Today, the Health Information and Quality Authority (HIQA) has published 28 inspection reports assessing compliance with medical exposure to ionising radiation in 15 medical facilities and 13 dental facilities. These inspections, carried out between June 2022 and February 2023, assessed 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.



Inspectors found that four dental undertakings were fully compliant with the assessed regulations. These undertakings were: Campbells Dentists Service; Carrigtwohill Dental Practice; Kerry Endodontics; and Tramore Dental. One medical imaging centre, Mater PET/CT Centre, was also found to be fully compliant with the assessed regulations.



Some examples of good practice observed by inspectors included:

• Good records of justification were available for review in Castleknock Dental Practice. The undertaking was also looking to proactively upgrade their computer system to incorporate more details about X-rays. 
• A range of clinical audits were being conducted by the undertaking, Alliance Medical Diagnostic Imaging Ltd at Alliance Medical, UPMC, Kildare. These audits included an annual radiation safety audit which indicated high levels of compliance with the areas included as part of this audit.
• Good involvement of medical physics experts (MPE) in St Vincent’s University Hospital. The hospital also had good processes in place to optimise medical procedures along with a strong multidisciplinary clinical audit programme.
• The comprehensive compliance plan response submitted by the undertaking at the Royal Victoria Eye and Ear Hospital which assured HIQA of the steps taken to come into compliance with the regulations.

Inspectors found varying levels of compliance in eight facilities. These included two dental facilities, Ashe Street Clinic and Virginia Dental Care & Implants, and six hospitals: Louth County Hospital; Mallow General Hospital; Monaghan General Hospital; Our Lady’s Hospital Navan; Royal Victoria Eye and Ear Hospital; and St Vincent's University Hospital.



Improvements required of undertakings included: ensuring that responsibilities were allocated appropriately; having processes in place for justifying and recording the reasons for medical exposures; implementing and maintaining quality assurance programmes; and ensuring that those conducting medical exposures have the correct education, information and training in the field of medical exposures.



Two of the 28 inspections were conducted to follow up on the outcomes of previous inspections. Mallow General Hospital had made progress and implemented the required improvements across a number of the reviewed regulations. For example, inspectors noted that significant work had been progressed in relation to the establishment, review and use of diagnostic reference levels (DRLs) in both the computed tomography (CT) and general X-ray units. However, further work was required in this hospital. For example, progress had not been made to ensure information relating to patient exposure was included on patients’ reports and there was still scope for improvement in relation to the reporting and analysis of, and learning from, potential incidents.

 

Similarly, the inspection of St Vincent’s University Hospital was conducted to follow up on the outcomes of a previous inspection and inspectors noted that good progress had been made to address gaps previously identified. Additional measures had also been implemented to strengthen the governance and management arrangements for medical exposures in the hospital. However, the hospital is required to ensure that all aspects of each individual medical exposure, conducted in all areas of the hospital, are aligned with the hospital's overarching delegation of responsibility and aligned with the requirements of the regulations. 



HIQA continues to engage with undertakings where non-compliances are found.



Read all reports at the link below.

Notes to the editor:

• HIQA is the competent authority for patient protection in relation to medical exposure to ionising radiation in Ireland after the EU’s Council Basic Safety Standards (BSS) Directive of 2013 was transposed into Irish law in 2019. 
• 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.
• A medical physics expert (MPE) is an individual having the knowledge, training and experience to act or give advice on matters relating to radiation physics applied to medical exposure and whose competence is recognised by the Minister for Health.
• Diagnostic reference levels (DRLs) are estimates of representative radiation dose levels for typical X-ray examinations.