This report contains Health Regulations and standards in Uganda, Clinical Decision Support Systems and Medical Imaging and Picture Archiving Communication Systems (PACs).

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MAKERERE UNIVERSITY
COLLEGE OF HEALTH SCIENCES
SCHOOL OF BIOMEDICAL SCIENCES
DEPARTMENT OF PHYISOLOGY
B.sc in BIOMEDICAL ENGINEERING
MUYANJA JONAH
COMPUTER BASED MEDICAL SYSTEM
REPORT
31st
October 2018

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DECLARATION
I, Muyanja Jonah declare that except from published literature references have been cited, this is
our original work done by the members above and has never been submitted to this Institution or
any other institution for any academic award or grant.

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ACKNOWLEDGEMENT
The completion of the report document would not have been possible without the guidance
and support of the BME members, to whom we are eternally grateful.
I would also like to thank Mr. David Amitu for mentoring us in the field of Computer based
medical systems as it has enabled us to make the relevant research about the topic I was
assigned.
Lastly, I would also like to thank Makerere University for providing us with the necessary
facilities during our research and report writing.

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EXECUTIVE SUMMARY
This Research was conducted at the College of engineering, design, art and technology
(CEDAT), at Makerere University.
The purpose of this research was to find out about the Health Regulations and standards in
Uganda, Clinical decision support systems, medical imaging systems and the Picture
Archiving and communication systems.
The content of this report is categorized into four main chapters.
The first chapter consists of health regulations and standards in Uganda; what are they? What
is their use? How and when were they established? Are they viable and realistic? Are they
being enforced? What are their strengths and weaknesses? What needs to be improved?
The second chapter is all about Clinical Decision Support Systems; what are clinical decision
support systems and the types under it? Why CDSS? What makes up a CDSS? CDSS
functions? CDSS interventions? Local integrations and Future Prospects?
The third chapter is the medical imaging systems and picture archiving and communication
systems; what are they? What are their components? What is their importance and
application? How do they work? What are their advantages and drawbacks? How can they be
improved?
The fourth chapter entails the conclusive remarks regarding the research performed.

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Table of Contents
DECLARATION ...............................................................................................................................................2
ACKNOWLEDGEMENT...................................................................................................................................3
EXECUTIVE SUMMARY..................................................................................................................................4
LIST OF ACCRONYMS AND SYMBOLS............................................................................................................7
LIST OF FIGURES............................................................................................................................................8
CHAPTER ONE ...............................................................................................................................................9
1.0 INTRODUCTION.............................................................................................................................9
1.1 Health Regulation .........................................................................................................................9
1.2 Health Standards...........................................................................................................................9
1.3 Development Process ...................................................................................................................9
1.4 Relevance and Importance of Health Regulations and Standards .............................................10
1.5 Health Regulatory Bodies in Uganda and their Roles.................................................................10
1.5.1 Professional Councils ..........................................................................................................10
1.5.2 Autonomous Bodies............................................................................................................11
1.6 Health Standards in Uganda .......................................................................................................12
1.6.1 International Organization for Standardization (ISO).............................................................12
1.7 UGANDA’S HEALTH CARE SYSTEM..................................................................................................13
1.7.1 Health care system definition.................................................................................................13
1.7.2 Health care delivery................................................................................................................13
CHAPTER TWO ............................................................................................................................................15
2.0 INTRODUCTION...............................................................................................................................15
2.1 Clinical Decision Support Systems ..............................................................................................15
2.2 Types of Clinical Decision Support System .................................................................................15
2.3 Components of CDSS ..................................................................................................................16
2.4 Basic Functions of CDSS ..............................................................................................................18
2.5 Drawbacks of CDSS .....................................................................................................................19
CHAPTER THREE..........................................................................................................................................20
3.0 MEDICAL IMAGING SYSTEMS AND PICTURE ARCHIVING COMMUNICATION SYSTEMS.................20
3.1 MEDICAL IMAGING SYSTEMS......................................................................................................20
3.1.1 METHODS OF MEDICAL IMAGING ......................................................................................20
3.1.2 MODERLITIES IN MEDICAL IMAGING..................................................................................22
3.2 MERITS AND DEMERITS OF MEDICAL IMAGING.........................................................................26

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3.2.1 MERITS: ...............................................................................................................................26
3.2.2 DEMERITS:...........................................................................................................................27
3.3 Picture archiving and communication system (PACS) ................................................................27
3.4 PACS has four major components: .............................................................................................28
3.5 PACS has four main uses:............................................................................................................28
3.6 Use with other medical imaging technologies:...........................................................................28
CHAPTER FOUR ...........................................................................................................................................29
4.0 CONCLUSIONS.................................................................................................................................29
4.1 HEALTH CARE REGULATION AND STANDARDS IN UGANDA.......................................................29
4.2 CLINICAL DECISION SUPPORT SYSTEM........................................................................................29
4.3 MEDICAL IMAGING SYSTEM AND PACS......................................................................................29

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LIST OF ACCRONYMS AND SYMBOLS
ISO International Organization for Standardization
MoH Ministry of Health
NPA National Planning Authority
UNBS Uganda National Bureau of Standards
NDA National Drugs Authority
AHPC Allied Health Professionals’ Council
NMS National Medical Stores
CPHL Central Public Health Laboratory
UAC Uganda AIDs Commission
UMDPC Uganda Medical and Dental Practitioners Council
UNMC Uganda Nurses and Midwives Council
RRH Regional Referral Hospital
VHT Village Health Team
CDSS Clinical Decision Support System
EPR Electronic Patient Record
CIS Clinical Information System
HIS Hospital Information System
BMJ British Medical Journal
CT Computed Tomography
PET Positron Emission Tomography
SPECT Single Proton Emission Computed Tomography
MRI Magnetic Resonance Imaging
PACs Picture Archiving and Communication Systems
EHR Electronic Health Record
RIS Radiology Information Systems
DICOM Digital Imaging and Communications in Medicine
CBMS Computer Based Medical Systems

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LIST OF FIGURES
FIG 1: Information framework
FIG 2: Radiology Images
FIG 3: Nuclear medicine generated Brain image
FIG 4: Optical imaging for a breast
FIG 5: X-ray of knee arthritis
FIG 6: Chest X-ray
FIG 7: Swallowed jack X-ray
FIG 8: Ultrasonic blood pressure
FIG 9: Pregnancy examination
FIG 10: MRI Technology
FIG 11: CT scan Technology
FIG 12: PET scan Technology
FIG 13: PACS System

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CHAPTER ONE
1.0 INTRODUCTION
This chapter will break through the health regulations and standards in Uganda and clearly
highlighting the roles of different health regulatory bodies in Uganda’s health sector.
The Ministry of Health (MoH) is mandated to set standards to guide health service delivery, as
well as the quality of health care. Every practice or procedure in health service delivery shall be
governed by a standard from leadership and governance, infrastructure development, human
resource management, Health information management, equipment, medicines and health
supplies management, preventive and essential clinical care, and client/patient responsiveness up
to support services[1].
1.1 Health Regulation
Health regulations deal with the set of local or international guidelines and laws that must be
adhered to in order to have proper functionality of the health sector through doing things in the
right order and in an attempt to save lives.
The Uganda Health Regulations are legal instrument for decisions, plans, and actions that are
undertaken to achieve specific healthcare goals within a society. They may cover topics of
financing and delivery of healthcare, access to care, quality of care, and health equity.
1.2 Health Standards
Health standards are statements that define the key functions, activities, processes and structures
and systems required for organizations to be in a position to provide quality services and as they
are determined by professional and regulatory bodies, health care professionals, staff, patients
and citizens[2].
1.3 Development Process
The development of the Health Standards and Regulations for the Health sector was a result of a
consultative process spearheaded by a Task Force established in November 2013, with support
from the National Planning Authority (NPA). The Task Force was composed of representatives
from MoH, Medical Bureaus, Private sector (Private Not-For Profit & Private Health Providers),
NPA, Mulago National Referral Hospital, Kampala City Council Authority, National Drug
Authority (NDA) and Uganda National Bureau of Standards (UNBS)[3].

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1.4 Relevance and Importance of Health Regulations and Standards
1. Primary health care (PHC) as the basic strategy for national health development.
2. Equity in health service delivery across the country.
3. Good quality health care is ensured through cost-effective intervention.
4. Health promotion, disease prevention
5. Ensure that only acceptable and proper health products are on market
6. Ensure the set standards of operation are adhered to in health facilities
7. Ethical codes of conduct and Standards of operation (SOP) are all taken in account
1.5 Health Regulatory Bodies in Uganda and their Roles
1.5.1 Professional Councils[4]
1. Allied Health Professionals council
The Allied Health Professionals Council (AHPC) is a statutory body established by
Allied Health Professionals Act Cap. 268 to regulate supervise and control the
training, practice and other related matters of Allied Health Professionals in Uganda.
2. Uganda Nurses and Midwives Council
The Uganda Nurses and Midwives Council is a statutory professional body
responsible for the regulation of the Nursing profession in Uganda. Since its inception
in 1922, the Uganda Nurses and Midwives Council (UNMC) has gone through a lot
of phases including the enactment of the current Uganda Nurses and Midwives Act of
1996. Uganda Nurses and Midwives Council (UNMC) exists to set and regulate
standards of training and practice, register nurses and midwives and provide
professional guidelines for public safety. The mandate of UNMC is regulation of the
nursing profession in Uganda with the view to: protect the public from unsafe
practices, ensure quality of services, foster the development of the profession and
confer responsibility, accountability, identity and status of the Nurses / Midwives.
3. Pharmacy Council
The overall goal of the Pharmacy council is to ensure national and International
pharmacy practice standards and codes of ethics are adhered to, both in the public and
private sectors and control the conduct and discipline of registered pharmacists.

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4. Uganda Medical and Dental Practitioners Council
UMDPC is a reputable Council that protects society from abuse of Medical and
Dental practice as well as research on human beings in order to effectively contribute
to a healthy and productive population
1.5.2 Autonomous Bodies
Autonomous bodies have sole right and power to establish their own regulations and code
of conduct[5]. They are free from an external pressure, thus they can act independently.
Under Ministry of Health there are a lot of autonomous bodies that are responsible for the
general health regulation in Uganda as explained below.
1. National Drug Authority
The National Drug Authority (NDA) was established in 1993 by the National Drug
Policy and Authority Statute which in 2000 became the National Drug Policy and
Authority (NDP/A) Act, Cap. 206 of the Laws of Uganda (2000 Edition). NDA gives
guidance on legal requirements for importation of drugs and medical equipments into
Uganda for both government and non-government facilities.
2. National Medical Stores
National Medical Stores is mandated to Procure, Stores & Distribute Essential
Medicines and Medical Supplies to all Public Health Facilities in the Country. This
mandate then grew to serve 100% of government health facilities including the
police, army and prisons. In August 2012 this mandate was further expanded to the
distribute Vaccines across the country.
3. Uganda AIDS Commission
Uganda AIDS Commission (UAC) was established by the Parliamentary Statute No.
2 of 1992, situating it under the Office of the President. The mandate of the
Commission is to oversee, plan and coordinate AIDS prevention and control activities
throughout Uganda.
4. Central Public Health Laboratory (CPHL)
CPHL is mandated to provide stewardship for the National Health Laboratory
Network to guide the prevention of disease and promotion of health in Uganda
through early detection of the disease burden in order to achieve overall sustainable

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development. It is the Technical focal point for Laboratory Services in Ministry of
Health, and is under direction supervision of National Disease Control Department.
1.6 Health Standards in Uganda
1.6.1 International Organization for Standardization (ISO)
ISO is an independent, non-governmental international organization that brings together
experts through its members to share knowledge and develop voluntary, consensus-based,
market relevant international standards that support innovation and provide solutions to
global challenges[2]. ISO has many standards in place regarding health and Uganda being a
member country is obliged to observe them. ISO Health standards include;
1. ISO/TC 212, CLINICAL LABORATORY TESTING AND IN VITRO
DIAGNOSTIC TEST SYSTEMS.
It provides standardization and guidance in the field of laboratory medicine and in
vitro diagnostic systems. This includes quality management, pre and post-analytical
procedures, laboratory safety, reference systems and quality assurance.
2. ISO/TC 94, PERSONAL SAFETY –PROTECTIVE CLOTHING AND EQUIPMENT.
This standard is responsible for standardizing the quality and performance of clothing
and personal equipment designed to safeguard people against hazards.
3. ISO/TC 210, QUALITY MANAGEMENT AND CORRESPONDING GENERAL
ASPECTS FOR MEDICAL DEVICES.
This standard focuses on the requirements and guidance in the field of quality
management for medical devices.
4. ISO/TC 198, STERILIZATION OF HEALTHCARE PRODUCTS.
This standard lays down the requirements for sterilization processes, sterilizing
equipment, washer disinfectors and ancillary products used to ensure the satisfactory
sterilization of healthcare products.
5. ISO/TC 215, HEALTH INFORMATICS
This standard strives to achieve compatibility and interoperability between
independent systems in the use of health-related data, information and knowledge to
support all aspects of the health system.

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1.7 UGANDA’S HEALTH CARE SYSTEM
1.7.1 Health care system definition
Complex to define, however, a health system is taken to include “all activities whose
primary purpose is to promote, restore or maintain Health”[6]. This definition
encompasses Health actions and Non-Health actions within and outside the Health Sector
that lead to desired health results.
The Uganda’s health system, like other systems, aims to achieve and sustain good health
for its people. The Health system has been evolving over the last 3 to 4 decades to handle
emerging concerns and challenges to the health situation in the country. Health Care
Delivery has mostly been through modern and Traditional practices.
1.7.2 Health care delivery
Health care delivery is done through a decentralized framework. The District health
structure is responsible for all structures in the district except the Regional Referral
Hospitals where they exist.
1.7.3 Structure of health care system
1. Village health teams/community medicine distributors
The first contact for someone living in a rural area would be a medicine distributor or a
member of a village health team (VHT). Each village is supposed to have these
volunteers using bicycles. They still have no medicine, but they can advise patients and
refer them to health centers.
2. Health centre II
According to the Ugandan government's health policy, every parish is supposed to have
one of these centers. A health centre II facility, serving a few thousand people, should be
able to treat common diseases like malaria. It is supposed to be led by an enrolled nurse,
working with a midwife, It runs an out-patient clinic, treating common diseases and
offering antenatal care.

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3. Health centre III
This facility should be found in every sub-county in Uganda. These centers should have
about 18 staff, led by a senior clinical officer; It should also have a functioning
laboratory.
4. Health centre IV/ District Hospital
This level of health facility serves a county. In addition to services found at health centre
III, it should have wards for men, women, and children and should be able to admit
patients. It should have a senior medical officer and another doctor as well as a theatre for
carrying out emergency operations.
5. Regional Referral Hospital (RRH)
There are 10 RRH which should have all the services offered at a health centre IV, plus
specialized clinics –such as those for mental health and dentistry –and consultant
physicians.
6. National Referral and Teaching Hospital
At the top of the healthcare chain is the national referral hospital. • This is where some of
the best medical brains can be found, often working part-time at private clinics to
supplement their meager government.

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CHAPTER TWO
2.0 INTRODUCTION
This chapter describes the ever growing need for a clinical decision support system (CDSS) for
healthcare organizations and the options that are available for them to implement it. CDSS has
been the buzz word for years amongst the healthcare IT community and for some of the
visionary clinicians and medical community. With almost every hospital now having an
Electronic Patient Records (EPR), Clinical Information Systems (CIS) or Hospital Information
Systems (HIS), the importance of CDSS has grown tremendously and is growing constantly.
2.1 Clinical Decision Support Systems
CDSS is defined as “a system that provides clinicians, staff, patients and other individuals with
knowledge and person-specific information, intelligently filtered and presented at appropriate
times, to enhance health and health care[7].” Clinical decision support system (CDSS) can
significantly impact improvements in quality, safety, efficiency, and effectiveness of health care.
2.2 Types of Clinical Decision Support System
There are different ways by which CDSS can be applied in an electronic patient records (EPR)
application. CDSS can even be applied without an EPR application, to provide stand-alone
decision support services. These are as below:
1. Alerts and reminders:
 Based on rules, the ability to alert the user when information is received or
recorded for the patient.
 The alert could be in different forms, including a simple pop-up message, a
detailed message with guidelines and an entry into a task list, SMS, email or
paging.
2. Clinical guidelines:
 Based on rules, the ability to provide a care pathway for a given patient
condition. The care pathway includes a simple guideline or reference link
when recording information, possible diagnosis, suggested investigations and
suggested treatment plan.
 Based on rules, the ability to provide a screening alert for a given patient
condition.

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3. Order sets
 Based on rules, the ability to provide a suggested order set for a given patient
condition.
4. Patient data reports / dashboards
 Based on rules, the ability to provide a list or dashboard on the set of patients
whose information complies with the rules.
5. Document templates
 Based on rules, the ability to trigger document templates/notes for a given
patient condition.
2.3 Components of CDSS
To provide a successful decision support mechanism the CDSS system has to be:
a. Very rich with its contents in terms of knowledge, references and data evidence.
b. Very powerful and intelligent to process this huge amount of data with quick response
times.
c. Very sophisticated and intuitive to catch the user’s attention and not impede the user’s
action.
Thus at a high level, a typical CDSS system comprises three vital components:
1. Data Repository
A data repository for a CDSS is quite complex and huge. The data repository holds all the
content that is required by the CDSS to provide meaningful information to the user. The
content could be structured knowledge data like the FDBE database that contains drug-
related data; or the content could be structured or unstructured text material from
renowned medical information institutes like the British Medical Journal (BMJ); or the
content could be processed structured data from the EPR applications themselves.
The information model of the data repository is equipped to handle any clinical scenario
and able to provide CDSS with relevant associated information for the context. At a high
level, the framework of the information model will look like the one below:

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FIG 1: Information framework
Needs: These are the cases that are to be considered and compared with future cases.
Actions: These are information/evidences to be considered for future cases.
Factors: These are parameters considered when an action takes place. These could be patient-
based, user-based or organization-based
Provenance: These are basic and detailed information about the action – who, when, where.
Outcome: These are information/evidences to be considered for future cases.
This framework tries to create a relationship between different data that are associated with an
object. Every action or data recorded for a patient is formalized into this framework, so that the
action or data is always qualified with rich attributes that provide more meaning to the
action/data.
Challenges around Data Repositories:
Growth rate of the data repositories that is created from various sources is too high and it is ever-
challenging for any system to keep pace with it.
Maintaining such huge data to provide zero down time and zero data loss with high performance
response times is always a challenge from the infrastructure perspective.
Data repositories don’t always come in a standard format – this varies from structured tables to
highly unstructured text material to charts and diagrams. It is quite challenging to handle all such
different data types in a single framework.

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2. Rules Engine
The Rules engine is the central component of any CDSS and plays a vital role in
analyzing and interpreting the knowledge data. This rich information interpreted by the
rules engine will form the basis of decision support that the CDSS offers to the user. The
user is thus well equipped to make an informed decision on whether it is relevant to
proceed with or chose an alternate test as suggested by the CDSS.
Challenges around a rules engine
The creation and maintenance of rules is a complex process requiring both clinical and IT
expertise.
The performance of the rules engine is always in question given the range of complex
rules that the CDSS has to process against such a voluminous knowledge data.
The quality, relevancy and dependency of the rules engine is not proven yet, as there are
no healthcare domain certifications available for rules engines.
3. Interface
Interfaces are the sophisticated part of any CDSS and play the vital role of establishing
the communication between the EPR applications and the CDSS.
2.4 Basic Functions of CDSS
1. Preventive care: Alert clinician and other providers who need to know about unusual data
(e.g., test results) or communications regarding specific patients for example
Immunization, screening, disease management guidelines for secondary prevention.
2. Diagnosis: Provision of information to the clinician at the point-of-need (e.g., clinical
pathway on pneumonia when patient with pneumonia is being admitted to hospital) for
example Suggestions for possible diagnoses that match a patient’s signs and symptoms.
3. Planning or implementing treatment: Diagnostic and therapeutic advice using a
comprehensive knowledge base and a problem-solving method, such as probabilistic
reasoning, neural nets, or heuristic rules for example Treatment guidelines for specific
diagnoses, drug dosage recommendations, alerts for drug-drug interactions
4. Follow-up management: Automation of routine and repeated tasks for the clinician on a
regular time schedule (e.g., provision of all new laboratory values on current patient list

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every morning) for example Corollary orders, reminders for drug adverse event
monitoring.
5. Hospital, provider efficiency: Organization and presentation of disparate data into logical,
intuitive schemas at the point-of-need for example Care plans to minimize length of stay,
order sets.
6. Cost reductions and improved patient convenience: Provide feedback by responding to an
action taken by the clinician or to new data entered into the system for example duplicate
testing alerts, drug formulary guidelines.
2.5 Drawbacks of CDSS
1. Changing relation between patient and the physician
2. Limiting professionals’ possibilities for independent problem solving
3. Legal implications
4. Tremendous amount of data and rules must be incorporated into system

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CHAPTER THREE
3.0 MEDICAL IMAGING SYSTEMS AND PICTURE ARCHIVING
COMMUNICATION SYSTEMS
3.1 MEDICAL IMAGING SYSTEMS
Medical imaging systems: are based on the physical interaction between some energy
source and the human body.
Medical imaging: is the technique of producing visual representations of areas inside the
human body to diagnose medical problems and monitor treatment. It has had a huge
impact on public health.
3.1.1 METHODS OF MEDICAL IMAGING
A. RADIOLOGY
Is the medical specialty that uses medical imaging to diagnose and treat diseases
within the body[8].
A variety of imaging techniques such as X ray radiography, ultrasound, computed
tomography (CT), nuclear-medicine including positron-emission
tomography (PET), and magnetic resonance imaging (MRI) are used to diagnose
and/or treat diseases. Uses electromagnetic radiation to take images of the inside
of the body. The most well-known and common form of radiography is x-ray.
It is often used when we want images of bone structures to look for breakages.
Fig 2: Radiology images

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B. NUCLEAR MEDICINE
Is a medical specialty that uses radioactive tracers (radiopharmaceuticals) to
assess bodily functions and to diagnose and treat disease[9]. Specially designed
cameras allow doctors to track the path of these radioactive tracers.
Single Photon Emission Computed Tomography or SPECT and Positron
Emission Tomography or PET scans are the two most common imaging
modalities in nuclear medicine.
FIG3: Nuclear medicine generated Brain image
C. OPTICAL IMAGING
Optical Imaging is an emerging technology with great potential for improving
disease prevention, diagnosis, and treatment in the medical office, at the bedside,
or in the operating room[10]. Optical imaging offers a number of important
advantages over existing radiological imaging techniques. First, optical imaging
uses non-ionizing radiation, which significantly reduces patient radiation
exposure and allows for repeated studies over time. Second, optical imaging
offers the potential to differentiate among soft tissues, and between native soft
tissues and tissue labeled with either endogenous or exogenous contrast media,
using their different photon absorption or scattering profiles at different
wavelengths. Third, optical imaging is very amenable to multimodal imaging. It
extends over a wide range on the imaging resolution scale and is often
complimentary to and easily combinable with other imaging techniques.

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FIG 4: Optical imaging for a breast
3.1.2 MODERLITIES IN MEDICAL IMAGING
A. X-RAY
An X-ray is a quick, painless test that produces images of the structures inside
your body-particularly your bones. X-ray beams pass through your body, and they
are absorbed in different amounts depending on the density of the material they
pass through. Dense materials, such as bone and metal, show up as white on X-
rays. The air in your lungs shows up as black. Fat and muscle appear as shades of
gray.
X-ray images are typically used to evaluate:
 Bones and teeth
 Chest
 Abdomen
FIG 5: X-ray of knee arthritis FIG6: Chest X-ray FIG7: Swallowed jack X-ray

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B. ULTRASOUND
Ultrasound imaging uses sound waves to produce pictures of the inside of the
body. It is used to help diagnose the causes of pain, swelling and infection in the
body’s internal organs and to examine a baby in pregnant women and the brain
and hips in infants. It’s also used to help guide biopsies, diagnose heart
conditions, and assess damage after a heart attack. Ultrasound is safe,
noninvasive, and does not use ionizing radiation.
Ultrasound is safe and painless, and produces pictures of the inside of the body
using sound waves. Ultrasound imaging, also called ultrasound scanning
or sonography, involves the use of a small transducer (probe) and ultrasound gel
placed directly on the skin. High-frequency sound waves are transmitted from the
probe through the gel into the body. The transducer collects the sounds that
bounce back and a computer then uses those sound waves to create an image
FIG 8: Ultrasonic blood pressure FIG 9: Pregnancy examination
Ultrasound is typically used to evaluate:
 heart and blood vessels, including the abdominal aorta and its major branches
 liver
 gallbladder
 spleen
 pancreas
 kidneys
 bladder
 uterus, ovaries, and unborn child (fetus) in pregnant patients
 thyroid and parathyroid glands
 scrotum (testicles)
 brain in infants
 hips in infants
 spine in infant

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D. MAGNETIC RESONANCE IMAGING (MRI)
Magnetic Resonance Imaging (MRI) is a medical imaging technology that uses
radio waves and a magnetic field to create detailed images of organs and tissues.
MRI has proven to be highly effective in diagnosing a number of conditions by
showing the difference between normal and diseased soft tissues of the body.
MRI is often used to evaluate:
I. Blood vessels, abnormal tissue, Breasts, Bones and joints
II. Organs in the pelvis, chest and abdomen (heart, liver, kidney, spleen)
III. Spinal injuries
IV. Tendon and ligament tears
FIG 10: MRI Technology
C. COMPUTED TOMOGRAPHY (CT)
Computed Tomography also commonly referred to as a CAT scan is a medical
imaging method that combines multiple X-ray projections taken from different
angles to produce detailed cross-sectional images of areas inside the body[11].

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CT images allow doctors to get very precise, 3-D views of certain parts of the
body such as soft tissues, pelvis, brain, heart, blood vessels, lungs, bones and
abdomen.
CT is also often the preferred method of diagnosing many cancers such as liver,
lung and pancreatic cancers.
CT is often used to evaluate:
I. Presence, size and location of tumors
II. Organs in the pelvis, chest and abdomen
III. Colon health (CT colonography)
IV. Vascular condition/blood flow
V. Pulmonary embolism (CT angiography)
VI. Abdominal aortic aneurysms (CT angiography)
VII. Bone injuries, Cardiac tissue, Traumatic injuries, cardiovascular disease
FIG 11: CT SCAN Technology

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D. POSITRON EMISSION TOMOGRAPHY (PET)
Positron Emission Tomography (PET) is a nuclear imaging technique that provides
physicians with information about how tissues and organs are functioning.
PET is often used in combination with CT imaging using a scanner and a small
amount of radiopharmaceuticals which is injected into a patient’s vein to assist in
making detailed, computerized pictures of areas inside the body.
PET is often used to evaluate:
I. Neurological diseases such as Alzheimer’s and Multiple Sclerosis
II. Cancer
III. Effectiveness of treatments2
IV. Heart conditions
FIG 12: PET scan Technology
3.2 MERITS AND DEMERITS OF MEDICAL IMAGING
3.2.1 MERITS:
 Diagnosis of illness, and the severity or benign nature of that process, is made
quickly and accurately.
 Invasive diagnostic procedures such as exploratory surgery or angiography or
cardiac catheterization may not be necessary.

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 When a child has a chronic disease or a form of cancer, medical imaging is essential
not only at initial diagnosis, but for monitoring how the disease is responding to
treatment or if the disease is progressing, and when a treatment plan might be
stopped or adjusted.
3.2.2 DEMERITS:
 Restrain and sedation for imaging procedures
 Ionizing radiation – from X-rays and CT scans
 Risks of not performing medical imaging in machine break downs
3.3 Picture archiving and communication system (PACS)
Is a medical imaging technology used primarily in healthcare organizations to securely
store and digitally transmit electronic images and clinically-relevant reports.
• Medical imaging storage technologies such as PACS are increasingly important as the
volume of digital medical images grows throughout the healthcare industry and data
analytics of those images becomes more prevalent
FIG 13: PACS System

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3.4 PACS has four major components:
1. hardware imaging machines;
2. A secure network for the distribution and exchange of patient images;
3. A workstation or mobile device for viewing, processing and interpreting images;
4. Electronic archives for storing and retrieving images and related documentation and
reports.
3.5 PACS has four main uses:
1. Replaces the need for hard-copy films and management of physical archives.
2. Allows for remote access, enabling clinicians in different physical locations to review the
same data simultaneously.
3. Offers an electronic platform for images interfacing with other medical automation
systems such as a hospital information system (HIS), electronic health record (EHR), and
radiology information system (RIS).
4. Allows radiologists and other radiology and medical personnel to manage the workflow
of patient exams
3.6 Use with other medical imaging technologies:
The universal format for PACS image storage and transfer is DICOM (Digital Imaging
and Communications in Medicine).
DICOM enables imaging technologies to connect with and transfer health data to systems
at other healthcare organizations.

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CHAPTER FOUR
4.0 CONCLUSIONS
4.1 HEALTH CARE REGULATION AND STANDARDS IN UGANDA
Health regulations and standards in Uganda are in place and very viable but their
implementation is quite lacking and limited to particular areas across the country.
This calls for our humble appeal to the government of the Republic of Uganda to
inspect and monitor the work of the health regulatory bodies more often to ensure
implementation of the available regulations and standards.
4.2 CLINICAL DECISION SUPPORT SYSTEM
With the ever-growing recognition and need for CDSS, it is evident that EPR
applications without CDSS will not stand in the future and will not add value for
clients. Aligning with CSC’s vision statement “FORWARD TOGETHER,” it is
imperative that CDSS plays a vital role in the healthcare portfolio and helps the
organization to GROW by offering a best-in-class industry solution.
4.3 MEDICAL IMAGING SYSTEM AND PACS
The use of medical imaging techniques has transformed healthcare over the years,
providing tools for better visualization, accurate diagnosis and determining proper
treatment for a variety of disorders including that of the neurological, cardiovascular,
gastrointestinal, reproductive, endocrine, respiratory and immunological systems.
However, it is vital to the health and wellbeing of patients, as well as the healthcare
system, to be properly informed about the use, benefits and risks associated with each
imaging technique. More importantly, communication between patients, practitioners,
and healthcare facilities is essential to help reduce the use of repetitive testing,
minimize the risks associated with each technique.

30. CBMS REPORT
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