Roles and Responsibilities in Medical Exposure

Understanding the roles of various professionals involved in medical exposure is crucial for ensuring safety and compliance with regulations. The following outlines key roles and their responsibilities:

Practitioner

Defined as an individual entitled to take responsibility for medical exposure in accordance with employer’s procedures.
Responsibilities include:
- Justification of medical exposure.
- Ensuring adequate training and knowledge of potential benefits.
- Acting locally as a practitioner for specific procedures, such as extremities, but not for interventional procedures.

Operator

Any person authorized by the employer to perform practical aspects of medical exposure.
Responsibilities include:
- Clearly defined in written procedures, which may specify by profession, grade, or individual name.
- Includes roles such as doctors, medical physicists, medical physics technicians, nurses, radiographers, radiopharmacists, and assistant practitioners.
- Medical physicists check equipment prior to use to ensure safety and compliance.

Medical Physics Expert

Must demonstrate competence through practical experience in areas such as:
- Compliance with IR(ME)R 2017 regulations.
- Equipment management and dosimetry.
- Optimization including quality assurance, acceptance testing, and dose reference levels.
- May require applications training and could also serve as a Radiation Protection Advisor (RPA).

Duties of Practitioner, Operator, and Referrer

All parties must comply with the employer’s written procedures.
Practitioner is responsible for the justification of medical exposure.
Practical aspects may be allocated to specific individuals by the employer or practitioner, who will then be responsible for those tasks.
Operators are accountable for every practical aspect they carry out.
Referrers must provide practitioners with sufficient medical data to assess the justification of the exposure.
Collaboration among practitioners, operators, and other specialists is essential for effective medical exposure management.

Diagnostic Reference Levels (DRLs)

Defined as dose levels in medical radiodiagnostic practices for typical examinations of standard-sized patients.
Departments are expected to monitor their own doses and investigate when doses exceed established levels.
National DRLs are reviewed every five years, with contributions from medical physics to the National Patient Dose Database (NPDD).
Reference doses indicate abnormally high doses and help identify areas needing investigation and corrective action.

Local DRLs

Employers are responsible for setting local DRLs, which should be reviewed annually.
Local DRLs may be revised based on national updates or changes in examination protocols.

Investigation of Exceeding Doses

When doses regularly exceed DRLs, investigations should be conducted by the Radiology manager and Medical Physics Expert (MPE).
Factors to consider include:
- Performance of X-ray equipment.
- Exposure protocols.
- Technique and training of operators.
- Level at which the DRL has been set.

Justification of Individual Medical Exposure

Special attention must be given to:
- Specific objectives of the exposure and individual characteristics.
- Exposures with no direct benefit to individuals.
- Potential detriment to the individual.
- Available alternative techniques.
- The urgency of the procedure.

Optimization of Medical Exposure

Optimization involves keeping doses as low as reasonably practicable while achieving the intended purpose.
Operators must consider:
- Quality assurance (QA).
- Assessment of patient dose.
- Adherence to diagnostic reference levels, which must be monitored.
Special considerations include:
- Medico-legal exposures.
- Medical exposures of children.
- Medical exposures in health screening programs.
- Medical exposures where pregnancy cannot be excluded.
- Medical exposures for breastfeeding females.

Employer Responsibilities

Employers must ensure:
- Clinical audits are conducted.
- Access to expert advice.
- Proper equipment management.
- Ongoing training for staff.

Useful Resources

Contact Information

City, University of London
Northampton Square
London EC1V 0HB
United Kingdom
T: +44 (0)20 7040 5060
E: department@city.ac.uk
Website: www.city.ac.uk/department

Introduction to Radiation Protection

Presented by Dr. Stamatia Papathanasiou, this section introduces the fundamental concepts surrounding radiation protection, including its significance in medical and occupational settings.

Summary of Key Topics

Sources of Radiation: Understanding where radiation originates.
Effects of Radiation: Exploring the biological impacts of radiation exposure.
Advisory Bodies: Identifying organizations that provide guidance on radiation safety.
UK Legislation: Overview of laws governing radiation protection.
Principles of Radiation Protection: Core principles guiding safe practices.
Ionising Radiation Regulations 2017 (IRR 2017): Key regulations for managing radiation risks.
Ionising Radiations (Medical Exposures) Regulations 2024 (IR(ME)R 2024): Regulations specific to medical exposures.
Relevance of Regulations: Discussion on how these regulations integrate into daily working practices.

Understanding Ionising Radiation

Ionising radiation refers to radiation with enough energy to remove tightly bound electrons from atoms, thus creating ions. This type of radiation can have significant effects on living organisms.

Quantifying Ionising Radiation

Radiation Dose: The primary measure of ionising radiation effects on living organisms.
Units of Measurement: Dose is quantified in Grays (Gy). For example, a chest X-ray delivers approximately 0.02 mGy.

Sources of Ionising Radiation

Radiation can originate from various sources, including natural background radiation and artificial sources such as medical imaging.

Medical Exposure

X-rays and Radioactive Isotopes: Commonly used for diagnostic imaging and treatment.
Radiotherapy: Involves higher doses but diagnostic imaging contributes significantly to population exposure.
Statistics: 90% of the medical dose to the population comes from diagnostic radiography, with CT scans accounting for 47% of the annual collective dose.

Comprehensive Study of Radiation Protection

A thorough understanding of radiation protection encompasses:

Radiobiology
Genetics
Statistical analysis of risk
Methods to reduce radiation doses to workers
Decay patterns of radioactivity in the environment
Material absorption capabilities against different types of radiation

Protecting Against Radiation

Effective radiation protection strategies are essential to minimize exposure and safeguard health.

Importance of Radiation Protection

Radiation protection is crucial to prevent health risks associated with exposure, including both deterministic and stochastic effects.

Inherited Radiation Damage

Inherited damage does not create new mutations but may increase the frequency of existing mutations.

Deterministic Effects from Diagnostic Imaging

Deterministic effects occur when radiation doses exceed a certain threshold, leading to predictable health outcomes.

Case Discussion

Considerations for a 22-year-old female patient referred for an abdominal X-ray include:

Age-related factors in radiation exposure.
Safety and radiation protection measures.
Justification and optimization of the procedure.

Protective Equipment

Lead Rubber Aprons: Essential for protecting sensitive areas, such as the thyroid, especially in pregnant patients.

Hazard Warnings

It is crucial to identify when equipment is active and to ensure that there are visible indicators of exposure.

Practical Methods to Reduce Dose

Maintain a safe distance (2m) from the radiation source during exposure.
Utilize personal monitoring dosimeters for staff.
Employ good technique to minimize the need for repeat procedures.
Ensure correct patient identification and obtain consent prior to X-ray procedures.

Aims of Radiation Protection

Prevent deterministic effects by keeping doses below established thresholds.
Reduce the risk of stochastic effects to acceptable levels.

Role of the ICRP

The International Commission on Radiological Protection (ICRP) establishes global standards and guidelines for radiation protection, aiming to prevent cancer and protect the environment.

Regulatory Framework

The Euratom/European Union Directive Basic Safety Standards Directive 2013 mandates that all EU member states implement new radiation safety regulations.
UK legislation includes the Ionising Radiations Regulations 2017 (IRR 2017) and the Ionising Radiations (Medical Exposures) Regulations 2024 (IR(ME)R 2024).

Principles of Radiation Protection

Justification: The benefits of radiation use must outweigh the risks.
Optimisation: Practices should be as low as reasonably practicable (ALARP).
Dose Limitation: Establish limits for staff and the general public, excluding patients.

Controlled and Supervised Areas

Controlled Areas: Defined as areas where radiation doses could exceed 6mSv per year, requiring restricted access.
Supervised Areas: Areas under review that may receive up to 1mSv per year.

Monitoring and Compliance

Monitoring is essential for ensuring safety, utilizing tools such as film badges and thermoluminescent dosimeters (TLD).

Roles in Radiation Protection

Radiation Protection Advisor (RPA): Provides guidance on compliance, equipment installation, and incident investigations.
Radiation Protection Supervisor (RPS): Ensures adherence to regulations and local rules, requiring appropriate training.

Over-Exposure Protocols

Immediate notification of the RPA and RPS is required in the event of over-exposure.
Incident reporting should also include the patient and relevant health authorities.

Routine Inspection and Quality Assurance

Regular inspections and quality assurance tests are necessary to maintain equipment standards and identify potential issues.

Ionising Radiation (Medical Exposure) Regulations 2024 (IR(ME)R 2024)

IR(ME)R 2024 focuses on patient radiation protection and outlines responsibilities for various roles in medical settings.
Responsibilities include those of the employer, referrer, practitioner, and operator.

Employer Responsibilities

Implementing IRR 2017 and IR(ME)R 2024 regulations.
Ensuring adequate training and investigation of adverse incidents.
Maintaining written procedures and protocols for medical exposures.

Referrer and Practitioner Roles

Referrer: Authorized to refer individuals for medical exposure, typically a healthcare professional.
Practitioner: Responsible for justifying individual medical exposures and ensuring patient safety.

Operator Responsibilities

The operator is tasked with the practical execution of radiographic procedures, including patient positioning and equipment settings.

Compliance Oversight

The Care Quality Commission (CQC) oversees compliance with IR(ME)R 2024, ensuring that radiation protection standards are met in medical environments.

Application of Regulations

The regulations apply to various medical exposures, including diagnostic imaging, occupational health surveillance, and research programs.

Carers and Comforters

Individuals providing support during medical exposures must also be considered in terms of dose constraints and optimization.

Specified Duty Holders

Employer
Referrer
Practitioner
Operator

Employer Definition

The employer is defined as any entity responsible for carrying out medical exposures at a radiological installation, such as a hospital trust in the NHS.

Duties of the Employer

Establishing written procedures and protocols for medical exposures.
Ensuring staff training and investigating adverse incidents.
Conducting clinical audits and maintaining quality assurance programs.

Written Procedures

Written protocols must be developed with input from radiology and related fields, ensuring compliance with safety standards.

Referrer and Practitioner Roles Defined

The referrer is a registered healthcare professional authorized to recommend medical exposure.
The practitioner is responsible for the individual medical exposure, requiring comprehensive knowledge of the procedure and its implications.

Operator Responsibilities Defined

The operator must be clearly defined in terms of responsibilities related to the practical aspects of medical exposures, ensuring patient safety and compliance with regulations.

Roles and Responsibilities in Medical Radiation Safety

Roles and Responsibilities in Medical Radiation Safety