IR(ME)R for Radiotherapy

Question 1

What does MGTI stand for?

Answer 1

Much Greater Than Intended

Question 2

What are the 2 classes of MGTI errors?

Answer 2

Equipment or procedural failure of a normally safe practice

Systematic failure at commissioning stage

Question 3

On average, how many MGTI incident occur per department per year?

Answer 3

1

Question 4

In 2014, how many radiotherapy therapeutic errors were reportable?

Answer 4

72 (49%)
Treatment error: 32%, (47)
Planning error: 13% (19)
Referror error: 3% (5)
Other: 1% (1)

Question 5

In 2014, how many radiotherapy imaging errors were reportable?

Answer 5

76 (51%)

Question 6

What is the multiplication factor for reporting imaging overdoses?

Answer 6

2.5

Question 7

What is the purpose of IR(ME)R?

Answer 7

Defines working rules to reduce chance of unnecessary exposures.

Question 8

Which regulation defines the IR(ME)R referrer, and what does it state?

Answer 8

5(5)
The referrer should supply sufficient medical data to the practitioner relevant to the exposure reuested to enable the practitioner to determine that there is a net benefit from the exposure.
Sometimes the referrer and practitioner is the same person.

Question 9

Who decides who can be an IR(ME)R referrer?

Answer 9

A local level decision should be made between the employer and healthcare professionals.

Question 10

Name 2 types of exposures in radiotherapy.

Answer 10

Diagnostic, staging, verification, review, planning, therapeutic.

Question 11

Which IR(ME)R regulation relates to justification of an exposure, and what does it state?

Answer 11

5(2)
The practitioner shall be responsible for the justification of a medical exposure and such other aspects of a medical exposure as is provided for in these Regulations.

Question 12

What are the two possible outcomes of the inital investigations when justifying therapy?

Answer 12

Therapy will be appropriate if result of investigative exposures shows positive.
Therapy already indicated but planning exposures show up something unexpected which causes therapy to be cancelled.

Question 13

Who decides who can be an IR(ME)R practitioner?

Answer 13

A local level decision should be made between the employer and healthcare professionals involved in medical exposure.

Question 14

Name 2 operators.

Answer 14

Clinical oncologist, treatment planner, radiographer, technologist, etc.

Question 15

How is it decided which operator is suitable for a task?

Answer 15

Operators are identified by the employer, e.g: in SOPs, lists (of grades, names or profession), job description, training records, etc.

Question 16

Why is authorisation required if an exposure has already been justified?

Answer 16

There may be a range of exposures that meet the criteria of the justification, and seperate authorisation allows operators to make technical decisions about individual exposures when a practitioner is not present.

Question 17

What optimisation principle applies to non-target tissues?

Answer 17

ALARP

Question 18

What is the practitioner responsible for?

Answer 18

Selecting appropriate planning for target volume.

Considering normal tissue ALARP, consistent with intent.

Question 19

What is the operator responsible for?

Answer 19

Selecting appropriate methods/equipment.
Ensuring adherence to dose constraints.
Ensuring appropriate QC.
Assessment of dose.

Question 20

Why is optimisation more important for children?

Answer 20

Children have a longer period to show latent effects, and have organs that are closer together and may be more sensitive.

Question 21

How is optimisation acheived for children in radiotherapy?

Answer 21

Paediatric specialists may use specialist protocols for therapy and for scanning.
Child specific OAR constraints may be used.

Question 22

When should an incident be reported?

Answer 22

If it is over 20% of an intended fraction.
If it is over 10% of an intended course.

MGTI if:
Partial or complete geometric miss of target.
Partial or complete imaging of wrong site.
Total CT dose > 1.5 intended caused by procedural error.

Question 23

Which regulations in IR(ME)R relates to research exposures, and what do they state?

Answer 23

6 – In the case of [research exposures] it has been approved by a Local Research Ethics Committee;
7 – The employer’s procedures shall provide that-
(a) the individuals concerned participate voluntarily…
(b) the individuals concerned are informed in advance about the risks…
(c) the [research] dose constraint … is adhered to
(d) individual target levels of doses are planned by the practitioner for …therapeutic practice from which the patients are expected to receive a diagnostic or therapeutic benefit.

Question 24

Do DRL’s apply to radiotherapy? If so, which part?

Answer 24

Yes - to planning procedures.

Question 25

Does IR(ME)R state anything about QA?

Answer 25

Yes - QA should be done for SOPs. e.g: VMAT QA, peer review, Iso 9000 quality management system.