Today, the Health Information and Quality Authority (HIQA) has published 14 inspection reports assessing compliance with medical exposure to ionising radiation regulations in eight public and six private facilities. These inspections were carried out from September through December 2024. 

HIQA found HSE Dental Clinic Louth HC was fully compliant with all regulations assessed on the day of inspection, while very high levels of compliance were found in The Rotunda Hospital, UPMC Whitfield Hospital Limited, Mid Western Radiation Oncology Centre and Arklow Community Diagnostic Service.

Inspectors observed several good practices, demonstrating efforts to ensure safe and optimised medical exposures for service users. Examples included: 

• a multidisciplinary team in Cavan General Hospital had established diagnostic reference levels (DRLs), and DRLs were compared with international data where national DRLs were unavailable for some examination types
• staff at the HSE’s Dental Clinic in Louth were developing regional DRLs for dental services in the Community Healthcare Organisation (CHO) regions (CHO 6, 7, 8 and 9)
• The Rotunda Hospital implemented a robust clinical audit strategy in line with national guidelines for medical exposures, ensuring that the results of clinical audits were effectively shared with all staff 
• the Mid Western Radiation Oncology Centre had introduced techniques to optimise patient positioning, reducing the amount of ionising radiation used.

Inspectors followed up on findings from previous inspections in five of the 14 facilities and found effective actions had been implemented to improve compliance with the regulations. However, 13 facilities still require further action to come into full compliance with the regulations. 

Areas identified for improvement included:

Regulation 6: Undertakings. Ensuring a clear allocation of roles and responsibilities in line with regulatory requirements. Nine of the 13 inspection reports identified non-compliance with this regulation, including Alliance Medical @Kingsbridge Private Hospital Sligo; Radiology Department Our Lady’s Campus Cashel; UPMC Whitfield Hospital Limited; and Cavan General Hospital where gaps in the allocation of roles and responsibilities for particular sub-sets of medical exposures were noted.

Regulation 10: Responsibilities. Seven of the nine services were found to be not compliant with both regulations 6 and 10. For example, responsibility for justification and optimisation were not appropriately allocated to persons as required, and led to distinct gaps in each regulation. 
Where non-compliance with the regulations was identified, undertakings were required to submit a plan outlining how they will come into compliance with the regulations. HIQA continues to engage with these services to ensure necessary improvements are made. 

Notes to the editor:

• The 14 inspection reports published today for eight public and six private facilities, and the associated undertakings, included the following:
  • Alliance Medical @Kingsbridge Private Hospital Sligo (Alliance Medical Diagnostic Imaging Ltd.)
  • Arklow Community Diagnostic Service (Health Service Executive)
  • Bon Secours Hospital Cork (Bon Secours Health System)
  • Cavan General Hospital (Health Service Executive)
  • Dublin Orthodontics – Swords (Dublin Orthodontics)
  • Dungloe Community Hospital X-ray Service (Health Service Executive)
  • Galway Clinic (Galway Clinic Doughiska Unlimited)
  • HSE Dental Clinic Louth HC (Health Service Executive)
  • Mid Western Radiation Oncology Centre (Mater Private Hospital)
  • Our Lady of Lourdes Hospital, Drogheda (Health Service Executive)
  • Our Lady’s Hospital, Manorhamilton (Health Service Executive)
  • Radiology Department Our Lady’s Campus Cashel (Health Service Executive)
  • The Rotunda Hospital (The Rotunda Hospital for Poor Lying In Women)
  • UPMC Whitfield Hospital Limited (UPMC Whitfield Hospital Limited)
• These inspections were carried out to assess compliance with the European Union (Basic Safety Standards for Protection Against Dangers Arising from Medical Exposure to Ionising Radiation) Regulations 2018 (S.I. No. 256 of 2018), as amended. 
• To support services to achieve compliance, the following guidance documents are available:
  • guidance on the assessment of compliance in undertakings providing medical exposure to ionising radiation
  • assessment-judgment framework for undertakings providing medical exposure to ionising radiation.
• 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.
• The conduct of medical exposure to ionising radiation is when radiation is used as part of diagnosis such as an X-ray or computed tomography (CT) scan, or the use of radiotherapy as part of cancer treatment at a hospital. It also includes radiation received for medical research purposes and radiation received by carers and comforters while attending to a patient. The regulations also include medical exposures used as part of a dental assessment, such as a dental X-ray.
• Justification of a medical exposure is the decision whether or not to carry out the medical exposure on the basis that the exposure should do more good than harm. Before a service user is exposed to ionising radiation, the practice of justification of that particular medical exposure determines if the net benefits outweigh the possible risks and if the examination is indicated and useful.
• Optimisation assures service users that the risks associated with an exposure to ionising radiation are minimised while also delivering the required clinical outcome, and that the most appropriate dose for each individual exposure is delivered.