RDGY30790

This module offers an introduction to the legal and professional rules, regulations and guidelines that govern safe referral of a patient for diagnostic imaging procedures.

Indicative content in respect of ionising radiation includes an introduction to ionising radiation, radiation sources, radiation dose, ionising radiation protection, risk of exposure to medical ionising radiation and it biological effects (deterministic vs stochastic).

General principles of radiation protection (i.e., justification, optimisation, and dose limitation) are discussed in the context of roles and responsibilities of the undertaking, practitioner and referrer in line with S.I. No. 256 of 2018 (with amendments SI 332 and SI 413 of 2019), with specific consideration to the area of justification. The role of the referrer in the justification of medical exposure to medical ionising radiation, based on the lowest possible radiation exposure while ensuring the best outcome for the patient is explored. Students critique the use of evidence-based guidelines (e.g., iRefer guidelines), that inform decision making when selecting the most appropriate investigation for a range of clinical problems and when communicating the risks and benefits to the patient. Legal requirements for writing and processing a referral for diagnostic imaging are discussed.

Students are introduced to the most common types of radiologic modalities such as projection radiography, CT scanning, fluoroscopy, DXA imaging, mammography, and radio-nuclide imaging procedures, MRI and US

Referral for radiological practice standards and competencies are explored with reference to the NMBI (2019) Nurse Authority to Refer for Radiological Procedures Standards and Requirements for Education Programmes. Adverse incidents, accidental or unintended exposure to ionising radiation are defined and discussed in the context of role responsibility, common referral errors/ near misses and the reporting and recording of such incidents/accidents to the appropriate local and regulatory authorities (i.e., National Incident Management System, State Claims Agency, HIQA). The importance of ongoing clinical audit as a quality improvement method that assists referrers to monitor and evaluate their performance against agreed practice standards is discussed. Students are introduced to the HSE ONMDS Nurse-Midwife Referrers Clinical Audit Tool Kit as a resource that supports the implementation and auditing of nurse-midwife referral practice.

Clinical governance and quality patient safety issues are explored in the context of the HSE ONMSD (2021) National Nurse and Midwife Authority to Refer for Radiological Procedures Guideline. The role of state regulatory bodies (i.e., HSE ONMSD, HIQA and the NMBI) in ensuring the provision of quality patient centred care and safe referral practice at organisation and practice level is critiqued. Working collegially and collaborative with members of the referring multidisciplinary team is highlighted as a key safety indicator. Issues of personal responsibility and accountability are explored in the context of one’s scope of practice, local PPPG’s, the granting of authority to refer for specific radiologic modalities by the undertaking, clinical indemnity insurance cover, the maintenance of practice competence, and the need for continuous education and ongoing professional development.