Legislation

Question 1

Why is legislation necessary?

Answer 1

• exposure to ionising radiation involves a risk to the person exposed
• the ultimate risk is death - though this unlikely
• patients, staff, and the general public could potentially be exposed to radiation
• complying with appropriate legislation helps to minimise the risks

Question 2

what are important points to note about IRR 99 (ionizing radiation regulations) and IR(ME) 2000 (ionizing radiation medical exposure)

Answer 2

• regulation governing the appropriate use of ionizing radiation in medicine and dentistry
• IRR99 deals with equipment, protection of staff and the general public
• IR(ME)R 2000 was aimed primarily at the protection of patients
• Both required large amounts of documentation

Question 3

Change in legislation 2018

Answer 3

• Ionizing radiation regulations 1999-IRR99
• On 1st january 2018 these were replaced with IRR17
• Ionizing radiation (medical exposure) regulations 2000
• replaced on 6th february 2018 with IR(ME)R 17

Question 4

Prior notice of intention to use X-rays

Answer 4

• IRR99 - this was necessary
• IRR17 - introduced a 3-tier approach - notification, registration & licensing
• A registered practice or company/employer & not individual machines
• An online process with a cost
• illegal to use equipment without registering
• Everyone will need to register even if had prior notification under IRR99

Question 5

What does RPA stand for ?

Answer 5

Radiation protection advisor

Question 6

Describe radiation protection advisor

Answer 6

• Need to appoint one - a medical physicist or specialist company
• Need to consult RPA when planning new surgery etc, radiation overdose
• Establishing the controlled area
• Name & contact details in radiation protection file
• How do the RPA and medical physics expert differ?
  RPA has a role in the IRR2017 regulations.
  MPE is part of IRMER2017 - though could be the same person

Question 7

Describe the controlled area

Answer 7

• Only the patient can be in the controlled area during exposure
• size depends on kV of machine
• 1.5m for under 70kV
• BUT size depends on Local Rules
• DDH stand 2m away for all machines
• or behind appropriate shielding
  No changes to the need for…
• Risk assessment
• Local Rules
• Radiation Protection Supervisors

Question 8

Local Rules

Answer 8

· All practices must have written local rules.

· Apply to all employees.

· Relate to radiation protection.

· Name of RPS & MPE

· Name of person with legal responsibility for compliance – usually employer

· Identification & description of controlled area

· Contingency arrangements if malfunction – these need to be rehearsed.

· Details & results of dose investigation levels

· Name & contact details of RPA.

· Personal dosimetry arrangements

· Arrangements for pregnant staff

· Reminder of IRR2017 obligations

· “Displayed” were x-ray equipment.

Question 9

What is IR(ME)R2017

Answer 9

• Dentists have to formally appoint a Medical Physics Expert as currently appoint a RPA
• they are not always the same person
• MPEs have enhanced role advising on IR(ME)R compliance
• Need to be involved in development & review of all dental procedures - not the case under IRMER 2000

Question 10

What are the 4 “Roles” in radiography?

Answer 10

• Employer
• Referrer
• Practioner
• Operator

Question 11

What are the duties of the referrer?

Answer 11

• Supply practitioner with sufficient information to allow the exposure to be justified
• state that there is a net benefit to the patient
• signed a request form
• given details to allow correct identification of the patient

Question 12

What can the dental nurse do?

Answer 12

Registered DN without an additional post registration qualification in dental radiography can have limited entitlement as an “operator.”

— Process dental radiographs – either conventionally or digital scanning

— Additional qualification allows entitlement to take dental radiographs on “prescription” of another dental registrant.

Question 13

Prescription and radiography

Answer 13

— Prescription is not a term/role in IR(ME)R!

— It is used by the GDC.

— In this context “prescription” would assume another registrant acting as both referrer and practitioner

— Most likely a registered dentist.

Question 14

dental hygienist and therapist

Answer 14

· According to the GDC they can prescribe radiographs and take, process, and interpret various film views used in general dental practice.

· Suggests qualified for limited entitlement as referrer, operator, and practitioner.

· The employer would need to make it clear what these limitations are.

Question 15

Clinical dental technician

Answer 15

— GDC Scope of Practice says they can “take and process radiographs and other images related to providing removable dental appliances.”

— This assumes entitlement as operators.

— Patients with natural teeth or implants need to be seen by a dentist before the CDT can start treatment.

— However, SoP also states that CTD could develop additional skills including “prescribing radiographs.”

Question 16

Dentist

Answer 16

· Does everything all the other DCP can do.

· Prescribe and interpret radiographs.

· Eligible to be entitled as referrers, operators, and practitioners for all dental related radiography.

Question 17

GDC advice to hygienists and therapists

Answer 17

— Dentists remain the only member of the team who can “report” on all aspects of a radiograph.

— Unlikely to be a problem in a practice were dentist available.

— Independent practices need to make sure there are appropriate referral arrangements in place so that a dentist can report on radiographs & ensure patient receives appropriate advice & subsequent treatment.

Question 18

What about GDP?

Answer 18

· (7) For the avoidance of doubt, where a person acts as an employer, referrer, practitioner, and operator concurrently (or in any combination of these roles) IR(ME)R 2000

· They should comply with all the duties placed on employers, referrers, practitioners, or operators under these Regulations accordingly.

Question 19

Selection criteria

Answer 19

— Need to have knowledge of the recommendations for:

— Caries – depending on the risk factors.

— Periodontal disease – depending on the severity & site.

— Orthodontic assessment – possibly only from specialists

— Oral surgery etc.

— Should be evidence based or specialist opinion.

— Little evidence available!