Notification codes, categories and criteria

Use these codes when you report an IR(ME)R incident.

Accidental exposure

Notification codeExposure categoryCriteria for notification
1 (England only)All modalities including therapy

3 mSv effective dose or above (adult)

1 mSv effective dose or above (child) (c)

1 (Northern Ireland, Scotland & Wales)All modalities including therapyAll, regardless of dose

These notification criteria apply to the total exposure from the incident, including any intended component plus over-exposure and/or necessary repeat exposures. Where a multiplication factor is specified, this is defined as the total dose from the incident divided by the intended dose.

Where the exposure is not easily estimated in mSv or the dose unit is not specified, you may apply an alternative recognised unit and specify this in the notification.

Unintended exposure

All modalities including nuclear medicine and radiotherapy imaging

Notification codeExposure categoryCriteria for notification
2.1Intended dose less than 0.3mSv3mSv or above (adult)
1mSv or above (child)
2.2Intended dose between 0.3mSv and 2.5mSv10 or more times than intended 
2.3Intended dose between 2.5mSv and 10mSv25mSv or above
2.4Intended dose more than 10mSv2.5 or more times than intended.
3

 

Interventional/cardiology

Any unintended exposure resulting in observable tissue reactions, including but not limited to procedural failures or equipment malfunctions.

See additional guidance from the ICRP (International Commission on Radiological Protection)

4.1Radiotherapy planning scansIf a planning scan needs to be repeated twice to obtain an appropriate dataset (3 scans in total, including the intended scan).
4.2aRadiotherapy treatment verification images

Set-up error and/or hardware or software failure leads to 3 or more imaging exposures in a single fraction (including the intended image, 3 images in total).

This applies to all radiotherapy treatment regimes, including radical short course fractionation (defined as 10 fractions or less).

4.2bRadiotherapy treatment verification images

When the number of additional imaging exposures is 50% greater than intended over the course of treatment as a result of protocol failure.

This applies to all radiotherapy treatment regimes, including radical short course fractionation (defined as 10 fractions or less).

4.2cRadiotherapy treatment verification images

When the number of additional imaging exposures is 50% greater than intended over the course of treatment as a result of thematic hardware or software failure.

This applies to all radiotherapy treatment regimes, including radical short course fractionation (defined as 10 fractions or less).

5Foetal 
All modalities 
Where there is an unintended foetal exposure AND the resultant foetal dose is 10mGy or more.
6Breast feeding infant
Nuclear medicine only
Where there has been a failure in procedure AND the resultant infant effective dose is 1 mSv or more.
7Incorrect radiopharmaceuticalAny administration of the incorrect radiopharmaceutical to a patient, regardless of dose.

Radiotherapy delivered dose (including brachytherapy)

Notification codeExposure categoryCriteria for notification
8.1Therapy over-exposureDelivered dose to the planned treatment volume or organs at risk is 1.1 or more times (whole course) or 1.2 or more times (any fraction) the intended dose.
8.2

 

Therapy under-exposure

Delivered dose to the planned treatment volume is 0.9 or less times the intended dose (whole course).

This excludes where the under-exposure to the target volume is a result of a geographical miss, which is reportable under either 9.1 or 9.2.

Radiotherapy geographical miss (including brachytherapy)

Notification codeExposure categoryCriteria for notification
9.1TotalAll total geographical misses, even for a single fraction or significant part thereof.
9.2Partial

Where the miss exceeds 2.5 times the locally defined error margin AND the guideline dose factors (codes 8.1 and 8.2) for the planning target volume or organs at risk are exceeded.

A surrogate for the locally defined error margin might be a displacement of 2.5 times the local imaging action level for specific anatomical site and treatment intent.

Nuclear medicine therapy

Notification codeExposure categoryCriteria for notification
10.1Selective internal radiation therapyDelivered activity is outside +/- 20% of the prescribed activity. 
10.2All other nuclear medicine therapiesDelivered activity is outside +/- 10% of the prescribed activity.

Complementary notification codes

For these codes, you need to add the relevant suffix code 1 to 10. As well as notification codes 1 to 10. For example:

  • M1 (accidental exposure of more than one individual within the same incident or theme)
  • M2.1 (unintended exposure of more than one individual within the same incident or theme)
Notification codeExposure categoryCriteria for notification
MMultiple patients exposed within the same incident or theme. 
(plus relevant suffix code 1 to 10)

A theme has been identified over a number of incidents.

A single incident has involved multiple individuals.

A separate, but similar incident has been identified that affects more than one individual.

Notification codeExposure category
EEquipment fault exposure (plus relevant suffix code 1 to 9)
VVoluntary notification (plus relevant suffix code 1 to 9)
CClinically significant event (plus relevant suffix code 1 to 9)