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BDS3 - radiology > Radiation Safety Legislation > Flashcards

Radiation Safety Legislation Flashcards

1
Q

why do we need radiation safety regulations?

A
  • there are risks associated with exposure to x-rays

* safeguarding the health of patients, staff and members of the public

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2
Q

what does ICRP stand for

A

International Commission for Radiological Protection

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3
Q

what does the ICRP103 publication recommend

A

a legal framework for Radiation Safety

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4
Q

what are the 3 basic principles of the ICRP system

A

all radiation exposures should be
> justified
> optimised
> limited

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5
Q

explain the “justified” principle

A

They must do more good than harm

There must be sufficient benefit to individuals or to society to offset any detriment

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6
Q

explain the “optimised” principle

A

The magnitude of radiation exposures, and the number of persons exposed, must be as low as reasonably practicable, taking into account social and economical factors

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7
Q

explain the “limited” principle

A

A system of individual radiation dose limits is used to ensure no person received an unacceptable level of exposure

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8
Q

what are the important legislations in diagnostic radiology

A

Ionising Radiation Regulations 2017 (IRR17)

Ionising Radiation (Medical Exposure) Regulations 2017 (IRMER17)

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9
Q

what are the important legislations in diagnostic radiology enacted under

A

Health and Safety at Work Act

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10
Q

in simple terms, what does IRR17 deal with

A

occupational exposures and exposure of the general public

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11
Q

in simple terms, what does IRMER17 deal with

A

medical exposures of patients

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12
Q

give examples of who IRR17 protects

A

> person taking the x-ray of the patient

> surgeons using x-ray to visualise what they are operating on

> members of the general public sitting in a waiting room, not yet considered patients as they are just waiting

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13
Q

what are the responsibilities of the employer and the employee with regards to IRR17

A

The employer is responsible for putting in place arrangements for compliance

Employees are responsible for following the safety arrangements

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14
Q

what is an RPA and what do they do

A

Radiation protection adviser

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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15
Q

what should regulations should the employer consult the RPA about

A

§ Designation of areas
§ Prior examination of plans for installations & 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

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16
Q

what does regulation 9 - ALARP - mean

A

Exposures are restricted to as low as reasonably practicable and the risk assessment must consider how to do this

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17
Q

what is a controlled area and how is it defined

A

this is a space in which no one should be in when the x-ray is being used unless it is absolutely essential that they are present in that
area

defined around the equipment, depending on the risk assessment and workload levels

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18
Q

how big should the controlled area be for intra-oral x-ray units

A

often at 1.5m from the x-ray tube and within the primary beam

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19
Q

how big should the controlled area be for cone beam CT

A

the entire room is normally a controlled area

No one, except the patient, should enter this area during exposure, unless special procedures are in placE

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20
Q

what are the annual radiation dose limits for radiation workers and members of the public specified in IRR17

A

• Radiation workers:
○ Whole body limit of 6mSv per year (unclassified staff)
○ Might wear a monitoring badge but not needed in dentistry (so low)

• Members of the public:
○Whole body limit of 1mSv per year

21
Q

what does IRMER17 stand for and who does it protect

A

Ionising Radiation (Medical Exposure) Regulations 2017

Patient exposed to x-rays protected by this

22
Q

who is IRMER17 enforced by

A

Healthcare Improvement Scotland

23
Q

name the various medically-related types of exposure that IRMER17 applies for

A

• Patients as part of diagnosis or treatment
○ Majority of the time with regards to IRMER17 you are talking about these patients who have been referred for some sort of x-ray

• Health screening
○ Asymptomatic individuals get exposure as they fall into a group worth screening to check for problems

• Research
○ To look at how well pharmaceuticals are working

• Asymptomatic individuals
○ For a while could just go to life companies and get a “life scan” x-ray to see if there was any problems and now its not used so much as MRI scan is used more

• Carers and comforters
○ More on this

• Individuals undergoing non-medical imaging using medical equipment
○ More on this

24
Q

who are “carer and comforter”s in terms of IRMER17

A

• Defined as 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
EG Child needing x-ray and parent staying with them to keep them calm while the x-ray takes place

25
Q

explain what is meant by non-medical imaging using medical radiological equipment with regards to IRMER17

A

(give no health benefit to the individual exposed)

• Health assessment for employment purposes
○ Work abroad - might be a requirement for chest x-ray to monitor for tuberculosis

• Health assessment for immigration purposes

• Health assessment for insurance purposes
○ Check health before taking out an insurance policy

• Radiological age assessment

• Identification of concealed objects within the body
○ Law enforcement purposes - requested by police

26
Q

What are the responsibilities of the employers and employees in IRMER17

A

The employer is responsible for putting in place arrangements for compliance

Employees are responsible for following those arrangements

27
Q

what are the particular roles defined in IRMER17

A

Referrer
Practitioner
Operator
Employer

28
Q

who performs the different roles in IRMER17

A

In a hospital scenario all these roles would be different people
In dentistry the dentist can perform all these roles

29
Q

Who can be a referrer

A

Registered healthcare professional

30
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 provider referral criteria

31
Q

who can be a practitioner

A

Registered healthcare professional

Must have ‘adequate training’

32
Q

what are the responsibilities of the practitioner

A

○ Justification and authorisation of each exam
○ Ensure doses ALARP
○ Comply with employer’s procedures

33
Q

explain the justification of the practitioner

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 of the radiation exposure

A justified exposure must then be authorised - it must be recorded that the exposure is justified and may proceed

34
Q

what happens to requests with insufficient information or exams that are not justfied?

A

they must be referred back to the referrer

35
Q

who can be the operator

A

Anyone who carries out practical aspects that can affect patient dose is an operator. They must be suitably trained

  • Eg person taking x-ray
  • Person performing QC on x-ray set
  • Person cleaning film processor
  • Person performing clinical evaluation
36
Q

what are the responsibilities of the operator

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

37
Q

what are the responsibilities of the employer

A

The employer must have procedures to ensure that a clinical evaluation of the outcome of each medical exposure is recorded

Staff carrying out any role under IRMER must be appropriately trained, and must be deemed competent by the employe

Employers must ‘entitle’ staff to carry out their roles

38
Q

IRMER17 requires all exposures are optimised - what does this mean

A

This means that exposures are as low as reasonably practicable, consistent with the intended purpose

39
Q

optimisation is the responsibility of who?

A

both the practitioner and the operator

40
Q

what does optimisation typically involve

A

○ Selecting appropriate investigation
○ Selecting appropriate equipment
○ Using appropriate exposure factors
○ Ensuring quality assurance is carried out
○ Assessing patient dose
○ Adherence to diagnostic reference levels

41
Q

what does MPE stand for

A

medical physics expert

42
Q

what does the MPE do

A

“an individual… having the knowledge, training and experience to act or give advice on matters relating to radiation physics applied to exposure, who competence.. Is recognised by secretary of state”

“involved as appropriate for consultation on optimisation”

43
Q

how often should radiation equipment be tested to ensure it is working correctly and delivering the expected dose level

A

Routine local tests, carried out by local staff who normally operate the equipment (done regularly) and,

Physics tests, carried out every 1 to 3 years by specialist staff

44
Q

what does DRL stand for

A

Diagnostic reference levels

45
Q

what are DRLs

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

46
Q

what is the dose indicator

A

a number that relates to the radiation dose that the patient receives

47
Q

summarise IRR17

A

IRR17 regulates radiation safety of staff and members of the public
○ Controlled areas with local rules are defined around the equipment
○ Risk assessments are used to evaluate control measures - To evaluate if exposures are ALARP

48
Q

Summarise IRMER17

A

IRMER17 governs medical exposures of patients and others
○ Exposures must be justified and optimised
○ Staff must be trained and entitled

BDS3 - radiology (19 decks)

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