Radiology 13 Flashcards
If your were unsure of terminology within the radiation legislation who could you seek for advice?
Radiation protection adviser OR medical physics expert
IRR99
Ionising Radiation Regulations 1999 (replaced on January 1st 2018 - now known as IRR17)
Deals with equipment and the protection of staff and general public
IR(ME)R 2000
Ionising Radiation (Medical Exposure) Regulations 2000 (replaced on 6th February 2018 - now known as IR(ME)R 17
Aimed primarily at the protection of patients
How was IRR17 introduced?
In a three tier approach:
1. Notification
2. Registration
3. Licensing
Legislation vs guidlines?
Legislation: a “MUST”
Guidelines: good practice based off expert opinions, contain the word “should”
Radiation protection advisor (RPA)
- Need to appoint one - medical physicist or specialist company.
- When to consult RPA - planning new surgery etc. radiation over dose.
- Establishing the controlled area
- Name and contact details in Radiation Protection File
How do the RPA and the Medical Physics Expert differ?
RPA has a role in the IRR2017 regulations.
MPE is part of IRMER2017 - though could be the same person.
Controlled area
- Only the patient can be in the controlled area during exposure
- Size depends on kV of machine
(1.5m for under 70kV) - BUT size depends on Local Rules
DDH stand 2m away for all machines
Or behind appropriate shielding
Radiation Protection Supervisor (RPS)
- Every practice must have one
- Usually dentist or senior member of staff
- Must be adequately trained
- To ensure compliance with IRR 2017 and Local Rules.
- Closely involved in radiography
- Have authority to carry out their duties
Local rules
- All practices must have written local rules
- Apply to all employees
- Relate to radiation protection
- 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
- “Displayed” where x-ray equipment
4 key roles in radiography
- Employer
- Referrer
- Practitioner
- Operator
Key duties of the employer
- Entitlement of duty holders
- Training
- Quality assurance
- Clinical audit
- Protocols
- Establish recommendations for selection criteria and for radiation dose levels
- Ensuring a clinical evaluation of every image is carried out.
- Ensuring staff have all read local rules.
Selection criteria 1
Radiograph must be able to be JUSTIFIED.
Selection criteria 2
Deciding which is the most appropriate radiograph to take depending on the clinical situation
Clinical evaluation
- All radiographs must be clinically evaluated and the findings recorded in the patient’s record
- Findings may include the quality of the radiograph – is it diagnostic or not – and any unusual factors relating to the exposure or dose to the patient
- Note must be made of any abnormal findings
- Even if everything is normal, this should be recorded
The referrer
A registered medical practitioner, dental practitioner or other health professional who is entitled in accordance with the employer’s procedures to refer individuals for medical exposure to a practitioner
Duties of the referrer
- Supply practitioner with sufficient information to allow the exposure to be justified
- State that there is a net benefit to the patient
- Signed a request form*
- Given details to allow correct identification of the patient*
Questions needed to be considered when justifying a radiograph
- Will exposure lead to a change in patient’s prognosis or management?
- Are other radiographs or reports available?
- Does the radiograph requested relate to the history & examination of patient?
- Have the risks & benefits been assessed?
- Could other techniques with lower or no radiation dose be utilised?
What is the dental nurse legally able to do?
- Can act as an “operator”
- Process dental radiographs – either conventionally or digital scanning
- Additional qualification allows entitlement to take dental radiographs on “prescription” of a another dental registrant.
What is the dental hygienist and therapist able to do?
- According to the GDC they can prescribe radiographs and take, process and interpret various film views used in general dental practice.
- Suggests qualified for limited entitlement as referrer, operator and practitioner.
- The employer would need to make it clear what these limitations are.
What is the clinical dental technician legally allowed to do?
- GDC Scope of Practice says they can “take and process radiographs and other images related to providing removable dental appliances”
This assumes entitlement as operators. - Patients with natural teeth or implants need to be seen by a dentist before the CDT can start treatment
- However SoP also states that CTD could develop additional skills including “prescribing radiographs”
What can the dentist legally do?
- Does everything all the other DCP can do
- Prescribe and interpret radiographs.
- Eligible to be entitled as referrers, operators and practitioners for all dental related radiography.
Who can physically take radiographs in GDP?
a dentist
a dental hygienist or therapist
a suitably qualified dental nurse
a clinical dental technician
The operator duties
- Taking radiographs
Other duties include:
- Medical physicists
- Technicians from medical physics
- Those who process films etc. possibly.
- The clinical evaluation is also an operator duty but this can only be undertake by those qualified to do so.
