Awareness of radiation risks by referrers and practitioners justifying radiological examinations [QSI Ref: XR-501]


An audit to assess knowledge about radiation risk amongst personnel performing IR(ME)R practitioner functions.


In order to perform IR(ME)R justification appropriately as specified in the legislation and subsequent guidance, practitioners or personnel delegated to perform practitioner functions must be trained. Staff cannot perform assessment of relative risks without maintaining knowledge of radiation risks.

The Cycle

The standard: 

All IR(ME)R practitioners and those performing delegated practitioner functions should be able to demonstrate:

1) Knowledge of effective radiation doses resulting from four relevant radiological examinations

2) The approximate added risk of malignancy of these radiological procedures


100% of staff possess the requisite knowledge.

Assess local practice


Proportion of staff who can correctly answer a questionnaire on the relevant radiation doses of four relevant radiological procedures and can give reasonable estimates of the increased relative risk of the associated radiation dose.

Data items to be collected: 

Answers to questions on dose and risk.

Suggested number: 

Typical number might be 15 staff acting as IR(ME)R practitioners.

Suggestions for change if target not met: 

- Staff education as a continuous process

- Use of a dose/risk chart similar to table 2 in iRefer -  Justifying and Optimising Dose - will help with local education - this could be displayed as a poster or an online reminder depending on local practice


- Questionnaire

- Excel or similar spreadsheet to tabulate responses and analyse statistics

- Five hours work

  1. The Ionising Radiation (Medical Exposure) Regulations 2017

  2. The Ionising Radiation (Medical Exposure) Regulations 2017 Explanatory Memorandum to IRMER 2017

  3. RCR iRefer: making the best use of clinical radiology. London. RCR 2017.

  4. Mettler F, Huda W, Yoshizumi T, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248:254–263

  5. Lee, RKL Chu, WCW Graham, CA Rainer, TH Ahuja, AT Knowledge of radiation exposure in common radiological investigations: a comparison between radiologists and non-radiologists. Emerg Med J. 2012 ;29(4):306-8. 

  6. Hart et al 2010 Frequency and collective dose for medical and dental X-ray examinations in the UK, 2008

  7. Wall et al 2011 Radiation Risks from Medical X-ray Examinations as a Function of the Age and Sex of the Patient 

  8.  S Shiralkar, A Rennie, M Snow, R B Galland, M H Lewis, K Gower-Thomas, Doctors’ knowledge of radiation exposure: questionnaire study. BMJ 2003;327:371–2.

  9.  J A Soye, A Paterson. A survey of awareness of radiation dose among health professionals in Northern Ireland. Br J Radiol. 2008 Sep;81(969):725-9.

Editor's comments: 

- Sample questions could be tailored to the staff group being targeted, with a mix of radiological examination appropriate to the type of referral

- Can also be used to assess those being trained as IR(ME)R practitioners

Published Date: 
Saturday 28 July 2012

Last Reviewed: 
Thursday 17 January 2019