Hawaii Administrative Rules › Title 11 - DEPARTMENT OF HEALTH › Subtitle 1 - GENERAL DEPARTMENTAL PROVISIONS › Chapter 45 - RADIATION CONTROL › Subchapter 6 - X-RAYS IN THE HEALING ARTS › Section 11-45-116 - General requirements

Current through June, 2024
(a) The licensee
				  shall be responsible for directing the operation of the x-ray system(s) under
				  the licensee's administrative control. The licensee or the licensee's agent
				  shall assure that the requirements of this subchapter are met in the operation
				  of the x-ray system(s).
(1) An x-ray system
				  which does not meet the provisions of this subchapter shall not be operated for
				  diagnostic purposes if so directed by the department.
(2) Individuals who will be operating x-ray
				  systems shall be adequately instructed on the operating procedures and be
				  competent in the safe use of the equipment.
(3) Individuals practicing radiologic
				  technology shall be licensed under chapter
				  11-44.
(4) A chart shall be provided in the vicinity
				  of the diagnostic x-ray system's control panel which specifies, for all
				  examinations performed with that system, the following information:
(A) Patient's body part and anatomical size,
				  or body part thickness, or age (for pediatrics), versus technique factors to be
				  utilized;
(B) Type and size of the
				  film or screen-film combination to be used;
(C) Type and focal distance of the grid to be
				  used, if any;
(D) Source-image
				  receptor distance to be used (except for dental intraoral
				  radiography);
(E) Type and location
				  of placement of patient shielding (e.g., gonad, etc.) to be used; and
(F) For mammography, indication of
				  kilovoltage peak/target/filter combination.
(5) The licensee of a facility shall
				  establish and make available to x-ray operators written safety procedures,
				  including patient holding and any restrictions of the operating technique
				  required for the safe operation of the particular x-ray system. The operator
				  shall be able to demonstrate familiarity with these procedures.
(6) Except for human patients who cannot be
				  moved out of the room, only the staff, ancillary personnel, or other persons
				  required for the medical procedure or training shall be in the room during the
				  radiographic exposure. Other than the patient being examined:
(A) All individuals shall be positioned such
				  that no part of the body will be struck by the useful beam unless protected by
				  not less than 0.5 millimeter lead equivalent material or otherwise authorized
				  by a qualified medical physicist.
(B) The x-ray operator, other staff,
				  ancillary personnel and other persons required for the medical procedure shall
				  be protected from the direct scatter radiation by protective aprons or whole
				  body protective barriers of not less than 0.25 millimeter lead equivalent
				  material, unless otherwise authorized by a qualified medical
				  physicist.
(C) Human patients who
				  cannot be removed from the room shall be protected from the direct scatter
				  radiation by whole body protective barriers of not less than 0.25 millimeter
				  lead equivalent material, or shall be so positioned that the nearest portion of
				  the body is at least two meters from both the tube head and the nearest edge of
				  the image receptor, unless otherwise authorized by a qualified medical
				  physicist.
(7) Gonad
				  shielding of not less than 0.5 millimeter lead equivalent material shall be
				  used for human patients, who have not passed the reproductive age, during
				  radiographic procedures in which the gonads are in the useful beam, except for
				  cases in which this would interfere with the diagnostic procedure.
(8) Individuals shall not be exposed to the
				  useful beam except for healing arts purposes and unless such exposure has been
				  authorized by a licensed practitioner of the healing arts. This provision
				  specifically prohibits deliberate exposure for the following purposes:
(A) Exposure of an individual for training,
				  demonstration, or other non-healing arts purposes; and
(B) Reserved.
(9) When a patient or film requires auxiliary
				  support during a radiation exposure:
(A)
				  Mechanical holding devices shall be used. The written safety procedures,
				  required by paragraph (5), shall list individual projections where holding
				  devices cannot be utilized;
(B)
				  Written safety procedures, as required by paragraph (5), shall indicate the
				  requirements for selecting a holder and the procedure the holder shall
				  follow;
(C) The human holder shall
				  be instructed in personal radiation safety and protected as required by
				  paragraph (6);
(D) No individual
				  shall be used routinely to hold film or human patients;
(E) In those cases where an individual must
				  hold the film (except during intraoral examinations), any portion of the body
				  other than the area of clinical interest struck by the useful beam shall be
				  protected by not less than 0.5 millimeter lead equivalent material;
				  or
(F) Each facility shall have
				  leaded aprons and gloves available in sufficient numbers to provide protection
				  for all personnel who are involved with x-ray operations and who are otherwise
				  not shielded.
(10)
				  Procedures and auxiliary equipment designed to minimize patient and personnel
				  exposure commensurate with the needed diagnostic information shall be utilized.
(A) The speed of the screen and film
				  combinations used shall be the fastest speed consistent with the diagnostic
				  objective of the examinations. Film cassettes without intensifying screens
				  shall not be used for any routine diagnostic radiological imaging, with the
				  exception of standard film packets for intraoral use in dental
				  radiography.
(B) The radiation
				  exposure to the patient shall be the minimum exposure required to produce
				  images of good diagnostic quality.
(C) Portable or mobile x-ray equipment shall
				  be used only for examinations where it is impractical to transfer the
				  patient(s) to a stationary x-ray installation.
(D) If grids are used between the patient and
				  the image receptor to decrease scatter to the film and improve contrast the
				  grid shall:
(i) Be positioned properly, i.e.,
				  tube side facing the right direction, and grid centered to the central ray;
				  and
(ii) If of the focused type, be
				  of the proper focal distance for the SID's being used.
(11) All individuals who are
				  associated with the operation of an x-ray system are subject to the
				  requirements of subchapter 4.
(12)
				  Reserved.
(13) The licensee shall
				  maintain the following information for each x-ray system for inspection by the
				  department:
(A) Model and serial numbers of
				  all major components, and user's manuals for those components;
(B) Tube rating charts and cooling
				  curves;
(C) Records of surveys,
				  calibrations, maintenance, and modifications performed on the x-ray
				  system(s);
(D) Copy of all
				  correspondence with this department regarding that x-ray system.
(14) Each facility shall maintain
				  either an x-ray log containing the name of the patient, the type of x-ray
				  examination, the date of the x-ray examination, the name of the referring
				  practitioner, and the name of the individual who performed the x-ray
				  examination (facilities subject to chapter
				  11-44), or
				  a patient record specifying the type of x-ray examination and the date of the
				  x-ray examination. When the patient or film must be provided with human
				  auxiliary support, the name of the human holder shall be recorded.