Reviewing radiation protection across the health service 

David Lynch examines the end-of-year report from the national radiation protection committee, which highlights governance challenges as well as progress

The end-of-year report for 2025 from the national radiation protection committee (NRPC) was recently published. The NRPC’s chief task is to promote safe practice and regulatory compliance throughout all hospital and community-based radiological services.

The opening section of the report focuses on the governance framework for radiation protection in the health system. The health service’s recent reform programme, including the creation of the six new health regions, has led to “some confusion” in services regarding radiation protection, according to the report. The issue was most evident in relation to local governance arrangements and the legal responsibilities of staff.

“This was mostly found in radiological services where staff worked across multiple locations which often had different governance arrangements,” noted the report.

A HSE spokesperson told the Medical Independent (MI) that as the new regional management and governance arrangements were introduced on a phased basis, the implementation of radiation protection governance structures progressed at different rates across individual regions.

Uncertainty

“During this transition period, some uncertainty arose regarding local governance arrangements and the respective responsibilities of managers and staff in relation to radiation protection.”

However, the spokesperson added that “at no stage” was there a gap in governance oversight for radiation protection matters.

Overall, the NRPC report highlighted that there is no single, written national policy or strategy for radiation protection.

There is a legal framework in place, based on statutory instruments. This framework identifies HIQA as the regulator for the protection of patients, and the Environmental Protection Agency (EPA) as the regulator for the protection of staff and members of the public.

“The EPA and HIQA take different approaches to regulation, which can sometimes cause confusion during an inspection when there are questions asked about local governance and the roles and responsibilities of staff,” according to the report.

Because of this situation, the NRPC developed a guidance document “in plain language” to help support local services.

The guidance also explains both the EPA and HIQA approaches to regulation and how these operate across the system. The document was published last month and is available on the HSE website.

“The NRPC maintains ongoing engagement with both the EPA and HIQA through established forums and working relationships,” the HSE spokesperson told MI.

They pointed out that radiation protection is a highly regulated area and governance arrangements continue to evolve alongside broader health service reforms.

Progress

The NRPC report also provided an analysis of radiation safety incidents reported last year. These statistics are collected by the national incident management system (NIMS).

The overall conclusion was positive, with the NRPC stating “great progress” was made in 2025 to promote safe practice and regulatory compliance.

However, the report noted that working with ionising radiation “will always carry a risk” to staff and patients.

There was an increased number of incidents reported in 2025 compared to 2024, in particular ‘near-miss’ events.

Incidents were reported from hospitals, community-based diagnostic imaging services, orthodontic and dental services, and from the HSE BreastCheck screening service.

These incidents mainly occurred in radiology and radiotherapy departments, with some taking place in cardiac catheterisation suites and theatre services.

“There were also reports associated with staff exposure to radioactive patients in general ward areas and exposure to radioactive medical samples in science laboratories.”

The committee stated an improved reporting culture was the principal factor behind the increase in reported incidents, particularly the rise in ‘near-miss’ events.

“Near-miss reporting is widely recognised as an important indicator of a positive safety culture, as it demonstrates that staff are identifying and reporting potential issues before harm occurs,” said the HSE spokesperson.

However, the committee did not attribute the increase solely to this factor. Fluctuations in activity levels, changes to service delivery, workforce pressures, and improvements in incident detection and reporting systems may also contribute to year-on-year variations in incident numbers.

“This would include increased public awareness about the importance of reporting harm or adverse events to their healthcare practitioner,” according to the spokesperson.

The committee underlined the fact that its focus is not solely on the number of incidents reported, but on the learning that can be derived from these reports.

Figures

In total, there were 1,664 radiation safety incidents involving radiology procedures reported on NIMS in 2025. In contrast, there were 1,369 in 2024.

Of the 2025 total, 40 were deemed ‘harmful’, 769 were classified as ‘non-harmful’, and 855 were categorised as ‘near-miss’ events.

Radiotherapy services reported 316 incidents on NIMS compared to 288 in 2024. In 2025, one incident was considered ‘minor but harmful’, and required first aid. Some 265 reports were categorised as ‘non-harmful’ and 50 were considered ‘near-miss’ events.

The NRPC report also provides a breakdown of those affected by reported radiation safety incidents last year. Some 1,524 radiology incidents involved adult patients, five newborn patients, and 46 members of the public (non-patients or healthcare staff). A total of 89 members of staff sustained an inadvertent occupational radiation exposure.

In radiotherapy services, there were 315 radiation safety incidents involving adult patients and one inadvertent staff exposure to radiation.

The reports of radiation exposure to a member of the public “typically occurred when a parent or carer was required to comfort or support a patient during a procedure”.

“In addition, there were numerous incidents where a medical sales representative or visiting engineer left a procedure room temporarily and returned, but forgot to put back on their personal protective equipment [PPE].”

When it comes to inadvertent exposure to healthcare staff, the NRPC analysis found that this “typically occurred” when a staff member entered a treatment room as the radiation exposure was taking place, or when they forgot or declined to wear PPE.

Inadvertent exposure of healthcare staff also took place “when they were preparing a radiopharmaceutical for administration to a patient and there was an accidental spillage”.

“In addition, ward staff were not always informed that an x-ray was taking place in their vicinity or that a patient in their care had recently undergone a nuclear medicine scan.”

NIMS does not routinely report staff exposures by professional group (for example, doctors, nurses, radiographers, or other staff) at national level.

“Importantly, the vast majority of staff exposure incidents reported involved very low radiation doses and did not result in harm to the staff members concerned,” said the HSE spokesperson.

These reports are reviewed as they provide opportunities for organisational learning and for strengthening radiation protection practices.

The NRPC 2025 report outlined what it regards as the main issues identified following the analysis of the NIMS data.

The “most common trend” was poor referral practices.

“Typically, the referral may have had the wrong patient information listed; an incorrect body part or area to be imaged; the wrong procedure requested; or had omitted relevant clinical information,” according to the report.

“In addition, the referrer may have failed to check if the patient had already undergone the same procedure elsewhere; or indeed if the patient’s previous medical imaging history was relevant to the new referral.”

Other issues included patient identification errors, communication errors within multidisciplinary teams, and errors when performing an imaging procedure.

“These errors typically occurred when the wrong body part was imaged, when an improper scan was performed, or when the correct procedure was set up, but performed inaccurately.”

Equipment failure and computer software issues were also identified; however, the NRPC noted that the HSE National Capital Plan includes a programme for replacing aged or defective medical equipment.

It was acknowledged that radiological services are specialised areas in healthcare that require specific advice. The consequences of an inadvertent radiation exposure can vary greatly, with the harm caused ranging from negligible to severe, according to the report.