IR(ME)R (lecture 1)

Question 1

To what do the Ionising Radiations (Medical Exposures) Regulations 2017 apply?

Answer 1

Medical exposures and protection of patients

Question 2

Who enforces IR(ME)R?

Answer 2

The Care Quality Comission

Question 3

What are the general principles of patient protection? (5)

Answer 3

All diagnostic procedures may carry some risk
Only necessary exposures should be carried out
Alternative methods using INIR should be considered
All medical exposures have to be justified
Diagnostic exposures should be ALARP

Question 4

What are the IR(ME)R duty holders? (4)

Answer 4

Referrers, Practitioners, Operators and MPEs

Question 5

Under IR(ME)R, what are the responsibilities of a referrer? (2)

Answer 5

They are entitled by their employer’s procedures to refer patients for medical exposures

They need to provide enough personal and clinical information to justify the exposure

Question 6

Under IR(ME)R, what are the responsibilities of a practitioner? (4)

Answer 6

Take responsibility for individual medical exposures
Confirm justification (from referrer)
Authorises the request for medical exposure
Can delegate responsibility to operators

Question 7

Under IR(ME)R, what are the responsibilities of an operator? (3)

Answer 7

Responsible for all practical aspects of the exposure
Responsible for optimisation for each individual exposure
Must be identified in the procedures

Question 8

Under IR(ME)R, what are the responsibilities of an MPE? (2)

Answer 8

Regognised by competent authority

Provide expert knowledge

Question 9

What is required to be able to justify and authorise procedures involving radionuclides?

Answer 9

The practitioner must hold an IR(ME)R 2017 license.

Question 10

What does DRL stand for?

Answer 10

DIAGNOSTIC Reference Level.

Question 11

What is a Diagnostic Reference Level (DRL)?

Answer 11

DRLs are standard doses for standard examinations for a standard sized cohort of patients using standard equipment.

Question 12

Who should be notified if there is a suspected radiation incident?

Answer 12

The CQC must always be notified

HSE must be notified if there is a public dose >1mSv OR if there has been an equipment malfunction.

Question 13

What needs to be done in the event of a suspected radiation incident? (4)

Answer 13

Notify the appropriate body/ies

Document, investigate and report the incident

Question 14

What are the guidelines for notification for high, medium and low dose examinations?

Answer 14

High doses 2.5x
Medium doses 10x
Low doses 20x

Question 15

Give some examples of a high dose examinations (7)

Answer 15

Intended doses above 5mSv

Interventional radiology

radiographic and fluorographic procedures involving contrast

diagnostic nuclear med

PETCT

CT

All radiotherapy planning and verification imaging

Question 16

Give some examples of medium dose examinations

Answer 16

Intended doses between 0.5-5mSv

Mammo, CT scouts, other radiographic examinations not included in the “high” or “low” categories

Question 17

Give some examples of low dose examinations (5)

Answer 17

Intended doses below 0.5mSv

DEXA, skull, dental, chest, in-vitro nuclear med.

Question 18

Give three examples of non-medical exposures

Answer 18

Medico-legal exposures, health screening, sports related assessments

Question 19

Give some measures that can be used to protect staff and the public during medical exposures (6)

Answer 19

PPE such as lead screens and aprons
Distance and time
keeping entrances closed/shielded
good collimation to reduce scatter
CE marked PPE
Appropriate PPE (aprons should be 0.35mmPb equivalent above 100kV, but can be 0.25mmPb under 100kV)

Question 20

Give some measures that can be used to protect patients during medical exposures (4)

Answer 20

Good collimation and positioning (use PA for chest to minimise breast dose)
Optimise exposure parameters
Use INIR where possible
Use patient PPE such as gonad shields