HSE in breach of X-ray rules for patients

REGULATIONS designed to protect patients from overexposure to radiation during procedures such as X-rays and mammograms have been breached by the Health Service Executive.

The regulations include provision for a clinical audit of all radiological equipment in use in health and dental facilities. Under EU legislation transposed into Irish law (Statutory Instrument 478) in October 2002, the first such clinical audit should have taken place in October 2007. It was not until December 2007 that a questionnaire was sent out by the HSE to public hospitals to self-audit the relevant installations. Dental practices have yet to be audited.

A taskforce set up by the HSE to oversee the implementation of the legislation found the Dental Council largely responsible for the delay. Both councils should have produced criteria for audit by October 2004. The Dental Council failed to do so until last year.

According to the as-yet-unpublished final report of the taskforce, which the Irish Examiner has seen, failure by the Dental Council to meet the deadline “could not berelied on as a reason for not undertaking the first audit within the time envisaged in the regulations” — any breach of which carries a €3,000 fine.

The HSE faces a number of additional difficulties in meeting the requirements. As owners of the majority of radiological installations in the state, the legislation places responsibility for audits and standard-setting with the HSE.

However, the taskforce saw this as a potential conflict of interest and has recommended the legislation be amended to transfer responsibility for regulatory audits to the Health Information and Quality Authority (HIQA). Even if this recommendation is moved on with reasonable speed, the taskforce warned “it would probably be late 2008 before standards development would be completed and well into 2009 before the HIQA would be fully functional in relation to monitoring standards in relation to clinical audit and compliance with regulations”.

Other difficulties include the capital cost of audits for stakeholders and a shortage of medical physicists for the purposes of meeting obligations. Stakeholders also identified a significant issue in relation to releasing people for audit work and a significant time commitment for individual practitioners.

The HSE said staffing issues are being pursued through the HSE framework on workforce planning and are still being considered.

It also said a baseline audit of public radiological installations had been conducted in December and a dental audit will take place “in early 2008”.

Discussions have taken place between the HSE, HIQA and the department with a view to changing the legislation to allow HIQA power to set standards and audit and a national radiation safety committee has been established.