CBCT Local Rules for Your Dental Practice: What IR(ME)R Requires and How to Write Them

Every dental practice with a CBCT scanner needs compliant local rules. Specifically, CBCT local rules for a dental practice are a legal requirement under the Ionising Radiations Regulations 2017 (IRR17). However, many practices treat this document as a one-off task, written at installation and never revisited. In this guide, we explain what your CBCT local rules must contain, the common mistakes that put dental practices at risk during inspections, and how outsourced radiology reporting fits into your local rule protocols.

Quick Answer: What Are CBCT Local Rules for a Dental Practice?

In short, local rules are written working instructions that describe how your practice safely operates its CBCT scanner. They sit alongside your radiation protection file and your employer’s procedures under IR(ME)R 2017. Specifically, IRR17 Regulation 18 requires every employer to draw up local rules for work carried out in controlled areas. For a dental practice with a cone beam CT unit, this therefore means a dedicated set of rules covering the equipment, the staff, and the procedures specific to three-dimensional imaging.

In addition, your Radiation Protection Adviser (RPA) should review these rules at least every two years. Furthermore, the rules must be accessible to all staff who work with or near the CBCT scanner. A named Radiation Protection Supervisor (RPS) is consequently responsible for ensuring that every team member follows them.

Why IR(ME)R Requires Local Rules for Every CBCT Installation

The regulatory framework for dental radiography in the UK rests on two main pillars. First, IRR17 governs the safety of staff and any person who might receive occupational radiation exposure. Second, IR(ME)R 2017 governs the protection of patients who undergo medical exposures. Together, these regulations therefore require dental practices to maintain a comprehensive set of written procedures and protocols.

Importantly, the PHE guidance document HPA-CRCE-010 specifically addresses CBCT equipment in dental settings. It confirms that CBCT scanners deliver higher radiation doses than conventional dental X-rays. As a result, the documentation requirements are more demanding. Your CBCT local rules must therefore address the unique aspects of cone beam CT, including field-of-view selection, exposure parameter protocols, and dose optimisation strategies.

Moreover, the CQC (in England) inspects dental practices against these requirements. Inspectors expect to see current, practice-specific local rules that staff can locate and explain. Consequently, a generic template downloaded from the internet will not satisfy an inspector who asks your dental nurse to describe the controlled area boundary or the correct exposure settings for your specific CBCT unit.

What CBCT Local Rules for a Dental Practice Must Include

Your CBCT local rules should contain several mandatory elements. Below is a practical breakdown of what regulators and your RPA expect to see in this document.

Equipment identification. First, name the specific CBCT unit, its manufacturer, model, serial number, and installation date. If your practice also operates an OPG or intraoral X-ray unit, each piece of equipment consequently needs its own section or a separate set of local rules.

Controlled area description. Second, define the physical boundaries of the controlled area around the CBCT scanner. Include a floor plan or diagram showing where the boundary lies. Notably, CBCT controlled areas are often larger than those for intraoral radiography because of the higher tube output.

Named duty holders. Additionally, list the individuals who hold specific roles under IR(ME)R 2017. This includes the IR(ME)R practitioner (who justifies exposures), the operator (who carries out practical aspects of the exposure), and the referrer (who requests the scan). For many practices, the training and entitlement requirements for these roles can be complex.

Standard operating procedures (SOPs). Furthermore, document the step-by-step process for performing a CBCT scan. This should cover patient positioning, exposure selection, field-of-view choice, and dose optimisation. Similarly, include protocols for pregnancy enquiry, patient identification, and clinical evaluation of every exposure.

Quality assurance schedule. In addition, outline the routine testing programme for your CBCT unit. This typically includes daily checks (warning lights, positioning lasers, mechanical stability), periodic checks (image quality tests, dose measurements), and the three-yearly critical examination by a medical physics expert.

Incident reporting procedures. Finally, describe how your practice handles radiation incidents, including overexposures, equipment faults, and unintended exposures. In particular, IR(ME)R 2017 requires employers to report certain incidents to the CQC (or equivalent regulator) and to investigate them internally.

Contact details for your RPA and RPS. These must be current and prominently displayed. Importantly, this information allows any team member to raise concerns quickly.

Common Mistakes in CBCT Local Rules at Dental Practices

After reviewing CBCT local rules across many dental practices, several recurring problems stand out. Consequently, avoiding these common mistakes can save your practice from compliance failures and protect your patients.

Using a generic template without customisation. For example, many practices download a template from their CBCT manufacturer or an online source. However, local rules must be specific to your practice, your equipment, and your team. As a result, a template that names a different scanner model or lists staff who no longer work at the practice will fail a CQC inspection.

Not updating after staff changes. When a practitioner or operator leaves the practice, their entitlements must be removed from the local rules immediately. Therefore, you should review your duty holder list whenever staffing changes occur.

Omitting the clinical evaluation pathway. IR(ME)R 2017 requires that every CBCT exposure receives a clinical evaluation. Consequently, your local rules should clearly state who performs this evaluation and within what timeframe. For practices that outsource their CBCT reporting, this section should specifically reference the external reporting arrangement and the expected turnaround time.

Failing to document referral criteria. Your local rules should reference the FGDP Selection Criteria for Dental Radiography and explain how your practice applies evidence-based justification for CBCT scans. Without this, you cannot demonstrate that exposures meet the IR(ME)R requirement for clinical justification. In particular, this is an area where CQC inspectors frequently find shortcomings.

No version control. Similarly, local rules should carry a version number, a review date, and a record of changes. This demonstrates to inspectors that the document is actively maintained rather than forgotten.

How to Write and Maintain Your CBCT Local Rules

Writing effective CBCT local rules for your dental practice does not require starting from scratch. Instead, follow a structured approach that ensures completeness and compliance.

First, commission your RPA to conduct a risk assessment for the CBCT installation. The risk assessment forms the foundation of your local rules. As a result, your RPA will assess the controlled area boundaries, the expected workload, and any specific hazards related to your premises.

Second, use the risk assessment findings to draft the local rules document. Specifically, work with your RPS to ensure the SOPs reflect actual working practice. There is no point writing a procedure that your team does not follow in reality.

Third, circulate the draft to all relevant staff members. Everyone who operates the CBCT unit, refers patients for scans, or works in the vicinity of the controlled area should read and understand the local rules. Additionally, keep a signed acknowledgement log to demonstrate that each staff member has received and understood the current version.

Finally, build a review schedule into your radiation protection file. Review your CBCT local rules at least every two years, after any significant equipment change, or whenever your RPA advises. Furthermore, update them immediately after a radiation incident or a change in relevant legislation.

How Outsourced Reporting Fits Into Your Local Rules

Many dental practices across the UK own CBCT scanners but do not have an in-house radiologist to report the scans. In these cases, practices outsource clinical evaluation to an external radiology reporting service. Importantly, CBCT local rules for any dental practice that outsources must clearly document this arrangement.

Specifically, your local rules should state who the external reporting provider is, how scans are transmitted securely, the expected report turnaround time, and how reports are stored and communicated to the referring clinician. This is essential for IR(ME)R compliance, because the regulations require a clear audit trail from exposure to clinical evaluation.

Moreover, outsourced reporting does not remove your practice’s responsibilities. The IR(ME)R practitioner at your practice still justifies every exposure. The operator still performs the scan according to your SOPs. In contrast, the external radiologist provides the clinical evaluation. Your local rules should therefore make these boundaries of responsibility explicit.

3Beam provides UK-wide consultant radiologist reporting for dental practices with their own CBCT scanners. Every report includes structured findings, clinical recommendations, and full IR(ME)R compliance documentation. For any dental practice looking to strengthen the reporting section of their CBCT local rules, our step-by-step guide to reporting a CBCT scan explains the workflow in detail.

Frequently Asked Questions

Q: Do I need separate local rules for my CBCT scanner and my intraoral X-ray unit?
A: You can combine them into one document, provided each piece of equipment has its own clearly identified section. However, many RPAs recommend separate documents because the controlled area, operating procedures, and dose considerations for CBCT differ significantly from intraoral radiography.

Q: How often should I review my CBCT local rules?
A: As a general rule, review at least every two years. Additionally, review sooner after any staff change, equipment modification, relocation of the scanner, radiation incident, or change in legislation. Your RPA should advise on the appropriate review interval for your practice.

Q: Can my dental nurse act as the Radiation Protection Supervisor?
A: Yes. Importantly, the RPS does not need to be a dentist. Any competent member of the dental team can take on this role, provided they have received appropriate training. The RPS ensures day-to-day compliance with local rules and should be named in the document.

Q: What happens if the CQC inspects and my local rules are out of date?
A: An inspector may issue a requirement notice or, in serious cases, take enforcement action. Consequently, out-of-date local rules suggest that the practice is not actively managing radiation safety. This is a common finding in CQC dental inspections.

Q: Do I need to include my outsourced reporting provider in my local rules?
A: Yes. Specifically, if you outsource clinical evaluation of CBCT scans, your local rules must name the provider and describe the workflow. This includes how scans are sent, who receives reports, and how they are stored. For further detail, see the 3Beam IR(ME)R compliance checklist.

The Bottom Line on CBCT Local Rules for Your Dental Practice

In summary, writing and maintaining CBCT local rules is a legal requirement for every dental practice with a cone beam CT scanner. Good local rules protect your patients, your staff, and your CQC registration. They should be specific to your equipment, your team, and your working procedures. Therefore, review them regularly, update them promptly, and ensure every relevant team member has read the current version.

For practices that outsource CBCT reporting, your local rules must include the reporting pathway and the responsibilities of each party. Ultimately, getting this right is straightforward when you have a reliable reporting partner and a clear workflow.