1. Purpose
These local rules set out how the Practice manages dental radiography under the Ionising Radiation (Medical Exposure) Regulations 2017 and related guidance.
The Practice must verify these rules against the current IR(ME)R 2017 legislation, the 2024 amendment guidance and its appointed radiation protection advisers before adoption.
2. Sources to verify before adoption
- Ionising Radiation (Medical Exposure) Regulations 2017: https://www.legislation.gov.uk/uksi/2017/1322/contents
- GOV.UK guidance to IR(ME)R 2017, updated 4 September 2024: https://www.gov.uk/government/publications/the-ionising-radiation-medical-exposure-regulations-2000
- CQC IR(ME)R notification criteria: https://www.cqc.org.uk/guidance-providers/ionising-radiation/ionising-radiation-medical-exposure-regulations-irmer/criteria-making-notification
- GDC Standards for the Dental Team, Principle 7 and relevant record-keeping standards: https://standards.gdc-uk.org/
- HCPC standards of proficiency for radiographers, where a radiographer-linked role is involved: https://www.hcpc-uk.org/standards/standards-of-proficiency/radiographers/
- HSE ionising radiation legal base for staff and public exposure context: https://www.hse.gov.uk/radiation/ionising/legalbase.htm
3. Equipment inventory
The Practice keeps a current inventory of radiography equipment. The inventory includes:
- intra-oral X-ray units
- panoramic equipment, including OPG where used
- cephalometric equipment where used
- CBCT equipment where used
- handheld X-ray equipment where used
- image receptors, sensors and processing equipment
- software used for image capture, storage and reporting
For each item, the inventory records:
- manufacturer and model
- serial number
- location
- date installed
- date of last service
- date of last quality assurance check
- radiation protection adviser or medical physics expert contact where applicable
- local procedure linked to that equipment
4. Duty holders
The Practice records named people or role holders for each IR(ME)R duty holder.
- Employer: the legal person or organisation responsible for the radiography service. The employer ensures employer's procedures, protocols, quality assurance programmes and training arrangements are in place.
- Referrer: the person entitled under the employer's procedures to refer a patient for a dental radiographic exposure.
- Practitioner: the person entitled under the employer's procedures to justify the exposure.
- Operator: the person entitled under the employer's procedures to carry out practical aspects of the exposure.
- Medical physics expert: the person or service providing expert advice where the current IR(ME)R framework requires it.
- Radiation protection adviser: the adviser for workplace radiation protection arrangements under the wider ionising radiation framework.
The same person may hold more than one role only where the current IR(ME)R source and employer's procedures allow it.
5. Justification process
No dental radiographic exposure is made until it has been justified and authorised according to the employer's procedures.
Before justification, the practitioner considers:
- the clinical question
- the patient's history and previous imaging where available
- whether a non-radiographic option can answer the question
- the expected benefit to the patient
- the radiation risk, including patient age and pregnancy status where relevant
- the equipment and exposure setting proposed
The Practice does not use standing wording from this template as a substitute for the current IR(ME)R justification requirements. The employer's procedure must cite the current source.
6. Optimisation
The Practice keeps exposures as low as reasonably practicable while still achieving an image that answers the clinical question.
The local optimisation procedure covers:
- selection of equipment and exposure setting
- patient positioning
- collimation and beam alignment
- use of rectangular collimation where adopted by the Practice
- repeat-image reduction
- image-quality grading and review
- child-specific and pregnancy-specific considerations
- CBCT-specific protocols where CBCT is used
The Practice reviews repeat images as part of clinical audit.
7. Dose recording and image records
The Practice records radiographic exposure information in the patient record or linked radiography record according to the local procedure.
Records include:
- reason for the exposure
- date
- equipment used
- operator
- practitioner or authoriser
- exposure type
- dose information where the equipment provides it
- image-quality assessment
- report or clinical interpretation
- repeat exposure reason where applicable
Radiographs, consent forms and related recordings form part of the patient record under GDC record-keeping standards. The Practice verifies the detail against GDC Principle 4 before adoption.
8. Accidental or unintended exposure
The Practice has a written process for suspected accidental or unintended exposure.
The process includes:
- immediate clinical review
- securing relevant equipment and records
- informing the Registered Manager and radiation lead
- recording the event in the Practice incident register
- seeking advice from the radiation protection adviser or medical physics expert as applicable
- assessing whether CQC notification criteria are met
- informing the patient where required by duty of candour or local procedure
- documenting corrective action and learning
Staff do not decide notification thresholds from memory. The Practice checks the current CQC IR(ME)R notification criteria and current IR(ME)R guidance before making a notification decision.
9. Quality assurance cadence
The Practice keeps a radiography quality assurance schedule for each equipment type.
The schedule covers:
- routine image-quality review
- reject and repeat analysis
- equipment performance checks
- service and maintenance
- staff competency review
- clinical audit
- local procedure review
The Practice must set the exact frequency and check type from the current IR(ME)R guidance, equipment manufacturer's instructions and adviser recommendations. This template does not restate regulatory test intervals.
10. Training requirements
Staff only act as referrer, practitioner or operator where the employer's procedures entitle them to do so and their training record supports the role.
The training record includes:
- GDC registration role where relevant
- HCPC registration role where relevant
- IR(ME)R training completed
- equipment-specific training
- CBCT-specific training where relevant
- date of competency sign-off
- refresher review date
- scope limits, such as intra-oral only or CBCT excluded
The Practice checks current GDC and IR(ME)R expectations before approving role entitlement.
11. Review and document control
The Registered Manager reviews these local rules:
- annually
- after equipment change
- after role-holder change
- after a reportable or potentially reportable exposure incident
- after source-material change
Review cadence: annual or on regulatory change, whichever sooner. Owner: Registered Manager.