principle which when adhered to strictly will help to av
oid legal tussles mentioned above.
It is of importance to state that the key principle underlying the notion of inf
ormed consent is respect for patient autonomy; it is for the patient, not the he
althcare professional, to determine what is in the patient s own best interests,
thus the consent-obtaining procedure must be centred on the patient, in the se
nse that it must be a primary objective to find out what the patient want (hppt:
//www.prs.heacademy.ac.uk Accessed on 9th November 2006).
Litigations have become common in our society today, for this reason, it is impo
rtant that radiographers and other health care workers become familiar with the
moral, ethical and legal implication of their behaviours and performance( Ehrlic
h, et al, 2004).
Legal Doctrines have been developed over the ages to protect the weak in society
. The ‘Doctrine of Informed Consent’ is a legal doctrine that has evolved sociologic
ally with the changing times and the courts have mandated that every patient is
entitled to an informed consent before any procedure can be performed (Parelli,
1994).
It is a general legal and ethical principle that valid consent must be obtained
before starting treatment or physical investigation, or providing personal care,
for a patient. This principle reflects the right of patients to determine what
happens to their own bodies, and is a fundamental part of good practice (Departm
ent of Health (DoH), 2006).
The consent, notwithstanding, must be deemed legally valid, and for consent to b
e valid, it must be given voluntarily by an appropriately informed person (the p
atient or where relevant someone with legal parental responsibility for a patien
t under the age of 12) and appropriately witnessed (DoH, 2006).
The patient upon whom the procedure is to be performed is legally the only one w
ho has authority over his/her body as long as he/she is conscious and competent
(Parelli, 1994). The consent becomes invalid if the patient is intoxicated, unde
r the influence of narcotics, delirious, and/or irrational (Parelli, 1994).
A health Professional who does not respect this principle may be liable to both
legal action by the patient and action by their Professional body (DoH, 2006).
Case Law (“Common Law”) states that an assault is the threat to do bodily harm to an
individual. The act of doing the physical harm is the battery. It is, therefore
, necessary for patients to consent to surgery or medical procedures in order fo
r a charge of assault and battery to be avoided. Consent is the affirmation by t
he patient to have his/her body touched by certain designated individuals such a
s the doctor, nurse, Radiographer and others (Parelli, 1994).
While there is no statute setting out the general principles of consent, Case la
w has established that touching a patient without valid consent may constitute t
he civil or criminal offence of battery. Further, if health Professionals fail t
o obtain proper consent and the patient subsequently suffers harm as a result of
treatment, this may be a factor in a claim of negligence against the health Pro
fessional involved (DoH, 2006).
A proper consent form is thus an important document for evidence in the event of
a dispute regarding the claim that an informed consent was not given (Parelli,
1994). The signed consent would generally be considered presumptive evidence tha
t information to a particular act was given and understood but then though this
is acceptable, the patient may rescind the consent given either verbally or in w
riting at any time; and any time a patient withdraws his consent, it is as thoug
h he/she had never given consent (Parelli, 1994). This means that any procedure
done on a patient who has rescinded his/her consent would be battery (Parelli, 1
994).
Though much of the Case Law refers specifically to doctors, the same principles
could apply to other health Professionals involved in examining or treating pati
ents, as in the case of radiographers (DoH, 2006).
The standard of care required of Professionals by law is not the highest possibl
e to which one can conceivably be expected to conform, nor is it the lowest stan
dard of which one as actually capable. It is between these two extremes- the sta
ndard of “the reasonable man” (Chesney and Chesney, 1984) thus in applying reasoning
professionals can conform to these standards without much hustle.
Health Professionals are advised by the Department of Health of the United Kingd
om that they must remember their duty to keep themselves informed of legal devel
opments which may have a bearing on their practice (DoH, 2006).
Ultimately, based on the afore stated reasoning, it is prudent to state that If
there is one rule that every Radiographer should know and clearly understand, i
t is the fundamental rule of law that every person is liable for his/her own neg
ligent conduct. Known in legal terms as the “Doctrine of Personal Liability” (Parell
i, 1994)
Finally, in all healthcare activities, the patient’s dignity and interest must be
paramount (GHS, 2002a)

CHAPTER THREE
3.0 METHODOLOGY
3.1 STUDY DESIGN
The research was a descriptive quantitative-qualitative survey. The descriptive
quantitative-qualitative survey type was chosen because, it helped the researche
r to compress the data gathered and present them in an easy to understand format
as suggested by Polgar and Thomas (1998).

3.2 STUDY POPULATION AND SITE

The study population included all Radiographers practicing in Ghana at the time
of the sampling exercise.
The survey was carried out in two regions, the Ashanti and Greater Accra Regions
of Ghana, and specifically in thirty (30) Government and Private Health deliver
y facilities, which have Radiography equipments and employing the services of Ra
diographers.
The regions selected were chosen, because, they employed more Radiographers than
all the other eight (8) regions in Ghana combined. (Government of Ghana, Minist
ry of Health – Human Resource Development Division)

3.3.1 SAMPLE SIZE

A non probability sampling method was adopted to obtain the required sample size
from the selected sites, A purposive sampling method, was adopted to obtain the
required sample size of one hundred (100) Radiographers representing 95% of the
population in the selected two regions, and 66% of an estimated nationwide Radi
ographers’ population of one hundred and fifty (150), the method of sampling was s
elected to effectively limit the exercise to the target group of Radiographers f
or this sole purpose (http://faculty.ncwc.edu/toconnor/308/308lect03.htm, acces
sed on 3rd January 2007).
the method was cheap and easier, and since the research was more interested in o
btaining a fair idea of the range of responses on ideas that respondents had in
relation to the topic, it afforded the researcher a fair opportunity to gather e
ffectively such ideas (www.tardis.ed.ac.uk/~kate/qmcweb/s8.htm, accessed 3 Janu
ary 2007). Finally it enabled the study sample size required to be maximized, an
d be representative of the national population.

3.3.2 SAMPLING TOOLS

The descriptive survey was undertaken by means of a structured questionnaire, th
ese comprise 25 close-ended questions, which were issued to respondents to gathe
r the required data. The choice of a questionnaire for this purpose had a lot of
advantages, which included its cheapness in comparison to other methods of data
 collection, safeguarding anonymity, ease of administration and when well design
ed, it ensured easy analysis of responses (Murphy-Black, 2000, pg 302)
The questions were captured under these three sub groupings listed;
1.Demographic data
2.Knowledge and Practice of radiation protection,
3.Medico-legal and Ethical concerns
3.4 VALIDATION AND PRE TESTING
The proposed questionnaire was validated by the supervisors of this research to
determine whether the contents and methods adopted, would serve the desired purp
ose of the research (Carter and Porter, 2000a, pg 31, 32).
Pre-testing of the questionnaire which was meant to test for suitability, ease o
f understanding by potential respondents, and the adequacy of the contents of th
e questionnaire in relation to the research design (Porter and Carter, 2000b,pg
24), was carried out with other staff of the Department of Radiology at Korle Bu
Teaching Hospital. These staff members were however not included in the main sa
mpling exercise as they fell well within the exclusion criteria.

3.5 DATA ANALYSIS

Computation and analysis of the data collected was achieved with the aid of the
Statistical Package for the Social Sciences (SPSS) software (version 11.5) (Bent
on, 2000)
The results have been presented in charts and graphs.
3.6.1 INCLUSION CRITERIA
Respondents selected were Radiographers, currently at post at the selected healt
h delivery facilities as at the time of the sampling exercise.
3.6.2 EXCLUSION CRITERIA
Radiographers on leave, student Radiographers and Technical Assistants.
3.7 ETHICAL CONSIDERATIONS
Ethical clearance for the proposed research was sought from the Ethical Review C
ommittee of the School of Allied Health Sciences (SAHS) of the College of Health
sciences – University of Ghana (Appendix IV).
An informed consent form, was attached to all questionnaires, to be filled by th
e respondents. This was to also fully assure participant’s anonymity and confident
iality of the information obtained in the course of the research (Polgar and Tho
mas, 1998).

CHAPTER FOUR
4.0 RESULTS AND ANALYSIS
FIGURE 1 - Age distribution of respondents in years
The highest number of respondents in a single range. were below the age of 31yea
rs (43%) as at the time of sampling. The least number of respondents however wer
e those above 51 years (6%). The rest of the respondents, combined (31 – 40years a
nd 41 – 50years), made up 51% of the sampled population.
FIGURE 2- Professional qualification(s) held/educational background
Most respondents (58%) were Certificate holders, the least number of respondents
(2%) were Radiographers with Master of Sciences (MSc.).
However the population of the remaining respondents (40%) were either Diploma or
Bachelor of Sciences (BSc.) holders.

FIGURE 3 - Working experience of respondents

Majority of the respondents (35%) had worked for 5 to 10 years whilst the least
representing 16% had worked for 10 to15 years. 28% of the respondents had howeve
r worked for over 15 years.

FIGURE 4 – frequency of Quality Assurance tests carried out on equipments and mate
rials used

*”Other = Respondent has no knowledge of the procedure

Majority of respondents (45%) replied in the affirmative that they carried out r
egular Quality Assurance procedure on all equipments and materials used.
A significant percentage of respondents (41%) did not carry out Quality Assuranc
e procedures on equipments and materials. However a small number of respondents,
(14%) had no knowledge of the procedure.
FIGURE 5 - Kinds of corrective measures taken if Quality Control tests are not w
ithin acceptable limits.
A significant minority stated that they took no action, Majority; however suspen
d use of equipment use and all work till problem is fixed.

FIGURE 6 – Availability and adequacy of shielding /protective lead aprons for use
by respondents

A significant few (30%) of respondents either had none or inadequate protective

lead aprons. Majority (70%) however had enough protective lead aprons.

FIGURE 7 – Types of patients that the lead aprons are used on

Majority (56%) of respondents asserted that they applied lead protection to all
patients. 42% applied them to only pregnant patients, the very least number of r
espondents, (2%) applied them to only children and elderly patients.

FIGURE 8 – Regularity by which Radiographers check their collimators for competenc

e.

No A = No it’s functioning well

Yes O = Yes occasionally
Yes A = Yes always
The minority of respondents (15%) admitted that they did not check their collima
ting devices for competence. Majority (51%) checked their collimators occasional
ly while few (34%) checked their collimators always.
FIGURE 9 – Regularity by which Radiographers check the competence of their lead ap
rons

Other = I don’t check, it’s always in good condition

Figure 9, indicates that a marginal number of respondents (7%) admitted to not c
hecking the competence of their lead aprons, 44% checked their lead aprons regul
arly and majority (49%) checked the competence of their lead aprons occasionally
.

FIGURE 10 – Level of continuous Professional education received by respondents

No N. = No never
Once = Once
Yes P = Yes periodically
Yes R= Yes regularly
From the figure above, the minority of respondents (11%) received regular furthe
r education on Professional Ethics and current trends in the Radiography practic
e. Majority (43%) received periodic education whilst a small number (16%) had ne
ver received any further training. Few of the respondents (30%) had received suc
h education only once.
FIGURE 11 – Conditions under Which Technical Assistants are permitted to X-Ray pat
ients

From figure 11 above, some respondents (20.5%), allowed their Technical Assistan
ts to expose equipments only under their supervision, whilst the minority of res
pondents (13.6%) allowed their Technical Assistants to expose equipments only in
emergency. Meanwhile most respondents (65.9%) Never allow their Technical Assis
tants to expose equipments under any condition.

FIGURE 12 - Types of examinations that Technical Assistants are allowed to perfo

rm

The very least of the Radiographers (3%) allowed their Technical Assistants to r
adiograph only the Extremities of patients. Some (19%) were restricted to only c
hest examinations. few (9%) permitted their Technical Assistants to radiograph a
ny requested part of patient’s body. The majority (69%) never allowed their Techni
cal assistants under any condition to radiograph patients.

FIGURE 13 - Patient legal actions

Results on figure 13 above, indicate that there had been few cases, (6%) of repo
rted legal or administrative actions against staff or colleagues of respondents
by patients. Majority (94%) however expressed their unawareness of the incidence
of any legal or administrative action by patients.

FIGURE 14 - Confirmation of possibility that females age 10 – 55years may not preg
nant?

From figure 14, majority of respondents, (73.9%) ask female patients for their L
ast Menstrual Period (LMP) to confirm that they are not pregnant. A few responde
nts (19.3%) do not confirm LMP from patients. The very minimum (6.8%) however co
llimate to site of interest thus no need to confirm pregnancy.

FIGURE 15 - Seeking of patient consent before discussion of medical records with

other staff
Yes A. = Yes I always seek patient consent before discussing medical records wit
h other staff.
No A. = there is no need, patient is always gone before I discuss such records.
No. B. =No I don’t seek patient consent before discussing their medical records wi
th other staff.
From figure 15 above, majority of respondents (51%) don’t seek prior consent of pa
tients before discussing their medical records with other staff, since they don’t
reveal patients’ identity. A quarter of respondents (25%) found no need as patient
was always gone before they discuss their records. However, the least number of
respondents, (24%) always sought patient consent before the patient left the de
partment.
FIGURE 16 - Discussion of patient records with other staff
A = When patient interest is at stake
B = When writing periodic departmental report
C = Only during clinical meeting
D = Never, I only return them to referring clinician.
Majority of respondents (42%) chose option A, minority of respondents (8%) selec
ted option B, very few of the respondents (19%) selected option C, and a good nu
mber of respondents (31%) selected option D.
FIGURE 17 - Forms of consent taken from patients before radiological examination
s

*Other = Do not seek any consent.

From figure 17, Majority of respondents (68%) only seek verbal consent, a combin
ed 16%, either seek written or implied consent. A somehow significant few (16%)
do not seek any consent.
FIGURE 18 – Explanations given patients on Radiographer’s intentions prior to examin
ations.

Minority (13.6%) of respondents only explain their intentions, only when patient
s seek prior explanation. Majority of respondents (86.4%) always explained the p
rocedure to patients before the procedure for their cooperation.

FIGURE 19 - Knowledge level of Professional Code of Ethics

Majority (60%) of respondents reported that they had in-depth knowledge of the c
ode of Professional Ethics in the Radiography profession, whilst the least (40%)
said they had partial knowledge. No respondent however stated that they were to
tally ignorant of the code of Professional Ethics.

CHAPTER FIVE
5.0 DISCUSSION, CONCLUSSION AND RECOMMENDATION
The research was undertaken to assess the status of Professional Ethics among Gh
anaian Radiographers, the study covered 30 Government and private Healthcare Fac
ilities, ranging from Teaching Hospitals, Polyclinics to Clinics in the two sele
cted regions that utilized the services of Radiographers.
Overall response rate was 88%, with the return of 88 of the total of 100 questio
nnaires sent out. This response rate can be attributed to lack of commitment and
interest in the research area, as well as misplacement of questionnaires by res
pondents.
However, the result could be generalized to truly reflect the real situation as
pertains in Ghana.

5.1 DEMOGRAPHIC DATA

The results obtained from the study indicates that majority of respondents sampl
ed, were below the age of 31years (43%). The next highest number of respondents
fell within the 31-40 years age group, representing 36%. The least number of re
spondents however were those above 51 years (6%).
The population of Certificate holders were the highest (representing 58%). Radio
graphers with Master of Sciences (MSc.) degree were the least populated (2%) How
ever the remaining 40% of the population were either Diploma or Bachelor of Scie
nces (BSc.) degree holders. There was no respondent with Doctor of Philosophy (P
hD) degree. Thus with most of respondents being in the certificate level and not
having upgraded their qualifications, it was most likely that with the current
advancement in Radiography, a lot of the current practitioners are under qualifi
ed, this is also against the background that 2% of respondents having MSc., is w
oefully inadequate for such a rapidly expanding sector in medical sciences in Gh
ana.
Majority of respondents (35%) had worked for periods ranging from 5 to 10 years
whilst the least representing 16% had worked for periods of 10 to15 years. 28% o
f the respondents had however worked for over 15 years.
All of the respondents with MSc. and BSc. had worked for periods ranging from 5y
ears to 15years reflecting the Ministry of health’s policy of mainly sponsoring st
aff who had worked for over three for further education.

5.2THE NEED FOR KNOWLEDGE AND PRACTICE OF RADIATION PROTECTION

The need for knowledge and practice of radiation protection is paramount in the
practice of Radiography worldwide as provided by the Basic Safety Standards (BSS
). However it was evident from the study results (Figure 7) that though most Rad
iographers sampled used lead aprons for protection of patients, only about 56% u
se them for all patients they attend to, 44.% were however selective of the pati
ents they used them on, (42% specifically for pregnant women and 2% for children
and the elderly).
Respondents opting to use the lead aprons for pregnant patients may be due to th
e fact that most practitioners have a misconception that only the foetus in the
mother should be protected.
This is due to the general support given this assertion that irradiation poses s
pecific risks to the developing embryo, or genetic damage to reproductive cells
(Chesney and Chesney, (1986), and Ehrlich, et al, (2004).
But then though being selective in the application of protective lead aprons (4
2% pregnant women only) is supported by literature reviewed, providing that the
primary focus of Radiographers should be in providing protection for females, es
pecially those of reproductive age because as it had been realized that irradiat
ion poses risks to the developing embryo (Chesney and Chesney, (1986), and Ehrli
ch, et al, (2004).
Findings from other researchers, rather suggests that radiation is harmful to al
l those exposed, no matter the dosage, now commonly referred to as the No-Thresh
old Principle, which states that no dose is considered permissible (Alder and Ca
rlton, 2003).
The findings as stated by Alder and Carlton (2003), is supported by the Internat
ional Atomic Energy Agency, which requires that radiation to any individual must
be justified and optimised, in recognition of evidence based facts that signifi
cant continuing radiation exposure causes harmful biological effects (Sherer, et
al, 2002).
The study further revealed on radiation exposure to females of reproductive age,
that a significant majority (73.9%) always confirmed the patient’s last menstrual
Period before performing abdominal or pelvic examinations on them. However, the
other 26.1% did not confirm if patient might be pregnant or not. Of this percen
tage, 6.8% admitted to collimating the beam to reduce irradiating areas not of d
iagnostic interest.
Though this attempt is acceptable in general Radiography, to reduce unnecessary
exposure, the rule is altered, when it has to be applied to females, especially
those of child bearing age. This is to fully ensure that an unseen or unknown fo
etus is not irradiated unnecessarily, and will be adequately protected from furt
her radiation exposure that may lead to several biological defects.
To buttress this assertion, IAEA (2006) writes on optimization of protection and
safety that “In diagnostic medical exposure, keeping the exposure of patients to
the minimum necessary to achieve the required diagnostic objective, while taking
into account norms of acceptable image Quality established by appropriate Profe
ssional bodies is a way that ensures that the embryo or foetus is afforded the s
ame broad level of protection as required for members of the public.
Though the IAEA provides for the optimization of protection and safety as stated
above, it also provides, in the same document, for justification of practices, “b
y weighing the diagnostic benefits they produce against the radiation detriment
they might cause, taking into account the benefits and risks of available altern
ative techniques that do not involve medical radiation exposure as in ultrasound
imaging.
Asked if they regularly checked their collimation devices for competence, 34% st
ated that they always checked, 51% checked occasionally, while 15% answered in t
he negative, since the collimator was functioning well. While the action of the
85% of respondents, who checked the collimators either always or periodically, w
as supported by literature (Parelli,1994; Ehrlich et al, 2004), which provides t
hat equipments must be checked before use to safeguard patient safety and optima
l performance of equipment. The minority (14.8%), who did not check their collim
ators, were acting in contravention to safety provisions in reviewed literature
supporting the checking of equipments for proper function and safety before use.

Thus by refusing to check the competence of the collimators, the possibility of

exposing patients and fellow staff to scatter radiation was very high. Images pr
oduced may not be diagnostic as there may be a lot of scatter that may interfere
with the intended image. The chances of coning off certain vital parts of inter
est are very high, thus necessitating repeat radiographs and a resultant increas
ed patient radiation dose.
A significant majority of respondents confirmed that they had adequate shielding
and protective lead aprons for use in their departments, but then though the IA
EA (2006) has made it mandatory for protective devices to be provided for all ra
diation workers, helpers of patients and patients, the situation on the grounds
did not support this.
The study revealed that 26% of respondents had inadequate shielding or protectiv
e lead aprons for use in their various units. About 3% of respondents had no suc
h protective devices for shielding from scatter radiation. The absence of these
devices may be due to the fact that they have either been relocated, destroyed,
stolen or their location simply unknown due to years of abandonment.
This then exposes patients and their relatives who visit such facilities to unne
cessary irradiation due to the unavailability of these devices. And coupled with
an instance of a non-functioning collimator, then radiation dose to patients wo
uld be substantially increased.
The IAEA (2006) in safeguarding the effectiveness and competence of protective l
ead aprons used in Radiography provides that all aprons should be tested at appr
oximately 12–18 month intervals for shielding integrity.
Though this provision is explicit enough, only 44% of respondents admitted to re
gularly checking the competence of their lead aprons. 49% checked occasionally a
nd 7% did not check at all since the aprons appeared in good conditions for them
.
Though the actions of 44% of the respondents was in agreement with the provision
of IAEA, it is of importance to note that, as there seem to be either inadequac
y in number or none in use for 29.5% of the respondents, the likelihood of putti
ng back into circulation, aprons found to be defective in anyway, remains a grea
t possibility. Reason for this action will be the claim that “it is better to have
half protection than no protection at all”. This may be misleading as it will the
n lead to carelessness with respect to radiation exposure to staff, patients and
relatives.
Giving further support to the issue of radiation protection, the BSS has establi
shed Managerial commitment and policy statement that a “safety culture shall be fo
stered and maintained to encourage a questioning and learning attitude to protec
tion and safety and to discourage complacency in the practice” (IAEA, 2006).
This commitment stated above, can be demonstrated by a written policy that: “In ad
dition to recognizing that the objective of the practice is the diagnosis, treat
ment and well-being of the patients, management assigns the required importance
to radiation protection and safety, which further to, the BSS advises that, this
unambiguous statement should be made known to all concerned and followed with t
he establishment of a radiation protection programme, which includes fostering a
safety culture in the radiology departments (IAEA, 2006).
5.3QUALITY ASSURANCE AND SAFETY MECHANISMS
It is a fact that the Quality of radiographic procedures and outcome is fundamen
tal to the proper diagnosis and treatment of patients (Commonwealth of Pennsylva
nia Department of Environmental Protection (DEP), 2006).
This then calls for an effective set of management tools (procedures and Control
s) organized to optimize the clinical value of radiographic images produced for
timely patient diagnosis while taking radiation exposure and impact to the imagi
ng facility into consideration (DEP, 2006).
It was evident from the study that Quality Assurance and control procedures were
not being observed largely as required.
Results from the study indicate that only 45% answered in the affirmative, that
they did carry out regular Quality Assurance procedure. 41% answered in the nega
tive, while 14% had no knowledge of Quality Assurance procedure.
This is against the IAEA (2006), provision that “The technical person needs to ens
ure that adequate maintenance (preventive and corrective) is performed as necess
ary to ensure that Radiographic systems retain their design specification for im
age Quality, radiation protection and safety for their useful lives”.
Not carrying out Quality Assurance programmes then indicates that optimal perfor
mance by equipments and materials can not be guaranteed, not forgetting the safe
ty of the patient for which reason the equipments are installed.
When questioned on the corrective measures taken if Quality Control tests are de
tected not within acceptable limits, most respondents (53.4%) answered that they
suspend all work and use of the affected equipment till the problem is fixed. T
his practice is in agreement with literature reviewed and provisions by the IAEA
and other international Organisations dealing with radiation safety.
Though rightly admitting that their patients are more important and as such shou
ld be given priority in services, 35.2%, of respondents who admitted to the abov
e assertion, stated that and they managed to work with the equipment to derive m
aximum benefit for the patients.
Though this claim seems to be partly supported by civil society’s claim that: “the p
atient is the most important visitor to any department in the hospital”, literatur
e reviewed fails to support this assertion, and rather states otherwise. That “the
quality of images (clinical value), and patient safety are most important when
it applied to Diagnostic Radiography” (DEP, 2006).
By this statement, it could be clearly inferred that the actions of a small numb
er of respondents (46.6%) comprising 35.2% respondents who admitted to putting t
he patient first thus ignoring the Quality Assurance results and the 11.4% who t
akes no action based on the Quality Assurance and Control test results, will not
be producing Quality images of clinical values upon close auditing, meanwhile m
ay be exposing patients to all sorts of unknown dangers, including mechanical an
d electrical accidents, over exposure and increased radiation dose to patients,
radiographs not being diagnostic and many other which might well be avoided if s
imple Quality Assurance and Control measures are observed routinely.
It has been proven that an effective Quality Assurance program helps to ensure t
hat radiation exposure to the patients and operators of Radiography equipment is
as low as reasonably achievable while providing efficient, consistent high Qual
ity diagnostic results (DEP, 2006).
The DEP (2006) in sharing its experiences on Quality Assurance indicated that th
e implementation cost of a basic Quality Assurance program may reduce down time,
waste and major repairs.
It further states that “Equipment can be expected to perform as intended only if a
dequately maintained and supported; and this can be achieved at a minimum, perio
dically checking the x-ray beam collimation and positioning stability and perfor
ming various maintenance procedures recommended by the manufacturer” (DEP, 2006).
However, in order for a Quality Assurance programme to be effective, it is impor
tant to have a maintenance programme in place that ensures that any under perfor
mance by equipment and materials, revealed by Quality Controls, is rectified (DE
P, 2006).
It must however be Considered that the program consists both human elements as w
ell as equipment and procedures, thus tests may need to be performed after maint
enance or repairs which may be likely to affect its, imaging and/or radiation ch
aracteristics (IAEA, 2006).
An effective QA programme finally, demands a strong commitment from the departme
ntal and institutional leadership to provide the necessary resources of time, pe
rsonnel and budget, and should also take into consideration both internal and ex
ternal auditing, as well as continual improvement, linked to the radiation prote
ction programme in order to strengthen safety while at the same time improving Q
uality and efficiency (IAEA, 2006).

5.4MEDICO-LEGAL AND ETHICAL CONCERNS

With the issue of Professional Ethics, findings from the study were at variance
with literature reviewed on the provisions of the BSS with regards to personnel,
which provides that all personnel on whom protection and safety depend be appro
priately trained and qualified so that they understand their responsibilities an
d perform their duties with appropriate judgement and according to defined proce
dures” (IAEA, 2006).
Though this provision is very clear, some Radiographers (34.1%) sampled, stated
that they allowed their technical assistants, who were not appropriately trained
and qualified to perform such duties, to irradiate patients. Of this percentage
, 13.6% of them allowed such practices by their technical assistants even in the
ir absence with absolutely no supervision.
Further to 31% allowed their technical assistants to radiograph various parts of
patients’ bodies. Of this 3% were restricted to only extremities, 9% to whole bod
y parts and 19% to chest examinations. It is evident from their backgrounds, no
t having received any formal training in Radiography that the patients they atte
nd to, will be greatly exposed to radiation, with no radiation protection what s
o ever for them.
The possibility of not having any justification for exposures made and also acci
dentally exposing female patients who might be pregnant is very high, increasing
further the danger that the possibly growing foetuses and their mothers might b
e put in. They may also ignore the BSS requirement that “It should be ascertained
whether a female patient is pregnant before performing an X ray examination for
diagnosis, and when the examination is likely to cause exposure to the abdomen o
r pelvis of the patient who is pregnant or likely to be pregnant then it should
be avoided unless there are strong clinical reasons for such examinations” (IAEA,
2006).
The practice of allowing technical assistants to expose patients is a negligent
conduct in its self, and exposes the Radiographer to legal action the patient mi
ght take due to that negligent act of relinquish his duties to an unqualified pe
rson.
Issues of breach of Professional conduct has been sited from the study results,
against literature which provides that patients medical records may be discussed
with only two people, these being the radiologist and the referring clinician,
and not even the patient, as the Radiographer is not the person authorized to gi
ve such reports. However, from the research results, nearly all respondents (69%
) discussed patients’ results with other staff for various reasons ranging from th
e patient’s interest being at stake, when writing periodic departmental reports to
open discussion during clinical meetings.
These however are still at variance with literature reviewed, because, though th
e motive behind these actions may be well intended, they are not supported Profe
ssionally, and in instances where such discussions are not Controlled and the id
entity of the patient in question is revealed, then issues of Professional compe
tence begins to be raised.
Though the revelation that the discussion of patient records, in whatever form i
t might take, may be routine for those respondents, only 24% went on to state th
at they sought patient consent before discussing such records. This may protect
them from any legal procedure that might be instituted against them for revealin
g such privilege information at a formal or informal gathering further safeguard
ing the nobility of their profession.
The largest part of respondents who admittedly discussed such records, did not a
lso make any move at seeking patient consent, those respondents may still be exp
osed to legal tussle should the issue come to light that they revealed patient r
ecords without prior consent of the patient concerned.
Further, results from the study revealed that majority of respondents gave full
prior explanation and effective instructions on the procedure to patients before
starting the procedure. This development is in agreement with literature review
ed on acceptable practices, especially in instances where patients could later r
aise issues with non explanation of procedure to them. It has also been realised
that prior explanations also increased the likelihood of patients cooperating,
and eventually reduced the incidence of having to repeat radiographs, there by i
ncreasing the radiation dose to patients.
13.6% of the respondents revealed that they only gave explanations on the proced
ure, after patient required prior information on the procedure. By inference, it
means explanations are not given to patients unless they did request, and the p
ossibility of having to repeat some radiographs as well as having increased time
with the patient is most likely.
Apprehension, emotional stress and anxiety of patients concerning the whole proc
edure and their ultimate refusal to participate in the whole procedure is most l
ikely for fear of being put through pain or generally fear of the unknown (Shere
r, et al, 2006).
From literature reviewed, seeking consent is a procedure which helps to determin
e what the patient wants, and a sign of respect for the patient’s autonomy (DoH,20
06), which eventually clears the Radiographer of any legal implication that may
arise as a result of informed decisions taken by the patient fully qualified to
give such consent (Parelli, 1994).
This is a principle generally accepted in healthcare, especially with procedures
that may cause harm to the patient.
The general Professional image of the Radiographer is enhanced, through effectiv
e communication of intentions and expectations to their patients.
In practice however, the situation may not always be so. From this research, maj
ority of respondents answered that they sought patient consent in one form or an
other, this ranged from verbal to written consent.
24% of respondents did not positively seek patient consent, of this number, 8% t
ook patient cooperation to imply that they were consenting to the procedure, whi
lst 16% just did not even seek the consent of their patient. This is against Pro
fessional Ethics and legal doctrines supporting the process of seeking informed
consent.
This practice of not seeking consent, may present some legal repercussions, espe
cially in instances where a generally normal and routine procedure turns complic
ated necessitating hospitalization or an emergency procedure to be performed on
the patient.
Litigations may then set in and the whole process and procedure may be called to
book, this may have great implications both financially and legally for both th
e Professional and the hospital of practice, eventually opening the door for oth
er potentially unfriendly situations, as a suit of civil or criminal nature as a
result of battery.
Currently, legal or administrative actions by patients against health profession
als and for that matter Radiographers are not that common in Ghana, and to suppo
rt this point, searches conducted at the Main library of the Supreme Court of Gh
ana, revealed that, though there have been cited cases of law suits by aggrieved
patients and their relatives against health professionals, these are not common
in Ghana, further to this, the most recent cases of such rulings on professiona
l negligence by professionals, are yet to be published in the Ghana Law Reports
2005-2007.
The low level of law suits by aggrieved individuals against health professionals
has been attributed to societal position that the health profession is a sacrif
icial one, and thus one needs to be circumspect about initiating legal suits aga
inst such professionals, as such professionals could deny the plaintiff medical
service upon the next visit. In the case of Master Frank Darko against Korle Bu
Teaching Hospital and three of its medical officers, the Ghana News Agency quoti
ng the plaintiff’s counsel, reported that after Master Frank Darko was denied medi
cal services at the hospital when he visited the facility for his scheduled medi
cal review two months later, (GNA, 2006b). To reinforcement this stance, the stu
dy revealed that only 6% of respondents reported of having knowledge of patients
taking legal or administrative actions against Radiographers or other health pe
rsonnel due to negligence or for other reasons. The social norms in Ghana may ha
ve contributed to the current state of events.
The situation is most likely to change within the next few year, as the level of
advocacy by several interest and pressure groups as consumer rights activists,
children rights advocates, human rights activists and the Commission on Human Ri
ghts and Administrative Justice begin to mount pressure for best services to be
rendered to clients, especially in the area of healthcare.
The situation might not be very pleasant especially for Radiographers who are no
t having continuing education on Professional Ethics and current trends in Radio
graphy.
The research revealed that most of respondents had in-depth knowledge of the Pro
fessional code of Ethics for Radiography in Ghana, whilst 40% had partial knowle
dge of the code of Ethics.
This however does not support the revelation that 16% had never had any further
education on Professional Ethics and current trends in Radiography, whilst a gre
ater part of the respondents reported of having received such education, had rec
eived such education only once or periodically.
It is of necessity that Radiographers receive further education after their init
ial qualification so as to be abreast with current trends in the profession, wit
h relation to new techniques, radiation protection, medico-legal and Professiona
l Ethics as well as Quality Assurance programmes.
Since the Radiographer is expected to undertake Quality Assurance activities, it
is then necessary that such personnel are adequately trained and supported to p
erform the Quality Assurance activities (DEP, 2006). it is also required that pe
riodically, evaluation of Radiographers performance would be carried out, to ens
ure that continuing education requirements are met (DEP, 2006), a procedure, aim
ed at reducing the chances of creating situations whereby accidents, equipment m
alfunction and an information gap, which could further lead to the creation of l
oopholes to be exploited by aggrieved patients and their relatives in instances
of legal tussles.
5.5CONCLUSSION
Data gathered from the present study, indicates that though efforts are being ma
de by some Professionals to attain a certain level of Professionalism in the pra
ctice of Radiography, some situations created, prevents such efforts from being
fruitful.
These situations may include the non availability of clearly defined Quality Ass
urance/Control programmes, customized radiation protection policies which manage
ments of the various institutions and facilities are strongly committed to.
There is also no standardized protocol in the practice of Radiography in Ghana,
and this has created a lot of loopholes for some Radiographers to take undue adv
antage of.
Currently there is no legislative instrument, to put in place systems of checks
and balances which would ensure that issues of Professional Ethics are strictly
adhered to by Radiographers in clinical practice.
It could thus be concluded, that though the system (Radiography practice in Ghan
a) seems to be running, its efficiency is questionable, as some individuals are
unduly exposing patients and other colleagues to all sorts of inexcusable danger
due to their non adherence and practice of acceptable Professional Ethics in th
eir places of practice.

5.6RECOMMENDATIONS
From findings of the study, carried out, the following recommendations have thus
been suggested:
1.A legislative instrument (National Law) should be introduced to ensure the app
lication of Professional Ethics in the practice of Radiography. A National Radio
graphy Inspection Team (spearheaded by the Ghana Society of Radiographers) must
be instituted, and mandated to ensure strict adherence to the Code of Profession
al Ethics among Ghanaian Radiographers.
2.The managers and institutional leaders must be fully committed to actively gua
rantee that Radiographers adhere strictly to a radiation protection policy as we
ll as strong quality assurance and quality control programmes for their institut
ions to safeguard the optimal and acceptable limits of functions of diagnostic e
quipments and materials used.
3.There should be continuing educational development programs organized for peri
odically practicing Ghanaian Radiographers to update them on professional ethics
, Quality Assurance/Control procedures, and current trends in the Radiography pr
ofession.
4.Special consent forms should be introduced in radiology departments to foresta
ll the incidence of legal tussles that may arise as a result of Professionals no
t seeking prior consent.
5.The Code of Professional Ethics for Radiographers which I have adopted from th
e American Society of Radiologic Technologists and modified to suit the Ghanaian
System of practice (Appendix iii), should be printed and widely circulated amon
g Radiography Professionals, clearly stating punitive measures that would be ta
ken against Professionals who do not adhere to those codes
6.Professionals, especially at the student level, should be made to study medica
l law and ethics, which captures enshrined codes of Ethics of their professions
to avert future Ethics related problems. (Patterson and vitello 1993)
7.Finally, It is recommended that future researchers cover a wider national popu
lation covering more than the two major regions covered, and efforts should be e
xtensively made to focus on the knowledge of radiation protection and the practi
ce of Quality Assurance and Quality Control programmes among Radiographers and R
adiology departments nationally,

5.7LIMITATIONS OF THE STUDY

The presentation of this final work was met with setbacks which has been acknowl
edged as having affected the general production in terms of progress and present
ation of the final work.
1.Time constraint: the delay of some respondents in completing or returning ques
tionnaires, led to the researcher taking several visits to those facilities in a
n attempt to retrieve them, this eventually resulted in a general delay in compl
eting the final work which had a strict timeframe for submission.
2.Most participants, felt insecure, though it was guaranteed on the consent form
, this resulted in some questions being answered to fulfil social expectations,
although on the grounds, the situation appeared very different. (this was confir
med by the participants)
3.Some participants would just not want to cooperate, thus causing a great reduc
tion in the sample size by 12%. This development was attributed to general lack
of commitment and interest in the research area, misplacement of questionnaires
by respondents.
4.The non availability of funds from the school to support academic research by
students, especially in radiography, led to this project being delayed till enou
gh funds were raised by the researcher from other sources for the project.
5.Finally, to the researcher’s knowledge, there had not been any published researc
h on this topic in Ghana, thus, being a fairly new research area, the general la
ck of published literature on the subject with relations to Ghana specifically a
nd Africa generally, led to major holdbacks in reviewing a greater number of lit
eratures for this final work.

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able on the internet at Http://jnm.snmjournals.org/cgi/content/abstract/44/11/1
818 (accessed 11th November 2006)
3.Benton, D.C. (2000) Computer-assisted data analysis. In Cormack, D (Ed) The Re
search Process in Nursing. 4th ed. Blackwell Publishing. Oxford: 411-425
4.Boone, R.J. (2001) Pocket Guide to Chiropractic Skeletal Radiography. McGraw-H
ill, New York.
5.Carter, E. D. and Porter S. (2000a) Validity and Reliability. In Cormack D. (E
d) The Research Process in Nursing. 4th ed. Blackwell Publishing, Oxford: 29-41
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6th ed. Blackwell Publishing. Oxford
7.College of Radiographers, 2002 “Status of Professional conduct”, available on the
internet at http://www.SoR.org/public/pdf/profcond2.pdf - (accessed 15th Novemb
er 2006)
8.Commonwealth of Pennsylvania - Department of Environmental Protection (2006) M
inimum Quality Assurance Requirements For Healing Arts Radiography. Available on
the internet at www.dep.state.pa.us/brp/Radiation_Control_Division/X-Ray/QARequ
Healing.htm (accessed 6th June 2007)
9.Council for the Professions Complementary to Medicine-Malta, (2006) “Code of Pra
ctice – Radiography” available on the internet at www.sahha.gov.mt/showdoc.aspx?id=8
4&filesource=4&file=COPRadiography.Pdf (accessed on 15th November 2006
10.Department of Health (2006) Reference Guide to Consent for Examination or Tre
atment. available on the internet at www.dh.gov.uk/assetRoot/04/01/90/79/040190
79.pdf (accessed 17th November 2006)
11.Dowd, SB. (1993) Medical Law and Ethics. University of Alabama at Birmingham
School of Health Related Professions. Available on the internet at www.asrt.org
/Media/Pdf/ForEducators/ 4_InstructionalTechniques/4.7MedEthics.pdf (accessed
17th November 2006)
12.Eastman Kodak Company; Kodak Dental Systems (2005) “Quality Assurance in Dental
film Radiography” available at http://www.kodakdental.com/documentation/film/N-41
6QADentRad.pdf (accessed 9th May 2007)
13.Ehrlich, R.A, McCloskey, E.D. and Daly, J.A (2004) Patient care in Radiograph
y: with an introduction to medical imaging. 6th ed. Mosby. St. Louis
14.Ghana Health Service, (2002a), Patient’s Charter
15.Ghana Health Service, (2002b), Code of Ethics
16.Ghana News Agency (2006a) Boy, 14, sues Korle-Bu Teaching Hospital and three
doctors for operating on wrong leg. Available on the internet at www.ghanaweb.co
m/ghanaHomePage/NewsArchive/artikel.php?ID=116453 (accessed 9th July 2007)

17.Ghana News Agency (2006b) Patient who sued Korle-Bu denied treatment. Availab
le on the internet at www.ghanaweb.com/ghanaHomePage/NewsArchive/artikel.php?ID=
107570 (accessed 9th July 2007)
18.Hood, C.A.,€Hope, T. and€Dove, P. (1998) Videos, Photographs and Patient Consent,
British Medical Journal 316: 1009-1011 available on the internet at http://www.
bmj.com/cgi/content/extract/316/7136/1009 ( accessed 8th December 2006)
19.Http://faculty.ncwc.edu/toconnor/308/308lect03.htm (accessed 3rd January 200
7)
20.Http://www.is.cityu.edu.hk/research/resources/isworld/Ethics/index.htm (acces
sed 15th November 2006)
21.Http://www.prs.heacademy.ac.uk/archive/oldsite//Ethics/documents/consent.html
(accessed 9th November 2006)
22.Http://www.tardis.ed.ac.uk/~kate/qmcweb/s8.htm (accessed 3rd January 2007)
23.International Atomic Energy Agency, (2006) Applying Radiation Safety Standard
s in Diagnostic Radiology and Interventional Procedures using X rays, Safety Rep
orts Series: No. 39 (STI/PUB/1206) 1-110 available on the internet at http://www
-pub.iaea.org/MTCD/publications/PDF/Pub1206_web.pdf (accessed 6th June 2007)
24.Murphy-Black, T (2000) Questionnaire. In Cormack D. (Ed) The Research Process
in Nursing. 4th ed. Blackwell Publishing, Oxford: 301-313
25.Oxford Advanced Learner’s Dictionary (1999) Oxford University Press. Oxford
26.Parelli, R.J. (1994) Medicolegal Issues for Radiographers 2nd ed. Eastwind Pu
blishing. Iowa.
27.Patterson, S.M, Vitello, E.M. (1993) Ethics in Health Education: The Need to
Include a Model Course. Journal of Health Education. 24:239-244.
28.Polgar, S. and Thomas, S.A. (1998) Introduction to Research in The Health Sci
ences. 3rd ed. Churchill Livingstone. Melbourne
29.Porter, S. and Carter, E. D. (2000b) Common Terms and Concepts in Research. I
n Cormack D. (Ed) The Research Process in Nursing. 4th ed. Blackwell Publishing,
Oxford: 17- 28
30.Sherer, M.A.S., Visconti, P.J., Ritenour, R.E. (2002) Radiation Protection in
Medical Radiography. 4th ed. Mosby. USA
31.Society of Radiographers in Finland, (2000) “Radiographers Professional Ethics”,
available on the internet at www.suomenrontgenhoitajaliito.fi/code_of_Ethics.pd
f - (accessed 15th November 2006)
32.The Ethox Centre (2004), Ethical Frameworks. University of Oxford, Oxford.
33.Willis, C.E., (2004) What s New in Quality Assurance for Computed Radiography
? Available at http://www.imagingeconomics.com/issues/articles/2004-10_02.asp -
(accessed 20th May 2007)
34.Wilson, B.G. (1997) Ethics and Basic Law for Medical Imaging Professionals. A
vailable on the internet at www.asrt.org/Media/Pdf/ForEducators/4_InstructionalT
echniques/4.7MedEthics.pdf (accessed 17th November 2007)
35.World Health Organization (2001a), making appropriate treatment possible; the
importance of diagnostic imaging, who/dil/01.4.
36.World Health Organization (2001b), Quality Assurance Workbook for Radiographe
rs and Radiological Technologists, who/dil/01.3.
APPENDIX I
SAMPLE INFORMED CONSENT FORM
Project Title: ASSESSING THE STATUS OF PROFESSIONAL ETHICS AMONG GHANAIAN RADIOG
RAPHERS.
I have been invited to take part in the research titled above. I have been told
the purpose of this study is to investigate “The status of Professional Ethics amo
ng Ghanaian Radiographers. How is Professional Ethics practiced in the carrying
out of radiological examinations and the resultant effect on the Quality of diag
nostic radiographs produced? My role in this study is to complete an attached qu
estionnaire and I understand that my participation is totally voluntary and free
; I am not going to be subjected to any risk or discomfort.
I have been informed that the confidentiality of the information that I will pro
vide will be safeguarded and that my privacy and anonymity will be ensured in th
e collection, storage and publication of the research material.
I have the right to refuse to participate at any time I wish to.
I have read the foregone information. All questions I asked have been answered t
o my satisfaction. I consent voluntarily to participate as a subject in this stu
dy.

Signature of Participant………………………………… Date……/……/2007

Signature of Researcher:…………..……..……………. Date……/……/2007

Name of principal researcher: Yahans Kojo De-Heer
Name of Institution: School of Allied Health Sciences.
College of Health Sciences
University of Ghana
Legon-Accra
Name of supervisors: Mr. Lawrence Arthur,
Head, Department of Radiography.
School of Allied Health Sciences.
 University of Ghana
Mr. William K. Antwi,
Lecturer, Department of Radiography,
School of Allied Health Sciences.
University of Ghana
Mrs. Harriet Duah
Lecturer, Department of Radiography,
School of Allied Health Sciences
University of Ghana

APPENDIX II
SAMPLE SURVEY QUESTIONNAIRE
Project Title: ASSESSING THE STATUS OF PROFESSIONAL ETHICS AMONG GHANAIAN RADIO
GRAPHERS.
Please answer as honestly, and to the best of your knowledge as possible. Tick t
he appropriate space provided in this manner [ ] or [ ], and where more than one ans
wer is required, tick all that apply.
DEMOGRAPHIC DATA OF RESPONDENT
1.Age in years
20-30 [ ] 31-40 [ ] 41-50 [ ] 51+ [ ]
2.Sex Male [ ] Female [ ]
3.Professional qualification(s) held/educational background. Please thick all th
at applies to you.
Certificate [ ] Diploma [ ] BSc.[ ] MSc
[ ] PhD[ ]
4.How long have you been working as a Radiographer?
1-4 yrs [ ] 5-10yrs [ ] 10-15yrs [ ] 15 yrs+
[ ]

KNOWLEDGE AND PRACTICE OF RADIATION PROTECTION

5.Do you carry out Regular Quality Assurance procedure on all equipments, films
and chemicals used?
Yes [ ] No [ ] Have no knowledge of the procedu
re [ ]
6.What corrective actions do you take if Quality Control tests are not within ac
ceptable limits?
I suspend use of equipment till problem is resolved [ ] Our patients ar
e more important, I manage the work till problem is corrected [ ]
I take no action [ ]
7.Do you have enough shielding/protective lead aprons for use at your unit?
Yes [ ] Inadequate [ ] None [ ]
8.Which patients do you use them on?
All patients [ ] Pregnant patients [ ] Children [ ]
Elderly [ ]
9.Do you regularly check your collimation devices for competence?
No it is functioning well [ ] Yes occasionally [ ]
Yes always [ ]
10.How often do you check the competence of your lead aprons?
Regularly [ ] Occasionally [ ] I don’t check, it’s always in good condit
ion [ ]
11.Do you have functioning immobilizing devices for patients?
Yes [ ] Yes, but not functioning [ ]
No [ ]
12.How do you ensure that all immobilization devices are functioning properly be
fore use for patients?
I test before I start work daily [ ] I don’t, because I hardly use often[ ]
I assume they always function properly [ ]
MEDICOLEGAL AND ETHICAL CONCERNS
13.Have you had any further education on Professional Ethics and current trends
in the Radiography practice?
No never [ ] Once [ ] Yes periodically [ ]
Yes regularly [ ]
14.Under what condition is your technical assistant allowed to expose x ray equi
pments?
In emergency when absent [ ] never [ ] Only under my supervisio
n [ ]
15.What examinations are your technical assistants limited to do?
Extremities [ ] Whole body [ ] Chest [ ]
None [ ]
16.Do you have any knowledge of the code of Professional Ethics in your professi
on?
Yes, in-depth [ ] Yes, partially [ ] No none [ ]
17.How do you confirm whether any female patient, age 10 – 55, might be pregnant?
I ask patient for LMP [ ] I don’t confirm [ ] Not important, I
collimate down [ ]
18.How do you verify the patient’s identity before any diagnostic procedure?
I refer to the request form [ ] I ask patient for confirmation [
]
19.Before starting procedures, do you fully explain and effectively instruct pat
ients on your intentions?
Yes, for their cooperation [ ] Only when patient seeks prior clarificat
ion [ ] No, it wastes time [ ] Other…………………………..
20.What form of consent do you seek from patients before radiological examinatio
ns?
Verbal [ ] Written [ ] Implied [ ] I don’t seek thei
r consent [ ]

21.Do you discuss patient’s diagnostic records with other healthcare staff, and un
der what circumstance?
When the patient’s interest is at stake [ ] When writing periodic department
report [ ] Only during clinical meetings [ ] Never, I only re
turn patient to referring clinician [ ]
22.Do you seek patient’s prior consent before discussing such records?
Yes always, before the patient leaves [ ] No need, patients always
gone before such discussions [ ] No, I never reveal the patient’s identity
[ ]
23.Has a patient ever taken legal or administrative action against any staff at
your department? Yes [ ] No [ ]
24.If you answered yes to 23 above, what was the reason for the suit?
Malpractice by a staff [ ] Not seeking patient’s consent prior to examination
[ ] wrongly revealing patient’s diagnostic information [ ] Other…………………………..
25.Do you know the legal implications of any action you take towards patients?
Yes am fully aware [ ] Yes partially aware [ ] No idea [ ]
Thank you very much for taking time out to fill this questionnaire, which will h
elp me to analyze the extent to which Professional Ethics in Radiography is bein
g practiced. Your help is much appreciated.
APPENDIX III
Code of Professional Ethics
1.The radiographer, conducting himself or herself in a professional manner, resp
onds to patient needs and supports colleagues and associates in providing qualit
y patient care.
2.The radiographer acts to advance the principal objective of the profession to
provide services to humanity with full respect for the dignity of mankind.
3.The radiographer delivers patient care and service unrestricted by concerns of
personal attributes or the nature of the disease or illness, and without discri
mination on the basis of sex, race, creed, religion or socio-economic status.
4.The radiographer practices technology founded upon theoretical knowledge and c
oncepts, uses equipment and accessories consistent with the purpose for which th
ey were designed and employs procedures and techniques appropriately.
5.The radiographer assesses situations; exercises care, discretion and judgment;
assumes responsibility for professional decisions; and acts in the best interes
t of the patient.
6.The radiographer acts as an agent through observation and communication to obt
ain pertinent information for the physician to aid in the diagnosis and treatmen
t of the patient and recognizes that unless adequately trained and permitted by
local protocol, intravenous administration of contrast media, interpretation of
radiographs, are outside the scope of practice for the profession.
7.The radiographer uses equipment and accessories, employs techniques and proced
ures, performs services in accordance with an accepted standard of practice and
demonstrates expertise in minimizing radiation exposure to the patient, self and
other members of the health care team.
8.The radiographer practices ethical conduct appropriate to the profession and p
rotects the patient s right to quality radiologic technology care.
9.The radiographer respects confidences entrusted in the course of professional
practice, respects the patient s right to privacy and reveals confidential infor
mation only as required by law or to protect the welfare of the individual or th
e community.
10.The radiographer continually strives to improve knowledge and skills by parti
cipating in continuing education and professional activities, sharing knowledge
with colleagues and investigating new aspects of professional practice.
This code of ethics originally issued by the American Society of Radiologic Tech
nologists, for individuals registered by the American Registry of Radiologic Tec
hnologists, has been modified by the researcher to suit the Ghanaian system of p
ractice.

APPENDIX IV

APPENDIX V
Glossary of Terms
Administrative Actions: Actions taken at the local level in organizations to res
olve issues, often resulting in deterrent punitive measures taken against the of
fender
Battery: Committing bodily harm.
Beneficence: Doing of good; active promotion of good, kindness, and charity
Care: The degree of concern or attention that would or should be exercised by a
professional in the course of an assigned duty.
Client: Individual, who visits the health delivery facility for the purpose of s
eeking diagnostic or therapeutic care and services.
Codes of Ethics: Articulated statement of role morality as seen by members of a
profession.
Common Law: Derived from decisions taken in court by the Judge, also referred to
as, judge-made law.
Consent: A voluntary act by which one person agrees to allow someone else to do
something. For hospital purposes, consent should be in writing with an explanati
on of the procedures to be performed so that proof of consent is easy.
Diagnostic Radiography: The science, which involves the use of sound energies, m
agnetism, ionizing or non-ionizing radiations, to record images of parts of the
human body for the purpose of detecting disease processes or conditions.
Doctrine of Forseeability: Individuals are liable for all natural and proximate
consequences of any negligent act to another individual of whom a duty is owed.
Ethics: The systematic study of rightness and wrongness of human conduct and cha
racter as known by natural reason.
Informed Consent: One in which the patient has received sufficient information c
oncerning the health care proposed, its incumbent risks, and the acceptable alte
rnatives.
Justification of Practice: A practice that entails exposure to radiation should
only be adopted if it yields sufficient benefit to the exposed individual to out
weigh the radiation detriment
Law: The sum total of man-made rules and regulations by which society is governe
d in a formal and legally binding manner.
Legal: Permitted or authorized by law.
Legal Actions: Actions taken by an aggrieved party against an offender, in a law
court to seek redress for damages caused him/her.
Litigation: A trial in court to determine the legal issues and the rights and du
ties between the parties.
Malpractice: Professional misconduct, improper discharge of professional duties
or failure to meet the standard of care by a professional that results in harm t
o another.
Medical Record: A written official documentary of what has happened to a particu
lar patient during a specific period of time.
Medicolegal: Actions/issues of medical nature, with legal implications
Negligence: Failure to act as an ordinary wise person, conduct contrary to that
of a reasonable person under specific circumstances.
Privileged Information: Statements made to one in a position of trust, usually a
n attorney, health worker, or spouse. Because of the confidential nature of the
information, the law protects it from being revealed, even in court.
Profession: A job that special skills and qualifications are needed accomplish,
and mostly, activities within the job, is backed by law.
Professional Conduct: Practice behaviours that are defined by members of a profe
ssion
Professional Ethics: Internal controls of a profession based on human values or
moral principles
Quality Assurance: A comprehensive set of policies and procedures designed to op
timize the performance of personnel and equipment
Quality Control: The regular tests done on equipments and materials to make sure
that output is optimum
Radiation Protection: Procedure followed to prevent inappropriate or accidental
irradiation of patients, public, and health care professionals.
Radiographer (Diagnostic): The health professional that practices the science of
detecting disease processes or conditions using sound energies, magnetism, ioni
zing or non-ionizing radiations.
Rights: Justified claims that an individual can make on individuals, groups, or
society; divided into legal and moral rights
Safety Mechanism: A protective system put in place to ensure the safety of both
operator and the visitor to the unit.
Standards: General criteria of measuring, and conforming to established practice
.
Void: Having no legal force.