Ionising Radiation (medical Exposure) Regulations Flashcards
IR(ME)R 2017
Ionising radiation (medical exposure) regulations 2017
What 6 exposures does the IRMER 2017 cover?
- Non medical imaging carried out with medical equipment
- Immigration
- Insurance
- Radiological age
- Concealed objects imaged for legal reasons
- Employment checks
What should you do if an Incident occurs?
Make situation safe
Tell patient
Report the incident
Ensure the situation can’t reoccur
Patient,referrer and practitioner may need to be informed
Learn from mistakes
Share learning
What are the roles identified under IRMER?
-referrer
-practitioner
-operator
-employer
-medical physics expert
What is a referrer?
A registered medical practitioner who is entitled in accordance with the employer’s procedures to refer individuals for medical exposure to a practitioner
Main responsibility is to ensure that the practitioner has adequate evidence to help with the justification process
Request an imaging opinion
What does a referral look like?
-referrer must be identifiable on it
-paper or electronic
-must be completed
It includes…
1) patient details
2)practice info
3)clinical details and questions
4)modality
4)background medical info
5)referrer details
Who is an operator?
Any person who is entitled in accordance with the employers procedures to carry out practical aspects related to medical exposures to ionising radiation
E.g radiographer
Must have training consistently
Examples of operators
Radiographer
Radiologist
Medical physicist
Surgeon
Who is a practitioner
A registered medical practitioner, dental practitioner or other health professional who is entitled in accordance with the employers procedures to take responsibility for an individual medical exposure.
Main purpose is to provide adequate justification for an exposure
Justification
Carried out by practitioner
Weigh the benefits assist the risks
Use protocols and professional judgement
Authorisation
Carried out by operator
Checking that the patient meets the criteria set down by the practitioner
Follows protocol
Typical limitations
Unconscious patient
Pregnant patient
High dose exams
Where management is not clear
What does a medical physics expert advise on (MPE)
Optimisation
Dosimetry
Advice on legislation
Training of other staff
Technical specifications of equipment
Selection of equipment
Analysis of incidents
Quality assurance
Acceptance testing
IRMER employers procedures
Employers duties : establishment of general procedures, protocols and quality assurance programmes to minimise the patient exposure, the risk of errors and the severity should incidents occur.
Give 5 examples of employers procedures by IRMER?
Patient identification
Identification of IRMER duty
Pregnancy
Quality assurance of procedures and equipment
Assessment of patient dose
Who is responsible for patient ID procedures
It’s the operators responsibility to ensure that the right patient is exposed
-active confirmation using 3 points of ID
-ask patient their name, DOB, address
PAUSED - clinical imaging examination IRMER operator checklist
Patient
Anatomy
Systems and settings
Exposure
Draw to a close
Who is responsible for pregnancy checking ?
It’s the operator’s responsibility to check pregnancy/breastfeeding and to ensure right patient is exposed
(Breastfeeding only an issue in nuclear medicine)
Define which exams are in scope - diaphragm to knee
Inclusive pregnancy status procedures
IPS
IPS forms have been produced and UHL procedures is to ask all patients to complete this form
Pregnancy checking
Typically can’t authorise an exposure on a pregnant individual
Low dose examination examples
Plain film x-rays of abdomen pelvis spine
Barium swallows
Interventional / fluoroscopy procedures where the fetal dose is below 10mGy
Who is the 28 day rule applied to
For females of childbearing capacity ages 10-55
Pregnancy checks on age 10-16 years
Have you started your periods?
YES/NO
If NO- patient must confirm they’re ‘not pregnant’ and must sign the declaration of pregnancy status form and proceed…
If YES- are you or might your be pregnant
If unsure- is your LMP over 28 days
If yes review requirements of radiological examination and discuss with radiologist to postpone cancel or override
Pregnancy checks for age 17-45 years
Are you or might you be pregnant ?
If unsure- is your LMP over 28 days
If yes review requirements for the radiological examination and discuss with radiologist to postpone cancel or override
If no patient is to confirm they’re not pregnant and mayst sign the declaration of pregnancy status form and record date of LMP and proceed
Pregnancy check for age 46-55 years
Do you still have periods?
If no patient is to confirm they’re not pregnant and must sign the declaration of pregnancy status form and record date of LMP and proceed
If yes ask are you or might be pregnant
If unsure ask if LMP is over 28 days
I’d yes review requirements for radiological examination and discuss with radiologist whether to delay postpone or override
Rebook according to 28 day rule
What is the assessment of patient dose
To ensure individual patient does are known
DLRs- diagnostic reference levels
Why should u use and review DRLs
To ensure dose are optimised
Informing patient of the risks and benefits
Tell patient prior to exposure where possible
contingencies e.g deaf, translator unconscious
What is an accidental exposure
Patients should not have been exposed
What is an Unintended exposure
Patient is not correctly exposed
What is a near miss
An accidental or unintended exposure that was prevented
What should you do if you have a
-accidental exposure
-unintended exposure
-near miss
REPORT TO CQC
Care quality commission
And incident reporting system
Have procedure to inform patient or their representative, referrer and practitioner if a CSAU occurs
How to stop things going wrong
Minimise probability and magnitude of accidental and unintended exposures by ensuring patient is not unnecessarily exposed
Why does the Quality assurance programme do?
Ensuring that the quality of the service with radiation use is maintained
Justification comforters and caterers
Ensure that the care and comforter is properly informed about dose constraints
Any likely health benefits to the patient being examined
Any possible benefits to the career or comforter
The detriment the exposure may cause
