Today, the Health Information and Quality Authority (HIQA) has published 22 inspection reports assessing compliance with medical exposure to ionising radiation regulations in seven dental facilities and 15 medical facilities. These inspections, carried out between February 2023 and May 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.

Of the seven dental inspections:

• two inspections were conducted to validate information provided by the undertakings in self-assessment questionnaires (SAQs) returned to HIQA. These facilities, Dennehy's Cross Dental Care and Midleton Dental Care, were found to be fully compliant with the assessed regulations
• three inspections were carried out because undertakings had not submitted an SAQ when requested. Some action was required by these facilities, Zita Geaney Dental Care; MW Dental, and Galway Orthodontics to come into compliance with the regulations assessed during the inspection 
• inspections were also conducted in Green Dental and Pro-Dental as both were found to be carrying out medical exposures to ionising radiation without notifying HIQA in advance, as required by the regulations
• where non-compliance with the regulations was identified, undertakings were required to identify how they will come into compliance with the regulations.

Of the 15 medical facilities inspected, full compliance with the regulations was found in Marymount University Hospital & Hospice and the National Rehabilitation Hospital. The Incorporated Orthopaedic Hospital of Ireland, Clontarf and Mayo University Hospital were fully compliant in all but one of the regulations assessed.

Some examples of good practice observed by inspectors included:

• the systems and processes in place at the National Rehabilitation Hospital allowed for regular monitoring of compliance and used key performance indicators and clinical audit to identify areas for improvement within the service
• the methods and approaches used for optimising high dose procedures in the Blackrock Clinic and Beacon Hospital 
• the use of technology to supplement the information provided on the benefits and risks of medical exposures to ionising radiation at Mayo University Hospital. This consisted of a QR code (quick response code) which, once scanned on a smart phone or similar device, provided service users with a link to a video explaining radiation dose. This resource was shared by the Saolta University Health Care Group.

South Tipperary University Hospital and University Hospital Limerick had previously been inspected as part of HIQA’s monitoring programme, and were found to have taken steps to address previous gaps in compliance. Similarly, University Hospital Limerick had made improvements to come into compliance with the regulations. However, further improvements were required in order to become fully compliant.

Overall, areas that were identified for additional focus for undertakings 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 local DRLs are established, compared to national levels and arrangements are in place for regular reviews. 

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.
• A self-assessment questionnaire (SAQ) is a tool that allows undertakings to self-appraise their level of compliance and helps to identify any possible risks or perceived gaps in compliance at their facility. Frequently asked questions about the SAQ are available here.