The Health Information and Quality Authority (HIQA) has published three inspection reports of hospitals that use medical exposure to ionising radiation. Medical exposure to ionising radiation is when radiation is used as part of diagnosis such as a dental X-ray or CT scan, or for medical research purposes or the use of radiotherapy as part of cancer treatment at a hospital.

Risk-based inspections were carried out between August and November 2020 of:

• Tallaght University Hospital
• Cork University Hospital
• Kilcreene Regional Orthopaedic Hospital, Kilkenny.

Tallaght University Hospital demonstrated good compliance or substantial compliance with the regulations assessed on the day of inspection. For example, there were clearly defined working arrangements with a separate undertaking working on the same location which gave good assurances that responsibilities were clearly defined. Areas identified for improvement related to the completion of performance testing or quality assurance of equipment, and reporting of significant events of accidental and unintended exposure within timelines specified by HIQA.

Cork University Hospital was also found to be compliant or substantially compliant with regulations. The allocation of responsibilities for the radiation protection of service users was clear among staff and management. The hospital had assurances in place to ensure effective and safe medical exposures, specifically around the justification of medical exposures. However, deficiencies in the allocation and availability of medical physics experts in the hospital impacted on the quality assurance testing of equipment and had the potential to further impact services provided. This had been escalated to the hospital's risk register and management at Cork University Hospital had given an assurance to address these compliance issues.  

Inspectors found evidence of non-compliances in Kilcreene Regional Hospital relating to deficits of governance and management, including oversight and allocation of responsibility for medical exposures. These deficits affected compliance with regulations relating to equipment oversight, written procedures for X-ray imaging, medical physics allocation, evidence of justification for medical exposures and absence of diagnostic reference levels for typical X-ray procedures. HIQA continues to engage with the Health Service Executive (HSE), as the undertaking responsible for Kilcreene Regional Hospital, to ensure compliance with the regulations.

Read all three inspection reports at www.hiqa.ie.

Notes to Editor:

• HIQA is the competent authority for patient protection in relation to medical exposure to ionising radiation in Ireland after the EU’s Council Basic Safety Standards (BSS) Directive of 2013 was transposed into Irish law in 2019. These inspections were carried out between August and November 2020.
• The Environmental Protection Agency (EPA) continues, under separate ionising radiation regulations, to be the competent authority for the protection of workers and members of the public. HIQA and the EPA work together to carry out their separate but parallel functions under the relevant legislation.
• An undertaking is a person or body who has the legal responsibility for carrying out, or engaging others to carry out, a medical radiological practice, or the practical aspects of a medical radiological procedure, as defined by the regulations.
• Diagnostic reference levels are estimates of representative radiation dose levels for typical X-ray examinations.
• Justification of medical exposures means the benefit of the X-ray has been considered to be greater than the risks related to the level of radiation received.
• Medical physics experts are people who have the knowledge, training and experience to advise on matters relating to radiation physics applied to medical exposure procedures.