Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 481 - VIRGINIA RADIATION PROTECTION REGULATIONS › Part VI - Use Of Diagnostic X-Rays In The Healing Arts › Section 12VAC5-481-1591 - General and administrative requirements

Current through Register Vol. 40, No. 24, July 15, 2024
A. Radiation safety requirements. The
				  registrant shall be responsible for directing the operation of the x-ray system
				  under his administrative control. The registrant or the registrant's agent
				  shall assure that the requirements of this chapter are met in the operation of
				  the x-ray system or systems.
1. An x-ray
				  system that does not meet the provisions of this chapter shall not be operated
				  for diagnostic purposes.
2.
				  Individuals who will be operating the x-ray systems shall meet the
				  qualifications of this part to conduct the practice of radiologic
				  technology.
3. A chart shall be
				  provided in the vicinity of the diagnostic x-ray system's control panel that
				  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 image receptor to be
				  used;
c. Type and size of the image
				  receptor combination to be used, if any;
d. Source to 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
				  kVp/target/filter combination.
4. The registrant of a facility shall create
				  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.
5. Except for 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 mm lead equivalent material;
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 mm lead equivalent material .
				  However, when distances provide sufficient protection from scatter radiation,
				  or for low dose rate devices such as bone densitometry equipment, no protective
				  devices may be necessary ; 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 mm 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.
6. Gonad shielding of not less than 0.5 mm
				  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.
7.
				  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. Exposure of an individual for the purpose
				  of healing arts screening except as authorized by subdivision 11 of this
				  subsection.
8. When a
				  patient or image receptor must be provided with auxiliary support during a
				  radiation exposure:
a. Mechanical holding
				  devices shall be used when the technique permits. The written safety
				  procedures, as required by subdivision 4 of this subsection, shall list
				  individual projections where holding devices cannot be utilized;
b. Written safety procedures, as required by
				  subdivision 4 of this subsection, 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 subdivision 5 of this
				  subsection . Caregivers who stay in the room to assist with imaging of patients
				  shall be positioned and instructed to keep the protective apron between
				  themselves and the patient ;
d. No
				  individual shall be used routinely to hold image receptors or
				  patients;
e. 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 mm lead equivalent
				  material; and
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.
9. Procedures and auxiliary equipment
				  designed to minimize patient and personnel exposure commensurate with the
				  needed diagnostic information shall be utilized.
a. The fastest imaging system consistent with
				  the diagnostic objective of the examinations shall be used. Film cassettes
				  without intensifying screens shall not be used for any routine diagnostic
				  radiological imaging, with the exception of veterinary radiography and 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
				  radiographic (exclude fluoroscopic) x-ray equipment shall be used only for
				  examinations where it is impractical to transfer the patient to a stationary
				  x-ray installation.
d. X-ray
				  systems subject to
				  12VAC5-481-1621 shall not be
				  utilized in procedures where the source to patient distance is less than 30 cm,
				  except for veterinary systems.
e.
				  If grids are used between the patient and the image receptor to decrease
				  scatter to the film and improve contrast, the grid shall:
(1) Be positioned properly, that is , tube
				  side facing the right direction, and grid centered to the central ray;
				  and
(2) If the grid is of the
				  focused type, be of the proper focal distance for the SIDs being
				  used.
10. All
				  individuals who are associated with the operation of an x-ray system are
				  subject to the requirements of
				  12VAC5-481-640,
				  12VAC5-481-700, and
				  12VAC5-481-710.
11. Any person proposing to conduct a healing
				  arts screening program shall not initiate such a program without prior approval
				  of the agency. If any information submitted to the agency becomes invalid or
				  outdated, the agency shall be immediately notified. Persons requesting that the
				  agency approve a healing arts screening program shall submit the following
				  information and evaluation:
a. Name and
				  address of the applicant and, where applicable, the names and addresses of
				  agents within this state;
b.
				  Diseases or conditions for which the x-ray examinations are to be used in
				  diagnoses;
c. A description of the
				  x-ray examinations proposed in the screening program, that is , type and number
				  of views;
d. Description of the
				  population to be examined in the screening program, that is , age range, sex,
				  physical condition, and other appropriate information;
e. An evaluation of any known alternate
				  methods not involving ionizing radiation that could achieve the goals of the
				  screening program and why these methods are not used instead of the x-ray
				  examinations;
f. An evaluation by a
				  qualified medical physicist of the x-ray system or systems to be used in the
				  screening program. The evaluation shall include the following:
(1) Documentation that such systems satisfy
				  all requirements of this chapter; and
(2) Measurement of patient exposures from the
				  x-ray examinations to be performed;
g. A description of the diagnostic x-ray
				  quality control program;
h. A copy
				  of the technique chart for the x-ray examination procedures to be
				  used;
i. The qualifications of each
				  individual who will be operating the x-ray system or systems;
j. The qualifications of the individual who
				  will be supervising the operators of the x-ray system or systems. The extent of
				  supervision and the method of work performance evaluation shall be
				  specified;
k. The name and address
				  of the practitioner licensed in the state who will interpret the
				  radiograph;
l. Procedures to be
				  used in advising the individuals screened and their practitioners of the
				  healing arts or health care providers of the results of the screening procedure
				  and any further medical needs indicated;
m. Procedures for the retention or
				  disposition of the radiographs and other records pertaining to the x-ray
				  examinations;
n. Frequency of
				  screening of individuals; and
o.
				  The duration of the screening program.
12. The registrant shall maintain the
				  following information and maintenance record for each x-ray system for
				  inspection by the agency:
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 or systems; and
d. A copy of
				  all correspondence with the agency regarding that x-ray system.
13. Except for veterinary
				  facilities, each facility shall maintain an x-ray utilization log containing
				  the patient's name, the type of examination, and the date the examination was
				  performed.
14. The registrant shall
				  maintain a list of x-ray operators for each facility. Operators must be
				  licensed by the Department of Health Professions where x-rays are used within
				  the scope of practice or be certified by the American Registry of Radiological
				  Technologists (ARRT), or be an individual enrolled , or was enrolled within the
				  past three months, in an accredited program for radiologic technology and under
				  the supervision of a licensed or certified radiological technologist, or if a
				  dental assistant, comply with the Board of Dentistry's radiation certification
				  requirements in
				  18VAC60-20-195.