RADIATION PROTECTION LAW

1. BY GAMINI SENANAYAKE RADIATION PROTECTION LAW

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

3. Legislation on Staff DosesIonising Radiation Regulations 1999( IRR99) • IRRR 99 Made under the Health and Safety at Work Act 1974 ( HSWA 74 ). • Enforced by Health and Safety Executive – ( HSE). • In force since 1st January 2000. • Replaces IRRR 85 GS

4. Employers Duties under IRR 99 • 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. Good Working Practice near x-ray Equipment. • 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. Radiation Protection Management Structure. RPA- Radiation protection adviser RPS – Radiation protection supervisor

7. Radiation Protection Management Structure MPE Employer Referrer Practitioner Operator MPE – Medical Physics Expert

8. Summary: Staff Legislation • 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. Summary: Staff legislation • 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. IR(ME)R 2000Ionising Radiation ( Medical Exposures) Regulations 2000 How did it all begin? • On the 30th 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. How does it work? The legislation identifies 4 duty holder roles. These are: • The Employer. • The Referrer • The Practitioner. • The Operator.

12. The employer • 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. The employer continued • 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. The referrer 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 referrers responsibilities • The referrer is responsible for supplying the practitioner with sufficient clinical data to justify every single exposure that they request.

16. The Practitioner 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

17. Practitioners Responsibilities • They must comply with employers procedures. • They are responsible for the Justification of medical exposure.

18. The Operator • Responsible for all practical aspects that they perform in relation to an exposure. • Responsible for the Authorisationof medical exposure. E.g. Radiographer assistants Radiographers Doctors

19. Justification of Exposure ‘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. Criteria for Justification 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. So, What does this really mean? • 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. Indication for an X-ray Request • Guidance booklet on requesting X-rays from The Royal College of Radiologists. • For more information see www.rcr.ac.uk

23. Are you to say that,Sorry, I’m still not sure about who the operator is and who the practitioner is?And just what is the difference between justification and authorisation?

24. Operator V Practitioner • 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 and Authorisation • 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. Schedule 1 • (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. Schedule 1 continued • (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. Schedule 1 continued • (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. Schedule 1 continued • (h) Bio-medical research To ensure that a patient involved in a study doesn’t receive more than an acceptable dose.

30. Additional Notes • (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. Additional Notes continued • (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. Additional Notes continued • (5) QA Programs. To ensure that equipment operates in a consistent manner in accordance with the manufacturers parameters.

33. To sum up • 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. Any Questions? Gamini Senanayake