3. Repeats, referrals and clinical evaluation

Repeat exposures

A repeat is a new exposure. It needs justification: the first image is non-diagnostic and the diagnostic question still stands. Repeating because of poor technique without changing the technique is not optimisation. Record the reason for the repeat. Reject analysis (Year 5) exists so repeats fall.

Images from elsewhere

If a patient brings recent radiographs, assess quality and whether they answer your question before exposing again. IR(ME)R expects you to use existing information.

Clinical evaluation is mandatory

IR(ME)R requires that the outcome of every exposure is evaluated. An unevaluated radiograph is an unjustified exposure after the fact. Record findings in the clinical notes (even “no caries, bone levels stable”). Do not export images to a folder that nobody reads.

Referring out

If you refer for hospital or specialist radiography, include the clinical question, relevant history, and pregnancy status where relevant so their practitioner can justify. Year 4 covers explaining benefit and risk to the patient before you expose or refer.

Always follow current selection criteria and your employer’s procedures.