Radiation Safety Legislation Flashcards
Why do we need regulations
There are risks associated with exposure to X-rays
The regulations are designed to safeguard the health of patients, staff and members of the public
What is background radiation
Throughout everyday life we are exposed to background radiation which comes from food, buildings, etc.
How much background radiation is 1 dental x-ray equivalent to
1.5 days or less of natural background radiation exposure
What is ICRP
The ICRP is an independent, international, non-governmental organization, with the mission to provide recommendations and guidance on radiation protection
What does ICRP publications recommend
a legal framework for radiation safety
What is ICRP aimed at
government level where it is about how systems should be put in place to regulate radiation
What is the basic principles of ICRP
That all radiation exposures are justified, optimized and limited
What is meant by justified
if you expose anyone to radiation then it must be justified and it must do more good than harm. There must be sufficient benefit to the individuals or society to offset any detriment
What is meant by optimized
the magnitude of radiation exposures, and the number of people exposed must be As Low As Reasonably Practicable, taking into account social and economic factor
What is meant by limited
a system of individual radiation dose limits is used to ensure no person receives an unacceptable level of exposure
What is the IAEA
another body that takes recommendations further
They are part of the UN
What do the IAEA do
publish ‘model regulations for the use of radiation sources and for the management of associated radioactive waste’
What is the IAEA designed to do
be used as a template for radiation safety legislation around the world
What are the two pieces of UK legislation for diagnostic radiology
ionizing radiations regulation 2017 ionizing radiation (medical exposure) regulation 2017
What are IRR17 and IRMER17 enacted under
health and safety at work act
What does IRR17 deal with
occupational exposure of staff and exposure of the general public
Who is IRR17 enforced by
the health and safety executive who have specialist inspectors for the radiation matters
For IRR17 who is responsible for putting in place arrangements for compliance
employer
For IRR17 who is responsible for following the safety arrangements
employees
For NHS practices who is responsible for compliance as the employer
NHS
For private’s practices who is responsible for compliance as the employer
owner
What does regulation 6 of IRR17 cover
licensing
How must the employer obtain licensing according to regulation 6 IRR17
employer must obtain registration from HSE for use of X-rays which can be obtained by HSE website by answering questions on compliance arrangements and paying £25
For dentist what is HSE registration required under IRR17 for
the ‘use of a radiation generator’ - the x ray unit
What does regulation 14 of IRR17 state
- Regulation 14 states that an employer should consult an RPA on certain matters
What is an RPA
(radiation protection adviser) is a person meeting HSE requirements to advise on radiation safety
What is the advice from the RPA
related to what an employer needs to do to comply with regulations of the public and employees are kept safe
What are some examples of the things an employer needs to consult the RPA about
○ Designation of areas
○ Prior examination of plans for installations and acceptance into service of safety features and warning devices
○ Regular equipment checks
○ Periodic testing of safety features and warning devices
○ Radiation risk assessment and dose assessment
○ Investigations
Contingency plans
What does regulation 8 require in IRR17
a radiation risk assessment must be carried
What issues does regulation 8 include in IRR17
What safety features are required?
What level of radiation exposure could staff receive?
What does regulation 9 or IRR require
exposures to be restricted to As Low As Reasonably Practicable, and the risk assessment must consider how that is being done or come up with ways to improve on it
How must adjacent areas protected
lining in walls
may have to be lead lined for OPT OR CBCT
What is a controlled area
- A controlled area will be defined around the equipment, depending on the risk assessment and workload levels
What is the controlled area for intra oral x rays
this is often 1.5m from the X-ray tube and within the primary beam
for cone beam CT what is the controlled area
normally the room
When is signage required for controlled areas
Where the entire room is a controlled area, or when the entrance leads directly into a controlled area
What is required for a controlled area
A set of Local Rules is required for a controlled area, to set out the key working instructions for safe work within the X-ray unit
A radiation protection supervisor must be appointed to oversee the arrangements
What does IRR17 specify regarding staff training
specifies training that staff operating X-ray units and working in or around a controlled area should receive
May include basic radiation safety measures, any specific requirements for that workplace, basic understanding of risks and awareness of the regulations
What does IRR17 specify regarding dose limits
○ For radiation workers the whole body limit is 6mSv/yr (unclassified staff)
○ Members of the public is 1mSv/yr
What is IRMER17
- IRMER17 deals with exposure of patients (and some other groups)
What is IRMER enforced by in scotland
- It is enforced by Healthcare Improvement Scotland
Have a team of 4 inspectors
What is IRMER enforced by in england
CQC
What are the various medically related types of exposures that IRMER covers
patient as part of diagnosis and treatment
health screening
research
asymptomatic individual
carers and comforters
individuals undergoing non-medical imaging using medical equipment
What are those who are health screening under IRMER
Asymptomatic person may get x-ray exposure if they are part of a group where it is worth screening
What are those who are research in IRMER
Require investigations - look how well pharmaceuticals are working
What are those who are asymptomatic individuals in IRMER
People who want to get scanned even though there is nothing wrong - pay their own money
Not allowed anymore as covered by regulation
What are those who are carers and comforters
Individuals who are knowingly and willingly exposed to ionising radiation through support and comfort of those undergoing exposure
are NOT those doing so as part of their employment
Commonly relatives or friends of those undergoing exposure
Who are individuals undergoing non-medical imaging using medical equipment
Does not confer a health benefit to individual exposed
When is non medical imaging done with no benefit
□ 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 (can be requested by police)
Who is responsible for putting in place arrangements for compliance in IRMER
employer
Who is responsible for following arrangements in IRMER
employees
What are 3 examples of the 14 part procedure that is put in place in IRMER
px identification
entitlement of staff
information provided to patients
How is info provided to patients under iRMER
a new requirement of IRMER17 was to provide patients with info on the risk and benefits of radiation exposure. An information poster is sufficient in many cases
What are the duty holders under IRMER
referrer
practitioner
operator
employer
Who is the referrer
§ Has to be a registered healthcare professional
Decide locally which groups can refer
What are the responsibilities of the referrer
Responsible for providing ‘sufficient medical data’ to the practitioner to enable justification
® Patient identification
® Clinical details in enough detail that the X-ray can be justified
Who is the practitioner
§ Has to be a registered health care professional
§ Decide locally who perform this role
Must have adequate training
What are the responsibilities of the practitioner
□ Justification and authorisation of each exam
□ Ensure doses ALARP
Comply with employers procedures
Who is the operator
§ Anyone who carries out the practical aspects that can affect patient is an operator
They must be suitably trained
Who does operator include
□ Person taking the X ray
□ Person performing QC on X-ray set
□ Person cleaning film processor
Person performing clinical evaluation
What are the responsibilities of the operator
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
What is the responsibility of the employer
§ Staff carrying out any role under IRMER must be appropriately trained and must be deemed competent by the Employer
§ Training records are required
Employers 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
What are the steps for carrying out a medical exposure
- Referral for imaging is requested by a referrer
2. The examination must be justified by a practitioner who may also authorise it
3. The examination may be authorised and will be carried out by an operator
4. The image is assessed and reported by an operator - The image and report are provided to the referrer
What must the practitioner take into account when looking to see if x ray is justified
○ The objectives of the exposure and the efficacy, benefits and risks 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 - consider altogether
What happens after a justification is authorized
must then be authorised - it must be recorded that the exposure is justified and may proceed
When can justification and authorization be a two step process
where it is not practicable for the practioners to carry out the authorisation
Describe steps taken in 2 step authorization
○ Written justification guidelines prepared by a practitioner
○ Authorisation as justified by an ‘operator’ at the time of exposure
§ Provided the referral meets the criteria in the written guidelines
Can an exam legally proceed without justification
no
What must be ensured is done before the x-ray regarding justification and authorization
○ Any requests with insufficient info 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
What must employers ensure regarding clinical evaluation
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
Procedures for images sent externally for reporting
If an exposure cannot result in a clinical evaluation, should itbee done
no
Who is responsible for optimization
This is a responsibility of both the PRACTITIONER and the OPERATOR who should ensure that radiation levels are enough to produce a diagnostic image but not too high
What elements should be considered for optimization
○ Selecting appropriate investigations
○ Selecting appropriate equipment - don’t use CBCT if intra-oral can be done
○ Using appropriate exposure factors - for children use a lower setting
○ Ensure QA is carried out - requirement for regular testing is to ensure that equipment is working
○ Assessing patient dose - ensure you are not giving the patient a higher dose, this can be compared to national levels
Adherence to diagnostic reference levels
What is an MPE
medical physics expert (MPE) is an additional role specificed in regulations
What does an MPE do
It is an individual who has 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
Various roles described in the regulations, most notably ‘involved as appropriate for consultation on optimisation’
What does IRMER state on quality assurance
The regulations specify that radiation equipment should be regularly tested to ensure it is working correctly and delivering the expected dose level
What is the QA test split into
○ Routine local tests, carried out by local staff who normally operate the equipment
Physics tests, carried out every 1-3 years by specialist staff who do much more in depth tests to ensure the equipment is functioning
What is IPEM91
QA testing
contains details of what tests should be carried out and recommends the frequency of testing
What are DLR’s
diagnostic reference levels
guideline dose levels for ‘standard sized’ patients undergoing typical examinations
What are DLR’s sued as
a benchmark against national and local practice which allows us to see if exposure levels are appropriate
What do some equipment show that is useful when looking at DLR
- Some equipment displays a ‘dose indicator’ following an exposure which can be compared against a DRL
For equipment that does not show a dose indicator what is done
dose levels using typical settings are checked during annual or 3-year physics QA tests
done for intra oral machines
