Health And Safety Citation and commencement 1 These Regulations may be cited as the Ionising Radiation (Medical Exposure) Regulations (Northern Ireland) 2018 and shall come into operation on 6th February 2018. Interpretation 2 1 In these Regulations— “accidental exposure” means an exposure to ionising radiation of individuals as a result of an accident; “adequate training” means training which satisfies the requirements of Schedule 3; “assessment” means prior determination of amount, parameter or method; “carers and comforters” means individuals knowingly and willingly incurring an exposure to ionising radiation by helping, other than as part of their occupation, in the support and comfort of individuals undergoing or having undergone an exposure; “clinical audit” means a systematic examination or review of medical radiological procedures which seeks to improve the quality and outcome of patient care through structured review, whereby medical radiological practices, procedures and results are examined against agreed standards for good medical radiological procedures, with modification of practices, where indicated, and the application of new standards if necessary; “Department” means the Department of Health; “diagnostic reference levels” means dose levels in medical radiodiagnostic or interventional radiology practices, or, in the case of radio-pharmaceuticals, levels of activity, for typical examinations for groups of standard-sized individuals or standard phantoms for broadly defined types of equipment; “dose constraint” means a constraint set on the prospective doses of individuals which may result from a given radiation source; “employer” means any person who, in the course of a trade, business or other undertaking, carries out (other than as an employee), or engages others to carry out, medical exposures described in regulation 3 or practical aspects, at a given radiological installation; “employer’s procedures” means the procedures established by an employer pursuant to regulation 6(1); “equipment” means equipment which— delivers ionising radiation to a person undergoing exposure; or which directly controls or influences the extent of such exposure; “evaluation” means interpretation of the outcome and implications of, and of the information resulting from, an exposure; “exposure” means the act of exposing or condition of being exposed to ionising radiation emitted outside the body (external exposure) or within the body (internal exposure); “health screening” means a procedure for early diagnosis in population groups at risk; “interventional radiology” means the use of X-ray imaging techniques to facilitate the introduction and guidance of devices in the body for diagnostic or treatment purposes; “ionising radiation” means the transfer of energy in the form of particles or electromagnetic waves of a wavelength of 100 nanometres or less or a frequency of 3 x 10 15 hertz or more capable of producing ions directly or indirectly; “Licensing Authority” means the Department; “medical exposure” means an exposure coming within any of paragraphs (a) to (e) of regulation 3; “medical physics expert” means an individual or a group of individuals, having the knowledge, training and experience to act or give advice on matters relating to radiation physics applied to exposure, whose competence in this respect is recognised by the Department; “medical radiological” means pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other medical uses of ionising radiation for planning, guiding and verification purposes; “medical radiological procedure” means any procedure giving rise to a medical exposure; “non-medical imaging exposure” means any deliberate exposure of humans for imaging purposes where the primary intention of the exposure is not to bring a health benefit to the individual being exposed; “operator” means any person who is entitled, in accordance with the employer’s procedures, to carry out practical aspects including those to whom practical aspects have been allocated, medical physics experts and, except where they do so under the direct supervision of a person who is adequately trained, persons participating in practical aspects as part of practical training; “patient dose” means the dose concerning patients or other individuals undergoing exposures to which these Regulations apply; “practical aspect” means the physical conduct of a medical exposure and any supporting aspects, including handling and use of medical radiological equipment, the assessment of technical and physical parameters (including radiation doses), calibration and maintenance of equipment, preparation and administration of radio-pharmaceuticals, clinical evaluation and image processing; “practitioner” means a registered health care professional who is entitled in accordance with the employers procedures to take responsibility for an individual exposure; “quality assurance” means all those planned and systematic actions necessary to provide adequate assurance that a structure, system, component or procedure will perform satisfactorily in compliance with generally acceptable standards and quality control is a part of quality assurance; “quality control” means the set of operations (programming, coordinating, implementing) intended to maintain or to improve quality and includes monitoring, evaluation and maintenance at required levels of all characteristics of performance of equipment that can be defined, measured, and controlled; “radioactive substance” means any substance that contains one or more radionuclides the activity or activity concentration of which cannot be disregarded from a radiation protection point of view; “radiodiagnostic” means pertaining to in-vivo diagnostic nuclear medicine, medical diagnostic radiology using ionising radiation, and dental radiology; “radiological installation” means a facility where exposures to which these Regulations apply are performed; “radiotherapeutic” means pertaining to radiotherapy, including nuclear medicine for therapeutic purposes; “referrer” means a registered health care professional, or a medical practitioner registered with the Medical Council of Ireland, who is entitled in accordance with the employer’s procedures to refer individuals for exposure to a practitioner; “registered health care professional” means a person who is a member of a profession regulated by a body mentioned in section 25(3) of the National Health Service Reform and Health Care Professions Act 2002 ; “relevant enforcing authority” means the Department; “unintended exposure” means any exposure to ionising radiation which is significantly different from the exposure intended for a given purpose. 2 In these Regulations, where an individual who is— a an employer; b a referrer; c an operator; or d a practitioner, and is also an individual coming within at least one other of sub-paragraphs (a) to (d), that individual is subject to each of the duties applying to every person described in a sub-paragraph which also describes that individual. 3 The Interpretation Act (Northern Ireland) 1954 shall apply to these Regulations as it applies to an Act of the Northern Ireland Assembly. Application 3 These Regulations apply to the exposure of ionising radiation in Northern Ireland— a to patients as part of their own medical diagnosis or treatment; b to individuals as part of health screening programmes; c to patients or other persons voluntarily participating in medical or biomedical, diagnostic or therapeutic, research programmes; d to carers and comforters; e to asymptomatic individuals; f to individuals undergoing non-medical imaging using medical radiological equipment. The Licensing Authority 4 1 The Licensing Authority may upon payment of a fee (where required) issue a licence to a person required by these Regulations to hold a licence. 2 A licence described in paragraph (1) may be— a issued for such period as the Licensing Authority may consider appropriate; b subject to such conditions which the Licensing Authority may consider appropriate; and c varied or revoked at any time. 3 Schedule 1 makes further provision relating to matters concerning the application for, and the issue of, a licence described in paragraph (1). Requirement to hold a licence 5 1 A person must hold a valid licence issued by the Licensing Authority if that person— a is an employer, in which case that person must hold a licence in respect of each radiological installation at which radioactive substances are to be administered for such purposes as may be specified in that licence; or b is a practitioner, in which case that person must hold a licence in order to justify, within the meaning of regulation 11 an exposure involving the administration of radioactive substances for such purposes as may be specified in that licence. 2 In this regulation, “purpose” when describing the purpose for which a licence is issued, means diagnosis, treatment or research. Employer’s duties: establishment of general procedures, protocols and quality assurance programmes 6 1 The employer must ensure that written procedures are in place in respect of— a those matters described in Schedule 2; and b any other matter in relation to which these Regulations mandate the establishment of procedures. 2 The employer must take steps to ensure that any written procedures are complied with by the referrer, practitioner and operator. 3 The employer must take steps to ensure that every practitioner or operator engaged by the employer to carry out exposures or any practical aspect of such exposures— a complies with the provisions of regulation 17(1); and b undertakes continuing education and training after qualification including, in the case of clinical use of new techniques, training related to these techniques and the relevant radiation protection requirements. 4 The employer must ensure, where appropriate, that written protocols are in place for every type of standard radiological practice coming within these Regulations, including practices involving non-medical imaging. 5 The employer must— a establish recommendations concerning referral guidelines for medical exposures, including radiation doses, and ensure that these are available to the referrer; b establish quality assurance programmes for written procedures and written protocols; c regularly review and make available to an operator, diagnostic reference levels in respect of an exposure falling within— i regulation 3(a)— aa where the exposure involves interventional radiology procedures, in which case, diagnostic reference levels are to be provided where appropriate; and bb where the exposure does not involve interventional radiology procedures, in which cases regard must be had to European and national diagnostic reference levels where available; ii regulation 3(b), or (e) in which cases regard must be had to European and national diagnostic reference levels where available; iii regulation 3(f) (non-medical imaging) where practicable; d establish dose constraints— i for biomedical and medical research programmes falling within regulation 3(c) where no direct medical benefit for the individual is expected from the exposure; and ii with regard to the protection of carers and comforters falling within regulation 3(d). 6 A dose constraint must be established by the employer in terms of individual effective or equivalent doses over a defined appropriate time period. 7 The employer must ensure appropriate reviews are undertaken whenever diagnostic reference levels are consistently exceeded and ensure that corrective action is taken where appropriate. 8 The employer must take measures to raise awareness of the effects of ionising radiation amongst individuals capable of childbearing or breastfeeding. Employer’s duties: clinical audit 7 The employer’s procedures must include provision for the carrying out of clinical audit as appropriate. Employer’s duties: accidental or unintended exposure 8 1 The employer’s procedures must provide that the referrer, the practitioner, and the individual exposed or their representative (if there is one) are informed of the occurrence of a clinically significant unintended or accidental exposure and of the outcome of the analysis of this exposure. 2 The employer’s quality assurance programme must, in respect of radiotherapeutic practices, include a study of the risk of accidental or unintended exposure. 3 The employer must establish a system for recording analyses of events involving or potentially involving accidental or unintended exposures proportionate to the radiological risk posed by the practice. 4 Where the employer knows or has reason to believe that an accident or unintended exposure has or may have occurred in which a person, while undergoing— a any exposure, was or could have been exposed to levels of ionising radiation significantly greater than those generally considered to be proportionate in the circumstances; b a radiotherapeutic exposure was or could have been exposed to levels of ionising radiation significantly lower than those generally considered to be proportionate in the circumstances, the employer must— i undertake an immediate preliminary investigation of the incident; ii unless that investigation shows beyond reasonable doubt that no such exposure has occurred, immediately notify the relevant enforcing authority; iii conduct or arrange for a detailed investigation of the circumstances of the exposure and an assessment of the dose received; and iv notify the relevant enforcing authority, within the time period specified by the relevant enforcing authority, of the outcome of the investigation and any corrective measures adopted. Relevant enforcing authority’s duties: accidental or unintended exposure 9 The relevant enforcing authority must put in place mechanisms enabling the timely dissemination of information, relevant to radiation protection in respect of medical exposures, regarding lessons learned from significant events. Duties of the practitioner, operator and referrer 10 1 The practitioner and the operator must comply with the employer’s procedures. 2 The practitioner is responsible for the justification of an exposure and such other aspects of an exposure as is provided for in these Regulations. 3 Practical aspects of an exposure or part of it may be allocated in accordance with the employer’s procedures by the employer or the practitioner, as appropriate, to one or more individuals entitled to act in this respect in a recognised field of specialisation. 4 The operator is responsible for each and every practical aspect which he carries out as well as for any authorisation given pursuant to regulation 11(5). 5 The referrer must supply the practitioner with sufficient medical data (such as previous diagnostic information or medical records) relevant to the exposure requested by the referrer to enable the practitioner to decide on whether there is a sufficient net benefit as required by regulation 11(1)(b). 6 The practitioner and the operator must cooperate, regarding practical aspects, with other specialists and staff involved in an exposure, as appropriate. Justification of individual exposures 11 1 A person must not carry out an exposure unless— a in the case of the administration of radioactive substances, the practitioner and employer are licensed to undertake the intended exposure; b it has been justified by the practitioner as showing a sufficient net benefit giving appropriate weight to the matters set out in paragraph (2); c it has been authorised by the practitioner or, where paragraph (5) applies, the operator; d in the case of an exposure taking place in the course of a research programme under regulation 3(c), that programme has been approved by an ethics committee and in the case of the administration of radioactive substances, approved by an expert committee who can advise on the administration of radioactive substances to humans; e in the case of an exposure falling within regulation 3(f) (non-medical imaging), it complies with the employer’s procedures for such exposures; and f in the case of an individual of childbearing potential, the person has enquired whether that individual is pregnant or breastfeeding, if relevant. 2 The matters referred to in paragraph (1)(b) are— a the specific objectives of the exposure and the characteristics of the individual involved; b the total potential diagnostic or therapeutic benefits, including the direct health benefits to the individual and the benefits to society, of the exposure; c the individual detriment that the exposure may cause; and d the efficacy, benefits and risk of available alternative techniques having the same objective but involving no or less exposure to ionising radiation. 3 In considering the weight to be given to the matters referred to in paragraph (2), the practitioner justifying an exposure in accordance with paragraph (1)(b) must have regard, in particular to— a recommendations from appropriate medical scientific societies or relevant bodies where a procedure is to be performed as part of any health screening programme; b whether in circumstances where there is to be an exposure to a carer or comforter such an exposure would show a sufficient net benefit taking into account— i the likely direct health benefits to a patient; ii the possible benefits to the carer or comforter; and iii the detriment that the exposure might cause; c in the case of asymptomatic individuals on whom any medical radiological procedure— i is to be performed for the early detection of disease; ii is to be performed as part of a health screening programme; iii requires specific documented justification for that individual by the practitioner, in consultation with the referrer, any guidelines issued by appropriate medical scientific societies, relevant bodies or published by the Department; d the urgency of the exposure, where appropriate, in cases involving— i an individual where pregnancy cannot be excluded, in particular if abdominal and pelvic regions are involved, taking into account the exposure of both the person concerned and any unborn child; and ii an individual who is breastfeeding and who undergoes an exposure involving the administration of radioactive substances, taking into account the exposure of both the individual and the child. 4 In deciding whether to justify an exposure under paragraph (1)(b) the practitioner must take account of any data supplied by the referrer pursuant to regulation 10(5) and must consider such data in order to avoid unnecessary exposure. 5 Where it is not practicable for the practitioner to authorise an exposure as required by paragraph (1)(c), the operator must do so in accordance with guidelines issued by the practitioner. 6 In this regulation— “ethics committee” means— an ethics committee established or recognised in accordance with Part 2 of the Medicines for Human Use (Clinical Trials) Regulations 2004 ; any other committee established to advise on the ethics of research investigations in human beings, and recognised for that purpose by or on behalf of the Department; “individual detriment” means clinically observable deleterious effects in individuals or their descendants, the appearance of which is either immediate or delayed and in the latter case, implies a probability rather than a certainty of appearance. Optimisation 12 1 In relation to all exposures to which these Regulations apply except radiotherapeutic exposures, the practitioner and the operator, to the extent of their respective involvement in an exposure, must ensure that doses arising from the exposure are kept as low as reasonably practicable consistent with the intended purpose. 2 In relation to all radiotherapeutic exposures the practitioner must ensure that exposures of target volumes are individually planned, their delivery appropriately verified taking into account that doses to non-target volumes and tissues must be as low as reasonably practicable and consistent with the intended radiotherapeutic purpose of the exposure. 3 Without prejudice to paragraphs (1) and (2), the operator must select equipment and methods to ensure that for each exposure the dose of ionising radiation to the individual undergoing the exposure is as low as reasonably practicable and consistent with the intended diagnostic or therapeutic purpose and in doing so must have regard, in particular to— a quality assurance; b assessment of patient dose or administered activity; and c adherence to diagnostic reference levels for radiodiagnostic examinations falling within regulation 3(a), (b), (e) and (f) as the employer may have established, as set out in the employer’s procedures. 4 For each medical or biomedical research programme falling within regulation 3(c), the employer’s procedures must provide that— a the individuals concerned participate voluntarily in the research programme; b the individuals concerned are informed in advance about the risks of the exposure; c the dose constraint set down in the employer’s procedures for individuals for whom no direct medical benefit is expected from the exposure is adhered to; and d individual target levels of doses are planned by the practitioner, either alone or with the input of the referrer, for patients who voluntarily undergo an experimental diagnostic or therapeutic practice from which the patients are expected to receive a diagnostic or therapeutic benefit. 5 In the case of regulation 3(d), the employer’s procedures must provide that appropriate guidance is established for the exposure of carers and comforters. 6 In the case of patients undergoing treatment or diagnosis with radioactive substances, the employer’s procedures must provide that, where appropriate, written instructions and information are provided to— a the patient, where the patient has capacity to consent to the treatment or diagnostic procedure; or b where the patient is a child who lacks capacity (within the meaning of the Mental Capacity Act (Northern Ireland) 2016 in the case of a child aged sixteen or seventeen) so to consent, a person with parental responsibility (within the meaning of Article 6 of the Children (Northern Ireland) Order 1995 ) for the child; or c where the patient is an adult who lacks capacity (within the meaning of the Mental Capacity Act (Northern Ireland) 2016) so to consent, the person who appears to the practitioner to be the most appropriate person. 7 The instructions and information referred to in paragraph (6) must— a specify how doses resulting from the patient’s exposure can be restricted as far as reasonably possible so as to protect persons in contact with the patient; b set out the risks associated with ionising radiation; and c be provided to the patient or other person specified in paragraph (6) as appropriate prior to the patient leaving the radiological installation where the exposure was carried out. 8 In complying with the obligations under this regulation, the practitioner and the operator must have regard, in particular to— a medical exposures of children; b medical exposures as part of a health screening programme; c medical exposures involving high doses to the individual being exposed; d where appropriate, individuals in relation to whom pregnancy cannot be excluded and who are undergoing a medical exposure, in particular if abdominal and pelvic regions are involved, taking into account the exposure of both the individual and any unborn child; and e where appropriate, individuals who are breastfeeding and who are undergoing a medical exposure involving the administration of radioactive substances, taking into account the exposure of both the individual and the child. 9 The employer must take steps to ensure that a clinical evaluation of the outcome of each exposure, other than where the person subject to the exposure is a carer or a comforter, is recorded in accordance with the employer’s procedures including, where appropriate, factors relevant to patient dose. Estimates of population doses 13 The employer must collect dose estimates from medical exposures for radiodiagnostic and interventional procedures, taking into consideration the distribution by age and gender of the exposed population and, when so requested, must provide the dose estimates to the Department. Expert advice 14 1 The employer must ensure that a suitable medical physics expert is appointed and involved, in accordance with paragraph (2), in relation to every type of exposure to which these Regulations apply. 2 A medical physics expert must— a be closely involved in every radiotherapeutic practice other than standardised therapeutic nuclear medicine practices; b be involved in practices including standardised therapeutic nuclear medicine practices, diagnostic nuclear medicine practices and high dose interventional radiology and high dose computed tomography; c be involved as appropriate for consultation on optimisation, in all other radiological practices not mentioned in sub-paragraphs (a) and (b); and d give advice on— i dosimetry and quality assurance matters relating to radiation protection concerning exposures; ii physical measurements for the evaluation of the dose delivered; iii medical radiological equipment. 3 A medical physics expert must also contribute to the following matters— a optimisation of the radiation protection of patients and other individuals subject to exposures, including the application and use of diagnostic reference levels; b the definition and performance of quality assurance of the equipment; c acceptance testing of equipment; d the preparation of technical specifications for equipment and installation design; e the surveillance of the medical radiological installations; f the analysis of events involving, or potentially involving, accidental or unintended exposures; g the selection of equipment required to perform radiation protection measurements; h the training of practitioners and other staff in relevant aspects of radiation protection; i the provision of advice to an employer relating to compliance with these Regulations. 4 The medical physics expert must, where appropriate, liaise with a radiation protection adviser and a radioactive waste adviser. 5 In this regulation— a “radiation protection adviser” means an individual who, or a body which is competent to advise on radiation protection in relation to occupational and public exposures; b “radioactive waste adviser” means an individual who, or a body which is competent to provide expert advice on radioactive waste management and environmental radiation protection. Equipment: general duties of the employer 15 1 An employer who has control over any equipment must— a implement and maintain a quality assurance programme in respect of that equipment which must as a minimum permit— i the assessment of the dose of ionising radiation that a person may be exposed to from an exposure to which these Regulations apply, by way of the ordinary operation of that equipment; and ii the administered activity to be verified; b draw up, keep up-to-date and preserve at each medical radiological installation an inventory of equipment at that installation and, when so requested, must provide it to the relevant enforcing authority. 2 The inventory referred to in paragraph (1)(b) must contain the following information— a name of manufacturer; b model number; c serial number or other unique identifier; d year of manufacture; and e year of installation. 3 An employer must undertake adequate— a testing of any equipment before it is first used for a medical radiological purpose; b performance testing at regular intervals; c performance testing following a maintenance procedure which is capable of affecting the equipment’s performance. 4 No person is permitted to use fluoroscopy equipment unless that equipment features— a a device to control automatically the dose rate; or b an image intensifier or equivalent device. 5 Equipment used for interventional radiology and computed tomography must have a device or other feature capable of informing the practitioner, at the end of an exposure, of relevant parameters for assessing the patient dose. 6 An employer must— a put in place any measures necessary to improve inadequate or defective performance of equipment; b specify acceptable performance criteria for equipment; and c specify what corrective action is necessary when, further to the application of any criteria specified under paragraph (b), equipment is ascertained to be defective; such corrective action may include taking the equipment out of service. Equipment installed on or after 6th February 2018 16 1 This regulation only applies in respect of— a equipment installed on or after 6th February 2018; and b an employer who has control of any such equipment. 2 Equipment used for external beam radiotherapy with a nominal beam exceeding 1MeV must have a device, or other feature, the purpose of which is, to verify key treatment parameters. 3 Equipment used for interventional radiology must have a device or other feature capable of informing any person involved in the conduct of an exposure of the amount of radiation produced by the equipment during such an exposure. 4 Equipment used for planning, guiding and verification purposes, must have a device or other feature capable of informing the practitioner, at the end of an exposure, of relevant parameters for assessing the dose. 5 Equipment used for interventional radiology and computed tomography must have the capacity to transfer, to the record of a person’s exposure, information relating to relevant parameters for assessing the dose. 6 Insofar as not already provided in this regulation, any equipment producing ionising radiation must— a have a device, or other feature, capable of informing the practitioner of relevant parameters for assessing the patient dose; and b where appropriate, have the capacity to transfer this information to the record of a person’s exposure. Training 17 1 Subject to the following provisions of this regulation a practitioner or operator must not carry out any exposure or any practical aspect without having been adequately trained. 2 A certificate issued by an institute or person competent to award degrees or diplomas or to provide other evidence of training is, if such certificate so attests, sufficient proof that the person to whom it has been issued has been adequately trained. 3 Nothing in paragraph (1) above prevents a person from participating in practical aspects of the procedure as part of practical training if this is done under the supervision of a person who is adequately trained. 4 The employer must keep and have available for inspection by the relevant enforcing authority an up-to-date record of all relevant training undertaken by all practitioners and operators engaged by the employer to carry out any exposures or any practical aspect of such exposures showing the date or dates on which training qualifying as adequate training was completed and the nature of the training. 5 Where the employer (employer A) enters into a contract with another employer (employer B) to engage a practitioner or operator otherwise employed by that employer B, employer B is responsible for keeping the records required by paragraph (4) and must supply such records to employer A forthwith upon request. 6 Schedule 3 makes further provision about the training of practitioners and operators. Enforcement 18 These Regulations are to be enforced by the relevant enforcing authority as if they were health and safety regulations made under Article 17 of the Health and Safety at Work (Northern Ireland) Order 1978 and the provisions of that Order, as regards enforcement and offences, are to apply for the purposes of these Regulations. Defence of due diligence 19 In any proceedings against any person for an offence consisting of the contravention of these Regulations it is a defence for that person to show that the person took all reasonable steps and exercised all due diligence to avoid committing the offence. Revocation and transitional provision 20 1 The Ionising Radiation (Medical Exposure) Regulations (Northern Ireland) 2000 are revoked. 2 Subject to the transitional provisions in paragraph (3), the Medicines (Administration of Radioactive substances) Regulations 1978 and the Medicines (Radioactive Substances) Order 1978 are also revoked to the extent that they apply in Northern Ireland. 3 Any certificate issued to a person under the Medicines (Administration of Radioactive Substances) Regulations 1978 which is valid on 6th February 2018 is deemed— a to be a licence issued under these Regulations for as long as that certificate remains valid; and b to license the employer responsible for the medical radiological installation for the matters specified in that certificate. 4 Nothing in paragraph (3) prevents a person from applying for a licence under these Regulations on or after the date that they come into operation. Consequential amendments 21 Schedule 4 (consequential amendments) has effect. Sealed with the Official Seal of the Department of Health on 1st February 2018 Alastair Campbell A senior officer of the Department of Health