As per HIQA’s interpretation of SI 256, 2018 (the implementation of the ionising Radiation basic safety standards EU directive 13/59) it is now a mandatory requirement that information relating to patient exposure forms part of the report of the medical Radiological procedure.
It is possible for NIMIS, or modern RIS/PACS systems to perform this function in an automated manner using exposure information from the equipment producing the Radiation. This information should be used in tandem with a dose management or dose tracking system to benchmark and highlight procedures that are outliers. Such an approach allows for inclusion of the actual exposure specific for an individual patient undergoing a particular examination, and then transferring that information into the report for that particular radiological examination by automation. Unfortunately, the installation of this system has not been prioritised by HSE, despite recommendations of the Faculty and current projections estimate that it will take approximately 2- years to install and therefore will not be available for clinical use by Radiologists until then.
In the meantime, an interim solution has been proposed by the HSE National Radiation Protection office. Unfortunately, this interim solution is a much inferior approach which requires time consuming manual input by the Radiologist and has the potential to provide inaccurate and misleading exposure information which furthermore; is not patient specific. It fails to take variation of equipment specification or technique into account or alert to high dose procedures requiring follow up for tissue effects.
The Faculty are recommending that Radiologists do not comply with this interim solution. It is not in the interest of safe patient care to do so, nor does it reach acceptable standards in clinical practice. The Faculty refutes the assertion that the interim solution actually complies with legislative requirements laid out in SI 256, 2018.
The Faculty are happy to endorse the permanent solution which has been shown to be a useful approach capable of providing accurate exposure information for individual patients undergoing specific examinations and which can be imported into the procedure report of those examinations in an automated manner, thus fulfilling adherence to legal obligations laid out in SI 256.
The Faculty urges HSE to accelerate the installation of this system onto the NIMIS platform, and to abandon the proposed interim solution, in the interest of good quality patient care.
Dr Peter Kavanagh
Faculty of Radiologists, RCSI