Chapter 13: Diagnostic tests
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Clinical governance
IR(ME)R sets out the legal roles and responsibilities of all duty holders related to medical exposures to X‐rays. In accordance with IR(ME)R, the completed request form for a medical exposure must be clear and legible and the following information must be supplied:
- unique patient identification, to include at least three identifiers from name, date of birth, hospital number and NHS number
- sufficient details of the clinical problem to allow the IR(ME)R practitioner to justify the medical exposure or the IR(ME)R operator to authorize it, and indication of examination thought to be appropriate
- if applicable, information on the patient's possible pregnancy status
- signature uniquely identifying the referrer as it is important that the referrer is qualified to order an X‐ray.
Blank request cards, pre‐signed by a referrer, are a breach of the regulations. Any entries on the request form made by others should be checked and initialled by the referrer prior to signing the form.
Competencies
IR(ME)R requires employers to only accept requests for X‐ray or nuclear medicine investigations from approved and authorized ‘referrers’. When the referrer is not a trained medical doctor or dentist, they must have received appropriate information, instruction and training in clinical assessment and radiation protection of the patient, and the scope and range of investigations for which they are authorized to request must be documented. All ‘referrers’ must be made aware of the appropriate referral criteria for such investigations, as set down by each individual's organization in its IR(ME)R procedures and protocols.
Risk management
Radiation protection is based on the three principles of justification, optimization and limitation:
- The procedure must be justified and be of net benefit to the patient.
- Optimization ensures that exposure to the patient, staff and public must be as low as reasonably practicable (ALARP).
- Limitation is essential to ensure that radiation doses to staff and members of the public do not exceed the dose limits (IR(ME)R [107]).
Note that there are no dose limits for patient exposures.
