IRMER , WHY?
Amanda Bath
Advance Practitioner
RPS
May 2014
RPS- Radiation Protection Supervisor
RPA- Radiation Protection Advisor
CMPE- Christies Medical Physics and
Engineering
Topics
•Ionising radiation and effects.
•Risks
•Legislation
•How does it effect our practice
Sources of Ionising Radiation UK
Medical
15%
Effects of Ionising Radiation
somatic effects
stochastic
deterministic
Stochastic Effects
• Stochastic effects are ones where the chance
of the effect happening increases with
radiation dose.
• There is no threshold dose at which they will
definitely occur.
Deterministic Effects
• These occur when high radiation doses are
received. This damage is a consequence of cell
death and the effects can show immediately
or after several cell divisions. The damage can
be directly linked to that exposure.
• There is a threshold below which no
deterministic effects occur.
Risks
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Annual Risk of death:
Smoking 10 cigarettes a day – 1 in 200
Road accident – 1 in 5,000
Natural radiation – 1 in 9,000
Accidents at work – 1 in 20,000
Medical radiation – 1 in 53,000
Legislation
The United Nations
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1953 Dwight D.Eisenhower “Chance for Peace”.
IAEA- International Atomic Energy Agency
WHO- World Health Organisation.
UNSCEAR- United Nations Scientific Committee on the
Effects of Atomic Radiation.
International Commission for Radiological Protection
(ICRP) Independent advisory body founded in 1928 ,
registered charity.
Three fundamental principles of radiation protection
Justification
Optimisation
Dose limits
European Union/Commission
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European Atomic Energy Community (EURATOM)
Peaceful use of Nuclear Energy .
Protection of patients exposed in medical practice
Issued directives that led to IR99 and IRMER.
UK Legislation
The Health and Safety Executive (HSE)Work with Ionising Radiation , which includes:
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The Ionising Radiations Regulations 1999
(IRR99)
• An approved Code of Practice
• Guidance notes
IRR99 is UK law and is enforced by the HSE.
IRR99
The employer has the responsibility for
complying with the regulations but will not be
able to fully discharge his responsibility without
the cooperation of his employees.
IRR99
As Low As Reasonably Practicable
ALARP
“Every radiation employer shall…take all necessary
steps to restrict as far as reasonably practicable the
extent to which his employees or other persons are
exposed to ionising radiation.”
IRR99- Requirements
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Appropriate training
Register of staff “engaged “ in work.
Staff uniquely identified .
Training dates and refresher dates recorded.
The Ionising Radiation (Medical Exposure)
Regulations 2000 IR(ME)R
Employers are required to provide written procedures
and protocols to cover medical exposures for which
they are responsible.
IR(ME)R 2000 is UK law and is currently enforced
by the Care Quality Commission.(CQC)
IR(ME)R
4 duty holders in the administering of ionising radiation
• Employer-radiological installation and risk
assessments. (advice from RPA)
• Referrer- registered medical practitioner/health
professional.
• Practitioner- registered medical practitioner/health
professional. Justifies the exposure.
• Operator- person who carries out the exposure.
No role is specific to any profession
IR(ME)R- Operators
An operator is any person who is entitled, in
accordance with the Employer’s procedures,
to carry out practical aspects of the exposure
allocated to them by the employer or
practitioner.
This includes identification of the patient!
IR(ME)R-Requirements
• Adequate training.
• Continuing education and training with up to
date records/register.
• Assistant practitioners- work-based training ,
e-learning , within scope of qualification you
have completed.
• Competence matrix- individual training
profiles.
How does this effect our practice?
How practice changes.
Incidents1. Paper to electronic systems.
2. Film screen to full field digital
mammography.
1.Electronic Requesting
• No mammograms repeated within 6 months
of previous mammogram. (exceptional
circumstances).
• Previous paperwork not available, no method
of recording information.
• Client had a mammogram 2 months earlier.
Outcome
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New protocol in place.
Check on PACS system for previous imaging
Record on ‘Q’ page of RIS system.
Result- fewer incidents.
2.FFD Mammography
• Flat field test
• The parameters are set
automatically ie. large
focal spot, Mo/Mo,
26kV and 200 mAs.
• Ensure that the
operating parameters
are returned to
Standard and Auto
2.FFD Mammography
Outcome
• New protocol in place.
• Sign to say have returned to “auto” and
“auto”.
• All staff informed of incidents.
• Not happened since.
Regulatory Changes
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2007 EU process of revision
Influenced by IRCP and IAEA recommendations.
The Department of Energy and Climate Change.
Audit- Identification and justification.
Audit
• Audited the ‘Q’ page.
• April 2013- 179 out of 196, (91%) of
examinations were justified, from a target of
100%.
• Dec 2013-199 out of 200 examinations
(99.5%) were justified and had the operator
recorded.
Summary
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Legislation is LAW.
Necessary to keep up to date with training.
Recording of evidence.
Resources.
www.e-lfh.org.uk
References
• www.hse.gov.uk/radiation/ionising
• www.christie.nhs.uk/the-foundation-trust/treatments-andclinical-services/christie-medical-physics-and-engineering(cmpe).aspx
• www.e-lfh.org.uk
• Amanda.bath@uhsm.nhs.uk