Why is legislation necessary?
- Exposure to ionising radiation involves a risk to the person exposed.
- The ultimate risk is death – though this unlikely
- Patients, staff and the general public could potentially be exposed to radiation
- Complying with appropriate legislation helps to minimise the risks
What is the Regulation governing the appropriate use of ionising radiation in medicine – and dentistry?
- IRR99 dealt with equipment and the protection of staff and the general public
- IR(ME)R 2000 was aimed primarily at the protection of patients
What is the IRR17 3 tier approach?
notification, registration & licensing
What is the Radiation protection Advisor - RPA from the IRR 2017?
- Need to appoint one – a medical physicist or specialist company
- When to consult RPA – planning new surgery etc. radiation over dose
- Establishing the controlled area
- Name & contact details in Radiation Protection File
What is IRR 2017?
- Dentist have to formally appoint a Medical Physics Expert as currently appoint a RPA
- They are not always the same person
- MPEs have enhanced role advising on IR(ME)R compliance
- Need to be involved in development & review of all dental procedures – not the case under IRMER 2000
What are the 4 “roles” in radiography?
- Employer
- Referrer
- Practitioner
- Operator
What does entitlement in dentistry mean?
- Anyone involved in the various roles described in IR(ME)R has to be entitled by their employer to undertake that role.
- As a Health Care Professional, it must be within their scope of practice & they must be trained and competent to undertake the role
- There must be a record of who is entitled to do what and some method of recording continuing competence and updated training
What procedures must the employer do?
Written procedures:
Entitlement of duty holders.
Identification of the patient.
Demonstrate staff training and competence.
Quality Assurance of procedures/documentation.
Clinical Audit.
Protocols – for taking radiographs.
Appoint RPA/MPE and RPS
Have and ensure staff read the LOCAL RULES
What are the selection criteria for radiographs?
- All radiographic exposures must be justified
- The selection of radiograph is based on the patient’s history & examination
- The choice of radiograph should be based on the prevalence of the disease & rate of progression & diagnostic accuracy of the imaging technique
- The decision to take or not to take radiographs should be documented in the patient’s records
- Selection Criteria can help overcome the wide variation in practice and minimise or prevent any inappropriate radiographic examinations
- Descriptions of clinical conditions derived from patient signs, symptoms and history that identify patients who are likely to benefit from a particular radiographic technique
What is 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
Who is a “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
What are the 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*
What things must be considered to “justify” taking 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 can a dental Nurce do?
- Registered DN without an additional post registration qualification in dental radiography can have limited entitlement 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 can the Dental Hygienist & Therapist 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 can a clinical dental technician 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”
So who can take radiographs in GDP?
- dentist
- dental hygienist or therapist
- suitably qualified dental nurse
- clinical dental technician
What is the GDC advice to dental hygienists and therapists?
- Dentists remain only member of team who can “report” on all aspects of a radiograph
- Unlikely to be a problem in a practice where dentist available.
- Independent practices need to make sure there are appropriate referral arrangements in place so that a dentist can report on radiographs & ensure patient receives appropriate advice & subsequent treatment
What must a record be made of?
Record of:
- Training
Competence in areas of:
- Referrer duties
- Practitioner duties
- Operator duties
- Signed by duty holder and employer/person you are entitled by.
How often must x-ray units be tested?
Minimum 3 Years but preferably every year
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Foundation m316
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Techniques m318
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Radiation Safety m317
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Production of x-rays m315
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Image receptors 227
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Consent14
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Candour6
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Claims for Compensation5
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Radiographic Techniques 28
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Legislation20
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JUSTIFICATION & INTERPRETATION21
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Periodontal Disease7
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Quality Assurance 113
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Quality Assurance 211
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Bisecting angle technique & Occlusal radiography9
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Panoramic Tomography 1 (DPT)14
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Dental Panoramic Radiology 2 (DPT)2
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Extra-Oral Radiography7
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Alternative Imagine Modalities6
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Cone Beam Computerised Tomography - CBCT11
