Abstract
This research report details the number of MRIs in Ghana. This document is based on information from two recent research documents in a similar topic, these documents are
- A.D. Piersson et al (2017) Assessment of availability, accessibility, and affordability of magnetic resonance imaging services in Ghana.
- E.K. Ofori et al (2020) An audit of MRI machines and services in Ghana
Findings from this research would be drawn from information in the above documents, where need be figures and data would be updated accordingly.
Most of the information was drawn for E.K Ofori et al (2020) because it is the most recent.
In that study, A quantitative descriptive cross-sectional survey was conducted involving all MRI machines in Ghana. Data obtained was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Independent-samples t-test was conducted to compare the mean cost of MRI examinations between privately-owned and state-owned MRI machines in Ghana.
They later identified that there were 18 MRI machines, spread across five regions, in Ghana. 15 (83.3%) of the MRI machines are located in the Greater-Accra and Ashanti regions. MRI examinations are more expensive in privately-owned machines compared to state-owned machines (p < 0.05). Four state-owned machines have been non-operational for between three-six years resulting in a revenue loss of GHC 36 million (US$7.2 million
Finally, they concluded that there are few MRI machines in Ghana and the majority are concentrated in the two largest regions. The increase in MRI machines over the past decade can be attributed to private investment in the sector.
Background
In the clinical diagnosis and management of patients, radiological studies are critical. In clinical settings, X-rays are the most prevalent medical imaging modality. X-rays have clinical limitations, despite their great clinical advantages. Furthermore, the dangers of x-rays on the human body have been extensively documented. There has been a technical transition to medical imaging modalities that use non-ionizing radiation, such as magnetic resonance imaging, to improve medical diagnosis and limit the quantity of ionizing radiation patients are exposed to (MRI).
For the diagnosis and management of patients, magnetic resonance imaging (MRI) is a helpful imaging technique. It is painless, non-invasive, and sensitive to soft tissue anomalies.
Because it plays a vital role in diagnosing disease disorders that would have been difficult or impossible to diagnose with conventional x-rays, the clinical use of MRI has transformed not only the practice of radiology but also the whole medical field. Furthermore, advances in MRI have enhanced musculoskeletal, cardiac, vascular, and paediatric imaging by increasing spatial resolution, decreasing scan times, and contributing to the invention of new medical imaging sequences.
Over the last two decades, the Ghanaian government has engaged in the procurement of MRI machines in collaboration with the commercial sector. This is owing to a rise in the demand for enhanced radiological services for patient diagnosis and treatment. However, there is a scarcity of information about the availability and accessibility of MRI machines around the country.
Piersson and Gorleku (2017) looked at the availability of MRI machines in Ghana. They concluded that, there was a wide disparity in the distribution of MRI scanners nationwide, with most of them located in the Greater Accra region. With only 5 regions having MRI scanners, it does imply that close to 40% of the general population do not readily have access to MRI services.
Their study however, did not specify if the MRI machines were active or not at the time of the research. Furthermore, given Ghana’s recent regional restructuring, which resulted in the creation of six new regions, such data is required to guide future health care development and encourage better parity in access to MRI services.
The Ghana Health Service policy is to increase access to healthcare services by constructing a regional hospital in each Ghanaian region. As a result of the construction of six new regions, six new regional hospitals will be built, increasing the need for MRI services. The current state of MRI machines in Ghana was discussed in this research
Results
The audit yielded a perfect response rate of 100%. In Ghana, 18 MRI machines are currently scattered among 18 hospitals in five regions. Table 1 lists the owners, locations, and specs of these MRI machines and equipment.
The data was checked for normalcy using subjective and objective metrics before employing inferential statistics. Histograms, QeQ plots, and stem and leaf were employed for the subjective measures. The Kolmogorov-Smirnov (KS) statistic, on the other hand, was utilized to objectively assess normalcy.
The data was normally distributed, according to visual inspections of the subjective measurements. Similarly, the KS statistic yielded a non-significant P-value (P > 0.05), indicating that the data was distributed normally. Following that, a parametric independent-samples t-test was used to compare the mean cost of MRI examinations in Ghana between privately owned and state-owned MRI equipment.
Table 2 shows the results of the independent-samples t-test. The most prevalent MRI tests were those for the brain, abdomen, spine, and pelvis, therefore these were selected to compare the costs of state-owned MRI equipment to privately-owned MRI machines (Table 2).
Privately owned MRI machines were more expensive than state-owned machines, as indicated in Table 2, with some exams costing over Gh222 (US$ 44.4) more.
According to the study’s findings, 14 (77.8%) MRI machines did not register any breakdown. However, four (22.2%) MRI machines have been out of commission for three to six years. Table 3 shows the estimated costs associated with the downtime of various MRI equipment.
Conclusions
Inpatient management continues to rely heavily on radiological investigations. The advantages of improved radiological investigations have led to the inclusion of magnetic resonance imaging (MRI) equipment in medical devices all over the world. Because it provides higher sensitivity to numerous illness conditions when compared to conventional x-rays, the introduction of MRI has had a considerable impact on the accuracy of medical diagnosis and patient care. Similarly, MRI
does not employ ionizing radiation in clinical applications, minimizing the quantity of ionizing radiation patients are exposed to.
Despite the clinical benefits of MRI, there is a difference in the availability and accessibility of MRI equipment between rich countries like the United States and poor countries like Ghana, mainly due to the high costs.
E.K. Ofori et al (2020) identified, that there were 18 MRI machines, spread across five regions, are available in Ghana. 15 (83.3%) of the MRI machines are located in the Greater-Accra and Ashanti regions. MRI examinations are more expensive in privately-owned machines compared to state-owned machines.
Recent research also indicate that there has not been any added number, the number still remains at 18.
Ownership, Locations and specifications of MRI machines in Ghana
| Region | Facility | Ownership | Manufacturer | Field Strength (Tesla) | Type of magnet | Year of | Current State |
| Installation | |||||||
| Northern | 1 | State | Toshiba | 1.5 | Superconducting | 2013 | Non-Operational |
| Volta | 2 | State | Toshiba | 1.5 | Superconducting | 2014 | |
| Central | 3 | State | Toshiba | 1.5 | Superconducting | 2015 | |
| Greater Accra | 4 | State | Philips | 1.5 | Superconducting | 2009 | |
| 5 | State | General Electric | 1.5 | Superconducting | 2017 | Operational | |
| 6 | State | Toshiba | 1.5 | Superconducting | 2012 | ||
| 7 | Private | General Electric | 1.5 | Superconducting | 2017 | ||
| 8 | State | Philips | 3.0 | Superconducting | 2016 | ||
| 9 | Private | Hitachi | 0.3 | Permanent | 2011 | ||
| 10 | Private | Siemens | 0.3 | Permanent | 2011 | ||
| 11 | Private | General Electric | 1.5 | Superconducting | 2019 | ||
| 12 | Private | General Electric | 1.5 | Superconducting | 2017 | ||
| 13 | Private | General Electric | 1.5 | Superconducting | 2012 | ||
| 14 | Private | Siemens | 1.5 | Superconducting | 2017 | ||
| 15 | Private | General Electric | 1.5 | Superconducting | 2019 | ||
| 16 | State | Toshiba | 1.5 | Superconducting | 2013 | ||
| 17 | Private | Siemens | 0.3 | Permanent | 2018 | ||
| 18 | Private | Hitachi | 0.3 | Permanent | 2015 | ||
Cost Comparison of MRI Examination between Private-Owned and State-Owned machines
| Protocol | Ownership | Mean Cost | Mean Difference | Significance level (p 0.05) | ||
| Brain with Contrast | Private | 1095.3 ± 197.8 | 222.8 | 0.017* | ||
| State | 872.5 | ± 158.3 | ||||
| Brain without Contrast | Private | 829.8 | ± 100.6 | 121.1 | 0.005 | |
| State | 708.8 | ± 51.9 | ||||
| Abdomen with Contrast | Private | 1095.3 ± 197.8 | 222.8 | 0.017* | ||
| State | 872.5 | ± 158.3 | ||||
| Abdomen without Contrast | Private | 829.8 | ± 100.6 | 121.1 | 0.005* | |
| State | 708.8 | ± 51.9 | ||||
| Spine with Contrast | Private | 1113.3 ± 198.4 | 218.3 | 0.019* | ||
| State | 895.0 ± 156.8 | |||||
| Spine without Contrast | Private | 839.8 | ± 180.8 | 137.5 | 0.004* | |
| State | 702.3 | ± 74.3 | ||||
| Pelvis with contrast | Private | 1108.0 ± 96.2 | 217.8 | 0.002* | ||
| State | 890.2 | ± 132.6 | ||||
| Pelvis without contrast | Private | 888.0 | ± 87.2 | 91.8 | 0.004* | |
| State | 796.2 | ± 90.9 | ||||
| *Indicates statistical significance. |
Table 3
Revenue loss due to equipment downtime in four state-owned MRI machines in Ghana
| Facility | Mean no. of MRI | Mean cost of an | Equipment | Estimated Lost | Estimated Lost |
| cases per year | MRI examination | downtime (years) | revenue (GHC) | revenue (US$) | |
| (GHC) | |||||
| 1 | 2640 | 805.8 | 3 | 6,381,837.00 | 1,276,367.40 |
| 2 | 6 | 12,763,872.00 | 2,552,774.40 | ||
| 3 | 5 | 10,636,560.00 | 2,127,312.00 | ||
| 4 | 3 | 6,381,936.00 | 1,276,387.20 | ||
| Total lost revenue | 36,164,205.00 | 7,232,841.00 |