Lecture 7: introduction to Legislation & IRR17

Question 1

What are the 2 sets of regulations that govern the use of radiation in the UK?

Answer 1

1- The Ionising Radiation Regulations 17

2- Ionising Radiation (Medical Exposures) Regulations 17

Question 2

Who does Ionising Radiation (Medical Exposures) Regulations 17 protect?

Answer 2

only patients and carers assisting in radiological examinations

Question 3

What are the 2 cornerstones to the regulations?

Answer 3

1- justification of the exposure

2-optimisation of the dose

Question 4

What are the 4 key roles defined with the regulations?

Answer 4

1- practitioner
2-employer
3- referrer (prescriber)
4- operator

Question 5

What are the general duties of the employer?

Answer 5

to provide a framework for radiation protection of the patient through provision of standard operating procedures

Question 6

What are the general duties of the operator?

Answer 6

to carry out practical aspects except when training, where they do so under the direct supervision of a person who is adequately trained

Question 7

What is the definition of an employer?

Answer 7

any person who is entitled to carry out practical aspects, except when training where they do so under the direct supervision of a person who is adequately trained

Question 8

What procedures must employers put in place?

Answer 8

protocols/guidelines for:

• patient ID
• referral criteria
• individuals of childbearing age
• competencies of practitioners and operators
• setting dose reference levels
• regular monitoring of patient doses
• medico-legal exposuez
• reduce accidental exposure to ALARP
• protocol for the protection of carers

Question 9

When and how is a patient identified?

Answer 9

• If the radiographic exam is not part of an examination or treatment, there must be a positive identification check
• a defined method of ID must be documented (name, date of birth, address)

Question 10

What are the 3 selection criteria for carrying out a radiograph?

Answer 10

1- selective: symptomatic to confirm or refute
2- routine: circumstantial evidence
3-screening: no evidence

Question 11

How should a person of child bearing age be managed?

Answer 11

There is no need to alter normal referral criteria, so there is no requirement to ask the question but it is up to the practice

Question 12

What is the diagnostic dose reference level (DRL)?

Answer 12

the level of dose that 75% of patients will fall below

Question 13

What are the arrangements for carers?

Answer 13

• should not be a member of staff
• should not be pregnant or under the age of 18
• risks must be explained to them
• dose constraints must be set
• justification for dose to the carer must be documented

Question 14

Who is the referrer?

Answer 14

a registered medical or dental practitioner or other HCP who is entitled in accordance with the employer’s procedures to REFER individuals for a medical exposure

Question 15

What are the general justifications that can explain x-ray exposure?

Answer 15

• part of patient’s diagnosis
• occupational health screening
• general screening
• voluntary participation in research
• none medical exposures

Question 16

What 3 things justify a medical exposure?

Answer 16

1- there must have been a clinical examination
2-the reason for the radiograph must be recorded
3- there must be a timely clinical assessment of the radiograph

Question 17

What quality control checks must be carried out on x-ray equipment?

Answer 17

• electrical: sockets, plugs, insulation
• mechanical: mountings, support, brakes, stability
• radiation: output checks, tube heads, mains isolation switch

Question 18

What does the quality assurance for automatic processors involve?

Answer 18

• transport
• electrical
• light proof
• image quality

Question 19

what does ALARP mean?

Answer 19

as low as reasonably practicable

Question 20

Who does the Ionising Radiation Regulations 17 protect?

Answer 20

workers
members of the public
protection of outside workers there for specific purposes

Question 21

Who is the IR(ME)R practitioner?

Answer 21

a registered medical or dental practitioner or other HCP who is entitled in accordance with the employer’s procedures to TAKE RESPONSIBILITY for an individual medical exposure

Question 22

Who is the operator?

Answer 22

any person who is entitled to carry out practical aspects, except when training, where they do so under the direct supervision of a person who is adequately trained

Question 23

What are the specific dose limits for all radiation employees?

• over 18 / carrying out xrays?
• under 18 / not carrying out xrays?
• pregnant employees

Answer 23

• over 18 year old / staff carrying out xrays: 1mSv per year
• under 18 year old / staff not carrying out x rays: 0.3mSv per year
• pregnant person: unborn baby/foetal dose: <1mSv for term of pregnancy

Question 24

What can employers do to keep doses to staff ALARP?

Answer 24

• reduce the number of people
• safe barriers (lead-lined walls)
• safe place to stand
• test equipment
• monitor doses

Question 25

How often must dental radiographic equipment be checked?

Answer 25

every 3 years

Question 26

Who is the RPA?

Answer 26

Radiation Protection Advisor

all dental practices must appoint a RPA

Question 27

What are the criteria of a Radiation Protection Advisor (RPA)?

Answer 27

• must be external to the practice
• must be accredited every 5 years
• practice must check accreditation
• must be appointed in writing
• only provides advice, they are not required to visit the site or take any active part in the work of the practice

Question 28

What do Radiation Protection Supervisors do?

Answer 28

• must have the required knowledge
• must work in the practice
• cannot cover multiple sites
• must be on site for the majority of the working week
• must have authority to act

Question 29

What are the criteria for a controlled area to be identified?

Answer 29

• any place where a person could get 3/10 of their annual dose limit
• anywhere near the x-ray machine
• 60/65kV, 1 metre around the x-ray tube and patient
• 70kV, 1.5 metres round the x-ray tube and patient continues in the direction of the primary beam, until it is attenuated by a barrier.

Question 30

what must each controlled area have?

Answer 30

• its own set of local rules
• systems of work
• standard operating instructions

Question 31

When is staff dose monitoring legally required?

Answer 31

for Classified Persons: anyone likely to receive 3/10 of their annual dose limit

Question 32

When is staff dose monitoring advised?

Answer 32

in cases where one person will undertake 100 introral or 50 extraoral examinations per week

Question 33

Can a dose monitor protect from radiation?

Answer 33

No, it does not prevent a dose from occurring.

It enables staff to see their level of exposure any time and can alert them when their levels are spiking.

Question 34

When is the only time someone is allowed to enter a controlled area under x-rays?

Answer 34

for a medical emergency with the PATIENT not the equipment

Question 35

at what point does a member of public become a patient?

Answer 35

the moment you decide to carry out an x-ray on them