Medical physics 3 – Radiation legislation: Flashcards
What does IRMER stand for?
The ionising radiation medical exposure regulations
What is The ionising radiation medical exposure regulations (IRMER) concerned with?
Concerned with protection of patients
They Protect the patient from detrimental effects of radiation
What is The ionising radiation medical exposure regulations (IRMER) enforced by?
Care quality commission (CQC)
Who do the IRMER regulations apply to?
- Radiation exposures of patients as part of diagnosis or
treatment - Radiation exposures of volunteers for research
- Radiation exposures for medico-legal purposes
- Radiation exposures as part of occupational health monitoring
- Radiation exposures as part of screening programmes
- Radiation exposures of asymptomatic persons – “the worried well”
What is the IRMER philosophy?
- Avoid unnecessary exposures
- Every exposure must have a net benefit
- Optimise exposures
- Ensure quality of exposures
- Written clinical evaluation for every exposure
- Define responsibilities of Referrers, Practitioners and Operators
What guidelines must medical radiation equipment fall under?
Must be:
- capable of restricting exposure to the patient
- fitted with a means of indicating the quantity of radiation produced
- subject to adequate testing before first use, after maintenance, and at intervals
- subject to a suitable quality assurance programme
What foes a suitable medical radiation equipment quality assurance include?
- Adequate testing before first use for clinical
purposes
2, Adequate testing at appropriate intervals & after major maintenance
3, Measurements at suitable intervals to assess representative doses to patients
Who has a duty of taking care of the patients radiation exposure safety?
- Employer
- Referrer
- Practitioner
4, Operator
What must a written procedures include according to IRMERS guidelines?
- Identification of: Referrers, Practitioners and Operators
- How and when referrals 3. Justification of a Medical Exposure
- Non-medical imaging exposures
- Patient Identification
- Pregnant or Potentially Pregnant Patients 7. Comforters and Carers
For which procedures do you need do a written procedure for?
- Standard Operating Protocols (SOPs)
- Clinical Evaluation
- Assessment of patient dose
- Diagnostic Reference Levels (DRL’s)
- Dose constraints
- Accidental / Unintended Exposures
- Quality assurance of medical radiological equipment
- Audit, review
What 3 roles does IRMER define?
- Referrer
- Practitioner
- Operator
Who is the referrer?
Anyone the employer decides is entitled to refer
– Usually the dentist but could be GP or other registered healthcare professionals
What must the referrer provide?
- sufficient & correct demographic information to correctly identify patient
- sufficient clinical information for ‘practitioner’ to justify examination
What must the referrer be provided with?
written referral criteria, including radiation dose & alternatives
Who is the practitioner?
Anyone the employer decides is entitled to justify a dental radiograph
In most cases, the Practitioner will be the Dentist
When must a justification for a radiograph be taken?
Prior to exposure
What is the duty of the practitioners?
Responsible for the justification & authorisation of each medical exposure.
Can only be based on data provided by the Referrer
What are the responsibilities of the practitioner?
- Justify the exposure in terms of clinical benefit and radiological risk
- Authorise the exposure or provide guidelines to allow the operator to authorise it
Who is the operator?
Anyone who impacts on the successful outcome of the medical exposure is an operator
Operators must be adequately trained
What is the role of the operator?
Key role of Operator is to optimise exposure
Balancing act between
maximising image quality / diagnostic
information and minimising patient radiation dose
What does the operator have to do when taking x rays?
Operator has to:
- Ensure the correct patient
- Ensure the correct examination
- Ask about pregnancy
- Use right exposure factors
- Position the patient correctly
- Minimise field size
What knowledge must the practitioner and operator have?
- Fundamental physics of 2. Management & radiation protection
of the patient - Statutory requirements & non- statutory recommendations
- Diagnostic (dental) radiology
What must you do before taking an x ray?
the patient must be identified before the exposure takes place
What should we ask the patient to ensure we are about to take an x ray of the right patient?
Operators making exposures must positively identify the patient by name, address and DoB before the exposure takes place
What must you ask to a female before taking an x ry?
in the case of a female of childbearing age, he has enquired whether she is pregnant or if relevant breastfeeding,
What does the diagnostic reference level refer to?
It is a Guide to acceptable levels of patient dose
What is the national diagnostic level for an adult patients having an intra oral examination?
1.7 mGy
What is the national diagnostic level for an adult patients having an OPT examination?
93 mGy.cm^2
What is the national diagnostic level for a child patients having an OPT examination?
67 mGy.cm^2
What mist the image evaluation include?
- Info o radiation dose
- Info on type of x ray
- Info on the exposure settings
What must all policies, protocols and procedures regularly have done?
They need to be regularly audited To prove whether they still work or whether they need to be amended
What does a clinical audit evaluate?
evaluate appropriateness of referral,
patient dose and outcome of test
What must audits include?
must include whether local procedures are being followed
What does an audiotapes of a dental radiograph include?
Quality control of processing
Scoring of images
Written evaluation
What incident must we report?
- Patient exposure much greater than intended due to equipment malfunction or failure to follow procedures/protocols
- Unintended exposures
- Near misses
When monitoring the population dose what must the employer do?
- collect dose estimates from medical exposures for
radiodiagnostic and interventional procedures - taking into consideration the distribution by age and gender of the exposed population
- when requested provide it to the Secretary of State
