Legislation

Question 1

Why is legislation necessary?

If you are unsure, who should you seek advice from?

Answer 1

• exposure to ionising radiation involves a risk to the person exposed
• ultimate risk is death - though unlikely
• pts, staff and general public could potentially be exposed to radiation
• complying with appropriate legislation helps minimise risks

If unsure seek advice from radiation protection advisor or medical physics expert

Question 2

What regulations govern the appropriate use of ionising radiation in medicine and dentistry?

What is the difference between legislation and guidelines?

Answer 2

IRR17: deals with equipment and protection of staff and general public

IR(ME)R17: aimed primarily at protection of patients

Legislation HAS to be followed - must

Guidelines advocate GOOD PRACTICE and EXPERT OPINIONS - should

Question 3

What does the IRR17 contain?

Answer 3

• risk assessment
• restriction of exposure - ALARP
• radiation protection advisor - RPA
• radiation supervisor - RPS

Question 4

Give a brief overview of a radiation protection advisor:

Answer 4

• need to appoint one - a medical physicist or specialist company
• consult RPA when planning new surgery, radiation overdose etc
• establishing control area
• name and contact details in radiation protection file

Question 5

What is a radiation protection supervisor?

Answer 5

• every practice must have one
• usually dentist or senoir member of staff
• must be adequately trained
• ensure compliance with IRR!& and local rules
• closely involved in radiography
• have authority to carry out their duties

Question 6

What are local rules?

Answer 6

• all practices must have written local rules
• apply to all employees
• relate to radiation protection
• name of RPS and MPE
• name of person with legal responsibility for compliance - usually employer
• identification and description of controlled area
• contingency arrangements if malfunction - must be rehearsed
• details and results of dose investigation levels
• name and contact details of RPA
• personal dosimetry arrangements
• arrangements for pregnant staff
• reminder of IRR17 obligations
• displayed with x-ray equipment

Question 7

What are the 4 roles in radiography?

Answer 7

• employer
• referrer
• practitioner
• operator

Question 8

List some points about selection criteria:

Answer 8

• all radiographic exposures must be justified
• selection of radiographs is based on pt history and exam
• choice of radiograph should be based on prevalence of disease and rate of progression and diagnostic accuracy of the imaging technique
• decision to take or not to take radiographs should be documented in pt notes
• selection criteria can help overcome variation in practice and minimise/prevent inappropriate radiographs

Question 9

What is clinical evaluation?

Answer 9

• all radiographs must be clinically evaluated and findings recorded in pt record
• findings may include quality of radiograph - diagnostic or not? any unusual factors relating to exposure or dose to patient
• note must be made of any abnormal findings
• even if everything normal, this should be recorded

Question 10

What is a referrer?

Duties of the referrer?

Answer 10

Referrer: registered medical/dental/other health professional who os entitled in accordance with employers procedures to refer individuals for medical exposure to a practitioner

Duties:

• supply practitioner with sufficient information to allow exposure to be justified
• state there is a net benefit to the patient
• sign a request form
• given details to allow correct identification of patient

Question 11

Questions to ask when justifiying exposure:

Answer 11

• will exposrue lead to change in patients prognosis or management?
• are other radiographs or reports available?
• does the radiograph requested relate to the history and exam of pt
• have the risks and benefits been assessed
• could other techniques with lower or no radiation dose be utilised

Question 12

What can a registered dental nurse do?

Answer 12

• without an additional qualification 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 another dental registrant

Question 13

What can a dental hygienist and therapist do?

Answer 13

• prescribe, take, process and interpret various film views used in general dental practice
• suggests qualified for limited entitlement as referrer, operator and practitioner
• employer would need to make it clear what these limitations are

Question 14

What can a clinical dental technician do?

Answer 14

• take and process radiographs and other images related to providing removable dentala appliances
• assumes entitlement as operators
• patients with natural teeth or implants need to be seen by a dentist before the CDT can start treatment
• SOP also states the CDT could develop additional skills including prescribing radiographs

Question 15

What can a dentist do?

Who can expose a patient to ionising radiation?

Answer 15

• does everything all other DCP can do
• prescribe and interpret radiographs
• eligible to be entitled as referrers, operators and practitioners for all dental related radiography

Dentist, hygienist, therapist, suitably qualified dental nurse or clinical dental technician can expose a pt to ionising radiation.

Question 16

What is the role of an operator?

What is meant by evaluation?

Answer 16

Operator:

• taking radiographs

Others have operator duties:

• medical physicists
• technicians from medical physics
• those who process films
• clinical evaluation is also an operator duty but this can only be undertaken by those qualified to do so

Evaluation: interpretation of the outcome and implications of and the information resulting from a medical exposure

• the employer must ensure that a clinical evaluation of each exposure is in place

Question 17

What must be documented?

Answer 17

Must document a record of:

• training
• competence in areas of: referrer duties, practitioner duties, operator duties
• signed by duty holder and employer/person you are entitled by

Question 18

How regularly should x-ray units be tested?

Which legislation stipulates this?

Answer 18

X-ray units must be tested preferably annually but minimum of every 3 years

• must include representative patient doses
• now part of IRMER