Ultrasound safety and bioeffects: review of international guidelines and local practices in Ghana and other African countries

Purpose: This review examines the safety of diagnostic ultrasound in Ghana and other African countries by linking established bioeffects evidence to real-world practice. It asks how international guidance on ultrasound safety (justification, ALARA, and attention to Thermal Index [TI] and Mechanical Index [MI]) can be implemented effectively in typical African service conditions, particularly in obstetrics, pediatric care, Doppler applications, and emerging techniques such as contrast-enhanced ultrasound (CEUS) and elastography. Methods: A narrative review was conducted using published literature on ultrasound bioeffects, safety indices, and exposure-related risk modifiers, alongside key international guidance from major professional and regulatory bodies (e.g., WHO, WFUMB, ISUOG, EFSUMB, FDA). Additional sources addressing implementation challenges in Ghana and Africa were considered, including training pathways, maintenance constraints, quality assurance/quality control (QA/QC), infrastructure limitations, and patient communication practices. Results: Across the reviewed evidence and guidance, diagnostic ultrasound has a strong safety profile when used appropriately, but the likelihood of thermal and mechanical bioeffects increases with higher output settings, Doppler modes, prolonged dwell time, scanning near bone, and the use of microbubble contrast. Reported practice challenges in Ghana and similar contexts include variable operator training, limited preventive maintenance and quality control, power instability, weak governance, and inconsistent patient counselling. These factors can contribute to suboptimal optimization and unnecessary repeat scanning. Conclusions: Ultrasound safety in Ghana and Africa depends less on lack of guidance than on consistent implementation. Practical, locally feasible measures include justified scanning, ALARA-based presets, short focused protocols, routine TI/MI awareness, competency-based training, strengthened maintenance and basic QC led with medical physics support, and standardized patient education.