Improving foundation doctors' knowledge and compliance with the radiology legislation: A quality improvement project

Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) exist to safeguard patients against unnecessary radiation exposure and enhance their involvement in decision-making. However, evidence suggests that resident doctors lack awareness of IR(ME)R. We conducted a quality improvement project to improve Foundation Doctors' (FDs') knowledge and compliance with IR(ME)R.

FDs at a hospital were surveyed (cycle-one). The survey assessed self-reported understanding of IR(ME)R and confidence in using iRefer, knowledge of common radiation doses and lifetime cancer-risk, and the number of risk-benefit discussions held with patients prior to imaging requests. Following a one-hour lecture, post-session surveys were administered afterwards (cycle-two), and after six-months (cycle-three).

Thirty-one FDs completed cycle-one, 28 completed cycle-two and 16 completed cycle-three. Knowledge and understanding of IR(ME)R improved significantly from cycle-one (1.0, IQR = 1.0) to cycle-two (3.0, IQR = 1.0) and cycle-three (3.0, IQR = 2.0; p < 0.01). Confidence using iRefer increased significantly post-session (1.0 [IQR = 1.0] to 3.0 [IQR = 1.0]; p < 0.01), but not after six-months (2.0 [IQR = 2.2]; p = 0.24). Knowledge of radiation doses rose significantly post-session (38.7 % to 61.6 %; p < 0.01), but not after six-months (46.6 %, p = 0.15). There were no significant improvements in knowledge of cancer-risk (71 % to 72.6 % to 74.3 %, p > 0.5). Risk-benefit discussions significantly increased from 2 (IQR = 6.25) to 7.5 (IQR = 8.25) by cycle-three (p = 0.029).

By evaluating long-term outcomes and increasing risk-benefit discussions with patients, this study builds on previous research. It demonstrates that dedicated teaching improves knowledge and compliance with IR(ME)R, supporting the integration of IR(ME)R education into the foundation curriculum. Longitudinal interventions may reduce outcome attrition. Larger, multicentred studies measuring objective behavioural or patient outcomes are recommended.