Assessment Of Computed Tomography Referrals. A Case Study Of University Of Nigeria Teaching Hospital Ituku-Ozalla, Enugu.

 Despite its clinical application, computed tomography scan is not readily available in developing countries, like Nigeria. Some patients who require CT examination are either managed blindly, or do not present for it at the appropriate time. This study assesses the referral pattern, indications and results of CT referrals, as they are obtained in University of Nigeria Teaching hospital Ituku/Ozalla, Enugu. Retrospectively recorded data of all patients who presented for CT scan between May 2011- April 2012 at UNTH, Enugu were analysed. A total of 726 CT scans studied, were made up of 416 males (57.30%) and 310 females (42.70%). Majority of the patients were within the age range of 21-30 years representing 15.30% of all referrals. 29.01% (211) of all CT scans were referred from accident and emergency unit, followed by surgical out-patient department 11.98%.Analysis of the clinical indications showed trauma and RTA to be the commonest indication for brain CT referrals 21.81%, abdominal neoplasm/metastasis for abdominal pelvic CT scan 24.48%, respiratory difficulty for chest CT 25%, suspected cervical fracture for neck CT scan 38.09% and spondylosis for spine CT 61.54%. Analysis of the CT diagnosis showed cerebral atrophy to be the commonest result for brain CT referral 12.48%, hepatic disorder for abdominopelvic 12.58%, laryngeal cancer for neck CT 24%, PTB for chest CT scan 21.48% and spondylosis for spine CT 29.41%. Out of the 726 CT scan studied, 228 (31.40%) had normal findings while 498(68.60%) had abnormal findings. CT had made substantial impact on patient care, though the study showed a relatively poor referral rate to CT examination. The study recommends proper sensitization of health personnel on the wide clinical applications of CT and improved health care insurance scheme to ensure better access to modern diagnostic tools by patients.     TABLE OF CONTENTS Title page         i Approval page        ii Certification        iii Dedication         iv Acknowledgment        v   Abstract         vi Tables of contents       vii List of Tables       viii
CHAPTER ONE:  INTRODUCTION  1.1 Background       1 1.2 statement of problems      3 1.3 General objectives of the study     3 1.4 Specific objectives  of the study    3 1.5 Significance of the study      4 1.6 Scope of study       4 1.7 Review of related literatures     4
CHAPTER TWO: THEORETICAL BACKGROUND  2:1   History of Computed tomography ( CT)  12 2.2 Basic principles of computed tomography   12 2.3 Evaluation and generation of CT scanners  13 2.4  Helical computed tomography     15 2.5 Multislice scanners      16 2.6 Other design of CT scanners              17   2.7 CT System Components              18 2.8 Different CT Examinations     20

CHAPTER THREE: RESEARCH METHODOLOGY  3.1 Research design       27 3.2 Population        27 3.2.1 Area of study       27 3.2.2 Target population                                                      27 3.2.3   Subject selection criteria 3.3   Ethical approval                                                           28                                                                                                                                           3.4  Method of data of data collection                                 28 3.4.1 Source of data                                                            28 3.4.2 Procedure for data collection                                     28 3.5 Data analysis                                                              28    CHAPTER FOUR: DATA ANALYSIS AND PRESENTATION  30  CHAPTER FIVE:                                                             46    5.1 Discussion                                                                46 5.2 Summary of findings                                                51 5.3 Recommendation                                                       52 5.4 Limitation of the study                                              53 5.5 Conclusion                                                                 53 5.6 Area of further study                                                53      References                                                                55   
INTRODUCTION The advent of CT has revolutionized diagnostic radiology.  It is estimated that more than 62 million CT scans per year are currently obtained in the United States, including at least 4 million for children1.
Although computed tomography has been in use in the diagnosis of head trauma and some pathologies of other part of the body, it is only in the last 15-20 years that it became widely used. In fact, since its invention in the 1970s, it has been shown to have wide application within all radiological sub specialties 2.CT has effectively replaced many other radiological procedures such as lymphangiography, catheter arterial and venous angiography of the brain and the spine 3.
 New applications and clinical roles for CT has emerged in the last few years including CT angiography, pulmonary embolism detection, the diagnosis of abdominal pain and appendicitis and the investigation of renal colic.
The use of multi-detector technique and improved multi reconstructive algorithms has introduced newer opportunities in the use of CT for diagnosis of pathologies of the brain, spine, orbits, fracture and vascular system4. 
Despite the vast clinical application, computed tomography is not readily available in developing countries like Nigeria and awareness of its clinical application based on anecdotal evidence is rather poor among general practice physicians and health care providers4.Enugu is a referral centre for the five south eastern states of Nigeria, but patients are also referred from other parts of Nigeria, especially the contiguous south-south and northern states5. Enugu as a state has over 723000 population6 with 17 L.G.A. Less than four (4) CT machines are in active use in Enugu as at the time of this research, with one owned by federal government and two by private establishment .This difference in acquisition could be attributed to high cost of machines, maintenance and poor awareness of its multifunctional attributes.
A previous study in Nigeria observed that the lack of CT scan facilities in a centre contributed a great deal to a high mortality rate of 19.8% in head trauma 7.In this environment, the prevalence of head injuries7,8,9,10., and other CT detectable pathologies had consistently risen over the decades. Unfortunately, many of these patients in many centres are still managed based on pre-CT era protocols, resulting in high mortality and morbidity. This is partially due to financial constraints, few CT scan centres which are not easily accessible to many of the referring doctors. Consequently, some patients who require imaging investigation are either blindly managed or do not present for CT scan at the appropriate time5. 
There is also false impression that CT scan is expensive and therefore, an avoidable financial burden to poor families. The pitiable transport facilities and unavailability of ambulance services make the transfer of ill patients to other hospitals particularly challenging. It is against this background that the researcher seeks to assess the pattern of computed tomography referrals in University of Nigeria Teaching hospital Ituku-Ozalla, Enugu state and hence the utilization of this very important imaging modality.