• What is IR(ME)R 2000?
• How does it affect me?
• Who is responsible for the "referral" and "justification" procedures?
• Can anyone be an IR(ME)R referrer?
• Who can be an IR(ME)R practitioner?
• If I refer a patient for a dental CT scan, who will justify the exposure?
• How are the referral and justification done in practice?
• Who will interpret the images?
• Can I request a CT scan before the patient comes to see me?
• Where can I find out more?

What is IR(ME)R 2000?

The Ionising Radiation (Medical Exposure) Regulations 2000 implement for Great Britain the majority of the provisions of EC Directive 97/43/Euratom which concerns the protection of persons undergoing medical exposures. The Regulations came into force on 1 January 2000 and replace the previous regulations known as POPUMET (Protection of Persons Undergoing Medical Examination or Treatment).

[ Back to the top ]

How does it affect me?

The Regulations require that all medical exposures to ionising radiation must go through a referral and justification process prior to the exposure, and a clinical evaluation of the results must be made and recorded after the exposure. All healthcare professionals (including dentists and surgeons) must follow this procedure regardless of whether they are taking x-rays in their own surgery or sending the patient to a hospital for a CT scan.

[ Back to the top ]

Who is responsible for the "referral" and "justification" procedures?

IR(ME)R defines and uses certain words in a way that is different from everyday usage. To avoid confusion we will use the terms "IR(ME)R referrer" and "IR(ME)R practitioner" here.

The IR(ME)R referrer is responsible for providing the medical reasons for the examination being requested (e.g. what clinical information will it provide?).

The IR(ME)R practitioner is responsible for justifying the exposure, taking into account the potential risks to the patient, the expected benefits, and whether an examination using less ionising radiation would deliver the same clinical information.

These roles are often carried out by the same person, e.g. a dentist taking x-rays in his or her own surgery may be IR(ME)R referrer, IR(ME)R practitioner, IR(ME)R operator and IR(ME)R employer all in one.

[ Back to the top ]

Can anyone be an IR(ME)R referrer?

Decisions on who is entitled to act as an IR(ME)R referrer are taken at local level by each hospital (known in IR(ME)R terminology as the "employer"). The range of procedures that can be requested are also agreed locally, e.g. a hospital might decide that registered dentists can refer patients for CT scans of the teeth and jaws (but not of other parts of the body) and this would be recorded into the hospital's written procedures.

[ Back to the top ]

Who can be an IR(ME)R practitioner?

Decisions on who is entitled to act as an IR(ME)R practitioner are also agreed at local level. The practitioner is responsible for justifying medical exposures and therefore must have wide-ranging knowledge of the potential benefits and risks. This implies adequate training and experience. Practitioners must undertake continuing professional education and may have to provide evidence of this to the employer (hospital). Clinical radiologists are almost always IR(ME)R practitioners.

[ Back to the top ]

If I refer a patient for a dental CT scan, who will justify the exposure?

Many hospitals take the view that dentists (because of their radiographic training) can act as IR(ME)R practitioners as well as IR(ME)R referrers. In this case the dentist must justify the exposure to the radiographer who will carry it out.

Radiographers can also act as IR(ME)R practitioners (within locally agreed guidelines) and a radiographer can justify an exposure provided that the dentist (acting as IR(ME)R referrer) provides sufficient clinical information about the reason for the examination.

In case of doubt, the opinion of a radiologist should be sought.

[ Back to the top ]

How are the referral and justification done in practice?

Different hospitals have different Local Rules, but a signed request is always required. It must be clear and legible and provide the following information:

• unique patient identification
• sufficient details of the medical problem to enable the IR(ME)R practitioner to justify the exposure and the operator to verify it against the local guidelines
• if pregnancy is possible, information on the patient's menstrual status
• a signature uniquely identifying the requester

Many hospitals will accept IDT's Appointment Card as meeting these criteria.

[ Back to the top ]

Who will interpret the images?

The regulations require that a clinical evaluation of each medical exposure must be made and recorded, i.e. the images must be reported or "read". IDT does not perform this function. Whoever requests the examination must also ensure that the images are evaluated and used, e.g. for surgical planning. If it is known prior to the examination that no clinical evaluation will take place, then the exposure cannot be justified.

[ Back to the top ]

Can I request a CT scan before the patient comes to see me?

In general, no. The IR(ME)R referrer must be able to state the medical question that the CT scan is designed to answer (e.g.  dental implants indicated - bone thickness required ). This implies that the referrer is familiar with the patient's clinical history.

[ Back to the top ]

Where can I find out more?

• The Department of Health's publication provides an overview of the Regulations and also contains some notes on good practice.
• The IPEM's document comprises an excellent and comprehensive set of Medical and Dental Guidance Notes.
• The "European Guidelines on Radiation Protection in Dental Radiology"can be found from the European Commission's (EUROPA) website.
• An excellent publication called "Selection Criteria for Dental Radiography" which can be purchased from The Faculty of General Dental Practitioners FGDP(UK)

[ Back to the top ]