WHY Fronts: The QSI safety domain

Asking the question ‘why?’ to promote quality service provision.

Published: 19 March 2021 SoR

Safety is the final domain of the Quality Standard for Imaging. For any hospital department safety in the workplace should be paramount but for radiography safety is a particularly pressing issue. Radiation is dangerous and as radiographers we should never lose sight of this fact in our everyday practice. 

The first part of the safety domain looks at managing the risks associated with ionising radiation. When X-rays were discovered in 1895 there was much excitement in the medical world and imaging/radiation seemed to be the solution to many and varied medical ailments. Ever heard of an X-ray eye bath to cure blindness or radium water? In around 1900, radium water was heralded as an elixir of youth and you could go to a radium spa in places such as Paris or Chicago to take the water. For a price, or course, because radium was not cheap.

In Russia a man claimed he had used X-rays to cure two boys who had been blind from birth. However, when a celebrity in the USA died from radiation poisoning after regularly taking radium water the practice was stopped. After further investigation many horrors were discovered, including deaths and disfiguring tumours of staff who had been working at these spas. The Elixir of Youth became known as Bottled Death – the harmful nature of radium and radiation was only just beginning to be understood.1

In hospitals, X-rays were quickly adopted to perform both diagnostic functions and treatments for cancer and particularly lung illnesses. However, the early adopters of X-rays paid a high price for their innovation as the dangers were poorly understood for many years.  There is a long list of eminent scientists, doctors and those who would now be called radiographers who died of radiation related illnesses. Clarence Dally (1865–1904) a glass blower who developed Edison’s X-ray focus tube is thought to be the first to die as result of X-ray exposure. He died of metastatic carcinoma at 39 years of age.2

Germany was the first country to develop safety regulations for radiation exposure in 1913 as a response to the alarming number of radiation workers’ deaths. The UK quickly followed in 1915 with regulations to protect radiation workers which included restrictions to the amount of time working with radiation and even advice on leisure activities. In 1921 an update to the standard regulations introduced measures to calibrate and inspect equipment. 

Today we have two pieces of legislation that all radiographers should know and work within and they are the Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) and the Ionising Radiation Regulations (IRR). The IR(ME)R is the legislation that protects patients from unintended, excessive or incorrect medical exposure, it ensures the benefits outweigh the risks and makes certain patients receive no more than the required exposure. IRR deals with the health and safety of those working with ionising radiation.  Please note that IR(ME)R was updated in 2020.

The next sections of the Safety Domain look at safety in different modalities such as ultrasound, MRI and interventional radiography. These are areas that have not been covered in the rest of the Standard and have their own particular needs when it comes to safety. 

The final three statement standards deal with health and safety issues common to all hospital departments – infection, hazardous materials and finally general health and safety for staff, patients and others.

Under the infection statement are two sections that have been most pertinent over the past year:

SA5C2 Systems in place to manage patients with contagious and communicable diseases, and/or suppressed immune systems.

SA5C3 Systems in place to ensure the care of any individual exposed to contagious and communicable diseases.

The Safety domain brings to an end my in-depth look at the domains of the Quality Standard for Imaging. Ensuring quality in departments is an ever changing and evolving task, and if we stand still we quickly become out of date. 

To this end, QSI is currently undergoing a comprehensive review.  QSI is reviewed every 3-4 years by the colleges to ensure it remains relevant and up to date for radiology departments. However, for this review it was decided to bring in an outside organisation, the Quality Review Service (QRS), to organise the review and give an independent perspective. 

We feel the Standard will move towards a more outcome-based approach where possible as this is felt by the Colleges to be more meaningful to the staff using them. Over the past few months the new Standard has been devised by QRS in conjunction with many professionals from our industry. 

A consultation of the new revised standard is currently ongoing with the new standard aiming to be in place later this year. If you would like to be part of that consultation, please email me and I will send you a link for where you can access the consultation webpage.

According to The Health Foundation’s report, Evaluating Healthcare Quality Improvement: 

‘The UK needs a healthcare system of the highest possible quality – safe, effective, person-centred, timely, efficient and equitable. In order to achieve this, health services need to continually improve the way they work.’  


If you want to know more about QSI or any aspects of raising quality in radiology please email me.


Katherine Jakeman

Quality Improvement Partner

Email: [email protected]


  1. Chicago Tribune, Before ‘raw water’ radium water was the craze – and then people died, Colleen Kujawa, Mar 03, 2018

  2. DMFR, Early victims of X-rays: a tribute and current perception, K Sansare,* V Khanna, and F Karjodkar, 2011 Feb; 40(2): 123–125