1. Radiology & Nuclear Medicine Referrals - some legal requirements & duties - Mr John Saunderson, Consultant Physicist / Radiation Protection Adviser, Radiation Physics, Queen’s Centre, Castle Hill Hospital ext 76-1329

2. The benefit of every medical radiation exposure (i.e. X-ray, CT scan, nuclear medicine scan) must be balanced against the risk of a radiation induced cancer. If the X-ray will not affect decisions on the treatment of the patient then it should not be requested. In the UK, the use of X-rays, nuclear medicine scans, etc. are controlled by the Ionising Radiation (Medical Exposure) Regulations 2000 (known as “IRMER”)

3. The radiation dose, and hence the risk, varies with the type of procedure, e.g. ProcedureCancers induced per million exposed Chest X-ray1 Nuclear medicine kidney scan 50 CT abdomen scan500

4. It is the legal responsibility of Radiology or Nuclear Medicine staff to make the decision as to whether a medical radiation exposure is justified, but it is the legal responsibility of the referring doctor to provide them with the correct patient information so that they are able to do this.

5. To help referring doctors, clear guidelines are available online at http://mbur.nhs.uk http://mbur.nhs.uk Specific local referral criteria for nuclear medicine scans are also available on the Trust’s Radiation Physics site at www.hullrad.org.uk/advice www.hullrad.org.uk/advice

6. Who is allowed to refer for a medical radiation exposure? For our Trust Registered GPs Registered Medical and Dental Officers employed directly or on an Honorary or Locum Contract. Certain named registered Nurses and Professionals working to written protocols who are on the list of authorised referrers It is illegal for non-registered staff to refer patients for X-rays, or for registered staff who do not fall into a category set by the Trust

7. report this to the Care Quality Commission as a radiation incident (via Trust Radiation Protection Adviser) investigate take action to reduce the risk of reoccurrence answer questions from the CQC Wrong Patient?! In recent years, incidents have occurred every 2 or 3 months in which the wrong patient has been referred and X-rayed. When this happens the law requires us to

8. Wrong Patient?! Referring the wrong patient leads to a potentially dangerous delay in testing the right patient unnecessary radiation risk, inconvenience and discomfort to the patient wrongly X-rayed time, money and resources wasted on X-raying and reporting for the wrong patient time, money and resources wasted on incident reporting and investigation a risk of prosecution for the Trust and the referring doctor Even more “near misses” are spotted by radiology staff before the X-ray is undertaken. You must always check that the correct patient is selected before ordering electronically, or the correct label used when ordering by paper.

9. If you realise that you have ordered an X-ray or scan for the wrong patient, or that the patient no longer requires an X-ray –follow the instruction for cancelling the order via Patient Centre and –(because computer systems can be surprisingly slow!) telephone Radiology or Nuclear Medicine to be sure that the order is cancelled Any questions, please contact John Saunderson, Consultant Physicist / Radiation Protection Adviser, Radiation Physics, Queen’s Centre, Castle Hill Hospital, ext 76-1329, john.saunderson@hey.nhs.uk