Legislation Flashcards
Why is legislation necessary?
As exposure to ionising radiation = risk to the person exposed
This could be patients, staff or the general public.
What helps to minimise the risks of exposure?
Complying with appropriate legislation
What are IRR99 & IR(ME)2000?
IRR99 - Ionising Radiation Regulations 1999
IR(ME)2000 - Ionising Radiation (Medical Exposure) Regulations 2000
Regulations governing the appropriate use of ionising radiation in medicine and dentistry
What did IRR99 deal with?
IRR99 deals with equipment and the protection of staff and the general public
What was IR(ME)R 2000 aimed at?
Aimed primarily at the protection of patients
What did both IRR99 & IR(ME)2000 require?
Large amounts of documentation!
What replaced the IRR99 on 1st Jan 2018?
IRR17.
What replaced the IR(ME)2000 on 6th Feb 2018?
IR(ME)R 17
What is a radiation protection advisor (RPA)?
A medical physicist or specialist company
When should you consult RPA?
- Planning new surgery
- Radiation over dose
How do the RPA and Medical Physics Expert differ?
RPA has a role in the IRR2017 regulations whereas MPE is part of IRMER2017
Although could be the same person!
What does the size of the controlled area depend on?
Size depends on:
- kV of machine
- 1.5m for under 70kV - Local Rules
- DDH stand 2m away for all machines or behind appropriate shielding
What members of staff usually take the role of Radiation Protection Supervisor - RPS?
Usually dentist or senior member of staff
Who do ‘local rules’ apply to?
Apply to all employees
What do local rules relate to?
Radiation protection
What must the local rules include?
- 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
Under IR(ME)R2017, what do Medical Physics Expert need to be involved in and what must they do?
Need to be involved in development & review of all dental procedures
What are the 4 roles in radiography?
- Employer
2. Referrer
3. Practitioner
4. Operator
What are the entitlements of an employer in dentistry?
- Referrers - Operators - Practitioners
What must employers be before they undertake various roles in IR(ME)R?
They must be;
- trained
- competent to undertake the role
What procedures must the employer carry out?
- Produce written procedures
- Protocols for taking radiographs
- Appoint RPA and RPS
- Ensure staff read the local rules
- Establish recommendations for Selection Criteria
- Establish recommendations for radiation dose levels
- Ensuring a Clinical Evaluation of every image is carried out, including where appropriate factors relating to patient dose.
What written procedures must the employer produce?
What does this involve?
Entitlement of duty holders
This includes:
- Identification of the patient.
- Demonstrate staff training and competence.
- Quality Assurance of procedures/documentation.
- Clinical Audit.
What are the enrolments of selection criteria 1?
- All radiographic exposures must be justified
- The selection of radiograph is based on the patient’s history & examination
- The choice of radiograph should be based on the prevalence of the disease & rate of progression & diagnostic accuracy of the imaging technique
- Decision making should be documented in the patient’s records
What should the choice of radiograph be based on?
- The prevalence of the disease
2. The rate of progression & diagnostic accuracy of the imaging technique
Where should the decision to take or not to take radiographs be documented?
Patient’s records
What can selection criteria help overcome?
What can it minimise?
It can help overcome the wide variation in practice
It can minimise or prevent any inappropriate radiographic examinations
What are the enrolments of selection criteria 2?
- Selection based on patients signs, symptoms and history
- Relating to a particular clinical situation
- Identify patients who are likely to benefit from a particular radiographic technique
All radiographs must be clinically evaluated and the findings recorded in the patient’s record.
What might the findings in the notes include?
- The quality of the radiograph - is it diagnostic or not
- Any unusual factors relating to the exposure or dose to the patient
- Normal and abnormal findings.
Who is the referrer?
Entitled in accordance with the employer’s procedures to refer individuals for medical exposure to a practitioner
What are the duties of the referrer?
- Must supply practitioner with sufficient information to allow the exposure to be justified
- Must state that there is a net benefit to the patient
- Must sign a request form
- Must give details to allow correct identification of the patient
What can a registered dental nurse without an additional post registration qualification in dental radiography do?
They can:
- Have limited entitlement as an “operator”
- Process dental radiographs – either conventionally or digital scanning
3.
What can a dental nurse with additional qualifications do?
Those with additional qualifications are able to take dental radiographs on “prescription” of another dental registrant.
What can dental hygienist & therapist do ?
- Prescribe radiographs
- Take, process and interpret various film views used in general dental practice.
- Qualified for limited entitlement as referrer, operator and practitioner - employer would need to specify these limitations
What can clinical dental technicians do?
They can take and process radiographs and other images related to providing removable dental appliances.
This means they are entitled as operators
SoP suggest CDT can gain prescribing skills.
What do patients with natural teeth or implants need to do before the CDT can start treatment?
They must be seen by a dentist.
What can dentists do?
- Prescribe and interpret radiographs.
2. Eligible to be entitled as referrers, operators and practitioners for all dental related radiography.
Is prescription a term/role in IR(ME)R?
No
Who can take radiographs in GDP?
- a dentist
- a dental hygienist or therapist
- a suitably qualified dental nurse
- a clinical dental technician
Can all operators undertake all operator duties?
Not all operators can undertake all operator duties.
What are the main roles of an operator?
- Taking radiographs
2. Clinical evaluation - although this can only be undertaken by those qualified to do so
Can other positions share operator duties?
Yes.
Medical physicists, technicians from medical physics, and those who process films etc. can possibly have operator duties.
Who must ensure that a Clinical Evaluation of each exposure is in place?
The employer
What is clinical evaluation?
What does it involve?
Interpreting:
- The outcome
- The implications of, and
- The information resulting from a medical exposure
It involves being able to diagnose or know when to seek advice
Why do 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
What equipment checks must be carried out according to IRMER?
- Must have an up to date inventory.
- X-ray units must be tested regularly: preferably annually but minimum of every 3 years.
- Must include representative patient doses.
- Routine maintenance by yourselves and the manufacturer/supplier.
What are the 2 audit procedures?
- Clinical Audit
- Audit of procedures
When selecting a radiograph what criteria must you have knowledge about 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.
What must selection criteria be?
Evidence based or specialist opinion.
What safety measures are put in place for carers and comforters during examination
Their potential dose from the procedure will required to be quantified & taken into account when justifying examination.
Will need to give informed consent
Who should you inform if something needs to be repeated or has gone wrong?
Tell patient (duty of candour) Tell referrer
What additional documentation is required?
- Patient information
- Risks and benefits
- Informing referrers, practitioners & patients of clinically significant over & under exposures
- Establish dose constraints
- Guidance for the exposure of comforters and carers.
What repeat training is available?
Refresher radiation protection training.
