IRMER REGUALTIONS Flashcards
1
Q
Name the 2 regulations we follow in the uK in regards to radiation
A
The Ionising Radiations Regulations 2017 (IRR17)
The ionising Radiation medical exposure regulations 2017 (IRMER17)
2
Q
When sis the IRR17 come into effect
A
1st Jan 2018
3
Q
When did IRMER17 come into effect
A
6th feb 2018
4
Q
Are the new radiation guidelines affected by BREXIT
A
NO
5
Q
What is a key aspect considered int eh new IRR17 that was not considered previously?
A
The use of radionuclides
6
Q
How are radionuclides approached in IRR17
A
In a graded approach
7
Q
Talk through the graded approach of how to handle radionuclides accordigfn to IRR17
A
if you work with low concentrations of radionuclides (low risk) you need to NOTIFY the health and safety executive
If you work with radiation generators (most dental practices) and artificial radionuclides you need to REGISTER with health and safety executives
If you administer radiopharmaceuticals to patients (high risk) you need to gain CONSENT from the health and safety executive
8
Q
What does HSE stand for
A
Health and safety executive
9
Q
What does the registration process to HSE for the use of ionising radiation entail
A
- 8-10 questions
- Risk assessment
- Identified and completed actions to restrict exposure
- Local rules
- Contingency plans
- Adequate training of staff
7.Designated and demarcated supervised and controlled areas - Estimation and/or measurement of employee’s exposure
10
Q
Does every dentist need to register to HSE to be Abel to take radiographs
A
No only employers
11
Q
Who is a classified worker
A
An employee Riley to receive:
1. An effective dose greater than 6mSv per year
OR
2. An equivalent dose greater than 15mSv per year to the lens of the eye
OR
3. A dose greater than 150mSv per year for the skin of the extremities
12
Q
What does a classified worker need
A
An appointed doctor
Annual health checks
A passbook if they work in other employers controlled areas to have your doses monitored
13
Q
Are there usually classified workers found in dentistry
A
no
14
Q
talk through the hierarchy of who ensures radiation rules are upheld and regulated
A
Chief Executive
Head of Dental Radiology
Clinical Governance Group
Radiology Team Leader
All staff who are involved with work with X-rays
15
Q
Name the 2 appointed people talked about in the local rules for radiation protection
A
- Radiation protection advisers
- Radiation protection supervisors
16
Q
Who is the radiation protection advisor
A
A person an employer consults about observance of the regulations
17
Q
What things must be discussed with the radiation protection advisor
A
- Plans for installation of new equipment
- Acceptance of new or modified equipment
- Controlled areas
- Working arrangements for pregnant employees
- PPE
18
Q
Under IRMER 17 who do you require to have in your team
A
A medical physics expert
19
Q
Under IRR17 who do you require to have in your team
A
A radiation protection advisor (RPA)
20
Q
Which two roles can be combined to fulfil both IRMER17 and IRR17
A
Medical physics expert (MPE) and radiation protection advisor (RPA)
21
Q
What does a radiation protection supervisor do
A
Supervises the day to day radiation work and must be appointed in writing
22
Q
What requirements must the radiation protection supervisor meet
A
They must:
1. Understand the regulations
2. Command sufficient authority to enable them to effectively supervise the radiation protection aspects of dental radiography
3. Understand the necessary precautions
4. Know what to do in an emergency
5. Be adequate trained
23
Q
What questions should you ask if you think you need a controlled area
A
- Is it necessary for persons to follow special working procedures to avoid, or restrict, significant exposure
- Could the annual dose exceed the dose thresholds
24
Q
Is it necessary to have a controlled area in dentistry
A
Yes
25
What is the threshold for employees and trainees over 18 years
Whole body: 20mSv per year
Lens of the eye: 20mSv per year
Skin hands, forearms, feet and ankles: 500mSv per year
26
What is the threshold for employees and trainees aged 18 and under according to II17
Whole body: 6mSv per year
Lens of the eye: 15mSv per year
Skin hands, forearms, feet and ankles: 150mSv per year
27
What is the threshold for 'other people' (the general public) under II17
Whole body: 1mSv per year
Lens of the eye: 15mSv per year
Skin hands, forearms, feet and ankles: 50mSv per year
28
What is the threshold for patients under II17
there is no limit
29
What requirements must a controlled area fulfil
1, Must be descriptor in the local rules
2. Must be demarcated
3. There must be a restriction to access
30
Who shovel be able to access the controlled areas
1. Employees involved in taking the radiographs
2. Other employees who require access eg cleaning staff
3. Outside workers including engineers
4. Prison officers and policemen
31
what can a controlled area be defined in relation to
A fixed distance from the x ray set
32
What is the average distance the controlled area lies in for intra oral radiography
1.5m around the x ray set
33
Who will need got enter the controlled areas
1. Those making the exposure
2. Comforters and carers
3. Cleaning staff
34
How can we offer personal dose monitoring
1. Issue staff with personal dosemeter provided by an approved dosimetry service
2. Issue staff with direct reading electronic personal dosemeters and record dose locally
3. Estimate annual doses at the operator’s position with RPA input (most common in dental practices )
35
If staff have been issued a personal dosemeter what must they do
1. Wear the dosemeters appropriately
2. Return them on time for assessment
3. Report any loss of damage of the dosemeter or holder immediately to team manager
36
What are the guidelines regarding a person who is directly supporting a patient undergoing radiography in regards to radiation protection
1. No one should be directly supporting or immobilising patient unless necessary
2. That person should not be pregnant
3. The dose should be optimised using good radiographic technique
4. Appropriate PPE should be provided to the person eg lead apron
37
What falls under contingency plans
1. Fire, flood and suspected mechanical damage
2. Exposure fails to terminate
3. Exposure started unintentionally
4. Person enters the Controlled Area during an Exposure
5. Malicious or Accidental Operation of the X-ray Unit
38
Talk through a typical contingency plan
1. Switch off the equipment and isolate it from the mains supply
2. Place a notice on the equipment indicating that it should not be used
3. Record the details of the incident including any error codes and dose information
4 inform the radiation protection supervisor at the earliest opportunity
5. if equipment fault the equipment must not be used until its performance has been verified as satisfactory
6. If the incident could have led to a potential overexposure then follow overexposure guidelines
39
If there is a radiation incident who should be informed
The incident should be reported to health and safety executive
40
What is the responsibility of the staff if a radiation incident has occurred
1. Ensure any equipment involved is taken out of use until an investigation has identified the cause of the incident and any remedial action to rectify the cause has been taken
2. Complete approparte incident reporting forms
3. Inform your radiation protection supervisor
41
What is the role of the radiation protection advisor in relation to a radiation incident
1. Advise if the incident is notifiable to an external authority
2. Determine the approparte level of investigation required is
3. Assist in the investigation if required
42
Who/what determined when equipment maintained should be carried out
According to the recommended manufacture intervals
43
Who/what determined when equipment maintained should be carried out
According to the recommended manufacture intervalsW
44
What criteria's must medical equipment meet prior to use
Must be:
1. Subject to adequate testing before first use, after maintain and at intervals
2. Subject to a suitable quality assurance programme
45
What principles are included in IRMER 17
1. Protection of patients
2. Justifying medical exposure
3. Ensuring medical doses are appropriate
4. Ensuring that those who expose patients to radiation are trained
46
What is the main requirement of the IRMER17 regulations
That employers have procedures in place to ensure patients are protected. these are called employers procedures
47
List the employers procedures
1.Identify correctly the individual to be exposed to ionising radiation
2. Identify people with responsibilities
3. Making enquires to establish whether the individual is or may be pregnant or breastfeeding
4. To ensure that quality assurance programmed in respect of written procedures, protocols and equipment are followed
5. The assessment of patient dose and administrated activity
6. Use and review of diagnostic reference levels that the employer may have established for radio diagnostic examinations
7. Establish procedures for the use of dose constraints for biomedical and medical research
8. The giving of information and written instructions for patients undergoing investigation or treatment using radioactive substances
9. Provide wherever practicable, and prior to an exposure, the individual to be exposed or their representative with adequate information relating to the benefits and risks associated with the radiation dose from the exposure
10. The carrying out and recording of an evaluation for each exposure including, where appropriate, factors relevant to patient dose
11, To ensure that the probability and magnitude of accidental or unintended exposure to individuals from radiological practices are reduced so far as reasonably practicable
12. Reducing accidental or unintended exposures
13. Procedures to be observed in the case of non medical imaging exposures
14. Establish Dose constraints and guidance for the exposure of Comforters and carers
48
What procedure to we have in place to identify correctly the individual to be exposed to ionising radiation
3 point check:
Full name
Date of birth
First line of address
49
List the different people with responsibilities in terms of radiation
1. Employer
2. Referrer
3. Practitioner
4. Operator
all of these people must act within their scope of practice
50
What is the employers responsibilities
To ensure that the employers procedures are in place
51
What are the referrers responsibilities
Must supply enough clinic information to allow the practitioner to justify the exposure.
A history and clinical examination of the patient is essential
52
Who is the referrers
A registered medical or dental practitioners or other health professional who has had appropriate training
53
What impact has COVID had on the referrers role
Referrers may refer patients for radiation without a clinical examination if a telephone exam has been undertaken
54
Who is the practitioner
Any registered medical or dental practitioner or other health profession who has been appropriately trained
55
What are the practitioners Responsibilities
1. To take responsibility fro the exposure
2. To justify the exposure
56
What are the operators responsibilities
1. Ensure the exposure has been authorised
2. They are repressible for each and every practical aspect of an exposure
3. They must follow employers procedures
57
List the different aspects of an exposure
1. Identification
2. Positioning
3. Setting the exposure factors
4. processing
5. Quality assurance
6. Writing a report
58
Under the IRMER17 Scope of practice that roles can the dentist undertake
practitioner
referrer
ALL operator roles
59
Under the IRMER17 Scope of practice that roles can the dental hygienist undertake
practitioner
referrer
ALL operator roles
60
Under the IRMER17 Scope of practice that roles can the dental therapist undertake
practitioner
referrer
ALL operator roles
61
Under the IRMER17 Scope of practice that roles can the dental nurse with additional training undertake
patient identification, preparing the x ray
initiating exposures, processing film and quality assurance
62
Under the IRMER17 Scope of practice that roles can the dental nurse without additional training undertake
patient identification, processing film and quality assurance
63
Under the IRMER17 Scope of practice that roles can the dental technician undertake
none
64
for dental exposures do we require to enquire about a patients pregnancy or breastfeeding status
no and you should have a procedure that states that enquiries are not required for dental exposure
65
What are all operators responsible for in terms of patietn dose
Responsible for ensuring that the factors relevant to patient dose are documented at the end of every examination
66
When does individual Patient dose for dental exposure need to be assessed
If the operator departs from the guideline exposure settings
67
What are diagnostic reference levels
They are guidelines doses which indicate good practice
they should not be routinely exceed
68
What information should patients be given proper to radiation
Patients should be given written information to tell them what to do to minimise the radiation dose to themselves and others
(not relevant to dent)
69
What information should patients be given proper to radiation
Patients should be given written information to tell them what to do to minimise the radiation dose to themselves and others
(not relevant to dent)
70
What is the typical dose for a single bitewing
less than 0.01 mSv
71
What is equivalent period of natural background radiation for a single bitewing
less 1.5 days
72
What is the typical dose for a panoramic
0.01 mSv
73
What is equivalent period of natural background radiation for a panoramic
1.5 days
74
What must we do for each radiograph we take
A REPORT
75
If an accidental or unintended radiation has been administered do we need to tell the patient
yes also notify the CQC
76
Which incidents do we need to report under IRMER
1. Report patties over exposure resulting from procedural failure or failures to follow procedures
2. Included exposure on wrong patient
77
When does an overexposure need to be reported to the CQC in England
More than 3mSv or above in adults
More than 1mSv or above in children
78
What is non medical imaging exposures
Any deliberate exposure of humans for imaging purposes where the primary intention of the exposure is not to bring a health benefit to the individual being exposed
79
What questions does the CQC want dental practices consider
1. How do you put arrangements fro radiation protection into practice
2. Have you consulted a radiation protection advisor and medical physical expert
3. Have you registered with HSE
4. Have you documented the arrangements for radiation protection
5. Do you quality assure performance test the radiography equipment
6. Is the x ray equipment maintained or serviced by the appropriate person
7. Which staff are involved in taking x rays and are they trained
8. Have staff been trained accordingly to current professional guidelines
