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EM 1 - Radiology in Africa: facing challenges and opportunities
Education EuroSafe Imaging General Radiology Management/Leadership Physics in Medical Imaging
Thursday, February 28, 10:30 - 12:00
Room: B
Type of session: ESR meets Africa
Topic: Education, EuroSafe Imaging, General Radiology, Management/Leadership, Physics in Medical Imaging
Moderators: L. E. Derchi (Genoa/IT), H. A. Gharbi (Tunis/TN)

Chairpersons' introduction (part 1)
L. E. Derchi; Genoa/IT
Learning Objectives

1. To give an overview of radiology in Africa.
2. To list the existing cooperation programmes of the European Society of Radiology in Africa.
3. To point out what African radiologists can do for the ESR and what the ESR can do for radiology in Africa.


Africa is a large continent, with people of different cultures and habits, which may be difficult to understand as a whole. Therefore, a number of speakers from different African regions have been selected to present an overview of Radiology in Africa from a variety of perspectives. They will present topics about professional issues such referral guidelines, radiation protection, use of radiological services and promotion of Radiology in their regions. Furthermore, there will be a discussion on how to develop cooperation between African Radiological Societies and the ESR. This point, specifically, will underline the bilateral nature of the relationship, discussing what ESR can do to help African radiologists as well as on what African radiologists, can offer to European societies.

Chairpersons' introduction (part 2)
H. A. Gharbi; Tunis/TN
Learning Objectives

1. To give an overview of radiology in Africa.
2. To list the existing cooperation programmes of the European Society of Radiology in Africa.
3. To point out what African radiologists can do for the ESR and what the ESR can do for radiology in Africa.


Africa is a real mosaïc of 54 different countries with a population of more than 1.200 Million inhabitants, making up 16% of the world’s population. The diversity of mosaïc is multifaceted. There are variable socioeconomic levels with GNPs ranging from less than 500 USD, in Somalia to more than 38000 USD in Equatorial Guinea. There are many different cultures and languages, but fortunately English, French, Arab and Portuguese, and internet facilities are widespread, adapted and efficient means of communications. The impact study of medical imaging on a diverse continent is challenging for several reasons. No complete official statistics are available in all countries. The medical imaging market is often very disorganised. There are enormous differences between the different countries and even between different regions in the same country. The number of radiologists varies from less than one radiologist for one million inhabitants, to more than 80 radiologists per one million inhabitants. We can divide the radiological situation in Africa into two regions; the North including Egypt, Tunisia, Algeria and Morocco and South Africa where the situation is more or less acceptable and the centre including 49 countries and 75% of the population where the situation require an urgent solution. In fact, the needs are everywhere and require more or less the same solution from the European Society of Radiology, training, collaborating programs, but Radiation Protection rules must be established and respected so that we can guaranty an efficient and good development of the Radiology.

Structured strategies to combat radiation protection challenges in Africa. What can the ESR do?
D. Husseiny Salama; Cairo/EG
Learning Objectives

1. To give an overview on the situation of imaging referral guidelines and clinical decision support (CDS) in Africa.
2. To update on the European societies' activities in the region in regard to guidelines.
3. To give tips from African radiologists on solutions and the way forward.
4. To present the bilateral strategic planning with the ESR to improve the performance of radiation protection.


The advances in health technology continue opening new horizons for the applications of ionising radiation in health care in Africa. This has resulted in an increase in the number of medical procedures, professionals and patients involved, and in the need for structured strategies and a holistic approach towards the full integration of radiation safety and the clinical imaging guidelines in the African health sector. There have been proactive actions in Africa to improve the situation and enhance the implementation of radiation protection in several African countries, however further actions and joint activities are needed to enhance the process. The European Society of Radiology and its Eurosafe campaign have always been at the forefront trying to promote the safe use of ionising radiation in medicine, and this presentation will address strategic planning through which the ESR- African cooperation can act through to impact the future of radiology and radiation-protection in Africa and similar countries in the globe.

Is imaging underused in Africa? East Africa as an example. Solutions: what can the ESR do?
S. Vinayak; Nairobi/KE
Learning Objectives

1. To present the current situation in Eastern Africa.
2. To describe what we are doing to promote radiology in Africa.
3. To present what we would like to request from the ESR.


The challenges faced by underdeveloped countries are immense; manpower, education, lack of equipment, maintenance of equipment etc. are just a few examples. Radiology equipment is often unaffordable, so innovative solutions have to be found, tried and tested so that communities can benefit. There are only 500 radiologists serving a population of 200 million inhabitants in Eastern Africa. For ultrasound, WFUMB already has three established COEs (centres of education) providing regular CMEs, training courses and other activities related to education on a regular basis. In addition, Bergen University trains physicians in Addis Ababa. In Khartoum, doctors are being trained to perform abdominal ultrasounds. All these initiatives are in conjunction with MASU & WFUMB. The current use of imaging can be robustly stimulated by using innovative ideas and technology. The WFUMB centre of education (COE) in Nairobi trained midwives to perform basic obstetric ultrasounds on a tablet ultrasound machine with a view to identifying high-risk pregnancies. The scans were transmitted using mobile phone internet technology for validation by radiologists. Imaging is still underutilised in East Africa, and governmental bodies are looking for local solutions to these problems. Help from European societies of radiology can take the form of education and training. How this can be implemented will be articulated in detail. Also, universities of this region can work with radiologists from Europe to carry out research. ESR can help coordinate these activities in a well-structured and robust format that is sustainable.

Interlude 1: Enjoy the difference between African and European music
Most important challenges for imaging in North Africa
L. Rezgui Marhoul; Tunis/TN
Learning Objectives

1. To give an overview of the radiology situation in North Africa.
2. To enlist the cooperation programmes between North African societies and the European societies with bilateral exchanges in radiodiagnosis and interventional radiology.
3. To understand what North African radiologists can bring back to the table for European radiology.
4. To propose a plan for the promotion of collaboration between North Africa and ESR.


The Maghreb region refers to five countries, three from North West Africa, Morocco, Algeria and Tunisia, also known as the Small Maghreb and two Central Maghreb countries, Mauritania and Libya. It has about 89 million inhabitants. The distribution of medical equipment using ionising radiation in this region is very disparate and depends on multiple factors. The number of radiologists is also very variable from one region to another. Radiation protection has made great strides in some countries, and much work remains to be done in others. Rigorous regulations applied at different levels to guarantee quality and safety in terms of radiation protection exist in some countries, but challenges remain to be faced by others. The Maghreb enjoys a considerable level of development in terms of health development and radiation protection. He remains dependent on deficiencies. These are not all of the same nature and do not require the same solutions.

Interlude 2: Enjoy the difference between Arabic and European music
The WHO's programme in Africa: the past, the present and the future
M. d. R. Perez; Geneva/CH
Learning Objectives

1. To present the WHO's role, objective, core functions, structure and where/how radiology fits into them.
2. To explain the WHO's programmes in Africa and the place of radiology and radiologists in the context of the current priorities in the global public health agenda.
3. To understand the WHO's views about radiation protection in Africa.
4. To present the WHO's radiology programmes/activities in Africa. What has been done? What is currently being done? What is planned in the future?


The World Health Organization (WHO) coordinates the international health work with the objective of attaining by all peoples the highest possible level of health. The WHO’s programme of work establishes a “triple billion” target: 1 billion more people enjoying better health and well-being, 1 billion more people benefitting from universal health coverage and 1 billion more people better protected from health emergencies. Medical imaging plays a key role in the achievement of this “triple billion” target because diagnostic radiology and image-guided interventions are linked to the entire healthcare pathway (e.g. health promotion, preventive services, diagnosis, treatment, follow-up, rehabilitation, palliative care). WHO is conducting a Global Initiative on Radiation Safety in Health Care Settings to enhance global access to safe and appropriate use of radiation in health care services. This initiative is currently focused on supporting the implementation of the 10 priorities to improve radiation protection in medicine identified in the Bonn Call for Action. WHO has contributed to the development and launching of the AFROSAFE Campaign to enhance radiation safety and quality in health care in Africa and continues cooperating with local and international partners to support its implementation. A culture of radiation safety and quality can be embedded into policies, processes and institutions as the health care systems grow and develop as it is the case in many African countries. This, which represents at the same time a challenge and an opportunity, can be achieved with good leadership, robust planning and strategic investment.

Panel discussion: Radiology in Africa, reality and dreams
G. Frija1, L. E. Derchi2, H. A. Gharbi3, D. Husseiny Salama4, S. Vinayak5, E. Niang6, L. Rezgui Marhoul3, M. d. R. Perez7, B. Mansouri8, K. M. Naidu9, F. Fezoua8; 1Paris/FR 2Genoa/IT 3Tunis/TN 4Cairo/EG 5Nairobi/KE 6Dakar Fann/SN 7Geneva/CH 8Algiers/DZ 9Cape Town/ZA
Conclusion (part 1)
L. E. Derchi; Genoa/IT

Challenges to African radiology are great, but even more significant are the opportunities for growth facing radiologists in this continent. As a matter of fact, the end of this session “ESR meets Africa” is just a beginning. From here reciprocal knowledge and reciprocal cooperation must start, aiming at a strong commitment to excellence and safety and increased availability and use of Radiology worldwide, and especially in Africa.

Conclusion (part 2)
H. A. Gharbi; Tunis/TN
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