Legislation

Question 1

radiology regulations?

Answer 1

Ionising radiation regulations 1999

Ionising radiation medical exposure regulations 2000

Question 2

what does IRR 99 do?

Answer 2

protects the public and those who work with radiation

also concerned with equipment

Question 3

what does IRMER 2000 do?

Answer 3

protects patient exposed to ionising radiation

Question 4

Internal roles associated with IRMER?

Answer 4

employer
referrer
practitioner
operator
radiation protection supervisor RPS

Question 5

external roles associated with IRR 99?

Answer 5

medical physics expert

radiation protection adviser

Question 6

what is RPA?

Answer 6

provides employer with advice in relation to IRR 99
examines plans to install new/modified equipment
risk assesment
contingency plans
staff training
QA
must have approp qualifications

Question 7

MPE?

Answer 7

person holding a science degree or its equivalent who is experienced in the application of physics to the diagnostic/theraputic uses of ionising radiation
provides advice of measurement and optimisation of pt dose
RPA may act as MPE
MPE and RPA appointed in writing

Question 8

what is RPS?

Answer 8

IRR 99 role
ensures compliance with regulations
appointed by employer
can be dentist/dcp
must have approp training

Question 9

what is the role of the employer?

Answer 9

‘legal person’
legal responsibility - ensures all staff comply
appoint and entitle of duty holders having regard to proper levels of training
written protocols for all medical exposures
referral criteria,diagnostic referrence levels, overexposure
audit and review

Question 10

role of the referrer?

Answer 10

Regular healthcare professional entitled to refer individual for medical exposure
must perform clinical exam
must provide sufficient clinical info to allow justification
must provide sufficient info for identification of pt

Question 11

role of practitioner?

Answer 11

registered healthcare professional who takes responsibility for individual medical exposures
entitled by employer
justification of exposure based on info from referrer following exam

Question 12

what is justification?

Answer 12

any exposure to ionising radiation cannot be carried out until justified
benefit of exam must outweigh the detriment from exposure

Question 13

what does the justification decision consider?

Answer 13

previous radiographs
question to be answered
risk of radiation from exposure
alternative techniques of investigation

Question 14

what is the role of the operator?

Answer 14

person who carries out practical aspect of the procedure
usually a number of operators all must be adequately trained
employer must clearly define responsibilities of each operator

Question 15

how to deal with pregnant pt’s needing a radiograph?

Answer 15

is the radiograph required?
could the routine check be delayed?
reassure and give pt option to delay

Question 16

lead protection in radiology?

Answer 16

not for dpt
thyroid collars if thyroid in main beam
lead aprons dont protect from internal scatter

Question 17

who is responsible for IRMER?

Answer 17

responsibility of the department of health
devolved
scotland - controlled by scottish government

Question 18

what is the IRMER inspectorate’s role?

Answer 18

reports back to government
warrant card
inspection following a period of notice
power to close or serve an improvement notice

Question 19

rules for controlling radiation to staff?

Answer 19

risk assessment - rev 5 yearly/sooner if new equipment
contingency plans for forseeable incidents
controlled areas
dosimetry if >100 periapicals, >50 dpt’s
rev pregnant staff, ensure foeatal dose

Question 20

what are local rules?

Answer 20

identify key working instructions to ensure staff exposure limited
employers responsible to provide rules for a controlled area
develop with rpa
ensure staff aware - keep in radiation protection file, consider displaying in each controlled area

Question 21

local rules should contain at least?

Answer 21

name/contact details of rps
despcription of controlled areas and summary of arrangements for restriction of access
summary of contingency arrangements
dose investigation level

Question 22

advisable to include what in the local rules?

Answer 22

name/contact details RPA
name of employer
arrangement of personal dosimetry
arrangements for pregnant staff

Question 23

how does irmer state to control dose to patients?

Answer 23

appropriate employers written procedures protocols for every standard projection for each x ray machine
reference doses
dose reduction techniques
clinical evaluation of images
selection criteria

Question 24

what is selection criteria?

Answer 24

systemically developed statements to assist dcp/pt in making decisions about appropriate healthcare for certain specific clinical circumstances
guidelines are not a rigid constraint, but good practice and can be compared against each individual pt’s needs

Question 25

aim to minimise/prevent radiographic exams when?

Answer 25

results unlikely to affect pt management or prognosis
duplicate images taken prev
inappropriate

Question 26

methadology for radiology?

Answer 26

SIGN

systemic reviews - evidence base

Question 27

high risk patients, take radiographs when?

Answer 27

6 monthly

Question 28

moderate risk patients take radiographs when?

Answer 28

annually

Question 29

low risk patients take radiographs when?

Answer 29

primary - 12-18 months

permanent - 2 yearly

Question 30

what is EAPD?

Answer 30

developed in 2004 
Scandinavian 
reiterate bitewings are useful
patients only high or low risk
bitewings only taken if necessary for tx

Question 31

radiographs and perio assessment?

Answer 31

perio disease diagnosed clinically and with radiographs
use x rays taken for other reasons
no clear evidence/frequency
radiographs show not past disease but only present activity
2d image

Question 32

general 4-5mm LOA what xray?

Answer 32

horizontal bitewings

Question 33

LOA of 6mm or more take?

Answer 33

vertical bitewings

and periapicals of areas where the crest is not seen

Question 34

take a DPT for?

Answer 34

concurrent problems

patient new to practice

Question 35

DPT’s and perio disease?

Answer 35

poor in ant region b/c spine superimposition
overlap in premolar/molar region may obscure bone
lack of fine detail and burnout