Ionising Radiation Medical Exposures Regulations 2000

1
Ionising Radiation (Medical Exposures)
Regulations 2000

• More commonly known as IRMER

2
Why, What and When?

• Response to New Council Directive 97/43/Eurotom
• Replaces POPUMET Regs 1988
• Came into force May 2000 (except regs 4(1) and
  4(2) covering procedures and protocols, Jan 2001)

3
Contents (Main Regulations)

• Main Changes
• New Terminology
• Referrer, Practitioner, Operator
• Justification/Authorisation
• Optimisation
• Expert Advice
• Clinical Audit
• Equipment/QA
• Employers Duties

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Main Changes

• Extended scope (volunteers, medico-legal)
• Requirement for written procedures/protocols
• Role of employer/referrer/practitioner/operator
• Introduction of other health professional
• Identification of special practices
• Continuing education and training
• Diagnostic Reference Levels (DRL)/Clinical Audit

5
Terminology to get used to

• Employer
• Referrer
• Practitioner
• Operator
• Justification
• Authorisation

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Referrers

• The referrer supplies the Practitioner with
  sufficient medical data relevant to the medical
  exposure only needs to know symptoms of disease
• List of referrers should be in place
• GPs
• Yourself (if you refer own patient)
• Referrers must have access to referral criteria
• Eg RCR guidelines for all exams

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Practitioners and Operators

• IRMER Practitioners justify the medical exposure
  i.e. decides whether the benefits of exposure
  outweigh the detriments
• List of practitioners and examinations they can
  justify by type/modality should be in place
• Operators carry out the practical aspects of the
  exposure
• List of operators and examination they can
  undertake should be in place
• Record of training of practitioners and operators
  to include date and type of training when were
  they first competent to work unsupervised?
• Record of continuing training eg CPD

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Justification and Authorisation

• System for justifying exams
• eg extra box on request form
• Electronic signature for computerised order
  communications systems
• System for authorising exam if impractical for
  practitioner to do so (written protocol must be
  in place for this)

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Optimisation (1)

• Protocols for all examinations using ionising
  radiation
• Printed exposure charts on all machines?
• Pay special attention to
• Medico-legal
• Research work

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Optimisation (2)

• Special consideration to paediatric, health
  screening and high dose examinations
• Policies
• Patient ID
• Women of childbearing age
• Incident reporting
• Record the exam is complete and record the dose
  (standard exposure factors/time/DAP)
• Diagnostic outcome Radiologist authorised
  reports for all exams

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Expert Advice and Dose

• Name of person providing expert advice (MPE)
• System for assessing and auditing patient doses
  against DRLs and local reference levels (record
  for each patient??)
• We do this on an annual basis during our routine
  equipment QA
• System for applying dose constraints for research
  programmes

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Equipment and QA

• Inventory of X ray equipment
• Service records for all equipment
• Hand over procedures
• QA of procedures not equipment, is required
  under IRMER
• Are exposures justified? Proof?
• Is the operator who exposed the patient entitled
  to do so under the employers procedures?
• Has the operator who exposed the patient
  adequately trained? Proof?

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Summary of Employers Procedures (1)

• IRMER requires written procedures for
• Patient identification
• Identification of referrer, practitioner,
  operator
• Who is entitled to act as referrer, practitioner
  and operator?
• Medico-legal exposures
• Identifying pregnant of breastfeeding patients
• QA programmes

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Summary of Employers Procedures (2)

• Patient dose assessments
• Use of DRLs
• Use of dose constraints for research programmes
• Evaluation of every medical exposure
• Reducing probability and magnitude of accidental
  exposures so for as reasonably achievable (is
  this a combination of all the other procedures)