Louisiana Administrative Code › Title 33 - ENVIRONMENTAL QUALITY › Part XV - Radiation Protection › Chapter 6 - X-Rays in the Healing Arts › Section XV-603 - General and Administrative Requirements

Current through Register Vol. 50, No. 6, June 20, 2024
A. Radiation Safety Requirements. The
				registrant shall be responsible for directing the operation of the X-ray
				system(s) under his or her administrative control. The registrant or his or her
				agent shall assure that the requirements of LAC 33:XV are met in the operation
				of the X-ray system(s).
1. An X-ray system
				that does not meet the provisions of LAC 33:XV shall not be operated for
				diagnostic or therapeutic purposes unless approved by the department.
2. Individuals who will be operating the
				X-ray systems shall be adequately instructed in the safe operating procedures
				and be competent in the safe use of the equipment.
3. The qualified expert, if required in this
				Section, shall complete initial and routine compliance evaluations following
				nationally recognized procedures. These evaluations shall include a review of
				the required quality control tests.
4. All X-ray equipment shall be installed and
				used in accordance with the equipment manufacturer's specifications.
5. For general radiographic systems not
				equipped with an operational anatomic programming option, protocols shall be
				documented and readily available to the operator. At a minimum, these protocols
				shall include:
a. patient's (adult and
				pediatric, if appropriate) body part and anatomical size;
b. technique factors;
c. type of image receptor used;
d. source to image receptor distance used
				(except for dental intraoral radiography); and
e. type of grid, if any.
6. At the request of the department, the
				registrant shall create and make available written safety procedures to each
				individual operating X-ray equipment, including 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.
7. Except for human
				patients who cannot be moved out of the room, only the staff and ancillary
				personnel, including parents or guardians, required for the medical procedure
				or training shall be in the room during the radiographic exposure. The
				following conditions shall be met for those 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;
b. the X-ray operator, other professional
				staff, and ancillary personnel 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; and
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 2
				meters from both the tube head and the nearest edge of the image
				receptor.
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. Any diagnostic information obtained from each exposure shall be
				reviewed 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. exposure of an individual for the purpose
				of healing arts screening without prior written approval of the
				department.
9. In cases
				where a patient or image receptor must be provided with auxiliary support,
				mechanical support devices shall be used whenever possible. If a patient or
				image receptor must be provided with auxiliary support during a radiation
				exposure:
a. written safety procedures, as
				required by LAC 33:XV.603.A.19, shall indicate the requirements for selecting a
				holder and the procedure the holder shall follow;
b. the human holder shall be instructed in
				personal radiation safety and protected as required by LAC
				33:XV.603.A.6;
c. no individual
				shall be used routinely to hold the image receptor or patients;
d. in those cases where the patient must hold
				the image receptor, 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;
e. when an animal must be
				held by an individual during an exposure, that individual shall be protected
				with appropriate shielding devices, such as lead equivalent aprons and gloves,
				and shall be positioned such that no part of his or her body shall be struck by
				the useful beam.
10.
				Each facility shall have lead equivalent aprons and gloves available in
				sufficient numbers to provide protection to all personnel who are involved in
				X-ray operations and who are otherwise not shielded.
11. All protective apparel and auxiliary
				shields shall be evaluated at intervals of no less than 12 months, and no more
				than 14 months, for integrity and clearly labeled with their lead
				equivalence.
12. Each registrant
				shall have a mechanism in place for the referring physician to access
				information on selecting the most appropriate diagnostic procedure to answer
				the clinical question.
13.
				Nationally recognized diagnostic reference levels (DRLs) shall be utilized when
				applicable.
14. The registrant
				shall use auxiliary equipment designed to minimize patient and personnel
				exposure commensurate with the needed diagnostic information.
15. 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.
16. Neither the X-ray tube housing nor the
				collimating device shall be held during an exposure. Exceptions are allowed for
				department approved devices specifically designed to be hand-held.
17. The useful X-ray beam shall be limited to
				the area of clinical interest.
18.
				Consideration shall be given to selecting the appropriate technique and
				employing available dose reduction methods and technologies across all patient
				sizes and clinical indications.
19.
				A registrant shall have a documented procedure in place for verification of
				patient identity and exam performed, including identification of the
				appropriate body part.
20. Each
				registrant, except for veterinarians, covered under this Chapter shall
				establish written standards for the proper performance of each diagnostic X-ray
				imaging system under the control of the registrant, and shall document by
				routine test record that the system is performing in accordance with these
				standards (quality control). Copies of this documentation shall be retained for
				at least six months and be available for inspection by the department. If a
				test interval is greater than six months, then a copy of the most recent test
				record shall be retained.
21. All
				individuals who are associated with the operation of an X-ray system are
				subject to the requirements of LAC 33:XV.410 and 411. In addition, when
				protective clothing or devices are worn on portions of the body and a personnel
				monitoring device or devices are required in accordance with LAC 33:XV.431,
				monitoring devices shall be used as follows:
a. when a protective apron is worn, at least
				one such monitoring device shall be worn at the collar outside of the
				protective apron;
b. the dose to
				the whole body based on the maximum dose attributed to the most critical organ
				shall be recorded in the reports required by LAC 33:XV.476. If more than one
				device is used and a record is made of the data, each dose shall be identified
				with the area where the device was worn on the body; and
c. deliberate exposure to an individual's
				personnel monitoring device is prohibited.
22. Any person proposing to conduct a healing
				arts screening program shall not initiate such a program without prior approval
				of the department. When requesting such approval, that person shall submit the
				information outlined in LAC 33:XV.699. Appendix C to the Office of
				Environmental Compliance. If any information submitted to the department
				becomes invalid or outdated, the Office of Environmental Compliance shall be
				immediately notified. See the definition of
healing arts
				screening
in LAC 33:XV.602.
23. Any person proposing to conduct a
				diagnostic or screening mammography program shall not initiate such a program
				without having a complete mammography facility survey performed by a
				mammography physicist initially and at intervals of no less than 12 months, and
				no more than 14 months thereafter.