Seven out of 12 medical practices – including three dental practices – inspected by Hiqa have been found to be in breach of regulations concerning the control of exposure to ionising radiation.
Medical exposure to ionising radiation is when radiation is used as part of diagnosis such as an X-ray or CT scan, for medical research purposes or in the use of radiotherapy as part of cancer treatment.
It also includes radiation received by carers and comforters while attending to a patient.
Inspectors from the Health Information and Quality Authority found evidence of non-compliance with controls in Bantry General Hospital; the Mater Private in Cork; Meridian Dental Clinic Clarehall, Dublin; River Lee Dental; Rowe Creavin Medical Practice in Waterford, Touchstone Dentistry in Dublin and University Hospital Kerry.
In its report published on Wednesday, Hiqa said Bantry General Hospital needed to address its documentation of justification of individual medical exposures in order to assure itself that it was meeting the regulations. This was particularly true in the context of off-site radiology support for the service, the report said.
At Mater Private Cork, inspectors found that “complex governance arrangements” meant responsibility for medical exposures within the service was unclear. Inspectors said improvements were needed in documentation relating to that allocation of responsibility for the conduct of medical exposures, the referral process and justification in advance of procedures.
An inspection of Rowe Creavin Medical Practice found non-compliances relating to the assignment of responsibilities. This included an absence of referral records and lack of full clinical involvement of a practitioner in the conduct of medical exposures.
Urgent compliance plans were issued to River Lee Dental and Touchstone Dentistry Dublin, due to the absence of medical physics experts’ involvement.
A medical physics expert is a person who has the knowledge, training and experience to advise on matters relating to radiation physics applied to medical exposure procedures. Hiqa identified further issues with River Lee Dental’s responsibilities and the implementation and use of diagnostic reference levels in the service.
Deficits in the involvement of medical physics experts, and in the use of written protocols for medical exposures were also found on inspection in Meridian Dental Clinic, Clarehall, Dublin.
At University Hospital Kerry, the hospital was required to make urgent improvements to ensure that governance of radiology services had more clinical input and oversight. Further issues were identified in relation to availability of medical physics expert support which, at the time of the inspection, “was very limited and was not in proportion to the services provided”, the inspectors said.
Hiqa said it would continue to engage with these services to ensure compliance with the regulations.
The inspections were carried out between July and November 2021.
Of the 12 inspection reports, compliance or substantial compliance with the regulations was found in Alliance Medical at Bon Secours Hospital Tralee, Galway Clinic, St Luke’s General Hospital, Kilkenny, and St Luke’s Hospital, Rathgar.
Hiqa said some examples of quality improvement initiatives seen on inspections included:
- Management at Alliance Medical had used the findings of previous inspections in other locations to develop and implement quality improvements for imaging facilities under its responsibility.
- Management at the Galway Clinic had used local facility dose audits to review radiation doses from typical procedures. This was seen as a positive use of reviews to optimise outcomes for people using this service.
- St Luke's Hospital, Rathgar, had used a local and network committee to discuss and share learning relating to incidents and near misses. Management had initiated a quality-improvement project to assess and implement processes to improve the culture of reporting and investigating incidents.
Although University Hospital Limerick had “yet to demonstrate a full return to compliance following a previous inspection” , a “strong commitment” to addressing compliance issues was demonstrated on the inspection on September 22nd, the report said.