JSP 392 Chapter 26 - MEDICAL X-RAY Alt Text
JSP 392 Chapter 26 - MEDICAL X-RAY Alt Text
JSP 392 Chapter 26 - MEDICAL X-RAY Alt Text
Scope
1. The instructions in this Chapter apply to MOD units and establishments; they do not
apply within Ministry of Defence Hospital Units where responsibility for health and safety in
general and radiation safety in the particular context of this publication, rests with the Chief
Executive of the NHS Trust concerned.
2. This Chapter covers medical diagnostic X-ray equipment (including fluoroscopes). The
following information describes the requirements for keeping and using such equipment.
Statutory Requirements
3. In addition to the general requirements of the Health and Safety at Work etc. Act 1974
and the Management of Health and Safety at Work Regulations 1999, the following specific
legislation applies directly:
Duties
4. Duties as detailed in Chapter 39 apply. In addition, the following duties also apply.
5. The RPS is to ensure that X-ray equipment is correctly used in accordance with local
orders for radiation safety including local rules, instructions and procedures. The RPS is
also to ensure that reporting procedures for any incidents are followed (see Chapter 14).
The RPS is normally the superintendent radiographer within the unit and should be
appropriately trained for the role. This training should be refreshed at least every five years.
Employees
7. It is the responsibility of all employees to ensure that X-ray equipment and personal
protective equipment is used correctly and not deliberately misused or interfered with and
that work is carried out in accordance with local orders, instructions and procedures. Any
incidents are to be immediately reported to the RPS.
Hazard
8. X-ray sets generate an in-beam exposure hazard. In addition, radiation from X-ray
head leakage and scatter from the beam may affect areas around the X-ray head and
beam.
11. All new installed X-ray equipment is to be fitted with a dose area product (DAP) meter.
15. For mobile X-ray sets, the controlled radiation area extends in the direction of the X-
ray beam until the beam is sufficiently attenuated by distance (approximately 8 m) or
shielding (e.g. solid floor or wall) and out to 3 m in all other directions.
Exposure Protocols
16. Written protocols are to be in place for each type of standard radiological practice and
for each type of X-ray equipment. For radiography equipment this will involve noting
exposure factors, focus to film / detector distance, grid use and automatic exposure control
(AEC) use as appropriate for each type of examination. For fluoroscopy equipment the
protocol is to include, e.g. collimation, magnification and dose settings. Where exposure
settings are programmed into the console, these are to match the values in the exposure
chart. Exposure settings are normally recorded in the form of an exposure chart, which is to
be signed and dated by a responsible person.
17. After each examination, a record of exposure factors, DAP meter reading or exposure
time is to be made in the patient’s notes.
20. Requests for a radiological examination are initiated by the referrer i.e. any registered
medical or dental practitioner or other health professional who is entitled to refer individuals
for medical exposure to an IRMER practitioner.
Training
21. Adequate training in the radiation protection of patients, as defined at Reference B, is
required for IRMER practitioners and IRMER operators. Adequate training is obtained
during professional training and qualification, or a MOD recognised course together with
practical experience, mentoring and continuing education and training as appropriate.
22. In most circumstances, adequate training will be met by satisfying the requirements of
the appropriate professional bodies, i.e. the Royal College of Radiologists and the College
of Radiographers.
23. Each establishment or unit is to maintain a register of adequate training for IRMER
practitioners and IRMER operators providing details and dates of training undertaken.
Referral Criteria
25. Referral criteria for medical exposures, including information on radiation doses to
patients, are to be made available to those health professionals who refer patients for
radiological examination. In MOD medical X-ray departments, referral criteria normally take
the form of the RCR Guidelines at Reference C.
30. Each piece of X-ray PPE is to have its own identifying number. Gloves, aprons, and
thyroid shields are to be visually examined at 3-monthly intervals and radiographically
examined at least every 12 months for the determination of deterioration or reduction in
shielding effectiveness. X-ray protective glasses should be visually inspected at 3-monthly
intervals. Records of examinations are to be kept for 2 years.
Protection of Patients
31. Radiation doses to patients are to be as low as reasonably practicable in accordance
with the intended clinical purpose.
33. The patient record is to be annotated to confirm that each exposure has been justified
/ authorised, and that evaluation of each radiograph has taken place.
36. The supporter is preferably to be an adult relative or friend of the patient and should
not be pregnant. The supporter must be adequately protected from exposure to X-rays
during the examination. The exposure of the Comforter / Carer is a medical exposure and
must be justified and authorised as such.
40. C - iRefer: Making the best use of clinical radiology, eighth edition, 2017, The Royal
College of Radiologists
41. D - Institute of Physics and Engineering in Medicine (IPEM) Report 91, Recommended
Standards for the Routine Performance Testing of Diagnostic X-ray Imaging Systems 2005
42. E - Doses to Patients from Radiographic and Fluoroscopic X-ray Imaging Procedures
in the UK – 2010 Review HPA-CRCE-034 (2012)