Start reading through the General Dental Council’s “Standards for the Dental Team”, and it’s not long until you find the first mention of radiography. Standard 1.5[i] notes that clinicians must treat patients in a hygienic and safe environment, which necessitates reading up on the laws and regulations that will affect the practice – including legislation relating to radiography.
Keeping up to date and informed on the regulatory requirements placed on practices that use dental radiographs is essential. Considering the range of health conditions that have been found to correlate with dental radiography exposure – such as brain and thyroid cancers, leukaemia and low birth weight[ii] – it is paramount to only use them in practice when justified, and be able to employ them in line with the appropriate regulations for optimal patient safety.
A new look IR(ME)R
Some of the most paramount pieces of legislation that dental professionals must understand are the Ionising Radiation (Medical Exposure) Regulations, often referred to as IR(ME)R, which have most recently seen new amendments take effect on 1st October 2024 – referred to as IR(ME)(A)R 2024.[iii] The updated documents supersede the IR(ME)R 2017, which took effect in February 2018 and were quickly amended upon their implementation.[iv]
The new amends are recognised by the British Dental Association, who approached the UK Health Security Agency for clarification into the changes made to dentistry.[v] Upon reviewing the amended legislation, there are few changes that will dramatically change the workflow of the average clinician. This is of little surprise considering that radiography use has been refined for safety in this field.
However, the amendments are further reaching than the 2018 update, with IR(ME)(A)R 2024 changing 17 separate regulations and schedules.[vi] Many are updates to wordage, making it more applicable to today’s practice of healthcare radiography. Notably the reference to “European” diagnostic reference levels are now “international”, and there is a conscious effort to widely include referrers and operators, as opposed to only practitioners.
One significant change requires practitioners to establish a system for the appropriate actions that should be taken when an accidental or unintended exposure occurs.vi Previously, the regulations only demanded that clinicians create a workflow that records the analysis of these events. It is imperative that this change is immediately implemented in the practice, and may require clinicians and radiographers to draw up an action plan that can be referred to depending on the severity of an unintended radiation exposure. This adds to the communication of review outcomes to referrers, practitioners and the affected patient. In the long term, this can prevent the repetition of mistakes and protect future patients.
Co-operation between practitioners and operators is briefly mentioned in Regulation 10 of IR(ME)R 2017,[vii] but the latest amends also reiterate this in a newly added Regulation 6A. IR(ME)(A)R 2024 formally introduces the need to share relevant patient information between practitioners, including the justification for the exposure, to better protect individuals who are treated by multiple professionals. This can optimise the communication between the team, improving outcomes and patient safety.
Minimising adverse results
The Care Quality Commission (CQC) is the enforcement body for the IR(ME)R in England.[viii] Under Regulation 8, clinicians must make their enforcing body aware of any accidental or unintended exposure that is significant or clinically significant.[ix] The differentiation between these is slight; significant accidental or unintended exposures are significantly greater than intended or perhaps as a result of equipment malfunction.[x] Clinically significant exposures can be defined as those that create moderate harm, increasing the patient’s need for treatment through dental or general health care.
To minimise the risk of such exposures, and ensure you are compliant when proceeding with radiographic imaging in the practice in the future, it is imperative that you choose equipment you can trust. Modern systems can make image capturing simple and safe, and clinicians new to radiology should seek out solutions that eradicate any difficulties when selecting factors such as dose strength.
The CS 8200 3D Access CBCT scanner from Carestream Dental can help professionals of all experience levels optimise their in-house workflows. It features a user-friendly interface that makes CBCT, panoramic, and cephalometric image data simple to produce, analyse and share with other clinicians. A low-dose imaging mode also allows clinicians to deliver high-quality 3D images at the same or lower does as a standard panoramic exam, to protect patients further.
Keeping up to date with the regulatory changes surrounding radiographic care is essential. Clinicians should review the updated IR(ME)R with their team, to ensure the entire practice can deliver the best possible care to each and every patient.
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[i] General Dental Council, (2019). Standards for the dental team. (Online) Available at: https://www.gdc-uk.org/standards-guidance/standards-and-guidance/standards-for-the-dental-team [Accessed October 2024]
[ii] Hwang, S. Y., Choi, E. S., Kim, Y. S., Gim, B. E., Ha, M., & Kim, H. Y. (2018). Health effects from exposure to dental diagnostic X-ray. Environmental health and toxicology, 33(4).
[iii] The Society of Radiographers, (2024). Ionising Radiation (Medical Exposure) Regulations 2017. (Online) Available at: https://www.sor.org/learning-advice/professional-practice/areas-of-practice/rad-protection/radiation-regulations [Accessed October 2024]
[iv] The Ionising Radiation (Medical Exposure) (Amendment) Regulations 2018, (Online). Available at: https://www.legislation.gov.uk/uksi/2018/121/introduction/made [Accessed October 2024]
[v] British Dental Association, (2024). Possible changes to dental radiography. (Online) Available at: https://www.bda.org/news-and-opinion/news/possible-changes-to-dental-radiography/ [Accessed October 2024]
[vi] The Ionising Radiation (Medical Exposure) (Amendment) Regulations 2024, (2024). (Online) Available at: https://www.legislation.gov.uk/uksi/2024/896/contents/made [Accessed October 2024]
[vii] The Ionising Radiation (Medical Exposure) Regulations 2017, (2017). (Online) Available at: https://www.legislation.gov.uk/uksi/2017/1322/contents/made [Accessed October 2024]
[viii] Care Quality Commission, (2024). Ionising Radiation (Medical Exposure) Regulations (IR(ME)R). (Online) Available at: https://www.cqc.org.uk/guidance-providers/ionising-radiation/ionising-radiation-medical-exposure-regulations-irmer [Accessed October 2024]
[ix] Care Quality Commission, (N.D.). Notify us about an exposure. (Online) Available at: https://www.cqc.org.uk/guidance-providers/ionising-radiation/ionising-radiation-medical-exposure-regulations-irmer/notify-us-about-exposure [Accessed October 2024]
[x] The British Institute of Radiology, The Royal College of Radiologists, Institute of physics and Engineering in Medicine, The Society & College of Radiographers, Public Health England, (2020). IR(ME)R Implications for clinical practice in diagnostic imaging, interventional radiology and diagnostic nuclear medicine. (Online) Available at: https://www.rcr.ac.uk/our-services/all-our-publications/clinical-radiology-publications/ir-me-r-implications-for-clinical-practice-in-diagnostic-imaging-interventional-radiology-and-diagnostic-nuclear-medicine/ [Accessed October 2024]
