Guide · checked October 2026

IR(ME)R clinical audit: what employers must do

Under IR(ME)R 2017 regulation 7, the employer's procedures must provide for clinical audit of medical exposures as appropriate and, since 1 October 2024, for taking appropriate action on the results; CQC enforces this in England.

The legal text

The Ionising Radiation (Medical Exposure) Regulations 2017 define clinical audit in regulation 2(1) as a systematic examination or review of medical radiological procedures against agreed standards, aimed at improving the quality and outcome of patient care. Regulation 7 places the duty on the employer: its written procedures must provide for clinical audit as appropriate.

Amendments in force from 1 October 2024 added a duty to take appropriate action on the results, and Schedule 2 now lists procedures for clinical audit and any resulting action among the employer's procedures. The regulations extend to England, Wales and Scotland; Northern Ireland has its own.

What DHSC's guidance adds

DHSC's guidance to IR(ME)R says the audit procedures should set out how audit is done locally and require change where practice falls short, and that re-audit should confirm the change worked. It names the enforcing authorities: CQC in England, Healthcare Improvement Scotland and Healthcare Inspectorate Wales.

What departments typically audit

The regulations leave the topics to the employer. Common subjects include whether exposures were justified and authorised before they happened, whether doses sit within local diagnostic reference levels, whether pregnancy enquiries were recorded where relevant, and whether every exposure has a recorded clinical evaluation. Choose topics from your own risks, incidents and employer's procedures, and write the method down so the next round is comparable.

What this does not mean

The regulations do not prescribe a list of audits or a frequency.
Measuring is not enough on its own: since 2024 the procedures must provide for acting on the results.
Staying under national reference levels does not by itself show optimisation.

Where Oriel fits

Oriel's standards library includes IR(ME)R 2017 with checks such as justification and authorisation, doses against local reference levels, pregnancy enquiry and recorded clinical evaluation, and its DICOMweb connector can read dose from RDSR. The demo hospital includes a radiation dose audit in the cath lab. Findings are decided by a named person and the report drafts in your template.

Oriel does not interpret the regulations for you or replace your Medical Physics Expert or radiation protection adviser. It is a pilot on synthetic data only.

Questions

Which IR(ME)R regulation covers clinical audit?

Regulation 7, Employer's duties: clinical audit, with the definition in regulation 2(1) and the procedure listed in Schedule 2.

Who enforces IR(ME)R in England?

The Care Quality Commission, according to DHSC's guidance and CQC's own pages.

Sources

Official pages, checked October 2026. Guidance changes, so check the current version before you rely on it.

General information for healthcare managers and clinical teams, checked October 2026. It is not legal, regulatory or clinical advice; follow the current official guidance and your organisation's own policies. No patient data is used in these examples. Oriel is a working prototype shown on a fictional demo hospital with synthetic data only. It is not a medical device and is not for clinical use. It drafts and flags for people to decide; it does not diagnose or change clinical records. A clinical safety case and information-governance approval come before any use with real patient data. Oriel is a working name.