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Ohio Laws and Rules
As used in this rule, "therapy equipment" means photon therapy systems and electron therapy systems operating at or above one megavolt (MV). In addition to the rules in Chapters 3701:1-38 and 3701:1-67 of the Administrative Code, handlers of therapy equipment shall comply with the following:
(A) Upon installation of therapy equipment, acceptance testing shall be performed to verify that the equipment complies with all manufacturer specifications. In the event that manufacturer specifications are unavailable for reference, all therapy equipment shall be tested to ensure compliance with the standards of this rule. Any modification of equipment that occurs pursuant to initial acceptance testing shall entail appropriate retesting in order to re-determine compliance with applicable manufacturer standards or standards of this rule.
(B) Each facility location authorized to use therapy equipment in accordance with this rule shall possess appropriately calibrated portable monitoring equipment. As a minimum, such equipment shall include a portable radiation measurement survey instrument capable of measuring doses over the range ten microsievert (one mrem) per hour to ten millisievert (one thousand mrem) per hour. The survey instrument(s) shall be operable and calibrated in accordance with rule 3701:1-67-07 of the Administrative Code.
(C) Leakage radiation outside the maximum useful beam in photon and electron modes shall not exceed the manufacturer specifications, or in the absence of the manufacturer specifications:
(1) The absorbed dose due to leakage radiation, excluding neutrons, at any point outside the maximum sized useful beam, but within a circular plane of radius two meters which is perpendicular to and centered on the central axis of the useful beam at the nominal treatment distance, such as patient plane, shall not exceed a maximum of 0.2 per cent and an average of 0.1 per cent of the absorbed dose on the central axis of the beam at the nominal treatment distance. Measurements shall be averaged over an area not exceeding one hundred square centimeters at a minimum of sixteen points uniformly distributed in the plane;
(2) Except for the area defined in paragraph (C)(1) of this rule, the absorbed dose due to leakage radiation, excluding neutrons, at one meter from the electron path between the electron source and the target or electron window shall not exceed 0.5 per cent of the absorbed dose on the central axis of the beam at the nominal treatment distance. Measurements shall be averaged over an area not exceeding one hundred square centimeters;
(3) For each piece of therapy equipment, the handler shall determine, or obtain from the manufacturer, the leakage radiation existing at the positions specified in paragraphs (C)(1) and (C)(2) of this rule for the specified operating conditions. Records on leakage radiation measurements shall be maintained at the installation for inspection by the department.
(D) Leakage radiation through beam limiting devices shall not exceed the manufacturer specifications, or in the absence of the manufacturer specifications, shall meet the following:
(1) Using photon radiation, all adjustable or interchangeable beam limiting devices shall attenuate the useful beam such that at the nominal treatment distance, the maximum absorbed dose anywhere in the area shielded by the beam limiting device(s) shall not exceed two per cent of the maximum absorbed dose on the central axis of the useful beam measured in a one hundred square centimeter radiation field, or maximum available field size if less than one hundred square centimeters;
(2) Using electron radiation, all adjustable or interchangeable electron applicators shall attenuate the radiation, including but not limited to photon radiation generated by electrons incident on the beam limiting device and electron applicator and other parts of the radiation head, such that the absorbed dose in a plane perpendicular to the central axis of the useful beam at the nominal treatment distance shall not exceed:
(a) A maximum of two per cent and average of 0.5 per cent of the absorbed dose on the central axis of the useful beam at the nominal treatment distance. This limit shall apply beyond a line seven centimeters outside the periphery of the useful beam; and
(b) A maximum of ten per cent of the absorbed dose on the central axis of the useful beam at the nominal treatment distance. This limit shall apply beyond a line two centimeters outside the periphery of the useful beam; and
(3) Measurements of leakage radiation for:
(a) Photon radiation shall have measurements through the beam limiting devices made with the beam limiting devices closed and any residual aperture blocked by at least two tenth value layers of suitable absorbing material. In the case of overlapping beam limiting devices, the leakage radiation through each set shall be measured independently at the depth of maximum dose. Measurements shall be made using a radiation detector of area not exceeding ten square centimeters; and
(b) Electron radiation shall have measurements through the electron applicators made with the electron beam directed into the air and using a radiation detector of area up to but not exceeding one square centimeter suitably protected against radiation which has been scattered from material beyond the radiation detector. Measurements shall be made using one centimeter of water equivalent build up material.
(E) Filters and wedges shall comply with the following:
(1) Each wedge that is removable from the system shall be clearly marked with an identification number. For removable wedges, the nominal wedge angle shall appear on the wedge or wedge tray, if it is permanently mounted to the tray. If the wedge or wedge tray is significantly damaged, the wedge transmission factor shall be redetermined;
(2) If the absorbed dose rate information required by paragraph (I) of this rule relates exclusively to operation with a field flattening filter or beam scattering foil in place, such foil or filter shall be removable only by authorized service personnel; and
(3) For equipment manufactured after the effective date of this rule, which utilizes wedges, interchangeable field flattening filters, or interchangeable beam scattering foils:
(a) Irradiation shall not be possible until a selection of a wedge or a positive selection to use "no wedge" has been made at the treatment control panel, either manually or automatically;
(b) An interlock system shall be provided to prevent irradiation if the filter selected is not in the correct position;
(c) A display shall be provided at the treatment control panel showing the wedges, interchangeable field flattening filter(s), or interchangeable beam scattering foil(s) in use; and
(d) An interlock shall be provided to prevent irradiation if any filter or beam scattering foil selection operation carried out in the treatment room does not agree with the filter or beam scattering foil selection operation carried out at the treatment control panel.
(F) All therapy equipment subject to the requirements of this rule shall be provided with redundant beam monitoring systems. The sensors for these systems shall be fixed in the useful beam during treatment to indicate the dose rate.
(1) Therapy equipment shall be provided with at least two independently powered integrating dose meters. Alternatively, dose meters with shared components may be used if the production of radiation is terminated upon failure of any common components.
(2) The detector and the system into which that detector is incorporated shall meet the following requirements:
(a) Each detector shall form part of a beam monitoring system from whose readings the absorbed dose at a reference point can be calculated;
(b) Each beam monitoring system shall be capable of independently monitoring, interrupting, and terminating irradiation;
(c) For equipment manufactured after the effective date of this rule, the design of the beam monitoring systems shall ensure that the:
(i) Malfunctioning of one system shall not affect the correct functioning of the other system(s); and
(ii) Failure of either system shall terminate irradiation or prevent the initiation of radiation; and
(d) Each beam monitoring system shall have a legible display at the treatment control panel. For therapy equipment manufactured after February 15, 2001, each display shall:
(i) Maintain a reading until intentionally reset;
(ii) Have only one scale and no electrical or mechanical scale multiplying factors;
(iii) Utilize a design such that increasing dose is displayed by increasing numbers; and
(iv) In the event of power failure, the beam monitoring information required in paragraph (F)(2)(d)(iii) of this rule, displayed at the control panel at the time of failure shall be retrievable in at least one system for a twenty minute period of time.
(G) The following requirements shall be met for beam symmetry:
(1) A bent-beam linear accelerator with beam flattening filter(s) subject to the requirements of this rule shall be provided with auxiliary device(s) to monitor beam symmetry;
(2) The device(s) referenced in paragraph (G)(1) of this rule, shall be able to detect field asymmetry greater than ten per cent; and
(3) The device(s) referenced in paragraph (G)(1) of this rule, shall be configured to terminate irradiation if the specifications in paragraph (G)(2) of this rule, can not be maintained.
(H) The following requirements shall be met for the selection and display of monitor units:
(1) Irradiation shall not be possible until a new selection of a number of monitor units has been made at the treatment control panel;
(2) The pre-selected number of monitor units shall be displayed at the treatment control panel until reset manually for the next irradiation;
(3) After termination of irradiation, it shall be necessary to reset the dosimeter display before subsequent treatment can be initiated; and
(4) For therapy equipment manufactured after the effective date of this rule, it shall be necessary for the operator to reset the pre-selected monitor units after each termination of an irradiation and before a new irradiation can be initiated.
(I) For therapy equipment manufactured after the effective date of this rule, a system shall be provided from whose readings the air kerma rate or absorbed dose rate at a reference point can be calculated. The radiation detectors specified in paragraph (F) of this rule may form part of this system. In addition:
(1) The monitor unit rate shall be displayed at the treatment control panel;
(2) If the therapy equipment can deliver under any conditions an air kerma rate or absorbed dose rate at the nominal treatment distance more than twice the maximum value specified by the manufacturer, a device shall be provided which terminates irradiation when the air kerma rate or absorbed dose rate exceeds a value twice the specified maximum. The dose rate at which the irradiation will be terminated shall be a record maintained by the handler;
(3) If the therapy equipment can deliver under any fault condition(s) an air kerma rate or absorbed dose rate at the nominal treatment distance more than ten times the maximum value specified by the manufacturer, a device shall be provided to prevent the air kerma rate or absorbed dose rate anywhere in the radiation field from exceeding twice the specified maximum value and to terminate irradiation if the excess absorbed dose at the nominal treatment distance exceeds four gray (four hundred rad); and
(4) For each piece of therapy equipment, the handler shall determine, or obtain from the manufacturer, the maximum value(s) specified in paragraphs (I)(2) and (I)(3) of this rule, for the specified operating conditions. Records of these maximum value(s) shall be maintained at the installation for inspection by the department.
(J) Termination of irradiation by the beam monitoring system or systems during stationary beam radiation therapy shall meet the following requirements:
(1) Each primary system shall terminate irradiation when the pre-selected number of monitor units has been detected by the system;
(2) If the original design of the equipment included a secondary dose monitoring system, that system shall be capable of terminating irradiation when not more than fifteen per cent or forty monitor units above the pre-selected number of monitor units set at the control panel has been detected by the secondary dose monitoring system; and
(3) For equipment manufactured after February 15, 2001, an indicator on the control panel shall show which monitoring system has terminated irradiation.
(K) It shall be possible to terminate irradiation and equipment movement or go from an interruption condition to termination condition at any time from the operator's position at the treatment control panel.
(L) If the therapy equipment has an interrupt mode, it shall be possible to interrupt irradiation and equipment movements at any time from the treatment control panel. Following an interruption, it shall be possible to restart irradiation by operator action without any reselection of operating conditions. If any change is made of a pre-selected value during an interruption, irradiation and equipment movements shall be automatically terminated.
(M) A suitable irradiation control device shall be provided to terminate the irradiation after a pre-set time interval and shall meet the following requirements:
(1) A timer shall be provided which has a display at the treatment control panel. The timer shall have a pre-set time selector and an elapsed time indicator;
(2) The timer shall be a cumulative timer that activates with an indication of "BEAM-ON" and retains its reading after irradiation is interrupted or terminated. After irradiation is terminated and before irradiation can be reinitiated, it shall be necessary to reset the elapsed time indicator; and
(3) The timer shall terminate irradiation when a pre-selected time has elapsed, if the dose monitoring systems have not previously terminated irradiation.
(N) Therapy equipment capable of both x-ray therapy and electron therapy shall meet the following additional requirements:
(1) Irradiation shall not be possible until a selection of radiation type (x-rays or electrons) has been made at the treatment control panel;
(2) The radiation type selected shall be displayed at the treatment control panel before and during irradiation;
(3) An interlock system shall be provided to ensure that the therapy equipment can principally emit only the radiation type that has been selected;
(4) An interlock system shall be provided to prevent irradiation with x-rays, except to obtain an image, when electron applicators are fitted;
(5) An interlock system shall be provided to prevent irradiation with electrons when accessories specific for x-ray therapy are fitted; and
(6) An interlock system shall be provided to prevent irradiation if any selected operations carried out in the treatment room do not agree with the selected operations carried out at the treatment control panel.
(O) Therapy equipment capable of generating radiation beams of different energies shall meet the following requirements:
(1) Irradiation shall not be possible until a selection of energy has been made at the treatment control panel;
(2) The nominal energy value selected shall be displayed at the treatment control panel until reset manually for the next irradiation. After termination of irradiation, it shall be necessary to reset the nominal energy value selected before subsequent treatment can be initiated; and
(3) Irradiation shall not be possible until the appropriate flattening filter or scattering foil for the selected energy is in its proper location.
(P) Therapy equipment capable of both stationary beam radiation therapy and moving beam radiation therapy shall meet the following requirements:
(1) Irradiation shall not be possible until a selection of stationary beam radiation therapy or moving beam radiation therapy has been made at the treatment control panel;
(2) The mode of operation shall be displayed at the treatment control panel;
(3) An interlock system shall be provided to ensure that the therapy equipment can operate only in the mode that has been selected;
(4) An interlock system shall be provided to prevent irradiation if any selected parameter in the treatment room does not agree with the selected parameter at the treatment control panel;
(5) Moving beam radiation therapy shall be controlled to obtain the selected relationships between incremental monitor units and incremental movement. For therapy equipment manufactured after the effective date of this rule:
(a) An interlock system shall be provided to terminate irradiation if the number of monitor units delivered in any ten degrees of rotation or one centimeter of linear motion differs by more than twenty per cent from the selected value;
(b) Where angle terminates the irradiation in moving beam radiation therapy, the monitor units delivered shall differ by less than five per cent from the monitor unit value selected;
(c) An interlock shall be provided to prevent motion of more than five degrees or one centimeter beyond the selected limits during moving beam radiation therapy;
(d) An interlock shall be provided to require that a selection of direction be made at the treatment control panel in all units which are capable of both clockwise and counter-clockwise moving beam radiation therapy; and
(e) Moving beam radiation therapy shall be controlled with both primary position sensors and secondary position sensors to obtain the selected relationships between incremental monitor units and incremental movement;
(6) Where the beam monitor system terminates the irradiation in moving beam radiation therapy, the termination of irradiation shall be as required by paragraph (J) of this rule; and
(7) For equipment manufactured after the effective date of this rule, an interlock system shall be provided to terminate irradiation if movement:
(a) Occurs during stationary beam radiation therapy; or
(b) Does not start or stops during moving beam radiation therapy unless such stoppage is a pre-planned function.
(Q) In addition to the requirements listed in rule 3701:1-67-08 of the Administrative Code, handlers of therapy equipment that produce photons with a maximum energy at or above one MV or electrons shall submit facility design information which contain, as a minimum, the following:
(1) All protective barriers shall be fixed, except for access doors to the treatment room or movable beam interceptors;
(2) In addition to other requirements specified in Chapter 3701:1-67 of the Administrative Code, the control panel shall:
(a) Be located outside the treatment room;
(b) Provide an indication of whether electrical power is available at the control panel and if activation of the radiation is possible;
(c) Provide an indication of whether radiation is being produced; and (d) Include an access control or locking device that will prevent unauthorized use of the therapy equipment;
(3) Windows, mirrors, closed-circuit television or an equivalent viewing system shall be provided to permit continuous observation of the patient following positioning and during irradiation and shall be so located that the operator may observe the patient from the treatment control panel. The therapy equipment shall not be used for patient irradiation unless at least one viewing system is operational;
(4) Provision shall be made for continuous two-way aural communication between the patient and the operator at the control panel. The therapy equipment shall not be used for irradiation of patients unless continuous two-way aural communication is possible;
(5) Treatment room entrances shall be provided with warning lights in a readily observable position near the outside of all access doors, which will state in words when the useful beam is on;
(6) Interlocks shall be provided such that all access controls are activated before treatment can be initiated or continued. If the radiation beam is interrupted by any access control, it shall not be possible to restore the therapy equipment to operation without resetting the access control and reinitiating irradiation by manual action at the control panel;
(7) If the shielding material in any protective barrier requires the presence of a beam interceptor to ensure compliance with the annual radiation dose limits for members of the public specified in rule 3701:1-38-13 of the Administrative Code, interlocks shall be provided to prevent the production of radiation, unless the beam interceptor is in place, whenever the useful beam is directed at the designated barrier(s);
(8) At least one emergency power cutoff switch shall be located in the radiation therapy room and shall terminate all equipment electrical power including radiation and mechanical motion, or operate per manufacturer's specification. This switch is in addition to the termination switch required on the treatment control panel. All emergency power cutoff switches shall include a manual reset so that the therapy equipment cannot be restarted from the unit's control console without resetting the emergency cutoff switch;
(9) All safety interlocks shall be designed so that any defect or component failure in the safety interlock system prevents or terminates operation of the therapy equipment; and
(10) Authorized service personnel shall conduct surveys for residual activity on all therapy equipment capable of generating photon and electron energies above ten MV prior to machining, removing, or working on therapy equipment components which may have become activated due to photo-neutron production.
(R) A qualified medical physicist shall develop a quality assurance program and shall be responsible for:
(1) Full calibration(s) required by paragraph (T) of this rule, and protection surveys required by paragraph (A) of rule 3701:1-67-03 of the Administrative Code;
(2) Supervision and review of dosimetry;
(3) Beam data acquisition and transfer for computerized dosimetry, and supervision of its use;
(4) Quality assurance, including the quality assurance check review required by paragraph (U)(3) of this rule;
(5) Consultation with the authorized user in treatment planning, as needed; and
(6) Perform calculations and assessments regarding misadministrations.
(S) Safe operating procedures for facilities subject to the requirements of this rule shall include:
(1) No individual, other than the patient, shall be in the treatment room during treatment or during any irradiation for testing or calibration purposes;
(2) Therapy equipment shall not be made available for medical use unless the requirements of paragraph (A) of rule 3701:1-67-03 of the Administrative Code, and paragraph (T) and paragraph (U) of this rule have been met;
(3) When not in operation, therapy equipment shall be secured to prevent unauthorized use;
(4) When adjustable beam limiting devices are used, the position and shape of the radiation field shall be indicated by a light field;
(5) If a patient must be held in position during treatment, mechanical supporting or restraining devices shall be used;
(6) A copy of the current operating and emergency procedures shall be maintained at the therapy equipment control console; and
(7) Equipment shall only be operated as designed by the manufacturer.
(T) Requirements for acceptance testing, commissioning, and full calibration measurements shall include:
(1) Acceptance testing, commissioning, and full calibration of therapy equipment subject to the requirements of this rule shall be performed by, or in the presence of, a qualified medical physicist;
(2) Commissioning shall be performed in accordance with "AAPM Code of Practice for Radiotherapy Accelerators: AAPM Report No. 47 (AAPM report 47)," prepared by "Radiation Therapy Task Group 45" (this publication can be obtained from the American association of physicists in medicine, One Physics Ellipse, College Park, MD 20740, telephone (301) 209-3350, http://www.aapm.org/pubs/reports) and the manufacturer's contractual specifications. Acceptance testing and commissioning shall be conducted before the first medical use following installation or reinstallation of the therapy equipment;
(3) Annual calibration shall be performed according to the quality assurance program developed by the qualified medical physicist in accordance with paragraph (B) of this rule, using as a basis AAPM reports 46, 47, and 142. These tests shall be performed every twelve months, not to exceed fourteen calendar months;
(4) The qualified medical physicist shall perform all elements of a full calibration necessary to determine that all parameters are within acceptable limits:
(a) Whenever quality assurance check measurements indicate that the radiation output differs by more than five per cent from the value obtained at the last full calibration and the difference cannot be reconciled. Therapeutic radiation machines with multi-energy or multi-mode capabilities shall only require measurements for those modes or energies that are not within their acceptable range; and
(b) Following any component replacement, major repair, or modification of components that could significantly affect the characteristics of the radiation beam. If the repair, replacement or modification does not affect all modes or energies, measurements shall be performed on the effected mode/energy that is in most frequent clinical use at the facility. The remaining energies/modes may be validated with quality assurance check procedures against the criteria in paragraph (T)(4)(b) of this rule; and
(5) The handler shall maintain a record of each calibration in an auditable form for the duration of the registration. The record shall include: the date of the calibration; the manufacturer's name, model number and serial number for the therapeutic radiation machine; the model numbers and serial numbers of the instruments used to calibrate the therapeutic radiation machine; and the name and signature of the qualified medical physicist responsible for performing the calibration.
(U) Requirements for quality assurance spot checks for therapy equipment with energies of one MV and above shall be performed according to the quality assurance program developed by the qualified medical physicist in accordance with paragraph (B) of this rule, using as a basis AAPM reports 46 and 142 and shall include the determination of central axis radiation output and a representative sampling of periodic quality assurance checks contained in AAPM report 46. The representative sampling shall include all applicable referenced periodic quality assurance checks and be performed every twelve months, not to exceed fourteen calendar months:
(1) The handler shall use a dosimetry system that has been intercompared within the previous twelve months with the dosimetry system described in paragraph (H)(1) of rule 3701:1-67-03 of the Administrative Code to make the periodic quality assurance checks required in paragraph (U) of this rule;
(2) The handler shall perform periodic quality assurance checks required by paragraph (U) of this rule in accordance with written procedures established by the qualified medical physicist;
(3) The handler shall review the results of each periodic radiation output check according to the following procedures:
(a) The authorized user and qualified medical physicist shall be immediately notified if any parameter is not within its acceptable tolerance. The therapy equipment shall not be made available for subsequent medical use until the qualified medical physicist has determined that all parameters are within their acceptable tolerances;
(b) If all quality assurance check parameters appear to be within their acceptable range, the quality assurance check shall be reviewed and signed by either the authorized user or qualified medical physicist within three treatment days; and
(c) The qualified medical physicist shall review and sign the results of each radiation output quality assurance check at intervals not to exceed thirty days;
(4) Therapy equipment subject to the requirements of this rule shall have applicable safety quality assurance checks listed in AAPM report 46 performed as prescribed in the quality assurance manual;
(5) To satisfy the requirement of paragraph (U)(4) of this rule, safety quality assurance checks shall ensure proper operation of:
(a) Electrical interlocks at each external beam radiation therapy room entrance;
(b) Proper operation of the "beam-on", interrupt and termination switches;
(c) Beam condition indicator lights on the access doors, control console, and in the radiation therapy room;
(d) Viewing systems;
(e) Electrically operated treatment room door(s) from inside and outside the treatment room; and
(f) At least one emergency power cutoff switch. If more than one emergency power cutoff switch is installed and not all switches are tested at once, each switch shall be tested on a rotating basis. Safety quality assurance checks of the emergency power cutoff switches may be conducted at the end of the treatment day in order to minimize possible stability problems with the therapeutic radiation machine;
(6) The handler shall promptly repair any system identified in paragraph (U)(5) of this rule, that is not operating properly; and
(7) The handler shall maintain a record of each quality assurance check required by paragraph (U) of this rule for three years. The record shall include: the date of the quality assurance check; the manufacturer's name, model number, and serial number of the therapy equipment; the manufacturer's name, model number and serial number for the instrument(s) used to measure the radiation output of the therapy equipment; and the name and signature of the individual who performed the periodic quality assurance check.
(V) Quality assurance checks for intensity modulated radiation therapy (IMRT) shall be a part of the departmental QA program and shall:
(1) Include commissioning and testing of the treatment planning and delivery systems, routine quality assurance of the delivery system and patient-specific validation of treatment plans;
(2) Be performed according to a QA program and based on "Guidance document on delivery, treatment planning, and clinical implementation of IMRT: Report of the IMRT subcommittee of the AAPM radiation therapy committee: AAPM Report No. 82 (AAPM report 82)," (this publication can be obtained from the American association of physicists in medicine, One Physics Ellipse, College Park, MD 20740, telephone (301) 209-3350, http://www.aapm.org/pubs/reports); and
(3) Include quality assurance checks for patient specific treatment plans. If a direct measurement for individual plans is not performed, the checks shall include both a dose calculation second check and a method to validate patient plan transfer and deliverability to the treatment unit.
(W) The control panel for all therapy equipment shall bear a warning label indicating that radiation is produced when the therapy equipment is energized and that the unit may be dangerous to patients and operators unless safety and operating instructions are observed.
(X) Quality assurance checks for radiographic imaging systems integrated with medical accelerators shall:
(1) Include acceptance testing and periodic verification of system performance; and
(2) Be performed using as a basis, "Quality assurance of medical accelerators:Report of AAPM Radiation Therapy Committee Task Group No. 142" (this publication can be obtained from the American association of physicists in medicine, One Physics Ellipse, College Park, MD 20740, telephone (301) 209-3350, http://www.aapm.org/pubs/reports).
(Y) Quality assurance checks for management of respiratory motion shall be performed using as a basis, "Quality assurance of medical accelerators: Report of AAPM Radiation Therapy Committee Task Group No.142" and "Management of Respiratory Motion in Radiation Oncology: Report of AAPM Radiation Therapy Committee Task Group No. 76" (this publication can be obtained from the American association of physicists in medicine, One Physics Ellipse, College Park, MD 20740, telephone (301) 209-3350, http://www.aapm.org/pubs/reports).
Replaces: 3701:1-66-14, 3701:1-66-15
Effective: 01/14/2011
R.C. 119.032 review dates: 01/01/2016
Promulgated Under: 119.03
Statutory Authority: 3748.04
Rule Amplifies: 3748.01, 3748.02, 3748.04, 3748.05, 3748.06, 3748.07, 3748.12, 3748.121, 3748.13, 3748.14, 3748.15, 3748.17, 3748.18, 3748.19, 3748.20, 3748.22, 3748.99
Prior Effective Dates: 2/15/2001, 9/1/05