Physics Radiation Presentation251146.ppt

Module:
IMAGING AND
REFERRAL
IR(ME)R

DR. GAIL REES-JONES
M.Tech:Chiropractic (RSA)

Ionising Radiation (Medical
Exposure) Regulations
[IR(ME)R]
Why is it so important?
Need regulations to keep away
the …

The Ionising Radiation (Medical
Exposure) Regulations 2000
[IR(ME)R].
Ionising radiation (medical exposure) regulations 2000
Purpose of Directive
Duty Holders
•Employer
•Practitioner
•Referrer
•Operator
Principles
•Justification
•Optimization
•Limitation

IR(ME)R
►In 1997 the Council of the European Union
(EU) issued a directive that came into force
in the United Kingdom on 13 May 2000
through the provisions of the Ionising
Radiation (Medical Exposure) Regulations
2000 [IR(ME)R].

Purpose of the Directive:
►Protection of individuals in relation to
radiographic exposure as part of their:
• Medical Diagnosis
• Treatment
• Occupational health surveillance
• Health screening
• Research
• Medico-legal procedures

Duty Holders – IR(ME)R 2000
Employer
Referrer Practitioner Operator
Request Justify Do

Duty Holders – IR(ME)R 2000
Employer
“CHIROPRACTIC HEALTH CLINIC”
Referrer Practitioner Operator

Employer (NHS
Trust/Chiropractic Clinic)
► Identify and record duty holders
► RPA (Radiation Protection Advisor)
► RPS (Radiation Protection Supervisor)
► Ensure appropriate education, training and supervision of
staff
► Establishing referral criteria and systems for justifying
examinations/procedures
► Written protocols for every standard examination of
equipment (e.g. reference levels (DRL’s)
► Assessment of patient dose
► Investigate incidents

Referrer
Responsible for providing clinical reasons for the
requested examination/s.
► 5.12.1. Decisions on who is entitled to act as a referrer
should be taken at local level by agreement between the
employer and the healthcare professionals involved in
medical exposures.
► 5.12.2. The range of procedures that can be requested by
a referrer should be agreed locally between the referrer
and the employer of the radiological installation.

Practitioner
► 5.10.1. Decisions on who is entitled to act as a practitioner
should be taken at local level by agreement between the
employer and the healthcare professionals involved in
medical exposures.
► 5.10.2. The primary responsibility of the practitioner is to
JUSTIFY medical exposures. This requires the practitioner to
have a full knowledge of the potential benefit and detriment
associated with the procedure under consideration.

Operator
► 5.8.1. An operator is anyone who carries out a “practical
aspect”.
► 5.9.1. The range of functions covered by this term is
extensive and includes the supporting functions prior to
the exposure taking place (e.g. the calibration of
equipment that emits ionising radiation, the preparation
of
radioactive medicinal products etc), as well as of
performing the exposure itself.

Duty Holders
► Is there always a referrer?
► Can individuals fulfill more than one role?

Principles
Justification Optimization Limitations

Justification
► 2.1. The Medical Exposures Directive requires that all
medical exposures to ionising radiation must be justified
prior to the exposure being made.
► Risk/Benefit:
The benefit of the radiation exposure should be greater
than the risk of using it.
► When applied directly to the exposure of patients;
each particular medical practice in a department must be
justified twofold:
1. As a general procedure (IRR 99)
2. As regards the individual patient (IR(ME)R 2000

Justification & Pregnancy
► “28 day rule” for routine radiographic examinations
► “10 day rule” for high-dose procedures, such as barium
enemas, abdominal or pelvic CT, and Nuclear Medicine
► Special case where individual justification is needed

►28 Day Rule:
Menstrual cycle varies, generally 28 days. If patient is to
be exposed to ionising radiation for diagnostic purposes
and the patient is of child-bearing age, postpone exposure
for 28 days from first day of menstrual cycle to next to rule
out pregnancy.
►10 Day Rule:
If patient is to be exposed to ionising radiation for
diagnostic purposes If patient is to be exposed to ionising
radiation for diagnostic purposes and the patient is of
child-bearing age, she should be booked in the first 10
days of the menstrual cycle, when conception is unlikely to
have occurred.

Advice from National Radiological
Protection Board:
Radiation doses resulting from most diagnostic
procedures in an individual pregnancy present no
substantial risk of
causing fetal death or malformation or impairment of
mental development.
Procedures giving the greatest foetal exposure are:
►Barium Enemas
►Pelvic and Abdominal CT scans
►Nuclear Medicine
[Most sensitive time period for CNS teratogenesis is between
10-17weeks.]

Special Cases:
A patient at 19 weeks of gestation presented with flank
pain and microscopic hematuria. She was diagnosed with
pyelonephritis and treated with parenteral antibiotics. Her
flank pain progressed despite antibiotic treatment,
necessitating a renal ultrasound examination, which was
inconclusive. An intravenous pyelogram (IVP) was ordered,
but the radiologist refused to perform the study because of
concern about radiation exposure to the fetus. Despite
further discussion, the study was denied until a
perinatologist verified the appropriateness and relative
safety of the study.
The IVP revealed two stones, and the patient eventually
required ureteral stent placement. Despite treatment, she
had progressive renal disease with obstruction, requiring
induction of labor at 35 weeks of gestation. At birth, her
infant was healthy and weighed an age-appropriate 2,500
g (5 lb, 8 oz).

Justification
► When might an individual exposure be unjustified?
► What do you do if an individual falls outside the
anticipated selection procedure?
► What do you do if the patient has been examined
radiologically at another hospital recently for the
same condition?

Justification
►Chief causes of wasteful use of radiology:
► Repeating investigations which have already been done
► Investigation when results are unlikely to affect patient management
► Investigating too often
► Doing the wrong investigation
► Failing to provide appropriate clinical information and questions that
the imaging investigation should answer.
► Over-investigating.
RADIATION PROTECTION 118 “Referral guidelines for imaging”

Optimization
► 9.1. Regulation 7 provides for the optimisation process
which involves ensuring that doses arising from
exposures are kept as low as reasonably practicable.
• ALARP
• Reducing number of images taken of a patient
• Dose-reducing equipment
• Good technique
• Quality Assurance Program
• Adequate training

Limitation
► Legal dose limits for workers and members of the public
• ensuring that no deterministic effects are produced and
probability of stochastic effects is reasonably low.
• diagnostic reference levels for each standard
radiological investigation
• Staff: 20mSv per year whole body dose. Not to exceed
100mSv over 5 year period
• Trainees/Students: 6mSv per year whole body dose
• Members of the public/foetus: 1mSv per year

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