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Radiology > Radiation Safety > Flashcards

Radiation Safety Flashcards

1
Q

What is the dental x-ray exposure equivalent to?

A

1.5 days natural background radation

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2
Q

What are the basic principles of the ICRP system?

A

Justified: They must do more good than harm
There must be sufficient benefit to individuals or to society to offset any detriment
Optimised: The magnitude of radiation exposures, and the number of persons exposed, must be As Low As Reasonably Practicable, taking into account social and economic factors
Limited: A system of individual radiation dose limits is used to ensure no person receives an unacceptable level of exposure

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3
Q

What is the ICRP?

A

International Commission for Radiological Protection

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4
Q

What did the ICRP publish?

A

publication 103 (system of radiological protection)

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5
Q

What did the international atomic energy authority pubish?

A

Model Regulations for the Use of Radiation Sources and for the Management of the Associated Radioactive Waste (based of ICRP recommendations)

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6
Q

What are the two laws regarding radiation in th UK?

what act are they under?

A

The important Legislation in diagnostic radiology is:
* Ionising Radiations Regulations 2017 (IRR17)
* Ionising Radiation (Medical Exposure) Regulations 2017 (IRMER17)
These are enacted under the Health and Safety at Work Act

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7
Q

What does IRR17 deal with?

A

with occupational exposure of staff and exposure of the general public

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8
Q

What is IRR17 enforced by?

A

Health and Safety Executive (HSE)

The employer is responsible for putting in place arrangements for compliance
Employees are responsible for following the safety arrangements

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9
Q

What are the implications of IRR17 for dentists?

private and NHS

A

NHS: NHS is responsible for compliance as the employer
Private practice: Owner(s) responsible as the employer

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10
Q

How is the radation liscensed?

A

Licensing (Regulation 6): Employer must obtain Registration from HSE for the use of X-rays
Obtained through HSE website by answering questions on compliance arrangements and paying £25

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11
Q

What should dentists register for?

A

use of a radiation generator’ – the X-ray unit

not other practises

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12
Q

What is regulation 14?

A

The employer should consult an RPA on certain matters:

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13
Q

What is an RPA?

A

A Radiation Protection Adviser (RPA) is a person meeting HSE requirements to advise on radiation safety: a certificate issued by ‘RPA2000’ based on portfolio of evidence, renewed every 5 years

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14
Q

What is regulation 8?

A

A Radiation Risk Assessment must be carried out to consider issues including
* What safety features are required?
* What level of radiation exposure could staff receive?

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15
Q

What is regulation 9?

A

requires exposures to be restricted ALARP, and the risk assessment must consider how.

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16
Q

What is the controlled area distance for intra-oral x-rays?

A

1.5m from x ray tube and within the primary bean

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17
Q

What is the controlled area distance for cone beam cts?

A

entire room is controlled area

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18
Q

When is signage required?

A

Where the entire room is a controlled area, or when the entrance leads directly into the controlled area,

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19
Q

What does training of staff operating include?

A

May include basic radiation safety measures, any specific requirements for that workplace, basic understanding of risks and awareness of the regulations

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20
Q

What is the annual radiation dose limits for radiation works and members of public?

A

Radiation workers: whole body limit of 6mSv/yr (unclassified staff)

Members of the public: whole body limit of 1mSv/yr

Dental staff dose levels should be far below the dose limits.

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21
Q

What does IRMER17 deal with?

A

with exposure of patients (and some other groups)

22
Q

Who is IRMER17 enforced by?

from when

A

Healthcare Improvement Scotland
december 2018

23
Q

Who does IRMER17 apply to?

A

Patients as part of diagnosis or treatment
Health Screening
Research
Asymptomatic individuals
Carers and Comforters
Individuals undergoing non-medical imaging using medical equipment

24
Q

Who are carers and comforters?

A

Carers and comforters are individuals who are ‘knowingly and willingly’ exposed to ionising radiation through support and comfort of those undergoing exposure

Individuals acting as Comforters or Carers are not those doing so as part of their employment

Carers and comforters are commonly relatives or friends of those undergoing exposure

25
Q

When is imaging used non-medically?

A
  • health assessment for employment purposes
  • health assessment for immigration purposes
  • health assessment for insurance purposes
  • radiological age assessment
  • identification of concealed objects within the body.
26
Q

Who is responsiblle for putting in place arrangements for compliance?

A

the employer

employees are responsible for following these arrangements

27
Q

What are 3 of the 14 pecific particular preocedures that must be in place?

A

patient identification
entitlement of staff
information provided to patients

28
Q

What was the new requirement for IRMER17?

A

Information to be given to patient about the benefits and risks of the radiation exposure.
An information poster is sufficient in many cases

29
Q

What are the types of duty holders?

A
  • referrer
  • practitioner
  • operator
  • employer
30
Q

What is the basic framework for carrying out medical exposures?

A
  • Referral for imaging Requested by a Referrer
  • The examination must be justified by a Practitioner who may also authorise it
  • The examination may be authorised and will be carried out by an Operator
  • The image is assessed and reported by an Operator
  • The image and report are provided to the Referrer
31
Q

Who is a referrer?

A

registered health care professional

32
Q

What is the responsibility of the referrer?

A

– responsible for providing ‘sufficient medical data’ to the Practitioner to enable justification
* Patient identification
* Clinical details
– Employer must provide referral criteria

33
Q

Who is a practitioner?

A

registered health care professional
must have adequate training

34
Q

What is the responsibilities of the practitioner?

A

– justification (and authorisation) of each exam
– ensure doses ALARP (as low as reasonly possible)
– comply with Employer’s Procedures

35
Q

What does the justification involve?

A

The Practitioner must take into account the information supplied by the Referrer and consider:

  • The objectives of the exposure and the efficacy, benefits and risks of available alternative techniques
  • All the potential benefits of carrying out the exposure, including the direct health benefits to the individual and the benefits to society
  • The detriment to the individual

A Justified exposure must then be Authorised: it must be recorded that the exposure is justified and may proceed

36
Q

When is justification and authorisation a two step process?

A

where it is not practicable for the Practitioner to carry out authorisation:

37
Q

How is the 2 step process carried out?

A
  1. Written Justification guidelines prepared by a Practitioner
  2. Authorisation as justified by an ‘Operator’ at the time of exposure
    Provided the referral meets the criteria in the written guidelines
38
Q

When can an exam not legally proceed?

A

unless justification process is complete

39
Q

If justification process is not complete, what is done?

A

–any requests with insufficient information must be referred back to the Referrer
–any exams that the practitioner feels are not justified must be referred back to the Referrer
–Exams must be authorised as justified before the exposure

40
Q

Who is the operator?

A

anyone who carries out practical aspects that can affect patient dose is an Operator. They must be suitably trained.
* e.g. person taking X-ray
* person performing QC on X-ray set
* person cleaning film processor
* person performing clinical evaluation

41
Q

What are the responsibilites of operators?

A

– to select equipment and methods to limit dose to patient
consistent with the purpose
– follow the Employer’s Procedures
– must not perform exam unless authorised as justified

42
Q

What is a clinical evaluation?

who ensures it

A
  • The Employer must have procedures to ensure that a clinical evaluation of the outcome of each medical exposure is recorded
    – Procedures for in-department reporting
    – Procedure for images sent externally for reporting.
  • An exposure cannot be Justified if it is known a Clinical Evaluation will not be performe
43
Q

What must the employer do after staff is trained?

A

must be deemed competent

training records are required

must ‘Entitle’ staff to carry out their roles, with a clear ‘scope of practice’ which clearly states what roles they are able to perform and what tasks they may carry out.

44
Q

What is optimisation?

who is responsible for it

A

IRMER17 requires that all exposures are optimised.
This means that exposures are as low as reasonably practicable, consistent with the intended purpose
This is a responsibility of both the Practitioner and the Operator

45
Q

What does optimisation involve?

A

– Selecting appropriate investigations
– Selecting appropriate equipment
– Using appropriate exposure factors
– Ensuring QA is carried out
– Assessing patient dose
– Adherence to diagnostic reference levels

46
Q

Who is a medical physics expert (MPE)?

A

“an individual… having the knowledge, training and experience to act or give advice on matters relating to radiation physics applied to exposure, whose competence… is recognised by the Secretary of State”

specified in regulatins

47
Q

What do MPEs do in the NHS?

A

In NHS GG&C, Health Physics MPEs provide advice on exposure factors and equipment-related matters

48
Q

What is the quality assurance of radiation equipment?

what do the regulations specifiy?

A

The regulations specify that radiation equipment should be regularly tested to ensure it is working correctly and delivering the expected dose level.

Tests are normally split into:
* Routine local tests, carried out by local staff who normally operate the equipment, and;
* Physics tests, carried out every 1 to 3 years by specialist staff

National guidelines suggest what tests should be carried out

49
Q

What document outlines quality assurance?

A

IPEM91

Outlines tests required and recommends frequency of testing

50
Q

What are diagnostic reference levels?

A

DRLs are guideline dose levels for “standard sized” patients undergoing typical examinations.

They can be used as a benchmark against national and local practice.

Some equipment displays a ‘dose indicator’ following an exposure which can be compared against a DRL

For other equipment, dose levels using typical settings are checked during annual or 3-yearly physics QA tests

Radiology (10 decks)

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