Radiology Requestor Registration

IRMER non-medical requestor application

APPLICANTS

Please provide all of the details required in the form below. Once completed, a copy will be emailed to your Clinical Supervisor for approval.

Note: if you are registering as an MRI requestor, please select the New MRI Registration form from the menu above.

First name:

Please complete

Last name:

Please complete

Email Address:

Please complete with a valid Email Address.

Job Role

Please complete

Date IRMER Training Completed:

Please complete

Professional registration No:

Please complete

Local Plan(s):

Please select one Local Plan

NB: you MUST have a local plan. If you do not have one please check with your clinical supervisor.

if you work to more than one local plan, in different wards that you work for example, please select all that you work to.

Clinical supervisor - name:

Please complete

Clinical supervisor - role:

Please complete

Clinical supervisor - Email:

Please complete with a valid NHS Email Address

Range of investigations / scope of practice

Examination area / type	Tick as appropriate
Appendicular skeleton:
Axial skeleton: (including pelvis)
Chest / Abdomen:
CT Head / Neck:
CT other:
UltraSound:
Fluoroscopy:
Mammography:
Dexa:
Other:

Are you a FULLY INDEPENDENT PRACTITIONER?

I diagnose and treat patients in clinical practice, but a consultant is ultimately responsible for my patients.

Please confirm

OR

I work as a fully independent practitioner with my own patient list and take complete responsibility for my own patients without consultant oversight.

Please confirm

New IRMER application

Please confirm

3 year renewal

Please confirm

By submitting this you are confirming that:

You have read document CG52 (Non-medical requestor policy)
You understand that it is a legal requirement for non-medical requestors to have IRMER training prior to requesting radiological procedures.
You have completed all of the IRMER modalities listed below and have retained a record of completion which can be provided as evidence if requested.

(Please note you do NOT need to submit copies of your certificates, but you must retain copies of your training to be produced as evidence when required).

List of IR (ME) R modules to be completed as a new applicant

E-IRMER Module 01 - Fundamental Physics of Radiation

Radiation Hazards & Dosimeter

01_02_04 Examples of Radiation Dose
01_02_05 Risks vs. Benefits in Patient Exposure

Special Circumstances

01_03_01 Use of Medical Exposures in Special Circumstances

E-IRMER Module 02 - Management and Radiation Protection of the Patient

Patient Selection

02_01_01 Patient Selection: The Justification of Patient Exposure

E-IRMER Module 03 - Legal Requirements

Regulations

03_01_02 Ionising Radiation (Medical Exposure) Regulations 2017- IR(ME)R 2017

Clinical Audit

03_03_01 Clinical Audit

E-IRMER Module 04 - Diagnostic Radiology

General Diagnostic Radiology

04_01_03 Equipment Selection and Use

List of IR (ME) R modules to be completed as a 3-yearly refresher

E-IRMER Module 01 - Fundamental Physics of Radiation

Radiation Hazards & Dosimeter

01_02_04 Examples of Radiation Dose
01_02_05 Risks vs. Benefits in Patient Exposure

E-IRMER Module 02 - Management and Radiation Protection of the Patient

Patient Selection

02_01_01 Patient Selection: The Justification of Patient Exposure

E-IRMER Module 03 - Legal Requirements

Regulations

03_01_02 Ionising Radiation (Medical Exposure) Regulations 2017- IR(ME)R 2017

Clinical Audit

03_03_01 Clinical Audit