1. BY GAMINI SENANAYAKE

2.  Legislation applicable to staff and public Ionising radiation regulations 1999  Legislation applicable to patients – Ionising Radiation ( Medical Exposure ) Regulations 2000 GS

3.  IRRR 99 Made under the Health and Safety at Work Act 1974 ( HSWA 74 ).  Enforced by Health and Safety Executive – ( HSE).  In force since 1 st January 2000.  Replaces IRRR 85 GS

4.  To carry out risk assessments.  To restrict levels of ionising radiation to employees and others to be as low as is reasonably practicable (ALARP).  To designate and monitor control areas.  To provide staff and others with information, instruction and training.  To implement QA programmes. GS 

5.  Time- only be there if it is essential.  Shielding- ideally, behind screen if not wear protective clothing.  Distance – Maximise distance from tube and the patient ( If not behind screen).  Follow local rules for radiation protection. GS

6. RPA- Radiation protection adviser RPS – Radiation protection supervisor

7. MPE Employer Referrer Practitioner Operator MPE – Medical Physics Expert

8.  Local rules outline good working practice with x-rays.  Each Department will have a Radiation Protection Supervisor ( RPS ).  Dose received through occupational exposure should be as low as reasonably practicable.

9.  Dose must not exceed certain limits.  Employer to ensure limits not exceeded.  Employee must act responsibly.  Whole Body Limit applicable is 6mSv per year.

10. How did it all begin?  On the 30 th June 1997,the EU countries adopted Directive 97/43 /Euratom.  ER(ME)R 2000 Policy devised.  Became law January 2000 and replaces all previous regulations.

11. The legislation identifies 4 duty holder roles. These are: 1. The Employer. 2. The Referrer 3. The Practitioner. 4. The Operator.

12.  In most cases this will be the NHS Trust.  Written procedures for all medical exposures ( schedule 1)  Written protocols for every standard investigation for each piece of equipment.

13.  Ensuring that all Practitioners and Operators are adequately trained and participate in CPD  Investigating incidences where patients receive a higher than intended dose.  Establish referral criteria including: Radiation doses DRL’s QA Programmes Dose limits

14. Defined as: A Registered medical or other health professional who is entitled to refer for a medical exposure. E.g. Doctors Nurses Radiographic practitioners Dentists

15.  The referrer is responsible for supplying the practitioner with sufficient clinical data to justify every single exposure that they request.

16. Defined as: A registered medical practitioner or other health professional who is entitled to take responsibility for a specific medical exposure. E.g. Doctors Radiographers Radiologists Dentists

19. ‘That no person shall carry out an exposure unless:’  It has been justified by the practitioner as showing a net benefit to the patient  It has been authorised by the practitioner

20. The practitioner must consider the following:  The specific objective for the exposure.  The total potential diagnostic benefit to the individual and to the society.  The risk to the individual.  Alternative diagnostic tests involving less or no radiation E.g. U/S or MRI.  Pregnancy.

21.  The practitioner and only the practitioner is legally responsible for exposing the patient to dose of radiation.  Responsibility can not be assumed by another party.  Under law a Practitioner/Operator must refuse an examination where insufficient clinical data has been supplied and / or where it doesn’t conform with the Royal College of Radiologist’s Guide Lines ( RCR).

22.  Guidance booklet on requesting X-rays from The Royal College of Radiologists.  For more information see www.rcr.ac.uk

24.  A practitioner is: A radiologist or radiographer. Who takes legal responsibility for the justification of an exposure.  An operator is: - A radiographer -Who authorises an exposure using guidelines or criteria devised by practitioner(s)

25.  Justification means that you understand why and exposure would or wouldn’t be beneficial to the patient.  Authorisation means using a set of criteria or guidelines to make decision of whether or not an exposure is beneficial or not.

26.  (a) Patient identification To ensure that the correct patient is examined and that they have the correct examination performed.  (b) Identification of referrers, practitioners, and operators. To list the referrers from whom referrals may be accepted, and to list those who may justify and authorise the exposure.

27.  (c)Medical – legal exposures. To ensure that no examinations are repeated purely for medical legal purposes.  (d)Pregnancy and breast screening. To ensure that foetus is not unnecessarily irradiated.  (e)Evaluation and Review of employers procedure and protocols. To establish review dates and criteria for reviewing the employer’s procedures and policies.

28.  (f) Assessment of patient dose and administered activity. To ensure that an assessment of dose is made after examination.  (g) Use of diagnostic reference levels-DRL’s To identify doses that exceeds DRL’s and to take corrective measures.

29.  (h) Bio-medical research To ensure that a patient involved in a study doesn’t receive more than an acceptable dose.

30.  (1) Evaluation of medical exposures. To ensure that an examination, once completed is taken in to account when a patient is reviewed.  (2) Accidental over exposure/ unintended doses to the patients. To ensure that the possibility and magnitude of accidental over exposure is kept to minimum.

31.  (3) Investigation of accidental overexposure/unintended doses to patients. To provide a system by which all incidents of accidental/unintended exposure can be investigated and recorded.  (4) General radiation protection matters. To ensure that all patients, staff and members of public are given adequate protection from ionising radiation.

32.  (5) QA Programs. To ensure that equipment operates in a consistent manner in accordance with the manufacturers parameters.

33.  Know your responsibilities. Are you a practitioner, operator or both.  Remember, as a practitioner, you and only you are legally accountable for any exposure you make.  Be sensible. Discuss requests that falls short in a polite and professional manner.  ER(ME)R is not to be used to get out of x-raying patients.

35. Gamini Senanayake