radiography – local rules

introduction

Every dental practice with radiographic (x-ray) equipment is required to provide a set of “local rules”. These record all the working practices we must follow to ensure that we are safe when working with radiation and that we comply with the various regulations governing radiation in dentistry; in particular the Ionising Radiations Regulations 2017 (IRR17). This document contains the “local rules” that apply to Hygeia Dental Care’s premises at Malt Mill Lane, Totnes.

management, supervision & authorised users

Joanne Giddy is ultimately responsible for ensuring compliance with IRR17 and, together with the Practice Director (Neil Phillips), has put together the radiation protection programme (documented in the Radiation Protection file) to achieve this.

In order to ensure that the arrangements in these local rules are followed, a Radiation Protection Supervisor (RPS) has been appointed: the RPS is Joanne Giddy.

The RPS should ensure that all dental radiography is carried out in accordance with these local rules.

It is the responsibility of the RPS to periodically review and (in consultation with the RPA/MPE – see below) update these local rules.

radiation protection adviser and medical physics expert

The UK Health Security Agency (formerly known as Public Health England Dental X-ray Protection Services; formerly known as the Health Protection Agency Radiation Protection Division; formerly known as the NRPB) has been appointed as Radiation Protection Adviser (RPA) and Medical Physics Expert (MPE) to Hygeia Dental Care in respect of its premises at Malt Mill Lane, Totnes in accordance with Regulation 14 of IRR17 and Regulation 14 of the Ionising Radiation (Medical Exposure) Regulations 2017 as amended by the Ionising Radiation (Medical Exposure) Regulations 2018 (“IRMER”), respectively. Our primary contact is Sharon Ely. She can be contacted on 0113 212 7430.

training

The entitlement of individuals to perform the role of duty holder in relation to dental radiographic exposures is demonstrated by the RPS (the entitler) recording the individual’s permitted duties in the personnel section (see section 1) of the Radiation Protection File. The entitler must decide whether the whether an individual’s training is sufficient for them to be deemed competent in the role of IRMER pratitioner, operator and/or referrer for dental exposures.

Duty holders will be informed by the RPS of their entitlement and of the need to maintain their competency in line with the recommendations of the GDC, and for dental CBCT exposures, section 3.10 of the Dental Guidance Notes (2nd edition).

The MPE (see above) will be considered entitled as an operator on appointment.

All new members of the team receive essential training in relation to the local rules as part of their induction process and records are maintained.

The RPS (Joanne Giddy) must also ensure that existing members of the team maintain their training and knowledge of the local rules and will maintain a record of qualifications, evidence of training and CPD for each entitled person (see section 1 of the Radiation Protection File).

Practitioners and operators must satisfy themselves that they have appropriate training and experience to undertake the duties they are entitled to perform. They must not carry out any duty for which they have not been trained and entitled.

Any students or trainees may undertake any aspect of the duty for which they are being trained provided this is done under the supervision of a person who is themselves adequately trained and entitled for that duty (eg nurses undergoing training to become competent in dental radiography being supervised in positioning the image receptor, patient and x-ray tube and selecting exposure settings). This must be DIRECT supervision – the supervisor must take responsibility for the activity as if they had carried it out themselves.

Where the practice enters into a contract with another to engage a practitioner or operator (eg agency staff or the MPE), the latter (eg MPE) will be responsible for keeping their training records.

duties of employees

All clinical personnel must:

a) Ensure that exposures to staff and all other people are kept as low as reasonably practicable;
b) Take reasonable care when working with any aspect of dental radiography – in particular, radiography must be conducted with due regard to minimising accidental or unintended doses to patients;
c) Immediately report to the RPS (Joanne Giddy) any incident that may result in the overexposure of themselves or anyone else.

All clinical personnel have a duty to exercise reasonable care and act responsibly in relation to radiography. They are required to know and observe these rules at all times.

x-ray equipment at Malt Mill Lane

There are usually 3 x-ray units at Malt Mill Lane, though 2 are currently out of service:

unit 1 – currently out of service pending practice refit

unit 2 – currently out of service pending practice refit

unit 3

It is the responsibility of Joanne Giddy (the RPS – see below) to notify the Health and Safety Executive of the use of, and any changes to, the radiography equipment in use at the premises.

controlled and supervised areas

IRR17 specifies “controlled” and “supervised” areas in relation to dental intra-oral x-ray equipment.

controlled areas

When either x-ray unit is switched on, a “controlled area” exists. A controlled area is somewhere that you MUST NOT GO while the x-ray unit is in operation. When an x-ray is being taken in a surgery, the whole of that room is a controlled area.

supervised areas

There are no supervised areas outside the controlled areas defined above. All that clinical personnel need to know about supervised areas is that there are none. Just be sure to stay out of the controlled areas when the x-ray unit is in operation.

classified persons and written system of work

There are no “classified persons” on our team and the provisions on written systems of work do not apply.

x-ray equipment – testing, servicing, maintenance & repair

NOTE: Service, maintenance and repair work should only be undertaken by adequately qualified service engineers and where work is carried out on x-ray equipment by a contractor, special procedures apply for the handover of the area where the work is to take place (see below for details).

All x-ray units at Malt Mill Lane must be subjected to a radiation safety assessment at least once every 3 years. It is the responsibility of the RPS (Joanne Giddy) to ensure that this is done. Radiation safety assessments are carried out using standard UKHSA test packs. It is the responsibility of the RPS (Joanne Giddy) to ensure that any recommendations made as a result of the assessments are acted upon within 3 months.

All x-ray units at Malt Mill Lane must undergo routine servicing at least once every year. It is the responsibility of the RPS (Joanne Giddy) to ensure that this is done. Servicing is undertaken by Edwards Dental who can be contacted on 01803 555739 or 07921 101111.

All x-ray units at Malt Mill Lane must undergo routine surveillance at least once every 6 months. Routine surveillance checks the correct functioning of the audible and visual warning systems, exposure controls, x-ray arm counterbalance mechanism and condition of the x-ray tube head. It is the responsibility of the RPS (Joanne Giddy) to ensure that this is done and to arrange for any necessary repairs to be carried out. Repairs are undertaken by Edwards Dental who can be contacted on 01803 555739 or 07921 101111.

Computer monitors used to view x-ray images at the practice (which means all of them) undergo testing every 3 months to ensure that they are correctly calibrated and reproduce images with good detail, contrast and without distortion. The results are recorded in section 7 of the Radiation Protection File. Monitors that do not perform acceptably must be replaced.

Digital x-ray sensors and imaging software used to capture x-ray images undergo testing every 3 months to check sensor condition, image uniformity and low contrast sensitivity. Sensor dose response testing has not been required since 2020. The results are recorded in section 7 of the Radiation Protection File. Sensors (or software) that do not perform adequately must be replaced.

No-one is permitted to interfere with or modify any part of the x-ray equipment unless they have first referred the matter to the RPS (Joanne Giddy).

When a contractor visits the practice to carry out work on dental x-ray equipment, the practice will formally hand over control of the area where the work is to take place for the duration of that work. During that time, the contractor will assume responsibility for the area and for the safety requirements under IRR17 (eg designating controlled areas, restriction of access, provision of local rules, etc). Once the work is complete, responsibility will be handed back to the practice. This handover is documented wither by using the transfer of responsibility form (see radiation protection file) or by using the contractor’s own documentation. A copy of the documentation will be retained by both parties.

Following any testing, servicing, maintenance or repair work, no x-ray unit or ancillary equipment may be accepted back into service until the RPS (Joanne Giddy) has reviewed the service report. This should confirm that the equipment has been left in a state fit for use and that no alterations have been made which may significantly affect patient doses. If such alterations have been made, the RPS (Joanne Giddy) should seek advice from the RPA/MPE before bringing the equipment back into use, since a critical examination may be required first.

use of x-ray equipment / guideline exposure protocols

The x-ray equipment must only be operated by a suitably qualified person, or by a person under their supervision who has received adequate training and instruction in the use of the x-ray equipment. At Malt Mill Lane only Joanne Giddy is qualified to operate the equipment.

The exposures used for radiography must be no greater than those required to yield correct radiographic densities with complete development of the film. The exposure timings for both x-ray units are pre-set. The correct film speed settings are selected using the patient size controls the wall-mounted control box. The practice uses digital sensors. The controls must also be set for the appropriate anatomical view. For guidance on adjustments and settings, refer to the CS2200 user’s manual.

Important note:   The garden area outside must be unoccupied whilst x-rays are being taken.

The operator of the x-ray equipment must take up a position outside the primary x-ray beam and where the instantaneous dose rate does not exceed 7.5 microsieverts per hour. For all x-ray sets, the appropriate operator position during exposures is outside the door of the room. The operator must ensure that they are able to view both the warning light on the control hand-switch and the patient during radiography. Electronic viewers installed on the doors permit the operator to view the patient from outside the room. The hand-switch controlling the exposure is on an extendable curly-cable and is brought outside the room by the operator so that the warning light remains visible. The audible warning tone is also easily audible from outside the controlled area and the operator must listen to ensure that the tone sounds and terminates as appropriate.

For intra-oral radiography, the primary x-ray beam (IE the tube head) must never be directed toward the operator. The operator must also ensure that the primary x-ray beam is never directed toward a window or an unshielded door. If this appears to be the case, the patient must be repositioned before the exposure is taken.

The operator must ensure that no-one except the patient is present in the controlled area when x-rays are being produced.

The operator is supplied with and is required to use x-ray film holders with integral beam alignment devices. These have been proven to reduce the number of radiographs that are judged unacceptable by reason of positioning errors, thereby reducing the overall number of x-rays taken and x-ray exposure for clinical personnel and patients alike.

During every radiographic examination the operator must observe the radiographic warning light and listen to the audible warning to check that the exposure terminates correctly before approaching the x-ray equipment and the patient.

X-ray sets must be turned off at the mains (using the switch on the unit) after each set of radiographs.

When the surgery is not in use the x-ray set must also be turned off at the local consumer unit in the room (the circuit breaker is labelled “X-ray unit”): this must be done as part of the closing-down process at the end of each working day.

assessment of patient dose

The MPE will ensure that representative measurements of patient dose are made as part of the x-ray equipment quality assurance programme and will recommend appropriate exposure settings based on these measurements.

The MPE will compare representative measurements of patient dose with relevant national or local diagnostic reference levels and recommend any necessary action to address any deficiencies.

The operator undertaking the exposure will ensure that data required to assess patient dose is recorded as outlined below:

Where practicable, operators initiating a dental radiographic exposure will adhere to the standard settings as set out in the practice’s guideline exposure protocols (see above). If standard settings are not used, the actual exposure settings used must be recorded as “off-protocol” exposures in the patient record. The total number of exposures and the reason for any repeat exposures must also be recorded.

use and review of diagnostic reference levels (DRLs)

The MPE will ensure that representative measurements of patient dose are made as part of the x-ray equipment quality assurance programme (see above).

The MPE will use the representative measurements of patient dose to recommend appropriate local DRLs or to review and, if appropriate, update existing local DRLs and recommend any changes to radiography practices.

Where there is evidence that patient doses consistently exceed one or more local DRLs, the MPE will assist the practice to undertake a thorough review of radiographic practices and recommend any changes that are necessary.

In consultation with the MPE, the RPS will establish local DRLs for each type of dental x-ray set that is in clinical use, having due regard to European and national DRLs where available. These local DRLs will be made available to operators.

Where patient doses consistently exceed one or more local DRLs, the RPS will take action to improve current techniques or justify their continued use, in accordance with the advice of the MPE.

Where patient doses consistently exceed twice the national DRL, the RPS will immediately withdraw equipment from clinical use until improvements can be made, or replace it, in accordance with the advice of the MPE.

The RPS must communicate to all relevant team members any corrective action that may be required.

Where it is suspected that a local DRL has been exceeded, operators must record the exposure settings used and any extenuating circumstances in the patient’s record (see section on significant unintended or accidental exposure, below).

damage to x-ray equipment

If an x-ray unit is damaged, immediately isolate the unit from the mains electricity supply.  To do this, simply switch the power off using the switch on the wall mount for the x-ray arm. The x-ray control unit is the box on the wall near the surgery entrance door (to which the remote switch is attached). Next, switch off the supply circuit labelled “X-ray unit” at the distribution board in the relevant surgery. Notify the RPS (Joanne Giddy) of the damage immediately. Do not use the x-ray unit again until the malfunction has been investigated by the RPS (Joanne Giddy) and any necessary remedial action has been taken by service agents. Servicing is undertaken by Edwards Dental Equipment Services who can be contacted on 01803 555739 or 07921 101111. The RPS must also inform and consult the RPA/MPE.

contingency plans

If the exposure warning light remains on after the set time has elapsed, or any other fault is indicated or suspected which causes the continuous generation of x-rays, immediately isolate the x-ray unit from the mains electricity supply. To do this, simply switch the power off using the switch on the wall mount for the x-ray arm. Next, switch off the supply circuit labeled “X-ray unit” at the distribution board in the relevant surgery. Notify the RPS (Joanne Giddy) of the malfunction immediately. Do not use the x-ray unit again until the malfunction has been investigated by the RPS (Joanne Giddy) in consultation with the RPA/MPE, a satisfactory explanation has been found and remedial action has been taken by service agents. Servicing is undertaken by Edwards Dental who can be contacted on 01803 555739 or 07921 101111.

If the above contingency plans are used, the RPS (Joanne Giddy), in consultation with the RPA/MPE, should analyse the cause of the event to determine if any action is required to prevent a recurrence of the incident. A record of the analysis should be made and kept for at least two years. If any person receives a radiation exposure as a result of the incident this should be noted on any relevant dose record.

Contingency plans must be rehearsed annually to ensure that they are effective and that all relevant team members understand the plans and actions to be taken. Records of these rehearsals must be maintained: refer to section 4 of the Radiation Protection File.

significant unintended or accidental exposure

If it is suspected that a patient undergoing a medical exposure (or any other person) may have been exposed to ionising radiation to an extent much greater than intended, the incident must be reported immediately to the RPS (Joanne Giddy). The operator must take a note of all display / control settings and save all images, including rejects.

If the incident was due to an equipment malfunction, the equipment must be removed from service pending an investigation. The MPE will advise whether equipment failure should be reported to the manufacturer and / or the MHRA.

The RPS must immediately consult with the RPA/MPE to determine an estimate of the patient dose. If the estimate of the patient dose indicates that the patient has been exposed to levels of ionising radiation significantly greater than those considered to be generally proportionate in the circumstances, the RPS (Joanne Giddy) will, on the advice of the MPE:

a) notify the Care Quality Commission (CQC)
b) arrange for a detailed investigation of the circumstances of the event and if necessary a more detailed assessment of the dose received
c) notify the Care Quality Commission within 12 weeks of the outcome of the investigation and any corrective measures adopted.

If the MPE advises that the exposure is clinically significant, the RPS (Joanne Giddy) should discuss the exposure with the patient or the patient’s representative.

The investigation into the exposure should be documented together with the outcomes of the analysis, including estimated patient dose. This should be done in consultation with the MPE. The report should be retained in the Radiation Protection file for at least 5 years. If the exposure is clinically significant, copies must be provided to the referrer, IRMER practitioner and the patient or the patient’s representative, and a copy retained for at least 30 years.

reducing the probability and magnitude of unintended or accidental exposures

The practice will ensure that all team members involved with dental radiography or dental CBCT imaging are adequately trained, competent and entitled. It will also ensure that an equipment inventory is kept and that the equipment is maintained in accordance with the manufacturers’ instructions.

All duty holders will comply with practice procedures.

IRMER practitioners and operators must ensure that the doses arising from exposure are kept as low as reasonably practical, consistent with the intended purpose.

The practice will reduce the risk of unintended exposures by adopting the following processes (records of which can be found in the Radiation Protection File):

• Procedures and protocols will be in place and will be regularly reviewed to ensure they match local practice
• Equipment will regularly undergo quality assurance (QA) checks to ensure it is functioning correctly
• Additional equipment QA checks will be carried out if over 10% of images are deemed unacceptable
• Feedback will be given to any dental professionals following any incident
• Training and competency assessments will be undertaken including when new equipment and procedures are introduced
• Induction programmes will be operated for new staff
• The quality of dental images will be graded and reviewed
• Clinical audit will be carried out as appropriate
• Audit of procedures will be carried out at regular intervals
• Good practice and technique will be applied
• Near-miss incidents will be investigated

dose investigation level

The formal dose investigation level set by this practice is 1mSv (refer to Radiography Risk Assessment – see section on IRR, regulation 22: Dose Assessment).  If it is suspected that any team member’s effective dose has exceeded 1mSv within a calendar year, the RPS (Joanne Giddy) must conduct a formal investigation in liaison with the RPA/MPE in order to establish why. The purpose of the investigation is to determine whether radiation doses are being kept as low as reasonably practicable. The results of any such investigation must be kept for at least 2 years.

pregnancy – clinical personnel

We must ensure that the dose to the foetus of any member of the team is unlikely to exceed 1mSv during the declared term of the pregnancy. As doses to operators have been assessed to be significantly lower than 1mSV there is no need for special arrangements for pregnant team members.

pregnancy – patients

Pregnant patients only present safety issues in connection with dental radiography when a radiographic examination would result in irradiation of the pelvic area by the primary x-ray beam (eg where a vertex occlusal projection is required). We do not use such projections on adult patients and so our dental radiographic imaging would not be damaging to a developing fetus. Consequently, no formal pregnancy enquiries are required under IRMER17.

Nonetheless, we always identify pregnant patients as part of our clinical risk management procedures by means of medical history taking (treatment code EMED1) and medical history updates (treatment code EMED2).

Where a patient knows or suspects that they are pregnant and is concerned about the potential for the radiograph to harm their unborn child, then they are advised that they may defer radiographic examination if they prefer. If this is not considered to be in the best interests of the patient (for example, because there is a need for urgent dental treatment and radiographic examination is considered essential), they should be advised of this.

The decision to defer and any advice given should be documented in the patient’s record.

patient identification

Joanne Giddy is the RPS and is currently the only referrer/operator/practitioner for the purposes of IRMER at this practice. The only patients treated at the practice are her patients and she knows them all personally. We do not accept referrals for radiographs from other practices/practitioners. Accordingly, there is no realistic possibility of a failure to correctly identify any patient and so we do not operate formal procedures for patient identification.

assistance with radiography

Practice personnel must never support the x-ray tube head, or the patient, or hold a sensor in position for the patient.

The practice also does not permit comforters / carers to support patients during radiography.

film processing

The practice no longer uses wet film systems, so all sections in older editions of these local rules relating to film processing, preparation of solutions, storage of solutions, replacement of solutions, processing times and temperatures and mounting of radiographs no longer apply.

radiographic quality control

When reviewing x-rays, the dentists must note any deterioration in image quality. If there is any deterioration in quality, they must consider whether this is a result of errors in positioning or exposure.

Errors of positioning should be virtually eliminated by the beam alignment devices provided. If not, the operator must adjust his or her technique to improve results.

Exposure times are pre-set on the x-ray units at the practice. This minimises the possibility of error.

Processing errors are no longer possible (because we use a digital system), so a loss of image quality may indicate a malfunction in the x-ray unit or the digital x-ray sensor and the RPS (Joanne Giddy) must be informed. It is her responsibility to investigate the matter and, if necessary, arrange for the x-ray unit, sensors and software to be checked if she suspects there may be a fault. In her absence, the operator should consult the RPA. If it is necessary to arrange for the unit to be checked, contact Edwards Dental on 01803 555739 or 07921 101111.

The practice aims to achieve the following x-ray quality targets:

a) Not less than 95% of x-rays should be “diagnostically acceptable” (grade “A”) – with no errors or minimal errors in either patient preparation, exposure, positioning, image (receptor) processing or image reconstruction and of sufficient image quality to answer the clinical question posed.

b) Not more than 5% of x-rays  should be “diagnostically not acceptable” (grade “N”) – with errors in either patient preparation, exposure, positioning, image (receptor) processing or image reconstruction which render the image diagnostically unacceptable.

If an operator becomes aware that the quality of films has fallen significantly below these targets, they must inform the RPS (Joanne Giddy) immediately. She must then take action to ensure that overall quality is improved.

The RPS (Joanne Giddy) is responsible for ensuring that audits of radiographic image quality are carried out at six monthly intervals. The results of these audits are recorded in our Radiation Protection File. If the quality targets set out above are not met, she is responsible for taking action to ensure that overall quality is improved.

The practice also carries out biannual audits of reject x-ray images to determine the causes of clinically unacceptable images and to determine whether any patterns arise that may allow corrective action to be taken.

All x-ray images are graded as either “diagnostically acceptable” (grade “A”) or “diagnostically not acceptable” (grade “N”) on the day they are taken and this is recorded in the patient notes. This ensures that any changes in image quality are noted as soon as they occur.

clinical evaluation of x-rays

Every dental exposure undertaken must be clinically evaluated in an accurate and timely fashion. Clinical evaluation of x-ray images is the responsibility of Joanne Giddy (who is also the RPS and is currently the only referrer/operator/practitioner for the purposes of IRMER at this practice). Images are captured using a digital CCD system and it is therefore available to view only a few seconds after the exposure. Often, the patient will be shown the image during their appointment to aid in explanations given.

Any findings relevant to the patient’s management or prognosis are recorded in the patient’s electronic notes either during the course of or shortly after their appointment (for example, at the end of the session).

The clinical evaluation must bear the name of the dentist.

It should also detail all findings, including, where relevant:

• details of the teeth imaged
• evidence of primary caries & CARS
• defective restorations (ledges, overhangs, negative steps, etc.)
• cracked / broken teeth
• bone loss (quantified where possible; estimated where not)
• intra-bony defects
• furcations
• quality of lamina dura
• periapical pathology
• widened periodontal ligament spaces
• subgingival calculus
• retained roots / root fragments
• unerupted teeth
• proximity of roots to the maxillary sinus / IA nerve canal
• root curvature
• cystic areas
• and any other abnormalities or items of note.

referral, justification and authorisation of x-rays

A clinical assessment of every patient’s teeth is performed prior to the taking of any x-rays.

Where the referrer also acts as the practitioner and operator for a dental exposure (as is currently always the case at Malt Mill), they must ensure that the request for the x-ray is documented within the patient’s dental record. The clinical indications for the x-ray should be clear and fit with the referral criteria mentioned below. Authorisation of the exposure as justified and the identity of the referrer must be clear in the notes.

This practice follows the procedures outlined in ss2.29 to 2.35 of “Guidance notes for dental practitioners on the safe use of x-ray equipment” published by the National Radiological Protection Board in 2001 and the more detailed good practice guidelines entitled “Selection Criteria for Dental Radiography” published by the Faculty of General Dental Practitioners (UK) of the Royal College of Surgeons of England (now the College of General Dentistry), 3rd edition (2013; updated 2018). Copies of these documents are available in the office and also online.

This practice does not carry out x-ray exposures for purely medico-legal reasons nor at the request of third parties (eg referrals from other practices).

Each individual exposure must be justified, taking into account:

a) The specific objectives of the exposure and the characteristics of the individual involved
b) The total potential diagnostic or therapeutic benefits of the exposure, including the direct health benefits to the individual and the benefits to society
c) The individual detriment that the radiation associated with the exposure may cause
d) The efficacy, benefits and risk of available alternative techniques having the same objective but involving less (or no) exposure to ionising radiation.

If the practitioner is aware, at the time of authorisation, that a recorded clinical evaluation shall not result from the exposure then the exposure must not be authorised and cannot take place.

When the referrer (who is also a registered dental practitioner and entitled IRMER practitioner) deems it in the patient’s best interests to have an x-ray then the referrer’s name in the clinical notes indicates that it is also deemed to be a justified exposure.

Any referral to another dental practice / hospital (eg for panoral or CBCT imaging) must be made in accordance with any referral guidelines supplied by that dental practice / hospital. If multiple referrals to a single organisation are likely then a service level agreement should be put in place.

medical research programmes

The practice does not undertake research exposures.

explanation of risks and benefits

The practitioner who undertakes the exposure is responsible for ensuring that the patient is informed about the benefits and risks associated with the radiograph prior to it taking place by describing the benefits to the patient in terms of the expected positive outcome from the radiograph and explaining that the risk is low.

The following words can be used: “The risks associated with dental radiography are extremely small under normal conditions and the radiograph will help inform our advice and your treatment decisions.”

To help put the risk into perspective, dental radiography can be compared to other exposure situations. For example: “The radiation dose from two bitewing radiographs is roughly equivalent to that received during a 1-hour plane flight.”

risk assessment

The practice is required to carry out, record and periodically review a risk assessment for work with x-rays.

It is the responsibility of the RPS (Joanne Giddy) to ensure that the risk assessment is reviewed, updated and any necessary action taken to maintain safe working practices and/or compliance with current regulations.

The risk assessment must be reviewed triennially AND:

a) whenever new radiographic techniques or equipment are introduced for the first time (eg first use of panoramic radiography or cephalometry);

b) whenever there are changes to the process or methods of work;

c) whenever new legislation is introduced relating to radiography.

The latest risk assessment is published on this website.

quality assurance programmes

The practice will ensure that all team members involved with dental radiography or dental CBCT imaging are adequately trained with respect to the quality assurance programmes relating to written procedures, written protocols and equipment as set out in the Radiation Protection File.

All duty holders must comply with the practice’s procedures.

The practice has assigned responsibility to:

• The RPS for reviewing the written procedures and protocols whenever there is a change in practice, equipment or service delivery or at least every 3 years
• The RPS for undertaking and recording x-ray and ancillary equipment QA checks
• The RPS for undertaking and recording imaging system quality assurance checks
• The RPS for undertaking and recording audits of radiographic image quality at least once every 6 months
• The RPS for undertaking the annual audit of the Radiation Protection File
• The RPS for reviewing the annual audit of the Radiation Protection File and for taking any necessary improvement actions.

Records of all reviews / revisions to documentation and QA checks will be recorded in the appropriate section of the Radiation Protection File.

disposal of radiographic waste

Since the practice uses a digital x-ray system, we no longer produce the waste products associated with wet film processes: lead foil from x-ray wrappers, x-ray developer solution and x-ray fixer solution.

Web version 22: 26.3.2026
Previous local rules published: 27.7.2006; 10.4.2008; 9.8.2008; 2.4.2009; 26.1.2012; 23.2.2012; 27.4.2012; 17.12.2012; 13.3.2013; 19.6.2014; 11.4.2015; 3.7.2015; 4.8.2016; 20.10.2016 (reviewed 1.9.2017); 3.9.2017; 2.2.2018; 16.7.2018; 7.11.2018 (reviewed 11.11.2018; 24.7.2019; 9.11.2019; 19.6.2020; 12.8.2020); 21.10.2021; 28.10.2021 (reviewed 18.11.2021; 28.8.2022); 14.12.2024

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