IRMER17 Referral Guidelines

Every dental practice must establish referral guidelines for dental radiography and ensure that these are available to all referrers, both those within and outside the practice. Note that as far as IRMER17 is concerned, a “referral” is always considered to have occurred, even when the referrer and practitioner are the same person.

Referral Criteria

Referral guidelines set out the conditions in which an individual would typically be referred for a specific type of radiograph. When establishing referral criteria, the employer may wish to refer directly to the latest guidelines published by expert groups and professional bodies. A couple of examples are shown below.

The Faculty of General Dental Practice (UK)’s Selection Criteria for Dental Radiography, 3rd Edition, covers the use of radiographs for the developing dentition, endodontic assessment, caries diagnosis, periodontal assessment, and implantology and was last updated in 2018.

Chapter 4 of the European Commission Radiation Protection No. 172 (the ‘Final Guidelines’ published by the SEDENTEXCT project in 2012), contain referral criteria guidelines specifically for dental CBCT imaging.

Appendix D, section D2 of the Dental GNs contains a template that dental practices might find useful for drafting their referral guidelines.

Following the merger of the FGDP with the College of General Dentistry (CGDent), the Guidance Notes for dental practitioners on the safe use of X-ray equipment (GNs), which are referred to extensively throughout this step have been moved to the CGDent website. If you cannot access the links in this step that take you directly to specific pages in the GNs, please access the Dental GNs here.

Referrals Between Dental Practices

The Dental GNs recommend that if a practice refers patients to another practice, both practices enter into a ‘service-level agreement’ (SLA) to cover all the administrative requirements of IRMER17, such as who will take responsibility for clinically evaluating the radiographs among other requirements.

Once the SLA has been established, the referring practice should ensure that each referred patient is provided with the following information in writing:

• Patient’s full name, date of birth and address
• Dental examination requested
• Type of imaging requested
• Sufficient clinical information to allow the practitioner to decide if the radiographic exposure requested can be justified
• Information required from the radiographic exposure
• Signature of referrer
• Name of referrer (printed) and GDC registration number
• Date of referral

A template ‘imaging referral form’ is provided in Appendix F of the Dental GNs.

Referral Justification

The IRMER practitioner is responsible for justifying each individual dental exposure taking the following into account:

• Specific objectives of the exposure and the characteristics of the individual involved
• The benefit to the individual from the exposure
• Individual risk that the radiation exposure associated with the exposure may cause
• Whether techniques using no or less radiation could be used instead

When the IRMER17 practitioner decides that the dental exposure is in the patient’s best interests, then it is considered to be a justified exposure.

Authorisation

The justification decision must be recorded; this is the authorisation. It is not necessary to record the full reasoning behind the justification decision, only the decision itself and the identity of the IRMER practitioner. However, if the IRMER practitioner were to reject an exposure request, then the reasoning should be recorded and the referrer informed.

Wherever possible, authorisation should be done at the same time as the justification and before the exposure takes place. However, in some circumstances, it may not be in the best interests of the patient for the dentist to leave them to document the authorisation, such as during surgery. In such situations the dentist justifying the exposure should be present in the room while the exposure is carried out and authorisation must occur as soon as possible within the same episode of care.