Today, the Health Information and Quality Authority (HIQA) has published 10 inspection reports assessing compliance with medical exposure to ionising radiation regulations in eight public facilities and two private medical imaging centres. These are:

• Alliance Medical at Beaumont (Dublin)
• Connolly Hospital (Dublin)
• Mater Misericordiae University Hospital (Dublin)
• Merlin Park University Hospital (Galway)
• Naas General Hospital (Kildare)
• St. Camillus Hospital (Limerick)
• St. Joseph’s Hospital (Dublin)
• St. Mary’s Hospital (Dublin)
• St. Joseph’s Care Centre (Longford)
• Vhi Swiftcare Clinic (Dublin) 

HIQA found Vhi Swiftcare Clinic Swords was fully compliant with all regulations assessed on the day of inspection, while very high levels of compliance were found in Alliance Medical at Beaumont, St. Joseph's Hospital in Raheny, and St. Joseph's Care Centre in Longford. 

Inspectors saw efforts had been made to address gaps in compliance identified previously in three hospitals: Connolly Hospital, Naas General Hospital, and Mater Misericordiae University Hospital. However, further improvements were required in all three hospitals to become fully compliant with the regulations. 

Examples of compliance observed by inspectors during these inspections included adherence to HIQA’s guidance on establishing, reviewing and comparing local diagnostic reference levels (DRLs - estimates of representative radiation dose levels for typical medical radiological procedures) with national DRLs, for example in: 

• St. Mary’s Hospital, where DRL reviews had been carried out frequently;
• Vhi Swiftcare Clinic Swords, where DRLs had been established for both adult and paediatric procedures based on 2023 data, compared to national DRLs, and displayed on colour-coded posters in the clinical area.

However, further work is required in two facilities, St. Camillus Hospital and Merlin Park University Hospital, to come into full compliance with the regulation on DRLs.

Inspectors also noted that facilities were beginning to implement HIQA’s National Procedures for Clinical Audit, which was published in November 2023. Specific examples of how clinical audit can be used as a quality improvement measure were seen in St. Joseph's Care Centre in Longford and in Connolly Hospital in Dublin.

Overall, areas that were identified for additional focus in facilities included: 

• ensuring that responsibilities are allocated appropriately as per the requirements of the regulations, are known by staff, and are documented accurately and reflective of local practice;
• ensuring that justification is carried out in advance of all medical exposures in the hospital; that referrals contain both the reason for requesting the procedure and sufficient medical data; and the record of justification is available for all procedures in all areas conducting medical exposures within the facility.

Where non-compliance with the regulations was identified, undertakings were required to identify how they will come into compliance with the regulations. HIQA continues to engage with facilities where non-compliances are found. 

Notes to the editor:

• These inspections were carried out to assess compliance with the European Union (Basic Safety Standards for Protection Against Dangers Arising from Medical Exposure to Ionising Radiation) Regulations 2018 (S.I. No. 256 of 2018), as amended.
• Since 2019, HIQA is the competent authority for patient protection in relation to medical exposure to ionising radiation in Ireland following the transposition of the European Commission Basic Safety Standards Directive 2013/59/Euratom into Irish law. 
• Medical exposure to ionising radiation is when radiation is used as part of diagnosis such as an X-ray or computed tomography (CT) scan, or the use of radiotherapy as part of cancer treatment at a hospital. It also includes radiation received for medical research purposes and radiation received by carers and comforters while attending to a patient. The regulations also include medical exposures used as part of a dental assessment, such as a dental X-ray.
• An undertaking is a person or body who has the legal responsibility for carrying out, or engaging others to carry out, a medical radiological practice, or the practical aspects of a medical radiological procedure, as defined by the regulations.
• HIQA also has responsibility for establishing national procedures for clinical audit of radiological procedures involving medical exposure to ionising radiation. The National Procedures for Clinical Audit set out the principles and essential criteria that undertakings must follow to ensure compliance with the requirements of the regulations.