Safety Legislation

Question 1

What are the 3 basic principles of radiation exposure?

Answer 1

The exposures should be:
-Justified

• Optimised
• Limited

Question 2

What does it mean by a radiation exposure must be justified?

Answer 2

The exposure <i>must </i>do more good than harm. Must be sufficient benefit to individuals (e.g. diagnosing medical condition)

Question 3

What does it mean by a radiation exposure must be optimised?

Answer 3

The magnitude of the radiation exposures, and number of people exposed must be as low as reasonably practicable

Question 4

What does it mean by a radiation exposure must be limited?

Answer 4

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

Question 5

What are the 2 important legislations un the UK regarding radiation?

Answer 5

• IRR17 (ionising radiations regulations 2017)

* IRMER17 (ionising radiation [medical exposure] regulations 2017)

Question 6

What does IRR17 deal with?

Answer 6

Occupational exposures (staff) and exposure of the general public

Question 7

What is the licencing regulation in IRR17?

Answer 7

The employer must obtain registration from HSE (health and safety executive) for the use of X-rays

They need this to open a practice that uses radiation

Question 8

Who should the employer consult, under IRR17, for certain matters in order to meet legislation and protect employees?

Answer 8

A radiation protection advisor (RPA)

Question 9

What will a RPA help with and give advice on?

Answer 9

• Designation of areas
• Prior examination of plans for installations
• Regular equipment checks
• Periodic testing of safety features and warning devices
• Radiation risk assessment and dose assessment
• Contingency plans

Question 10

What kind of assessment needs to be carried out under IRR17?

Answer 10

A radiation risk assessment

Question 11

What issues should a radiation risk assessment consider?

Answer 11

What safety features are required?

What level of radiation exposure could staff recieve?

Question 12

Describe what the control areas that fall under IRR17 are?

Answer 12

Areas adjacent to the radiation exposure that must be protected`

Question 13

What will a Radiation protection advisor advise if required? (regarding controlled areas)

Answer 13

if additional plasterboard or lead is required in the walls.

Question 14

What is normally the controlled area for an intra-oral x-ray machine?

Answer 14

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

Note: for CBCT it is normally the full room

Question 15

What is in place when there are controlled rooms?

Answer 15

Signage to highlight that it is a controlled room

Question 16

What is the annual radiation dose limits for radiation workers and the public?

Answer 16

radiation workers = 6m/Sv/year

public = 1m/Sv/year

Question 17

What is the purpose of the IRMER 17?

Answer 17

This deals with/protects the exposure of patients (and some other groups).

Question 18

IRMER 17 applies to various types of medically-related types of exposure such as what?

Answer 18

• Patients as part of diagnosis or treatment (main one for dentistry)
• Health screening
• Research
• Asymptomatic individuals
• Carers and Comforters = individuals who are ‘knowingly and willingly’ exposed to ionising radiation through support and comfort of those undergoing exposure (it is NOT part of their employment). Normally relatives/friends.
• Individuals undergoing non-medical imaging using medical equipment e.g. health assessment for employment purposes, immigration purposes, insurance purposes or identification od concealed objects within the body (law enforcement).

Question 19

What different roles during medical x-ray exposures are defined by the IRMER17?
Of these roles, what is the dentist?

Answer 19

• Referrer
• Practitioner
• Operator (radiographer)
• Employer

Can be ALL of them

Question 20

Describe the basic framework set out by IRMER17 for carrying out medical exposures.

Answer 20

1- Referral for imaging 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
5- The image and report are provided to the referrer

Question 21

Who can be a referrer and what do they have to do?

Answer 21

Can be any registered health-care professional and is responsible for providing ‘sufficient medical data’ to the practitioner to enable justification including patient identification and clinical details

Question 22

There must be a referral criteria for x-rays. Who’s responsibility is it to set this out?

Answer 22

The employer

Question 23

Who can be the practitioner and what are their responsibilities?

Answer 23

Can be any registered healthcare professional but must have had ‘adequate training’. Their responsibilities are:
• Justification and authorisation of each exam
• Ensure the dose is ALARP
• To comply with the Employer’s Procedures

Question 24

In order to justify an exposure, what must you consider?

Answer 24

• 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.

Question 25

According to IRMER17. who is the operator and what is their responsibility?

Answer 25

Is anyone who carries out practical aspects that can affect patient dose such as:
• Person taking x-ray
• Person performing quality control on X-ray set
• Person cleaning film processor
• Person performing clinical evaluation
The responsibility of the operator is 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

Question 26

What needs to be carried out after the exposure in order for it to be justified?

Answer 26

A clinical evaluation

Question 27

IRMER17 says all exposures must be optimised. Who’s responsibility is this and what does optimised mean?

Answer 27

As low as reasonably practicable

Practitioner and operator responsibility

Question 28

What things may have to be considered for optimisation?

Answer 28

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

Question 29

Who can advise on exposure factors and equipment related factors to help optimise exposures?

Answer 29

A medical physics expert

Question 30

What types of quality assurance tests must be carried out under IRMER17?

Answer 30

• Routine local tests, carried out by local staff who normally operate the equipment
• Physics test, carried out every 1 to 3 years by specialist staff

Note: There is national guidance to suggest what tests should be carried out.

Question 31

What are diagnostic reference levels?

Answer 31

DLR’s are guideline dose levels for “standard size” patients undergoing typical examinations. They can be used as a benchmark against national and local practise.