Regulations and legal responsibilities Flashcards
examples of effects of ionising radiation (4)
genetic effects (can affect later generations)
cataracts
radiation burns
tumours (esp thyroid)
2 biggest sources of radiation
radon
CT
Why are dental radiographs worrying
low dose but high volume
millions of dental radiographs every year, many of these not helpful for diagnosis
what is the background radiatio dose in UK
2.5 mSv
name of most recent radiation regulation
IRMER2000 (Ionising Radiation (medical exposure) Regulations
name of legislation to keep
a) general public and staff safe
b) keep patient dose as low as poss
a) IRR99
b) IRMER2000
5 elements of a risk assessment
- identify hazards (dose)
- decide who might be harmed and how they might be affected
- likelihood of risk
- record
- periodic review
what does RPA stand for and what do they do 6
Radiation Protection Adviser every dental practice must have one -sets requirements for controlled areas/local rules -prior examination of plans for new equipment, rooms -periodic safety testing -calibration of dose measuring equip -RA/contingency plan -investigation after radiation incident
what does RPS stand for, what do they do
Radiation Protection Supervisor (usually dentist)
every dental practice must have one.
RPS ensures local rules are followed (how to work safely in controlled area) must be trained and have authority
what is contained in local rules WARC
- how to work safely in controlled area
- RPA and RPS name and contact no.
- identification of controlled area
- summary of working instructions
- contingency for accidents/ emergencies
radiation limits in controlled area
annual dose >6mSv or 3/10 of dose limit
who should be allowed in controlled area
pt ONLY
who does dose limits apply to
staff, trainees, anyone OTHER THAN PATIENT
what is a ‘classified person’
someone exposed to more than 6mSv/ year or more than 3/10 of dose limit
eg nuclear power statio worker (never dentists)
what is a dose constraint
not limits but recommended levels that should not be exceeded in normal practice
– 1mSv Operators directly involved with
radiography
– 0.3mSv For employees not directly involved &
“comforters and carers”
4 Classes of duty holder, defined in IRMER 2000
- referrer: requests radiograph, must include history and examination (justification for radiographs)
- practitioner: justification of radiographs using selection criteria
- operator: carries out investigation
- employer
what does ALARP stand for
As Low As Reasonably Practicable
activites undertaken by operator
- identify pt
- position film, x-ray tube, pt
- set exposure parameters
- process films
- evaluate quality of films
What is optimisation?
keeping dose ALARP-eg justification, field reduction, using modern equipment
duties of employer
- have written protocols
- establish diagnostic reference levels
- RA
- ensure staff are trained
- notificatio of HSE
duties of employee
- not expose yourself or anyone to ionising radiation greater than necessary
- use PPE as necessary
- report equipment defects
- keep up with training
who is the medical physics expert often the same person as?
RPA
what do medical physics experts give advice on?
- patient dosage
- development/ use of new or complex techniques
- other matters of patient dose/ exposure
should we ask if pt are pregnant before taking x-rays in dentistry
no-not relevant bc of field of x-ray
difference between dose limit and diagnostic reference levels
dose limit: max radiation dose for staff/ public
diagnostic reference levels: dose for typical examinations for patient from specific equipment/ technique
how were DRLs decided?
1/3rd quartile of national
why is ionising radiation dangerous
generation of free radicals and direct interaction with DNA
DRL in 1999 and 2007 in
a. mandibular molar intra-oral
b. standard adult panoramic
a. mandibular molar intra-oral: 4 –> 2.4 mGy
b. standard adult panoramic: 65 –> 60mGy
who to report excessive exposure (20x intended) by
a. human error
b. equipment fault
a. human error: RPA,CQC
b. equipment fault: RPA, HSE, MDA
3 functions of training
ensure staff know:
- risks of x rays
- necessary precautions
- importance of complying with legislations
recommended training continuation
1 day course every 5 years
certificate required by operators
NEBDN or BDA certificate in dental radiography
certificate required to process x ray
certificate of dental nursing or equivalent