Neil Pick, Senior Radiation Protection Adviser at DBG, discusses the current regulations governing radiation protection and radiography in dental practices.
Dental practices undertaking dental radiography must comply with UK and Northern Ireland radiation protection legislation - this covers occupational exposure to ionising radiation (e.g. x-rays)1 and patient protection from ionising radiation2 .
Having been in force for over 8 months, at the time of writing, you should be familiar with the legislation. I aim, however, to explore further some of the most pertinent areas.
REGISTERING YOUR USE OF IONISING RADIATION
An area of compliance where an enforcer, in this case the Health & Safety Executive (HSE), has expressed concerns is that dental practices may not have ‘registered’ their use of ionising radiation, e.g. x-rays.
All employers, whether individuals, partnerships or corporate bodies, that work with dental x-ray equipment are required to ‘register’, even if they have previously ‘notified’ of their work under the previous regulations.
There is a fee of £25 per registration per employer in England, Scotland and Wales; in Northern Ireland however, registration is free. It is a one-off registration, meaning there is no requirement to periodically renew your registration, but you will be required to register again if any of the details included in your registration change, e.g. if you relocate your practice, the practice name or ownership changes, you acquire/dispose of a significant number dental practices.
Local rules should now reference IRR17 / IRR(NI)17, as appropriate, and include the following key information:
name(s) of the appointed Radiation Protection Supervisor(s) [RPS(s)];
identification and description of the designated controlled area(s);
the dose investigation level adopted by your practice;
an appropriate summary of the working instructions related to the work with x-rays, including the written arrangements relating to non-classified persons entering or working in designated controlled areas, and instructions for another employer’s employee(s) working in a room where an x-ray set is installed (including outside workers);
identification or summary of any contingency arrangements relating to reasonably foreseeable accidents.
NOTIFICATION AND RECORDING OF SIGNIFICANT EVENTS
If a contingency plan needs to be enacted, a record of the event must be kept and analysis of the cause (or potential cause) including the measures, if any, required to prevent a recurrence of such circumstances, be documented, and retained for two years.
PROCEDURES ARE REQUIRED THAT ESTIMATE THE DOSES TO MEMBERS OF THE PUBLIC
Employers must make realistic estimates of the exposures to members of the public for comparison with the dose limit, which is 1 mSv per calendar year (whole body dose). This is best recorded in the practice’s radiation risk assessment.
Exposure to radon gas may be an issue that you are unfamiliar with but it is another, potentially significant, source of exposure to ionising radiation.
You are required to assess all the risks associated with exposure to ionising radiation. If you have not already done so, you should check whether your practice(s) is situated in a radon affected area. You can do this by typing in your postcode into UKradon’s indicative radon map3 . Once you have done this, I suggest speaking to your appointed Radiation Protection Adviser (RPA) about the outcome.
MEDICAL PHYSICS EXPERT (MPE)
You must appoint an MPE who will provide advice on matters relating to radiation protection concerning exposures using medical radiological equipment, including the measurement and optimisation of patient doses and quality assurance.
NON-MEDICAL IMAGING (USING MEDICAL RADIOLOGICAL EQUIPMENT)
This is any deliberate exposure of humans for imaging purposes where the main intention of the exposure is not about bringing a health benefit to the individual being exposed. For example, if a patient has had dental work carried out at another practice and believes it has been carried out poorly and wishes to make a claim against that dental practice.
Even if you do not carry this type of exposure out, a procedure stating so is still required.
CARERS AND COMFORTERS
This means individuals knowingly and willingly incurring an exposure to ionising radiation by helping, other than as part of their occupation, in the support and comfort of individuals undergoing or having undergone an exposure. There are additional employer’s procedures required:
a procedure to establish the appropriate dose constraints and guidance for the exposure of carers and comforters, and a procedure for the justification for exposure of a carer or comforter;
again, if carers/comforters do not assist patients during radiographic examinations at your practice, you will still need to have a procedure in place to reflect this approach.
EMPLOYER’S WRITTEN PROCEDURES
In addition to the new written procedures required for non-medical imaging, and for carers and comforters, the following additional written procedures are required; a procedure to:
provide, wherever practicable, and prior to an exposure taking place, the patient or their representative with adequate information relating to the benefits and risks associated with the radiation dose from the exposure;
ensure that the referrer, the practitioner, and the patient or their representative are informed of the occurrence of any relevant clinically significant unintended or accidental exposure, and of the outcome of the analysis of this exposure.
At the time of writing this article, guidance on how best to comply with radiation protection legislation has not yet been published. However, The Department of Health and Social Care has published summary guidance on compliance with
Please note that the enforcers of legislation have stated that just because finalised guidance has not yet been published, this does not mean that an employer need not comply with legislation. On that basis, and if you have not already done so, I highly recommend that you speak to your appointed RPA and MPE.
For further information about DBG’s Radiation Protection Consultancy, please visit www.thedbg.co.uk, email email@example.com or call 01606 861 950
1. Ionising Radiations Regulations 2017 [IRR17]) in England, Scotland and Wales Ionising Radiations Regulations (Northern Ireland) 2017 [IRR(NI)17] in Northern Ireland.
2. Ionising Radiation (Medical Exposure) Regulations 2017 [IR(ME)R17] in England, Scotland and Wales Ionising Radiation (Medical Exposure) Regulations (Northern Ireland) 2018 [IR(ME)R(NI)18] in Northern Ireland.