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Staff involved in interventional cardiology receive the highest occupational doses in Norway, and skin burns of patients have been reported. To identify the level of radiation protection (RP) for patients and staff, and compliance with the RP regulation, the Norwegian Radiation Protection Authority carried out inspections. The inspections were conducted (2013-14) as quality system reviews, based on document reviews, interviews, on-site inspections and observations of interventional procedures. The inspections revealed that most of the hospitals had non-compliances according to the RP regulation. Most deviations were associated with education in RP and follow-up of patients who had received high radiation doses. Lack of systematic optimisation of procedures and estimation of eye lens doses to evaluate the risk for cataracts were also common. Inspections turned out to increase the awareness of RP in cardiology and are identified as an effective tool for improving RP., (© The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

To identify the level of compliance with the new radiation protection regulation among Norwegian health care enterprises (HCEs). Totally, 41 HCEs were authorised to use advanced X-ray equipment for medical purposes during 2005-07. Follow-up inspections with 14 HCEs were carried out during 2007-09. Main topics for the inspections were those requirements identified as most challenging to implement in the authorisation process. Totally, 192 non-conformities with the regulation were revealed during the authorisation process. The inspections revealed that 93 % of the inspected HCEs had non-conformities with the regulation. Most common non-conformities dealt with skills in radiation protection, establishment of local diagnostic reference levels, access to medical physicists and performance of quality control of X-ray equipment. Inspections are an effective tool for implementation of regulation the requirements at the HCEs, thus improving radiation protection awareness.

The Norwegian Radiation Protection Authority (NRPA) was contacted by a cardiology department because of a suspicious radiation burn on a patient. The patient had undergone two bi-ventricular pacemaker implantations and the lesion was recognised as radiation dermatitis. The NRPA sent sets of thermoluminescense dosemeters to the department to measure the skin dose on eight successive patients undergoing bi-ventricular pacemaker implantations. The average maximum entrance surface dose for the eight patients was 5.3 Gy, ranging from 2.0 to 13.1 Gy. A site audit was performed during a procedure, with the aim to observe the general skills in radiation protection. Based on the findings in the audit, a few very simple 'Do's' and 'Don'ts' were highlighted in a meeting directly after the audit. After the audit, dose measurements were performed on six new patients showing an average maximum entrance surface dose of 0.4 Gy, ranging from 0.2 to 0.8 Gy. The aim of this work was to illustrate the dose reductions that are possible to achieve with a very few basic advices, especially when the operator has suboptimal competence.