Chapter 3701:1-66 Radiation Generating Equipment

3701:1-66-01 Definitions.

(A) Terms defined in this rule are intended to be used only within this chapter of the Administrative Code.

(B) As used in this chapter:

(1) "Air kerma" means the sum of the initial kinetic energy of all charged ionizing particles liberated by uncharged ionizing radiation in a given mass of air. The unit for air kerma is joules per kilogram which is given the special name of gray (Gy). To determine air kerma in Gy from exposure in units of roentgens (R) multiply exposure by the conversion factor 0.00876 Gy/R.

(2) "Air kerma rate (AKR)" means the air kerma per unit time.

(3) "Aluminum equivalent" means the thickness of type 1100 aluminum alloy affording the same attenuation, under specified conditions, as the material in question.

(4) "Annual" means at least once a year, not to exceed fourteen months.

(5) "Automatic exposure control (AEC)" means a device which automatically controls one or more technique factors in order to obtain, at a preselected location, a required quantity of radiation.

(6) "Beam-limiting device" means a collimator which provides a means to restrict the dimensions of the x-ray field.

(7) "C-arm fluoroscope" means a fluoroscopic x-ray system in which the image receptor and the x-ray tube housing assembly are connected or coordinated to maintain a spatial relationship. Such a system allows a change in the direction of the beam axis with respect to the patient without moving the patient.

(8) "Calibration" means the determination of the response or reading of an instrument relative to a series of known radiation values over the range of the instrument, or the radiation output of a source of radiation relative to a standard.

(9) "Coefficient of variation" means the ratio of the standard deviation to the mean value of the observations.

(10) "Collimator" means a device or mechanism by which the x-ray beam is restricted in size.

(11) "Computed radiography" means a system that utilizes a photostimulable phosphor (PSP) plate for capturing radiographic images. The components of the system include, at a minimum, the PSP plate and a computed radiography reader which laser scans the exposed plate, collects the stimulated light and ultimately creates the digital image.

(12) "Computed tomography (CT)" means an imaging procedure that uses multiple x-ray transmission measurements and computer programs to generate tomographic images .

(13) "Control panel" means that part of the radiation-generating equipment used for setting the technique factors.

(14) "CT conditions of operation" means all selectable parameters governing the operation of CT radiation-generating equipment including, but not limited to, nominal image thickness, filtration, milliampere (mA), kilovoltage peak (kVp), and scan time.

(15) "CT noise" means the per cent standard deviation of the fluctuations in CTN expressed as a percentage of the attenuation coefficient of water.

(16) "CT number (CTN)" means the number used to represent the x-ray attenuation associated with each elemental area of the CT image.

(17) "Cumulative air kerma" means the total air kerma accrued from the beginning of an examination or procedure and includes all contributions from fluoroscopic and radiographic irradiation.

(18) "Dead-man switch" means a switch so constructed that a circuit closing contact can be maintained only by continuous pressure on the switch by the operator.

(19) "Direct scattered radiation," means scattered radiation which has been deviated once in direction only by materials irradiated by the useful beam.

(20) "Enclosed system" means industrial radiation-generating equipment operated in an enclosure or cabinet and may include, but is not limited to, cabinet radiography, irradiation devices, and other equipment.

(21) "Executive administration" means individuals employed in the hospital's administration and having the authority to expend capital funds, approve personnel actions, and implement changes to hospital policy and procedure.

(22) "Filter" means material placed in the useful beam to preferentially attenuate selected radiations.

(23) "Fluoroscopic irradiation time" means the cumulative duration of x-ray tube activation in any fluoroscopic mode of operation.

(24) "Half-value layer (HVL)" means the thickness of specified material which attenuates the beam of radiation to an extent such that the AKR is reduced by one-half of its original value.

(25) "Hand-held radiation-generating equipment" means x-ray equipment that is specifically designed to be held in the hand during operation.

(26) "Handle" means receive, possess, use, store, transfer, install, service, or dispose of radiation-generating equipment unless possession is solely for the purpose of transportation.

(27) "Handler" means a facility that handles radiation-generating equipment unless possession is solely for the purpose of transportation.

(28) "Hybrid imaging system" means a combination of systems that separately produce anatomic and functional images in very close temporal proximity without the need for patient repositioning and allow images to be co-registered and fused. These systems may be used for purposes including, but not limited to, attenuation correction, localization, registration, or fusion, but not used independently for diagnosis.

(29) "Image receptor" "means any device that transforms incident x-ray photons into either a visible image or another form that can be made into a visible image by further transformation. In those cases, where means are provided to preselect a portion of the image receptor, the term "image receptor" means the preselected portion of the device.

(30) "Individual responsible for radiation protection (IRRP)" means an individual designated by the registrant who has the knowledge and responsibility for overall radiation safety and the quality assurance program at the facility, to include daily radiation safety operations and compliance with the rules.

(31) "Interventional procedure" means an invasive procedure that utilizes radiation-generating equipment for diagnostic or therapeutic purposes.

(32) "Kilovoltage peak (kVp)" means the maximum value of the electrical potential difference between the cathode and the anode of the x-ray tube during an exposure.

(33) "Lateral fluoroscope" means the portion of a biplane system consisting of an x-ray tube housing assembly and an image receptor that are fixed in position to produce a horizontal x-ray beam.

(34) "Lead equivalent" means the thickness of lead affording the same attenuation, under specified conditions, as the material in question.

(35) "Leakage radiation" means all radiation coming from within the x-ray tube housing except the useful beam.

(36) "Licensed practitioner" means an individual licensed by the state of Ohio pursuant to:

(a) Chapter 4715. of the Revised Code to practice dentistry;

(b) Chapter 4731. of the Revised Code to practice medicine or surgery or osteopathic medicine or surgery;

(c) Chapter 4731. of the Revised Code to practice podiatry;

(d) Chapter 4741. of the Revised Code to practice veterinary medicine;

(e) Chapter 4734. of the Revised Code to practice chiropractic medicine; and

(f) Chapter 4723. of the Revised Code to practice as a clinical nurse specialist within the scope of practice of his or her collaborating physician and in accordance with the stadard care arrangement.

(g) Chapter 4730. of the Revised Code to practice as a physician assistant within the scope of practice of his or her supervising physician and in accordance with the utilization plan approved by the state medical board.

(37) "Light field" means that area of the intersection of the light beam from the beam-limiting device and one of the set of planes parallel to and including the plane of the image receptor, whose perimeter is the locus of points at which the illumination is one-fourth of the maximum in the intersection.

(38) "Medical use" or "Medical purpose" means using radiation-generating equipment to irradiate human beings or animals for diagnostic, localization, or other healing arts purposes.

(39) "Milliampere (mA)" means the measurement of tube current which reflects the number of electrons flowing from the cathode to the anode of an x-ray tube during x-ray production.

(40) "Mobile radiation-generating equipment" means x-ray equipment permanently mounted on a base with wheels or castors for moving while completely assembled and is not used in a fixed location.

(41) "Patient" means an individual or animal subjected to radiation for the purposes of examination or therapy.

(42) "Portable radiation-generating equipment" means radiation-generating equipment designed to be hand-carried.

(43) "Primary protective barrier" means a barrier sufficient to attenuate the useful beam to the required radiation level.

(44) "Protective apron" means an apron made of radiation-attenuating materials used to reduce radiation exposure.

(45) "Protective barrier" means a barrier of radiation-attenuating materials used to reduce radiation exposure.

(46) "Protective glove" means a glove made of radiation-attenuating materials used to reduce radiation exposure.

(47) "Radiation expert" means an individual that meets the qualifications of:

(a) Applicable paragraphs of rule 3701:1-66-03 of the Administrative Code ;

(b) Paragraph (D) of rule 3701-83-45 of the Administrative Code for any facility providing radiation therapy services;

(c) Paragraph (C)(3) of rule 3701-83-52 of the Administrative Code for CT equipment or paragraph (F)(3) of rule 3701-83-52 of the Administrative Code for fluoroscopy at any facility providing CT or fluoroscopy services; or

(d) 21 C.F.R. 900.12(a)(3) (as published in the April 1, 2013, Code of Federal Regulations) for any facility providing mammography services.

(48) "Radiation-generating equipment (RGE)" means any manufactured product or any component of such a product or device, or any machine or system that during operation can generate or emit ionizing radiation, except those that emit ionizing radiation only from radioactive material. The system includes, minimally, an x-ray high voltage generator, an x-ray control, a tube housing assembly, a beam-limiting device, and the necessary supporting structures. "Radiation-generating equipment" does not include either of the following:

(a) Diathermy machines; or

(b) Microwave ovens including food service microwave ovens used for commercial and industrial uses, television receivers, electric lamps, and other appliances and products such as computer monitors that generate very low levels of radiation.

(49) "Radiation worker" means an individual engaged in activities registered by the department and controlled by the registrant.

(50) "Reference plane" means a plane which is displaced from and parallel to the computed tomographic plane.

(51) "Scan" means the complete process of collecting x-ray transmission data for the production of a tomogram. Data can be collected simultaneously during a single scan for the production of one or more tomograms.

(52) "Scan sequence" means a pre-selected set of two or more scans performed consecutively under pre-selected CT conditions of operation.

(53) "Scattered radiation" means radiation that, during passage through matter, has been deviated in direction.

(54) "Secondary protective barrier" means a barrier sufficient to attenuate stray ionizing radiation to a required level.

(55) "Source" means the point of origin of the useful radiation beam.

(56) "Source-to-image receptor distance (SID)" means the distance from the source to the center of the input surface of the image receptor.

(57) "Source-to-skin distance (SSD)" means the distance between the source and the skin of the patient.

(58) "Stationary radiation-generating equipment" means equipment which is installed in a fixed location.

(59) "Stray radiation" means leakage radiation or scattered radiation.

(60) "Table increment" means the amount of relative displacement of the patient with respect to the CT x-ray system between successive scans measured along the direction of such displacement.

(61) "Technique factors" means any combination of the following which determines the exposure rate: kVp, mA, time, x-ray pulses, or the product of tube current and exposure time in mAs.

(62) "Tomogram" means the depiction of the radiation attenuation properties of a section through a body.

(63) "Tomographic plane" means that geometric plane which is identified as corresponding to the output tomogram.

(64) "Tube housing assembly" means the tube housing with tube installed. It includes high voltage or filament transformers and other appropriate elements when they are contained within the tube housing.

(65) "Useful beam" means that part of the radiation which passes through the window, aperture, cone, or other collimating device of the source housing.

(66) "Visible area" means that portion of the input surface of the image receptor over which incident x-ray photons are producing a visible image.

(67) "X-ray field" means that area of the intersection of the useful beam and any one of the set of planes parallel to and including the plane of the image receptor, whose perimeter is the locus of points at which the air kerma rate is one-fourth of the maximum in the intersection.

Effective: 07/01/2014
R.C. 119.032 review dates: 03/03/2014 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 3748.04
Rule Amplifies: 3748.01 , 3748.02 , 3748.04 , 3748.05 , 3748.06 , 3748.07 , 3748.12 , 3748.13 , 3748.14 , 3748.15 , 3748.17 , 3748.18 , 3748.19 , 3748.20 , 3748.22 , 3748.99
Prior Effective Dates: 2/15/2001, 6/1/06, 6/20/10

3701:1-66-02 General administration requirements for handlers of radiation-generating equipment.

As used in this rule, "radiation-generating equipment" means radiation-generating equipment, other than therapeutic radiation-generating equipment, used for dental, veterinary, or medical purpose. Handlers of this equipment shall comply with the following:

(A) The director may, upon application thereof or upon his or her own initiative, grant a variance to the requirements of rules in this chapter as he or she determines is authorized by law, provided that the registrant shows to the satisfaction of the director that there is good cause for the variance, and that the variance will not result in any undue hazard or effect on the public health and safety or environment. The terms, conditions, and expiration of the variance shall be set forth in writing by the director. Failure to comply with the terms of the variance may result in immediate revocation of the variance.

(B) No individual shall be exposed to the useful beam except a patient for dental or medical radiologic procedures and unless such exposure has been authorized by a licensed practitioner within his or her scope of practice. This provision specifically prohibits deliberate exposure for the following purposes:

(1) Exposure of an individual for training, demonstration, or other non-medical purpose; and

(2) Exposure of an individual for the purpose of self-referred screening except as authorized by the department in accordance with paragraph (C) of this rule.

(C) Any person proposing to conduct a self-referral screening program using radiation-generating equipment shall not initiate such a program without prior approval by the department. When requesting such approval, that person shall submit information on a form prescribed by the department. If any information submitted to the department becomes invalid or not current, the department shall be immediately notified in writing.

(D) The department may use interview or observation to determine that the handler assures:

(1) Every individual who performs radiologic procedures on human beings holds the appropriate radiologic license as required by Chapter 3701-72 of the Administrative Code and Chapter 4715. of the Revised Code; and

(2) Every individual who is licensed to perform radiologic procedures is adequately instructed in the registrant's safe operating procedures and can demonstrate competency in the safe use of the equipment.

(E) Any radiation-generating equipment that does not meet the provisions set forth in this rule or any other applicable equipment requirements of Chapter 3701:1-66 of the Administrative Code shall not be used to irradiate patients unless the director or a radiation expert determines that the non-compliance will not pose a radiation risk and arrangements have been made to promptly correct the non-compliance.

(F) Radiation-generating equipment shall bear a warning label on the control panel, by the exposure switch or by the main power switch which cautions individuals that radiation is produced when it is energized.

(G) Unless otherwise specified in this paragraph, radiation-generating equipment shall meet the following standards:

(1) On battery-powered x-ray generators, visual means shall be provided on the control panel to indicate whether the battery is in a state of charge adequate for proper operation.

(2) The leakage radiation from the diagnostic source assembly measured at a distance of one meter in any direction from the source shall not exceed 0.88 milligray air kerma (one hundred milliroentgen exposure) in one hour when the x-ray tube is operated at its leakage technique factors. Compliance shall be determined by measurements averaged over an area of one hundred square centimeters with no linear dimension greater than twenty centimeters;

(3) Except for mammographic radiation-generating equipment, the half-value layer (HVL) of the useful beam for a given x-ray tube potential shall not be less than the values shown in table 1. If it is necessary to determine such HVL at an x-ray tube potential which is not listed in table 1, linear interpolation or extrapolation may be made.

Table 1.

X-Ray Tube Voltage (kilovolt peak)

Minimum HVL (millimeter of aluminum)

Designed

Measured

Specified

I - Other

II - Other

Operating Range

Operating

Dental

X-Ray

X-Ray

  

Potential

Systems1

Systems2

Systems3

Below 51

30

1.5

0.3

0.3

  

40

1.5

0.4

0.4

  

50

1.5

0.5

0.5

51 to 70

51

1.5

1.2

1.3

  

60

1.5

1.3

1.5

  

70

1.5

1.5

1.8

Above 70

71

2.1

2.1

2.5

  

80

2.3

2.3

2.9

  

90

2.5

2.5

3.2

  

100

2.7

2.7

3.6

  

110

3.0

3.0

3.9

  

120

3.2

3.2

4.3

  

130

3.5

3.5

4.7

  

140

3.8

3.8

5.0

  

150

4.1

4.1

5.4

1 Dental x-ray systems designed for use with intraoral image receptors and manufactured after December 1, 1980.

2 Dental x-ray systems designed for use with intraoral image receptors and manufactured before or on December 1, 1980, and all other x-ray systems subject to this section and manufactured before June 10, 2006.

3 All x-ray systems, except dental x-ray systems designed for use with intraoral image receptors, subject to this section and manufactured on or after June 10, 2006.

(a) For capacitor energy storage equipment, compliance with the requirements of this paragraph shall be determined with the system fully charged and a setting of ten milliampere-seconds (mAs) for each exposure; and

(b) The required minimal HVL of the useful beam shall include the filtration contributed by all materials which are permanently between the source and the patient.

(4) For x-ray systems which have variable kilovolt peak (kVp) setting and variable filtration for the useful beam, a device shall link the kVp selector with the filter and shall prevent an exposure unless the minimum amount of filtration necessary to produce the HVL required by paragraph (G)(3) of this rule is in the useful beam for the given kVp which has been selected.

(5) Where two or more x-ray tubes are controlled by one exposure switch, the tube that has been selected shall be clearly indicated prior to initiation of the exposure. This indication shall be both on the x-ray control panel and for dental equipment at or near the selected tube housing assembly.

(6) The x-ray tube housing assembly supports shall be adjusted such that the tube housing assembly will remain stable during an exposure unless tube housing movement is a designed function of the radiation-generating equipment.

(7) The technique factors to be used during an exposure shall be indicated before the exposure begins. If automatic exposure controls are used, the technique factors which are set prior to the exposure shall be indicated. This requirement may be met by permanent markings on equipment having fixed technique factors. Indication of technique factors shall be visible from the operator's position except in the case of spot films taken during fluoroscopy procedures or dental intraoral or panoral films.

(8) All position locking, holding, and centering devices on radiation-generating equipment components shall function as designed by the manufacturer.

(H) In addition to other applicable radiation safety rules in Chapter 3701:1-66 of the Administrative Code, handlers of radiation-generating equipment shall meet the following radiation safety requirements:

(1) Software-based technique selections, a chart, or a combination of the two shall be provided in the vicinity of the radiation-generating equipment's control panel which specifies, for examinations performed with that system, the following information:

(a) Patient's body part, radiographic projection, anatomical size or age , and the technique factors to be utilized for each;

(b) Type and size of the image receptor to be used;

(c) Type and focal distance of the grid to be used, if any; and

(d) Source-to-image receptor distance (SID) to be used, except for fluoroscopy, and dental intraoral or panoral radiography.

(2) Gonadal 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 radiologic procedures in which the gonads are in the useful beam, except for cases in which this would interfere with the radiologic procedure.

(3) 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 radiologic procedure. Other than the patient being examined:

(a) All individuals shall be positioned such that no part of the body shall be struck by the useful beam unless protected by not less than 0.5 millimeter 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 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 two meters ( 6.5 feet) from both the tube head and the nearest edge of the image receptor.

(4) If performing a radiologic procedure requires auxiliary support for holding a patient or an image receptor, the handler shall ensure the following:

(a) Mechanical holding devices shall be used when the procedure permits their use in lieu of having an individual hold the patient or image receptor;

(b) Written safe operating procedures required by paragraph (B)(4) of rule 3701:1-66-04 of the Administrative Code shall indicate the requirements for selecting someone to hold a patient or image receptor, and the procedure that shall be followed. All individuals holding a patient or image receptor during radiation exposures shall be at least eighteen years of age; and

(c) No individual shall routinely hold patients or image receptors during radiologic procedures.

(5) The facility shall have protective aprons and gloves available in sufficient numbers to provide protection to anyone who is involved with x-ray operations.

(6) Any radiation worker participating in fluoroscopic, veterinary, or mobile or portable x-ray procedures shall be required to wear an individual monitoring device unless the registrant demonstrates it is unlikely the radiation worker will receive in excess of the doses specified in paragraphs (B)(1)(a) to (B)(1)(c) of rule 3701:1-38-14 of the Administrative Code.

(7) The entrance air kerma resulting from the technique used for the specified average adult patient for routine diagnostic radiography shall not exceed the values listed in table 2. The entrance air kerma resulting from the technique used for routine intraoral bitewing exams shall not exceed the values listed in table 3. All values of entrance air kerma are specified as free-in-air, without backscatter. The corresponding entrance exposure in milliroentgens is listed in parentheses. Linear extrapolation or interpolation shall be used for an x-ray tube potential (kVp) not listed in table 3.

Table 2.

     

Radiographic technique

Adult thickness cm

Entrance air kerma mGy (mR)

Chest (pa), (non-grid)

23

0.26(30)

Chest (pa), (grid)

23

0.35(40)

Abdomen (kub)

23

5.26(600)

Lumbo-sacral spine (ap)

23

6.13(700)

Thoracic spine (ap)

23

3.50(400)

Full spine

23

3.50(400)

Cervical spine (ap)

13

1.75(200)

Skull (lateral)

15

1.75(200)

Foot (dp)

8

0.88(100)

Table 3.

     

Tube Voltage kVp

D-Speed Film mGy (mR)

F-Speed Film Digital Receptor mGy (mR)

50

4.82(550)

2.45(280)

55

4.56(520)

2.19(250)

60

4.12(470)

1.93(220)

65

3.64(415)

1.66(190)

70

3.15(360)

1.45(165)

75

2.72(310)

1.23(140)

80

2.28(260)

1.01(115)

85

2.06(235)

0.92(105)

90

1.84(210)

0.83(95)

95

1.71(195)

0.74(85)

100

1.58(180)

0.61(70)

(8) Procedures and auxiliary equipment designed to minimize patient and radiation worker exposure shall be utilized as follows:

(a) For facilities utilizing radiographic film, 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 radiography, with the exception of veterinary and specimen radiography;

(b) Radiation-generating equipment subject to rule 3701:1-66-05 of the Administrative Code shall not be utilized in procedures where the source-to-skin distance (SSD) is less than thirty centimeters, except for veterinary x-ray systems;

(c) If grids are used between the patient and the image receptor to decrease scatter to the image receptor and improve contrast, the grid shall be:

(i) Properly aligned, with the x-ray tube side facing the correct direction, and the grid centered to the central ray; and

(ii) The proper focal distance for the SID being used.

(9) Except for radiation-generating equipment used for veterinary, portable, dental panoral, dental intraoral, lithotripsy, or bone densitometry applications, the operator shall stand behind a protective barrier, either in a separate room, in a protected booth, or behind a shield.

(10) Except for dental intraoral, each radiographic image shall contain permanent identification of the following:

(a) Patient identification;

(b) Type of examination;

(c) Date of examination;

(d) Operator's name(s); and

(e) Radiation-generating equipment used.

(I) In addition to other applicable structural shielding requirements in Chapter 3701:1-66 of the Administrative Code, handlers of radiation-generating equipment shall comply with the following:

(1) For all units, except those used for bone densitometry, mammography, dental panoral or dental intraoral radiography:

(a) Handlers shall utilize a radiation expert to prepare a shielding design to include specifications for all structural radiation barriers:

(i) Prior to new construction, renovation .

(ii) For new radiation-generating equipment installations which might cause a significant increase in radiation hazard.

(b) Prior to patient use, handlers shall utilize a radiation expert to determine compliance with exposure levels in accordance with rule 3701:1-38-14 of the Administrative Code by performing:

(i) An area radiation survey for new installation of radiation-generating equipment .

(ii) An area radiation survey for reinstallation or after any change in structural shielding unless, in the documented determination of a radiation expert, the reinstallation or change will not cause a significant increase in radiation hazard.

(iii) A re-calculation of an area radiation survey results after an increase in the clinical workload that exceeds the assumptions used in the existing radiation survey.

(c) Notwithstanding paragraph (I)(1)(b)(ii) of this rule, reinstallations of radiation-generating equipment of the same operating parameters, location and geometry does not require another survey as long as the previous documented area radiation survey is maintained and available for inspection.

(d) The individual responsible for radiation protection shall obtain a written report of the shielding design and the area radiation survey . A copy of the report shall be made available to the department's inspector upon request.

(2) Handlers shall assure that no individual operates or permits the operation of radiation-generating equipment unless structural shielding and protective barriers are used such that no person other than the patient being examined shall receive a total effective dose equivalent in excess of the limits prescribed in rules 3701:1-38-12 and 3701:1-38-13 of the Administrative Code.

(3) Handlers shall provide a protective barrier either in a separate room, in a protected booth, or use a mobile barrier that will intercept the useful beam and any direct scattered radiation.

(4) Handlers shall provide a window of lead equivalency affording protection equal to that required by the adjacent barrier, a television monitoring system, or a mirror system large enough and so placed that the operator can see the patient without having to leave the protected area during exposure.

(5) Handlers of stationary CT and mobile CT radiation-generating equipment used in one place shall assure the facility design provides for two-way aural communications between the patient and operator.

(J) In addition to all applicable rules in Chapter 3701:1-66 of the Administrative Code, handlers of radiation-generating equipment shall meet the following quality assurance requirements:

(1) X-ray systems and associated components used on humans and certified pursuant to 21 C.F.R. part 1020 (as published in the April 1, 2013 Code of Federal Regulations) shall be maintained in compliance with applicable requirements of that standard, and handlers shall maintain documentation of compliance between inspections.

(2) The handler shall maintain the following information for all radiation-generating equipment for inspection by the department:

(a) User's manuals;

(b) Records of surveys, calibrations, maintenance, and modifications performed on the radiation-generating equipment which shall be maintained between inspections; and

(c) A copy of all correspondence with the department regarding each piece of radiation-generating equipment.

(3) Unless otherwise specified in another rule in this chapter, each installation using a piece of radiation-generating equipment and using analog image receptors, such as radiographic film, shall have available suitable equipment for handling and processing radiographic images in accordance with the following provisions:

(a) For manually processing film:

(i) Developer and fixer tanks shall be constructed of mechanically rigid, corrosion resistant material; and

(ii) The temperature of solutions in the tanks shall be maintained within the range of 15.6 to 26.7 degrees celsius (sixty to eighty degrees Fahrenheit). Film shall be developed in accordance with the time-temperature relationships recommended by the film manufacturer, or, in absence of such recommendations, with the following time-temperature chart:

Time-Temperature Chart

Thermometer Reading (Degrees)

Minimum Developing Time (Minutes)

°C

°F

  

26.7

80

2

26.1

79

2

25.6

78

2.5

25.0

77

2.5

24.4

76

3

23.9

75

3

23.3

74

3.5

22.8

73

3.2

22.2

72

4

21.7

71

4

21.1

70

4.5

20.6

69

4.5

20.0

68

5

19.4

67

5.5

18.9

66

5.5

18.3

65

6

17.8

64

6.5

17.2

63

7

16.7

62

8

16.1

61

8.5

15.6

60

9.5

(iii) Devices shall be utilized which will indicate the actual temperature of the developer and signal the passage of a preset time appropriate to the developing time required;

(b) For automatic processors and other closed processing systems:

(i) Films shall be developed in accordance with the time-temperature relationships recommended by the film manufacturer; in the absence of such recommendations, the film shall be developed using the following chart:

Developer Temperature (Degrees)

Minimum Immersion Timea/ (Seconds)

°C

°F

Seconds

35.5

96

19

35

95

20

34.5

94

21

34

93

22

33.5

92

23

33

91

24

32

90

25

31.5

89

26

31

88

27

30.5

87

28

30

86

29

29.5

85

30

a/Immersion time only, no crossover time included.

(ii) The specified developer temperature and immersion time shall be posted in the darkroom, on the automatic processor, or be readily available to the operator; and

(c) Processing deviations from the requirements listed above shall be documented by the handler in such manner that the requirements of this rule are shown to be met or exceeded, such as with extended processing, and special rapid chemistry.

(d) Film processing solutions shall be prepared in accordance with the directions given by the film manufacturer, and shall be maintained in strength by replenishment or renewal so that full development is accomplished within the time specified by the manufacturer.

(4) Pass boxes, if provided, shall be so constructed as to exclude light from entering the darkroom when cassettes are placed in or removed from the boxes, and shall incorporate adequate shielding from stray radiation to prevent exposure of undeveloped film.

(5) The darkroom shall be light tight and use proper safelighting such that any film which would produce an optical density between one and two when exposed in a cassette to x-radiation and then processed shall:

(a) Not suffer an increase in optical density greater than 0.1 when exposed in the darkroom for two minutes with all safelights on; and

(b) Not suffer an increase in optical density greater than 0.05 for mammography when exposed to the darkroom for two minutes with all safelights on.

(6) Darkrooms typically used by more than one individual shall provide a method to prevent accidental entry of light while undeveloped films are being handled or processed.

(7) Film shall be stored in a cool, dry place and shall be protected from exposure to stray radiation. Film in open packages shall be stored in a light-tight container. If used, daylight film handling boxes shall preclude fogging of the film.

(8) Expired x-ray film shall not be used for diagnostic radiographs.

(9) Cassettes, intensifying screens, and computed radiographic imaging plates shall be:

(a) Cleaned according to manufacturer's specifications or an alternate frequency approved and documented by a radiation expert in the quality assurance program;

(b) Inspected for damage; and

(c) Replaced as necessary to assure radiographs of good diagnostic quality.

(10) For those registrants employing computed radiography imaging systems, the following shall apply:

(a) If the computed radiography reader is located in the same room as the radiation-generating equipment and it is not behind a protective barrier, x-ray exposures shall not be made during processing;

(b) Computed radiography plates shall be processed as soon as possible after exposure, not to exceed eight hours under any circumstances; and

(c) Computed radiography plates shall be adequately shielded from stray radiation. Registrants shall develop a process that will ensure that computed radiography plates are used frequently enough or erased so as to produce diagnostic quality images.

Effective: 07/01/2014
R.C. 119.032 review dates: 03/03/2014 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 3748.04
Rule Amplifies: 3748.01 , 3748.02 , 3748.04 , 3748.05 , 3748.06 , 3748.07 , 3748.12 , 3748.13 , 3748.14 , 3748.15 , 3748.17 , 3748.18 , 3748.19 , 3748.20 , 3748.22 , 3748.99
Prior Effective Dates: 2/15/2001, 7/31/06, 6/20/10

3701:1-66-03 Certification of radiation experts.

(A) An individual may seek certification from the Ohio department of health as a radiation expert in one or more of the following categories of radiation-generating equipment:

(1) Therapeutic;

(2) Diagnostic other than mammography; or

(3) Mammography.

.

(B) An individual seeking certification or renewal of certification as a radiation expert shall apply to the department on a form prescribed and provided by the director. The application shall contain at least the following:

(1) Name and address of the applicant;

(2) Category or categories for which application is being made;

(3) A non-refundable check, electronic payment, or money order payable to "treasurer, state of Ohio" for the appropriate certification fee in the amount of one hundred dollars for each category specified in paragraph (A) of this rule;

(4) Evidence that the applicant has appropriate training and qualifications to perform oversight and maintenance of quality assurance programs required by division (A) of section 3748.13 of the Revised Code for the category for which the applicant is applying as set forth in paragraphs (C) to (E) of this rule; and

(5) As applicable, a certified copy of any felony conviction.

(C) An applicant for radiation expert certification for the category of therapeutic radiation-generating equipment shall have at least one of the following:

(1) Certification by the "American Board of Radiology" in one of the following:

(a) Therapeutic radiological physics;

(b) Roentgen-ray and gamma-ray physics;

(c) X-ray and radium physics;

(d) Radiological physics; or

(2) Certification by the "American Board of Medical Physics"; or

(3) Certification by the "Canadian College of Medical Physics"; or

(4) A master's or doctor's degree in physics, medical physics, other physical science, engineering, or applied mathematics from an accredited college or university; and

(a) Have completed one year of full time training in medical physics and an additional year of full time work experience under the supervision of a board certified medical physicist who meets the qualifications of paragraph (C)(1), (C)(2) or (C)(3) of this rule at a medical institution. This training and work experience shall be conducted in clinical radiation facilities that provide high-energy external beam radiation therapy with photons and electrons with energies greater than or equal to one MV or one MeV;

(b) The individual shall have performed the applicable tasks listed in rules 3701:1-67-03 to 3701:1-67-06 of the Administrative Code under the supervision of a qualified medical physicist during the year of work experience; and

(c) Obtain certification pursuant to paragraph (C)(1), (C)(2), or (C)(3) of this rule within five years after the effective date of this rule.

(D) An applicant for radiation expert certification for the category of diagnostic radiation-generating equipment shall have at least one of the following:

(1) Certification by the "American Board of Radiology" in radiological physics or diagnostic radiological physics;

(2) Certification by the "American Board of Medical Physics" in medical physics with a specialty in diagnostic imaging physics;

(3) A master's degree or doctorate from an accredited college or university in physics, biophysics, medical physics, radiological physics or health physics, or mechanical, electrical, or nuclear engineering, or applied mathematics with a minor in physics; and three years of experience within the five years prior to the date of application under the direct supervision of a certified individual as provided in paragraph (D)(1) or (D)(2) of this rule or a radiation expert certified in diagnostic radiation-generating equipment in developing and performing oversight of quality assurance for diagnostic radiation-generating equipment.

(E) An applicant for radiation expert certification for the category of mammography radiation-generating equipment shall have at least one of the following:

(1) Certification by the "American Board of Radiology" in radiological physics or diagnostic radiological physics;

(2) Certification by the "American Board of Medical Physics" with a specialty in diagnostic imaging physics;

(3) A master's degree or higher in a physical science from an accredited college or university, and at least the following:

(a) Twenty semester hours or thirty quarter hours of graduate or undergraduate level physics;

(b) Twenty contact hours of documented specialized training in conducting surveys of mammography facilities; and

(c) Have the experience of conducting surveys of at least ten mammography x-ray units under the direct supervision of a certified individual as provided in paragraph (E)(1) or (E)(2) of this rule or a radiation expert certified in mammography.

(F) The department may return an incomplete application for certification or certification renewal. The applicant shall respond to the director's request for additional information within twenty days of receiving the request.

(G) A certificate issued under this rule shall expire two years after the date of its issuance and may be renewed in accordance with the standard renewal procedures established in Chapter 4745. of the Revised Code. On or before thirty days prior to the expiration of a certificate, the department shall mail a notice and application for renewal to the certificate holder. The certificate holder shall complete the application and return it to the treasurer of state with the certification renewal fee in the form of a check, electronic payment, or money order payable to "treasurer, state of Ohio," in the amount of one hundred dollars for each category specified in paragraph (A) of this rule.

(H) Within sixty days of receiving a complete application for certification or certification renewal, the director shall, pursuant to Chapter 119. of the Revised Code, either issue a certification or certification renewal or, deny the application, or the director may at any time suspend or revoke a certification if the applicant or certificate holder:

(1) Does not meet the applicable requirements specified in this rule for attaining and maintaining certification as a radiation expert;

(2) Previously had a radiation expert certificate revoked or currently has a certificate suspended pursuant to this paragraph;

(3) Has provided services for a category of radiation-generating equipment that is not identified on his or her radiation expert certificate;

(4) Misrepresents the types of quality assurance programs for which he or she is certified to provide services or otherwise has provided services for which he or she was not certified to provide;

(5) Misrepresents information on the application or has misrepresented an audit report filed with the director pursuant to rule 3701:1-66-04 of the Administrative Code;

(6) Has submitted an audit report to the director that the radiation expert did not personally perform or supervise the individual assisting in the performance of quality assurance tests;

(7) Does not respond to the request for additional information within twenty days of receiving the request as provided in paragraph (F) of this rule;

(8) Does not comply with paragraphs (C) to (E) of this rule, as applicable, in which case the director shall deny the application only for that certification for the affected category of radiation-generating equipment;

(9) Fails to pay any fee assessed in accordance with this rule;

(10) Fails to comply with Chapter 3748. of the Revised Code or the rules adopted thereunder; or

(11) Has any felony conviction that indicates that the individual may pose a risk to public health and safety.

(I) An individual certified as a radiation expert shall immediately notify the director in writing of the following:

(1) If the radiation expert is no longer practicing as a CRE;

(2) A change in the name, address, or phone number of the radiation expert;

(3) A change to the listing of hospitals in which the radiation expert is designated as CRE; and

(4) Any other change that would render an application or certificate no longer accurate.

(J) The individual certified as a radiation expert shall provide the director upon request with any other information regarding the requirements set forth in this rule.

(K) Each certified radiation expert shall obtain continuing education for each certification period in accordance with the following:

(1) Certified radiation experts having certification in one category specified in paragraph (A) of this rule shall obtain fifteen hours of continuing education pertaining to the category of certification;

(2) Certified radiation experts having certification in two categories specified in paragraph (A) of this rule shall obtain twenty hours of continuing education pertaining to one or both categories of certification; and

(3) Certified radiation experts having certification in three categories specified in paragraph (A) of this rule shall obtain twenty-five hours of continuing education pertaining to one or more categories of certification.

(L) Continuing education programs are subject to approval by the director.

(M) A certified radiation expert who provides instruction in a continuing education program related to radiation safety is eligible to claim up to five hours of instruction time for the required continuing education for his or her certification period.

(N) In accordance with section 3748.12 of the Revised Code, a certification renewal fee that remains unpaid on the ninety-first day after the original invoice date shall be assessed an additional amount equal to ten per cent of the original fee.

(O) Application for the same certification category may be denied after the expiration date of the previous certification for individuals who do not renew their certification according to this rule, and who do not provide written notification that they no longer require or want certification in that category.

(P) If an individual allows his or her certification to expire and the individual applies for the same certification within one year following the expiration of that certification, the individual shall submit evidence of completing the continuing education requirements provided in this rule.

Effective: 05/20/2013
R.C. 119.032 review dates: 03/05/2013 and 05/15/2018
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: 6/1/1998, 9/7/01, 12/1/03, 2/10/06, 8/1/11

3701:1-66-04 Quality assurance program.

(A) Each registrant shall develop, implement and maintain a written quality assurance program. For purposes of this chapter and Chapter 3701:1-67 of the Administrative Code, quality assurance program means a program providing for verification by written procedures such as testing, auditing, and inspection to ensure that deficiencies, deviations, defective equipment, or unsafe practices, or a combination thereof, relating to the use, disposal, management, or manufacture of radiation devices are identified, promptly corrected, and reported to the appropriate regulatory authorities.

(B) The written quality assurance program of each registrant shall address and include records to verify implementation of at least the following:

(1) The intervals of and procedures for the evaluation of all radiation-generating equipment to ensure compliance with all applicable rules of this chapter;

(2) Procedures for maintaining compliance with occupational and public exposure limits;

(3) Procedures for notifying the director when individuals are occupationally over-exposed to radiation, pursuant to Chapter 3701:1-38 of the Administrative Code;

(4) Safe operating procedures for each type of radiation-generating equipment to be handled;

(5) Training of operators of each type of radiation-generating equipment to be handled in order to assure competency in the operating procedures;

(6) In addition to the requirements of paragraph (B)(1) of rule 3701:1-38-10 of the Administrative Code, individuals likely to receive an annual occupational dose in excess of one millisievert (one hundred millirem) shall be instructed in the following:

(a) The location, boundaries, and purpose of restricted areas;

(b) A description of the radiation-generating equipment and its location;

(7) The quality control tests to be performed, the frequency of the quality control tests to be performed and the personnel responsible for the performance of the quality control tests as applicable to the radiation-generating equipment type and use;

(8) Policies regarding the state licensure or certification of each person operating radiation-generating equipment as required by Chapters 4773. and 4715. of the Revised Code;

(9) The dissemination of quality assurance policies and a method to educate affected workers on those policies and any policy changes;

(10) Radiation workers' role and responsibility for following and supporting the quality assurance program;

(11) Policies regarding personnel protection, including time, distance, and shielding;

(12) Policies regarding occupational exposure of pregnant workers;

(13) Policies regarding radiation safety training for ancillary personnel;

(14) Policies regarding training for personnel with quality control responsibilities; and

(15) Policies regarding patient protection, including screening for pregnancy, exposure of pregnant patients, patient shielding, patient education, patient identity verification .

(C) In addition to the requirements of paragraphs (A) and (B) of this rule the quality assurance program of hospital registrants shall comply with the following:

(1) A certified radiation expert shall conduct oversight and maintenance of quality assurance programs for hospital registrants, by:

(a) Auditing the quality assurance program on an annual basis;

(b) Performing quarterly reviews;

(c) Completing and submitting all required information with the annual audit form in accordance with paragraph (C)(6) of this rule, and;

(d) Serving on the quality assurance committee.

(2) Employees working in the radiation areas shall be made aware of the identity, scope of authority, and a method for contacting the certified radiation expert and the individual responsible for radiation protection. This information, or a specific location where this information may be obtained, shall be conspicuously posted in each area where radiation-generating equipment is used.

(3) Each hospital registrant shall establish a quality assurance committee for the management of the quality assurance program. The members of the quality assurance committee shall be approved by an executive administrator. Committee meetings may be attended by the members or similarly qualified, designated alternates. The quality assurance committee shall include at least the following members:

(a) A member of the hospital's executive administration;

(b) The individual responsible for radiation protection;

(c) A radiologist or radiation oncologist;

(d) A certified radiation expert representing each of the following as applicable in each hospital;

(i) Radiation therapy services,

(ii) Mammography, or

(iii) Diagnostic radiography other than mammography; and

(e) A management representative of each department of the hospital which has responsibilities involving the handling of radiation-generating equipment.

(4) The quality assurance committee shall meet as often as is deemed necessary to carry out its duties, but at least on a quarterly basis. To establish a quorum at least one-half of the committee's membership must be present either in person or by telecommunication means, and must include the individual responsible for radiation protection for the hospital, and the member of the executive administration of the hospital. In addition, each member must attend at least one quarterly meeting each calendar year. A record of each meeting shall be maintained and distributed to each member which shall include the following:

(a) The date of the meeting;

(b) An indication of members present ; and

(c) A summary of meeting including any recommended actions and ALARA reviews.

(5) Each quarter, the certified radiation expert shall submit, to each appointed quality assurance committee member, a review of the quality assurance plan which shall contain, as applicable:

(a) Radiation safety policy revisions proposed by the certified radiation expert;

(b) A review of occupational exposure records by the certified radiation expert;

(c) Radiation safety incidents;

(d) Radiation-generating equipment performance evaluation summaries to include a description of any issues found; and

(e) Any corrective actions recommended by the certified radiation expert necessary to comply with the requirements of this chapter.

(6) The quality assurance program shall be audited at least annually as defined in paragraph (A)( 18) of rule 3701:1-38-01 of the Administrative Code by a certified radiation expert. The certified radiation expert shall develop a written report of the audit findings on forms prescribed by the director and submit the report to the quality assurance committee within thirty days of completing the audit. The quality assurance committee shall review the audit report and implement any corrective actions determined to be necessary. The certified radiation expert shall file the audit report with the director within ninety days of completing the audit. Every audit report shall include a determination of whether the quality assurance program properly addresses the matters described in this rule and whether it is being carried out in accordance with the written quality assurance program, and any corrective actions to be taken to comply with the requirements of this chapter. The audit report shall become a part of the inspection record.

(D) At the time of the state inspection the following items shall be readily available for review:

(1) A complete listing of the inventory of radiation-generating equipment, including the location and description of each unit;

(2) The written quality assurance program as required by this rule shall be maintained in the form of a readily available manual or manuals, either in hard copy printed format or electronic format;

(3) Data and test results of the evaluation of each unit of radiation-generating equipment and its shielding and surroundings;

(4) Maintenance logs and incident reports for each radiation-generating equipment system;

(5) Current copies of department's licensure verification web page for each individual who is required to possess a license at the facility; and

(6) Instrumentation used to perform area radiation surveys, calibrations and evaluations, as appropriate for each type of radiation-generating equipment, including at least biennial calibration certificates or cross-calibration documentation done within the biennium.

Effective: 02/01/2014
R.C. 119.032 review dates: 10/09/2013 and 02/01/2019
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: 6/1/1998, 12/1/03, 12/22/08

3701:1-66-05 General purpose radiographic equipment.

As used in this rule, "radiographic equipment" means radiation-generating equipment that is operated for medical use. The requirements of this rule do not apply to radiation-generating equipment used for dental intraoral or panoral, mammography, bone densitometry, computed tomography, fluoroscopy or spot film imaging, and radiation therapy simulators. In addition to other applicable rules contained in Chapters 3701:1-38 and 3701:1-66 of the Administrative Code, handlers of radiographic equipment shall comply with the following:

(A) General purpose radiographic equipment shall meet the following equipment standards:

(1) A means shall be provided for limiting the x-ray beam to the image receptor and area of clinical interest.

(2) For radiographic equipment having a variable x-ray field limitation device, the limitation device shall have means for independent stepless adjustment of both the length and width of the x-ray field.

(3) For radiographic equipment that employs a light field for visually defining the perimeter of the x-ray field, the light source shall be functional and the total misalignment of the edges of the visually defined field with the respective edges of the x-ray field along either the length or width of the visually defined field shall not exceed two per cent of the source-to-image distance (SID).

(4) In addition to the requirements of paragraphs (A)(1), (A)(2) and (A)(3) of this rule stationary radiographic equipment having a variable x-ray field limitation device shall have:

(a) A means provided to indicate when the axis of the x-ray beam is perpendicular to the plane of the image receptor;

(b) A means provided to align the center of the x-ray field with respect to the center of the image receptor to within two per cent of the SID, when the x-ray beam is perpendicular to the plane of the image receptor;

(c) A means to indicate the SID to within two per cent. If it is a fixed SID, the distance shall be indicated with a permanent marking;

(d) The beam limiting device indicate numerically the field size in the plane of the image receptor to which it is adjusted and be accurate within two per cent of the SID; and

(e) Compliance measurements made to discrete SID's and image receptor dimensions in common clinical use, or at any other specific dimensions at which the beam-limiting device or its associated diagnostic x-ray system is uniquely designed to operate.

(5) Radiographic equipment designed with only one image receptor size at a fixed SID shall have:

(a) A means to limit the field at the plane of the image receptor to dimensions no greater than those of the image receptor, and to align the center of the x-ray field with the center of the image receptor within two per cent of the SID; or

(b) A means to align the field such that the x-ray field at the plane of the image receptor shall not extend beyond any edge of the image receptor.

(6) Radiographic equipment designed with multiple removable or selectable fixed aperatures shall have:

(a) A means to limit the x-ray field in the plane of the receptor so that such field does not exceed each dimension of the image receptor by more than two per cent of the SID when the axis of the x-ray beam is perpendicular to the plane of the image receptor;

(b) A means to align the center of the x-ray field with the center of the image receptor to within two per cent of the SID or for equipment uniquely designed where the beam axis is intended to be offset from the center of the image receptor, the x-ray field at the plane of the image receptor shall not extend beyond the image receptor; and

(c) Paragraphs(A)(6)(a) and (A)(6)(b) of this rule may be met with either:

(i) An assortment of removable, fixed-aperture, beam limiting devices sufficient to meet the requirement for each combination of image receptor size and SID for which the unit is designed with each such device having clear and permanent markings to indicate the image receptor size and SID for which it is designed; or

(ii) A beam-limiting device having multiple fixed apertures sufficient to meet the requirement for each combination of image receptor size and SID for which the unit is designed. Permanent, clearly legible markings shall indicate the image receptor size and SID for which each aperture is designed and shall indicate which aperture is in position for use.

(7) If a positive beam limitation, (PBL) device is used, it shall meet the following additional requirements:

(a) The PBL shall prevent the production of x-rays when any of the following conditions are met:

(i) Either the length or width of the x-ray field in the plane of the image receptor differs from the corresponding image receptor dimensions by more than three per cent of the SID, except as permitted by paragraph (A)(7)(c) of this rule;

(ii) The sum of the length and width differences as stated in paragraph (A)(7)(a)(i) of this rule without regard to sign exceeds four per cent of the SID; or

(iii) The beam-limiting device is at an SID for which PBL is not designed for sizing;

(b) Compliance with paragraph (A)(7)(a) of this rule shall be determined:

(i) When the equipment indicates that the beam axis is perpendicular to the plane of the image receptor; and

(ii) No sooner than five seconds after insertion of the image receptor;

(c) The PBL system shall be capable of operation, at the discretion of the operator, such that the size of the field may be made smaller than the size of the image receptor through stepless adjustment of the field size. The minimum field size at a SID of one hundred centimeters shall be equal to or less than five centimeters by five centimeters;

(d) The PBL system shall be designed such that if a change in image receptor does not cause an automatic return to PBL function as described in paragraph (A)(7)(a) of this rule, then any change of image receptor size or SID must cause an automatic return; and

(e) The PBL system shall function as described in paragraph (A)(7) of this rule whenever all the following conditions are met:

(i) The image receptor is inserted into a permanently mounted cassette holder;

(ii) The image receptor length and width are less than fifty centimeters;

(iii) The x-ray beam axis is within plus or minus three degrees of vertical in any direction and the SID is ninety to one hundred thirty centimeters inclusive; or the x-ray beam axis is within plus or minus three degrees of horizontal and the SID is ninety to two hundred five centimeters inclusive;

(iv) The x-ray beam axis is perpendicular to the plane of the image receptor to within plus or minus three degrees; and

(v) Neither tomographic nor stereoscopic radiography is being performed.

(8) A device shall be provided to terminate the exposure at a preset time interval, preset product of current and time, preset number of pulses, or preset radiation exposure to the image receptor.

(9) For radiographic equipment that provides manual exposure control, the operator shall be able to terminate the exposure at any time unless:

(a) The exposure is 0.5 second or less; or

(b) During serial radiography, means are provided to permit completion of any single exposure of the series in progress.

(10) In the case of radiographic equipment that provides automatic exposure control:

(a) The control panel shall indicate when this mode of operation is selected;

(b) The density setting and automatic exposure control detector positions that are selected prior to the exposure shall be indicated; and

(c) A visible signal shall indicate when an exposure has been terminated at the back-up limit. Manual resetting shall be required before further automatic timed exposures can be made.

(11) The x-ray control panel shall provide visual indication when x-rays are produced and an audible signal shall indicate when the exposure has terminated.

(12) The exposure control switch shall meet the following requirements:

(a) The switch shall be a "dead-man switch";

(b) It shall not be possible to initiate an exposure when the timer is set to the "zero" or "off" position if either position is provided; and

(c) The switch shall be permanently mounted in a protected area so that it cannot be operated outside the protected area except for portable, mobile, or veterinary radiographic equipment.

(B) In addition to the applicable quality assurance requirements of Chapter 3701:1-66 of the Administrative Code, handlers of radiographic equiment shall comply with the following:

(1) The kilovoltage peak (kVp) accuracy shall be within plus or minus ten per cent of the indicated value.

(2) The accuracy of the timing device shall be within plus or minus ten per cent of the indicated setting. The timing device shall be tested at a minimum of two settings within the operative range of fifty milliseconds to one thousand milliseconds.

(3) The coefficient of variation:

(a) Of the kVp reproducibility for at least four consecutive exposures shall not exceed 0.05;

(b) Of the timing device reproducibility for at least four consecutive exposures shall not exceed 0.05; and

(c) Of radiation exposure reproducibility for at least four consecutive exposures shall not exceed 0.05 for any specific combination of selected technique factors.

(4) For radiographic equipment having independent selection of x-ray tube current (mA), the average ratios of exposure to the indicated mA-seconds (mAs) product obtained at any two consecutive tube current settings shall not differ by more than ten per cent of their sum.

(5) For radiographic equipment having a combined x-ray tube current-exposure time product, or mAs selector, but not a separate tube current, or mA selector, the average ratios of exposure to the indicated milliampere-seconds product (milligray/mAs) values obtained at any two consecutive mAs selector settings shall not differ by more than ten per cent of their sum.

(6) The average exposure ratio for paragraphs (B)(4) and (B)(5) of this rule shall be expressed as follows:

|X1 - X2| < 0.10 (X1 +X2 )

Where the value of X1 and X2 are the average milligray/mAs values obtained at each of the two consecutive tube mA or mAs settings, or at two settings differing by no more than a factor of two where the mA or mAs selector provides continuous selection.

(C) In addition to the applicable radiation safety rules in Chapter 3701:1-38 and rules 3701:1-66-02 and 3701:1-66-04 of the Administrative Code, the operator of radiographic equipment shall limit the useful beam to the area of clinical interest, not to exceed the size of the image receptor by more than two per cent of the source-to-image distance.

(D) Handlers of mobile or portable radiographic equipment shall not be required to comply with the requirements of paragraph (I) of rule 3701:1-66-02 of the Administrative Code, and shall comply with the following:

(1) Mobile and portable systems which are:

(a) Used continuously for greater than one week in the same location, such as a room or suite, shall have the x-ray control permanently mounted in a protected area so that the operator is required to remain in that protected area during the entire exposure; or

(b) Used for less than one week at the same location shall be provided with either a protective barrier at least 6.5 feet high for operator protection during exposures, or means shall be provided to allow the operator to be at least six feet from the tube housing assembly during exposures and the operator shall wear a protective apron of not less than 0.25 millimeter lead equivalent when making exposures;

(2) Radiation emitted from the x-ray tube when a capacitor energy storage system is fully charged and the exposure switch, timer, or any discharge mechanism is not activated shall not exceed an air kerma of 0.26 microgray in one minute at five centimeters from any accessible surface of the diagnostic source assembly, with the beam-limiting device fully open; and

(3) A tube stand or other mechanical support shall be used so that the x-ray tube housing assembly shall not be hand-held during exposures.

(E) Handlers of stationary veterinary radiographic equipment shall not be required to comply with the requirements of paragraph (I)(4) of rule 3701:1-66-02 of the Administrative Code. However, stationary veterinary radiographic equipment shall be provided with either a 6.5 foot high protective barrier for operator protection during exposures, or shall be provided with means to allow the operator to be at least six feet from the tube housing assembly during exposures. If the operator or assistant is not behind the protective barrier, a lead apron of not less than 0.25 millimeter lead equivalent shall be worn when making exposures;

(F) Handlers of mobile or portable veterinary radiographic equipment shall not be required to comply with the requirements of paragraph (I) of rule 3701:1-66-02 of the Administrative Code. However , mobile or portable veterinary radiographic equipment shall be provided with either a 6.5 foot high protective barrier for operator protection during exposures, or shall be provided with means to allow the operator to be at least six feet from the tube housing assembly during exposures. If the operator or assistant is not behind the protective barrier, a lead apron of not less than 0.25 millimeter lead equivalent shall be worn when making exposures;

(G) Handlers of certified veterinary radiation-generating equipment specifically designed by the manufacturer to be hand-held during radiographic exposures shall not be required to comply with the requirements of paragraph (I) of rule 3701:1-66-02 of the Administrative Code. The handler shall develop and implement safe operating procedures as part of the quality assurance program specified in rule 3701:1-66-04 of the Administrative Code, which shall address and document at least the following:

(1) Hand-held radiation-generating equipment shall be used for intraoral, extremity or small animal purposes only;

(2) Examination specific source-to-image distances shall be developed and implemented to assure the useful beam is limited to the area of clinical interest or no larger than the image receptor;

(3) Operators of the hand-held radiation-generating equipment and individuals participating in the x-ray procedure shall be protected from direct scatter radiation by protective aprons of not less than 0.25 millimeter lead equivalent material;

(4) If the hand-held radiation-generating equipment is designed with a back scatter shield, the backscatter shield shall be in place during all radiographic exposures;

(5) Storage and security procedures shall be developed and implemented to assure hand-held radiation-generating equipment is secured against unauthorized use or removal when not under the control and constant surveillance of the handler;

(6) Hand-held radiation generating equipment shall not be used in hallways or waiting rooms; and

(7) Operator training shall include documented specific instruction to the x-ray operator regarding:

(a) The prohibition on placing any part of their body into the useful beam unless protected by not less than 0.5 millimeter lead equivalent material;

(b) The proper use of source-to-image distance for the examination to assure the size of the radiation beam is no larger than necessary;

(c) Ensure that all individuals required for the examination are wearing the appropriate lead equivalent aprons and no bystanders are in the vicinity;

(d) The areas of use, proper storage and security procedures for the hand-held radiation-generating equipment; and

(e) The use of the dead-man switch and software safety devices such as locks and sensors.

Replaces: 3701:1-66-05

Effective: 07/01/2014
R.C. 119.032 review dates: 02/01/2019
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 , 3748.18 , 3748.19 , 3748.20 , 3748.22 , 3748.99
Prior Effective Dates: 2/15/2001, 2/10/06, 4/1/12

3701:1-66-06 Dental radiation-generating equipment.

As used in this rule, "dental equipment" means radiation-generating equipment used for dental radiography. In addition to other applicable rules adopted pursuant to Chapter 3748. of the Revised Code and Chapter 3701:1-66 of the Administrative Code, handlers of dental equipment shall comply with the following:

(A) Dental equipment for intraoral use shall meet the following equipment standards:

(1) A means shall be provided to limit the source-to-skin distance (SSD) to not less than:

(a) Eighteen centimeters if operable above fifty kVp; or

(b) Ten centimeters if operable at fifty kVp.

(2) The x-ray field at the minimum SSD shall be containable in a circle having a diameter of no more than seven centimeters .

(3) A means shall be provided to terminate the exposure at a preset time interval, a preset product of current and time, a preset number of pulses, or a preset radiation exposure to the image receptor.

(4) The exposure control switch shall meet the following requirements:

(a) The switch shall be of the "dead-man" type.

(b) The operator shall be able to terminate the exposure at any time during an exposure of greater than one-half second. Except during panoramic radiography, termination of the exposure shall cause automatic resetting of the timer to its initial setting or to zero.

(c) It shall not be possible to make an exposure when the timer is set to "zero" or "off" position if either position is provided.

(5) The kVp accuracy shall be within plus or minus ten per cent of the indicated value.

(6) For manual exposures, the accuracy of the timing device shall be within plus or minus ten per cent of the indicated setting. The timing device shall be tested at a minimum of two settings within the operative range of fifty milliseconds to one thousand milliseconds.

(7) Visual indication shall be provided whenever x-rays are produced. Certified equipment also shall provide audible indication to the operator while x-rays are produced or on termination of the exposure.

(8) The coefficient of variation for reproducibility of kVp, timing, and radiation exposure shall not exceed 0.05 for four consecutive exposures

(B) In addition to other structural shielding requirements in rule 3701:1-66-02 of the Administrative Code, handlers of dental equipment shall comply with the following:

(1) Intraoral and panoral units shall be provided with primary barriers at all areas struck by the useful beam. Consideration may be given to the attenuation provided by the patient as a result of direct interaction with the useful beam.

(2) When intraoral or panoral units are in adjacent patient occupied rooms or areas, protective barriers shall be provided between the rooms or areas, unless safety procedures are documented and implemented to require that no patients shall be present in the adjacent rooms or areas while exposures are being made.

(3) Intraoral and panoral units shall be provided with a protective barrier for the operator or shall be so arranged that the operator is located at a minimum distance of six feet from the patient and out of the useful beam. The operator's position shall be arranged so that the operator views the patient during the entire exposure.

(4) When the operator is behind a protective barrier, a viewing system shall be provided large enough and so placed that the operator can see the patient without having to leave the protected area during exposure.

(C) In addition to the radiation safety requirements listed in rule 3701:1-66-02 of the Administrative Code, handlers of dental equipment shall not permit any individual to hold any part of the x-ray tube housing, cone, or mechanical support of the x-ray tube during exposure.

(D) Handlers of dental equipment shall comply with all applicable quality assurance requirements of rules 3701:1-66-02 and 3701:1-66-04 of the Administrative Code.

(E) Handlers of dental panoral equipment shall comply with all requirements of paragraphs (A) to (D) of this rule, except for paragraphs (A)(1) and (A)(2) of this rule, and must comply with the following:

(1) Dental panoral x-ray machines shall be certified pursuant to 21 C.F.R. part 1020 (as published in the April 1, 2012, Code of Federal Regulations).

(2) The x-ray field shall be limited to the dimensions of the slit in the image receptor holder or limited to the dimensions of the active portion of the image receptor.

(F) Except for dental equipment used for panoral use, handlers of radiographic equipment used for extraoral dental procedures shall comply with the requirements of paragraphs (A) and (B) of rule 3701:1-66-05 of the Administrative Code.

(G) Fluoroscopy without image intensification shall not be used for dental examinations. Handlers of image intensified fluoroscopic equipment shall comply with the applicable requirements of rule 3701:1-66-07 of the Administrative Code and be included in the registrant's quality assurance program as specified in rule 3701:1-66-04 of the Administrative Code.

(H) Handlers of dental cone-beam CT radiation-generating equipment , shall comply with the applicable requirements of rule 3701:1-66-10 of the Administrative Code and be included in the registrant's quality assurance program as specified in rule 3701:1-66-04 of the Administrative Code.

(I) Handlers of hand-held radiation-generating equipment used for dental procedures shall meet the requirements of paragraphs (A), (B), and (D) of this rule, and shall develop and implement safe operating procedures as part of the quality assurance program specified in rule 3701:1-66-04 of the Administrative Code, which shall address at least the following:

(1) Hand-held radiation-generating equipment shall be used for intraoral purposes only;

(2) Operators of the hand-held radiation-generating equipment shall wear a full lead apron of not less than 0.25 millimeter lead equivalent;

(3) If the hand-held radiation-generating equipment is designed with a back scatter shield, the backscatter shield shall be in place during all radiographic exposures;

(4) Storage and security procedures shall be developed and implemented to assure hand-held radiation-generating equipment is secured against unauthorized use or removal when not under the control and constant surveillance of the registrant;

(5) Operator training as required in paragraph (B)(5) of rule 3701:1-66-04 of the Administrative Code, shall include documented specific instruction to the x-ray operator regarding the prohibition on placing any part of their body into the useful beam and ensuring there are no bystanders within a radius of at least six feet from the patient being examined during exposure.

(J) Dental equipment with a nominal fixed kVp of less than fifty shall not be used to make diagnostic dental radiographs of human beings.

(K) Dental equipment used by veterinarians shall comply with all requirements of this rule except paragraphs (A)(1), (E), and (J) of this rule. Additionally, the useful beam shall be limited to the area of clinical interest.

(L) Extraoral dental equipment used by veterinarians shall follow the requirements of paragraph (F) of rule 3701:1-66-05 of the Administrative Code.

Effective: 02/01/2014
R.C. 119.032 review dates: 10/09/2013 and 02/01/2019
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, 2/1/05, 4/15/09

3701:1-66-07 Fluoroscopic radiation-generating equipment.

For the purposes of this rule, "fluoroscopic equipment" means a type of radiation-generating equipment that is used for real-time imaging of internal structures for medical purpose. In addition to other applicable rules adopted pursuant to Chapter 3748. of the Revised Code, handlers of fluoroscopic equipment shall comply with the following:

(A) Fluoroscopic equipment shall meet the following standards:

(1) Unless the United States food and drug administration (FDA) has granted a variance for the specific fluoroscopic equipment, the source-to-skin distance (SSD) shall not be less than:

(a) Thirty-eight centimeters on stationary fluoroscopic equipment unless a particular procedure application prohibits that distance, in which case the SSD shall not be less than twenty centimeters.

(b) Thirty centimeters on mobile fluoroscopic equipment unless a particular procedure prohibits that distance, in which case it shall not be less than twenty centimeters .

(c) Nineteen centimeters for c-arm type fluoroscopic equipment having a maximum source-to-image distance (SID) less than forty-five centimeters unless a particular procedure prohibits that distance, in which case it shall not be less than ten centimeters. Such systems shall be used for extremity or dental purposes only.

(2) For c-arm fluoroscopic equipment equipped with a removable spacer cone, the spacer cone shall be attached to the x-ray source during use at all times unless it interferes with the clinical procedure.

(3) The fluoroscopic imaging assembly shall be provided with a primary protective barrier which intercepts the entire cross -section of the useful beam at any SID and shall prevent further exposures when the primary barrier is not in the path of the entire x-ray beam.

(4) All fluoroscopic equipment shall provide intensified imaging. As used in this rule "intensified imaging" will include the use of digital image receptors.

(5) Fluoroscopic equipment shall meet the following field limitation specifications:

(a) For fluoroscopic equipment manufactured before June 10, 2006, the following applies:

(i) Neither the length nor the width of the x-ray field in the plane of the image receptor shall exceed that of the visible area of the image receptor by more than three per cent of the SID. The sum of the excess length and the excess width shall be no greater than four per cent of the SID.

(ii) For rectangular x-ray fields used with circular image receptors, the error in alignment shall be determined along the length and width dimensions of the x-ray field which pass through the center of the visible area of the image receptor.

(b) For fluoroscopic equipment with a circular image receptor manufactured on or after June 10, 2006, the maximum area of the x-ray field in the plane of the circular image receptor shall conform with one of the following requirements. When any linear dimension of the visible area of the image receptor measured through the center of the visible area is:

(i) Less than or equal to thirty-four centimeters in any direction, at least eighty per cent of the area of the x-ray field shall overlap the visible area of the image receptor ; or

(ii) Greater than thirty-four centimeters in any direction, the x-ray field measured along the direction of greatest misalignment with the visible area of the image receptor shall not extend beyond the edge of the visible area of the image receptor by more than two centimeters.

(c) For fluoroscopic equipment with a rectangular image receptor manufactured on or after June 10, 2006, the following applies:

(i) Neither the length nor the width of the x-ray field in the plane of the image receptor shall exceed that of the visible area of the image receptor by more than three per cent of the SID. The sum of the excess length and the excess width shall be no greater than four per cent of the SID; and

(ii) The error in alignment shall be determined along the length and width dimensions of the x-ray field which pass through the center of the visible area of the image receptor.

(d) If the fluoroscopic x-ray field size is adjusted automatically as the SID or image receptor size is changed, a capability may be provided for overriding the automatic adjustment in case of system failure. If it is so provided, a signal visible at the operator's position shall indicate whenever the automatic field adjustment is overridden. Each such system failure override switch shall be clearly labeled as follows:

"For X-ray Field Limitation System Failure"

(e) Beam-limiting devices shall be provided with a means for stepless adjustment of the x-ray field; and

(f) Stepless adjustment shall, at the greatest SID, provide continuous field sizes from the maximum obtainable to a field size of five centimeters by five centimeters or less.

(6) Timers shall meet the following specifications:

(a) A means shall be provided to preset the cumulative on-time timer of the fluoroscopic tube. The maximum cumulative time of the timer shall not exceed five minutes without resetting; and

(b) The timer shall terminate the exposure or emit a signal audible to the operator when the exposure time reaches a maximum of five minutes. The signal shall continue to sound while x-rays are produced until the timer is reset.

(c) For x-ray controls manufactured on or after June 10, 2006, there shall be provided for each fluoroscopic tube:

(i) A display of the fluoroscopic irradiation time at the operator's working position. This display shall function independently of the audible signal described in paragraph (A)( 6)(c)(ii) of this rule. The following requirements apply:

(a) When the x-ray tube is activated, the fluoroscopic irradiation time in minutes and tenths of minutes shall be continuously displayed and updated at least once every six seconds.

(b) The fluoroscopic irradiation time shall also be displayed within six seconds of termination of an exposure and remain displayed until reset.

(c) Means shall be provided to reset the display to zero prior to the beginning of a new examination or procedure.

(ii) A signal audible to the operator shall sound for each passage of five minutes of fluoroscopic irradiation time during an examination or procedure. The signal shall sound until manually reset or, if automatically reset, for at least two seconds.

(7) X-ray production in the fluoroscopic mode shall be controlled by a device which requires continuous pressure by the operator for the entire time of any exposure. When recording serial fluoroscopic images, the operator shall be able to terminate the x-ray exposure at any time, but means may be provided to permit completion of any single exposure of the series in progress.

(8) Fluoroscopic systems shall meet the following air kerma rate limits:

(a) Fluoroscopic equipment provided with only automatic exposure rate control, or provided with both automatic exposure rate control and manual mode capabilities, shall not exceed an air kerma rate of eighty-eight milligray per minute (ten roentgens per minute exposure rate) in either mode at any combination of tube potential and current, at the point where the center of the useful beam enters the patient;

(b) Fluoroscopic equipment provided with only manual mode capabilities shall not exceed an air kerma rate of forty-four milligray per minute (five roentgens per minute exposure rate) at any combination of tube potential and current, at the point where the center of the useful beam enters the patient; and

(c) For fluoroscopic equipment that is provided with high-level control, and the high-level control is activated, the air kerma rate shall not exceed one hundred seventy-six milligray per minute (twenty roentgens per minute exposure rate) at any combination of tube potential and current, at the point where the center of the useful beam enters the patient;

(i) For all fluoroscopy equipment that is provided with high-level control, special means of activation of high level control, such as manual pressure applied continuously by the operator, shall be required to avoid accidental use; and

(ii) A continuous signal audible to the operator shall indicate that high level control is being employed.

(9) During fluoroscopy and cinefluorography the x-ray tube potential and current shall be continuously indicated.

(10) For undertable fluoroscopic equipment, a shielding device of at least 0.25 millimeter lead equivalent shall cover the bucky-slot.

(11) For undertable fluoroscopic equipment, protective drapes, or other devices, at least 0.25 millimeter lead equivalent shall be provided between the patient and the individual operating the fluoroscopic equipment to intercept scattered radiation which would otherwise reach the fluoroscopist and others near the x-ray unit, except when such drapes or other devices would compromise the sterile field. Such devices shall not substitute for wearing required protective apparel.

(12) Radiography using the fluoroscopic imaging assembly shall meet the following specifications:

(a) A means shall be provided between the source and the patient which will automatically limit the x-ray field at the time the exposure is initiated to no more than the portion of the image receptor selected by the operator. If the x-ray field size is less than the size of the selected portion of the image receptor, the field size shall not open automatically to the size of the selected portion of the image receptor unless the operator has selected such a mode of operation;

(b) Neither the length nor the width of the x-ray field in the plane of the image receptor shall differ from the corresponding dimensions of the selected portion of the image receptor by more than three per cent of the SID when adjusted for full coverage of the selected portion of the image selector;

(c) The center of the x-ray field in the plane of the image receptor shall be aligned with the center of the selected portion of the image receptor to within two per cent of the SID; and

(d) Means shall be provided to reduce the x-ray field size in the plane of the image receptor to a size smaller than the selected portion of the image receptor. The minimum field size at the greatest SID shall not exceed five centimeters by five centimeters .

(13) Fluoroscopic equipment manufactured on or after June 10, 2006, shall display at the operator's working position the air kerma rate (AKR) and cumulative air kerma in accordance with the following requirements:

(a) When the x-ray tube is activated and the number of images produced per unit time is greater than six images per second, the AKR in milligrays per minute shall be continuously displayed and updated at least once every second.

(b) The cumulative air kerma in units of milligrays shall be displayed either within five seconds of termination of an exposure or displayed continuously and updated at least once every five seconds.

(c) The display of the AKR shall be clearly distinguishable from the display of the cumulative air kerma.

(d) The AKR and cumulative air kerma shall represent the value for conditions of free-in-air irradiation at one of the following reference locations specified according to the type of fluoroscope.

(i) For fluoroscopes with x-ray source below the x-ray table, x-ray source above the table, or of lateral type, the reference location shall be the respective locations specified in paragraph (C)(6)(a), (C)(6)(b) or (C)(6)(d) of this rule.

(ii) For C-arm fluoroscopes, the reference location shall be fifteen centimeters from the isocenter toward the x-ray source along the beam axis. Alternatively, the reference location shall be at a point specified by the manufacturer to represent the location of the intersection of the x-ray beam with the patient's skin.

(e) Means shall be provided to reset to zero the display of cumulative air kerma prior to the commencement of a new examination or procedure.

(f) The displayed AKR and cumulative air kerma shall not deviate from the actual values by more than plus or minus thirty-five per cent.

(B) In addition to other applicable radiation safety rules adopted pursuant to Chapter 3748. of the Revised Code, handlers of fluoroscopic radiation-generating equipment shall comply with the following:

(1) Any individual who is in the room during the fluoroscopic procedure shall be adequately protected by standing behind a whole body protective barrier or shall be required to wear a protective lead apron of not less than 0.25 millimeter lead equivalent.

(2) Protective lead or lead equivalent gloves shall be used by individuals who are required to have their hands in or near the useful beam.

(3) In accordance with Chapter 3701-72 of the Administrative Code, individuals who perform fluoroscopic procedures on human beings shall hold a radiographer license or shall be a licensed practitioner, except for those individuals identified in paragraph ( D) of rule 3701-72-04 of the Administrative Code who are limited to performing only the radiologic tasks related to cardiac catheterization procedures as specified in paragraph (D) of rule 3701-72-04 of the Administrative Code. Personnel working for veterinarians that use radiation generating equipment are not required to comply with this paragraph.

(4) Handlers of fluoroscopic equipment used for interventional or cardiac procedures or on pediatric or pregnant patients shall maintain a record of:

(a) Cumulative air kerma or dose area product used for each examination, if the display of either is available on the fluoroscopic equipment; or

(b) The following items if the cumulative air kerma or dose area product is not displayed on the fluoroscopic equipment:

(i) Mode of operation such as high-level or pulsed mode;

(ii) Cumulative fluoroscopic exposure time; and

(iii) Number of radiographs and number of acquisitions.

(C) In addition to other applicable quality assurance requirements of Chapter 3701:1-66 of the Administrative Code, handlers of fluoroscopic equipment shall comply with the following:

(1) Handlers shall designate and utilize a radiation expert who shall develop in writing and perform fluoroscopic image quality evaluations appropriate for the fluoroscopic equipment including written procedures to include time intervals and system conditions for the evaluation of image quality.

(2) On new installations or reinstallations of existing equipment prior to patient exposure, handlers shall utilize a radiation expert to perform the following:

(a) Radiographic device tests to determine compliance with allowable limits as specified in paragraph (A)(12) of this rule;

(b) Fluoroscopic image quality evaluations as specified in paragraph ( C)(1) of this rule; and

(c) Air kerma rate tests as specified in paragraph (C)(6) of this rule.

(3) After initial evaluations of fluoroscopic equipment have been performed, the test and evaluations in paragraph ( C)(2) of this rule shall be performed by a radiation expert annually within periods not to exceed fourteen months.

(4) After repair or replacement of any component of the fluoroscopic equipment which may alter the radiation output or image quality, prior to patient use , a radiation expert shall perform and document measurements of air kerma rates as specified in paragraph (C)(6) of this rule and image quality as specified in paragraph (C)(1) of this rule unless in the documented determination of a radiation expert, the repair or replacement will not cause a significant change in radiation output or significant degradation of image quality as specified in the quality assurance program.

(a) The radiation expert may designate qualified individuals to perform and document the measurements specified in paragraphs (C)(6) and (C)(1) of this rule ;

(b) The radiation expert shall provide the criteria for qualifying these designees in the quality assurance program; and

(c) The radiation expert's approval of the test results shall be documented.

(5) The results of all tests performed in accordance with paragraphs ( C)(2) to ( C)(4) of this rule shall:

(a) Include the technique factors used in determining such results;

(b) Include the name of the individual performing the measurements;

(c) Include the date the measurements were performed; and

(d) Be maintained by the IRRP between inspections for review by the department.

(6) Compliance with air kerma rate allowable limits in paragraph (A)(8) of this rule shall be determined as follows:

(a) If the source is below the x-ray table, the air kerma rate shall be measured at one centimeter above the tabletop or cradle.

(b) If the source is above the x-ray table, the air kerma rate shall be measured at thirty centimeters above the tabletop with the end of the beam limiting device or spacer positioned as closely as possible to the point of measurement.

(c) For c-arm type fluoroscopic equipment, the air kerma rate shall be measured at thirty centimeters from the input surface of the image receptor with the source positioned at any SID.

(d) For fixed SID lateral fluoroscopes attached to the x-ray table, the maximum air kerma rate shall be measured at a point fifteen centimeters from the centerline of the x-ray table and in the direction of the x-ray source with the end of the beam-limiting device or spacer positioned as closely as possible to the point of measurement. If the table top is moveable, it shall be positioned as closely as possible to the lateral x-ray source, with the end of the beam-limiting device or spacer no closer than fifteen centimeters to the centerline of the table.

(e) For c-arm type fluoroscopic equipment having a SID less than forty-five centimeters, the air kerma rate shall be determined at the minimum SSD.

(f) The maximum air kerma rate shall be determined with the kVp, mA and/or other selectable parameters adjusted to those settings which give the maximum air kerma rate. X-ray systems that incorporate automatic exposure control shall have sufficient attenuative material placed in the useful beam to produce the maximum exposure rate of the system.

(D) Handlers of mobile fluoroscopic equipment shall not be required to comply with the requirements of paragraphs (A)(10), and (A)(11) of this rule and paragraph (I) of rule 3701:1-66-02 of the Administrative Code.

(E) Handlers of c-arm fluoroscopic equipment having a maximum SID less than forty-five centimeters shall not be required to comply with the requirements of paragraphs (A)(5)(e), (A)(5)(f), (A)(10), (A)(11), and (A)(12) of this rule and paragraph (I) of rule 3701:1-66-02 of the Administrative Code. In addition, if a radiation expert has specified in the registrant's quality assurance program that an individual is unlikely to receive a total effective dose equivalent of greater than two millirem in any one hour or one hundred millirem in a year, the handler shall not be required to comply with the requirements of paragraph (B)(1) of this rule.

(F) All individuals operating fluoroscopic equipment, and individuals likely to receive an annual effective dose equivalent in excess of one millisievert (one hundred millirem) from participating in fluoroscopic procedures, shall receive at least two hours of radiation protection training specific to fluoroscopy in addition to the training required by rule 3701:1-38-10 of the Administrative Code prior to performing or participating in fluoroscopic procedures. Additionally, each individual shall receive one hour of re-training whenever the individual receives in excess of thirty per cent of the allowable occupational dose measured over one calendar year.

(G) The training required by paragraph ( F) of this rule shall be provided by an Ohio registrant, approved by the registrant's designated radiation expert, and be specific to the type of fluoroscopic equipment used. Documentation of receiving the training required by paragraph ( F) of this rule shall be retained by the registrant and be available for review upon inspection. At a minimum, training topics shall include, but not be limited to:

(1) Principles and operation of the fluoroscopic equipment to be used;

(2) Fluoroscopic outputs including high-level control options as applicable;

(3) Dose reduction techniques for fluoroscopic equipment; and

(4) A review of the safe operating procedures of each piece of fluoroscopic equipment that may be used by each individual.

(H) Fluoroscopic equipment used for radiation therapy simulation is regulated pursuant to rule 3701:1-67-09 of the Administrative Code.

(I) Computed tomography scanners equipped with fluoroscopic capabilities are regulated pursuant to rule 3701:1-66-10 of the Administrative Code.

Effective: 07/01/2014
R.C. 119.032 review dates: 03/03/2014 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 3748.04
Rule Amplifies: 3748.04
Prior Effective Dates: 2/15/2001, 12/1/03, 4/15/09

3701:1-66-08 Mammography radiation-generating equipment.

This rule provides standards for radiation-generating equipment used for screening and diagnostic mammography, and mammography equipment used for invasive localization and stereotactically-guided breast biopsy purposes, except as provided by paragraphs (E) and (F) of this rule. In addition to Chapters 3701:1-38 and 3701:1-66 of the Administrative Code, a handler of mammography radiation-generating equipment that uses either stationary or mobile installations, shall comply with all applicable standards in 21 C.F.R. 1020 (as published in the April 1, 2012, Code of Federal Regulations) and the following:

(A) In addition to meeting the applicable equipment standards in rule 3701:1-66-02 of the Administrative Code, a facility performing screening or diagnostic mammography shall have a valid certificate issued by the U.S. department of health and human services, pursuant to the Mammography Quality Standards Reauthorization Act of 1998, Public Law 105-248, and 21 C.F.R. Part 900.

(B) A handler of all types of mammography radiation-generating equipment shall comply with the shielding requirements in paragraphs (I)(2) to (I)(4) of rule 3701:1-66-02 of the Administrative Code.

(C) In addition to applicable radiation safety requirements in rules adopted pursuant to Chapter 3748. of the Revised Code and rule 3701:1-66-02 of the Administrative Code, a handler of all types of screening and diagnostic mammography radiation-generating equipment shall comply with the following:

(1) When a film/screen mammography system is used, clinical films shall be processed as soon as possible, but not to exceed twenty-four hours from the time the first clinical image is taken. Facilities utilizing batch processing shall:

(a) Use a container to transport clinical films that will protect the film from exposure to light, excessive heat and radiation; and

(b) Maintain a log to include date and identification of each patient, time of first exposure of each batch, and date and time of each batch processing.

(2) An individual, other than a licensed practitioner, operating any type of mammography equipment on human beings shall possess an Ohio radiographer license in accordance with rules in Chapter 3701-72 of the Administrative Code and meet at least one of the following initial qualifications:

(a) Documented evidence of having completed sixteen hours of structured education in mammography which was university-awarded or approved by a recognized continuing education evaluation mechanism as accepted by the "American Registry of Radiologic Technologists"; or

(b) Proof of advanced certification in mammography issued to the operator by the "American Registry of Radiologic Technology."

(D) In addition to all applicable quality assurance requirements in rules 3701:1-66-02 and 3701:1-66-04 of the Administrative Code, the facility shall maintain phantom and quality control images for three months.

(E) Radiation-generating equipment designed for mammography but used exclusively for radiography of tissue from a biopsy, shall be exempt from paragraphs (A) to (D) of this rule, and shall comply with the requirements set forth in paragraphs (A), (F), (H)(1), (I)(2), (I)(3) and (J) of rule 3701:1-66-02 of the Administrative Code.

(F) Radiation-generating equipment used for radiography of tissue from a biopsy and equipped with an x-ray tube enclosure designed to exclude personnel from its interior during x-ray generation shall be exempt from paragraphs (A) to (E) of this rule, and shall comply with the requirements set forth in paragraph (H)(2) of rule 3701:1-68-03 of the Administrative Code.

(G) Quality control testing by a medical physicist shall be conducted on mammography radiation-generating equipment used for invasive localization or having stereotactically-guided breast biopsy capability. Quality control testing for stereotactically-guided breast biopsy equipment shall follow the "American College of Radiology (ACR) Practice Guideline for the Performance of Stereotactically Guided Breast Interventional Procedures" (as revised in 2009). This document is available from the "American College of Radiology, 1891 Preston White Drive, Reston, Virginia 20191, telephone (703) 648-8900."

(1) The medical physicist shall meet the requirements of the aforementioned ACR guideline; and

(2) The medical physicist shall document and verify that the facility is taking proper corrective actions when results of the quality control tests indicate the need.

Effective: 02/01/2014
R.C. 119.032 review dates: 10/09/2013 and 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 3748.04
Rule Amplifies: 3748.01 , 3748.02 , 3748.04 , 3748.05 , 3748.06 , 3748.07 , 3748.12 , 3748.14 , 3748.15 , 3748.17 , 3748.18 , 3748.19 , 3748.20 , 3748.22 , 3748.99
Prior Effective Dates: 2/15/2001, 2/1/05, 4/15/09

3701:1-66-10 Computed tomography radiation-generating equipment.

As used in this rule, "computed tomography (CT) radiation-generating equipment" means CT units as defined in paragraph (B)(12) of rule 3701:1-66-01 of the Administrative Code and used for medical purpose, except for fluoroscopy units with CT capability, CT units used exclusively for radiotherapy simulation and CT units integrated with linear accelerators. In addition to other applicable rules adopted pursuant to Chapter 3748. of the Revised Code and Chapter 3701:1-66 of the Administrative Code, handlers of CT radiation-generating equipment that includes either mobile or stationary installations shall comply with the following:

(A) CT radiation-generating equipment shall be maintained to meet the following equipment standards:

(1) The operator shall be able to terminate x-ray exposure at any time during a scan, or series of scans under CT radiation-generating equipment control of greater than 0.5 second duration.

(2) In the case of premature termination of the x-ray exposure by the operator, the CT radiation-generating equipment shall require the operator to reset CT conditions of operation prior to the initiation of another scan.

(3) The CT x-ray control and gantry shall provide visual indication whenever x-rays are produced.

(4) If the x-ray production period is less than 0.5 second, the indication of x-ray production shall be actuated for at least 0.5 second. Visual indicators at or near the gantry shall be discernible from any point external to the patient opening where insertion of any part of the human body into the primary beam is possible.

(5) Each emergency button or switch shall be clearly labeled as to its function.

(6) The CT radiation-generating equipment shall be designed such that the CT conditions of operation are indicated prior to the initiation of a scan or a scan sequence.

(7) The indicated table increment shall not deviate from the actual table increment by more than one millimeter.

(8) Means shall be provided to permit visual determination of the location of the tomographic plane or a reference plane. A reference plane may be offset from the location of the tomographic plane(s).

(9) If a device using a light source is used to satisfy paragraph (A)(8) of this rule, the light source shall provide illumination levels sufficient to permit visual determination of the location of the tomographic plane or reference plane under ambient light conditions of up to five hundred lux.

(10) The total error in the indicated location of the tomographic plane or reference plane shall not exceed five millimeters.

(11) Mobile CT radiation-generating equipment permanently mounted on a base with wheels or castors for moving while completely assembled shall be provided with curtains of not less than 0.25 millimeter lead equivalent that completely surrounds the gantry bore during exposures.

(B) In addition to paragraph (H) of rule 3701:1-66-02 of the Administrative Code, handlers of CT radiation-generating equipment shall meet the following radiation safety requirements:

(1) Techniques shall be provided in the vicinity of the control panel or on a pre-programmed menu, based on patient age, weight, body mass index, or patient dimensions, as appropriate, that specifies for each routine examination the CT conditions of operation, including techniques specific to pediatric patient examinations, if applicable.

(2) The limits of radiation dose shall not exceed a volume computed tomography dose index CTDIvol of:

(a) Eighty milligray (eight rad) for the facility's routine adult head scan;

(b) Thirty milligray (three rad) for the facility's routine adult or seventy kilogram (one hundred fifty-four pound) abdomen scan;

(c) Twenty milligray (two rad) for the facility's routine pediatric five-year old or eighteen kilogram (forty pound) abdomen scan; and

(d) Forty milligray (four rad) for the facility's routine (one-year old) pediatric head scan.

(3) If the results of the quality control tests, the image quality evaluations, or the radiation dose measurements exceed a tolerance limit established by a radiation expert, use of the CT radiation-generating equipment on patients shall be limited to those uses permitted by written instruction of a radiation expert.

(4) Operators of CT radiation-generating equipment used on humans shall possess an Ohio radiologic license in accordance with Chapter 3701-72 of the Administrative Code or hold an appropriate license or certificate in accordance with Chapter 4715. of the Revised Code for dental imaging.

(C) In addition to other applicable quality assurance requirements in rule 3701:1-66-04 of the Administrative Code, handlers of CT radiation-generating equipment shall comply with the following quality assurance requirements:

(1) The registrant shall designate and utilize a radiation expert who shall:

(a) Perform measurements of the radiation dose and image quality prior to medical use:

(i) Upon installation.

(ii) After repair or replacement of any component of the CT equipment which may alter the radiation output or image quality, prior to patient use, a radiation expert shall perform and document measurements of radiation output, using a method specified by a radiation expert in the quality assurance program, and image quality as specified in paragraph (C)(1)(c) of this rule unless in the documented determination of a radiation expert, the repair or replacement will not cause a significant change in radiation output or significant degradation of image quality as defined in the quality assurance program according to paragraph (C)(1)(c) of this rule.

(A) The radiation expert may designate qualified individuals to perform and document the measurements specified in paragraph (C)(1)(a)(ii) of this rule;

(B) The criteria for qualifying the designees specified in paragraph (C)(1)(a)(ii)(a) of this rule shall be specified by a radiation expert in the quality assurance program; and

(C) The radiation expert's approval of the test results shall be documented.

(b) Perform measurements of radiation dose annually, not to exceed a fourteen month period.

(c) Develop written procedures to include system conditions and tolerance limits for the evaluation of image quality. The procedures shall incorporate the use of a CT phantom which has the capability of providing an indication of CT number accuracy for at least three materials, noise, image thickness, alignment light accuracy, and the resolution capability of the system for low and high contrast objects.

(d) Perform evaluations of image quality according to the written procedures upon installation and prior to scanning patients and at least annually, not to exceed a fourteen month period, thereafter.

(e) Approve the quality control program conducted by the CT technologist including the image quality evaluations appropriate for the system and allowable variations for the indicated parameters.

(2) Written records of all image quality evaluations and radiation dose measurements shall be maintained between inspections for review by the department's inspector.

(3) The images for quality shall be retained until a new image quality evaluation is performed as follows:

(a) Photographic copies of the images obtained from the image display device; or

(b) Images stored in digital form on a storage medium compatible with the CT x-ray system.

(4) In consultation with a radiation expert, develop and implement a written program for radiation dose optimization and scan protocol review. The protocol review must include perfusion studies, if performed. The written program shall be audited by a radiation expert on an annual basis, not to exceed a fourteen month period.

(5) Radiation dose measurements shall be performed using clinical protocols representative of the utlization of the CT unit. If protocols are estimated, measurements must be based on a sample of actual patient data. The specific CT conditions of operation shall be documented for each protocol;

(a) Radiation dose measurements shall be expressed in terms of CTDIvol ;

(b) Radiation dose measurements shall be performed using a CT dosimetry phantom that meets the following specifications and conditions of use:

(i) The CT dosimetry phantom shall be a right circular cylinder of a material having approximate tissue equivalence of one gram per cubic centimeter. The phantom shall be at least fourteen centimeters in length and shall have diameters of thirty-two centimeters for measuring radiation dose from the adult abdomen scan protocol and sixteen centimeters for measuring radiation dose from the head and pediatric abdomen scan protocols;

(ii) The CT dosimetry phantom shall provide a means for the placement of a dosimeter along the axis of rotation and along a line parallel to the axis of rotation on the outer surface or within one centimeter from the outer surface and within the phantom. Means for the placement of dosimeters or alignment devices at other locations may be provided;

(iii) Any effects on the doses measured due to the removal of phantom material to accommodate dosimeters shall be accounted for through appropriate corrections to the reported data or included in the statement of maximum deviation for the values obtained using the phantom; and

(iv) All dose measurements shall be performed with the CT dosimetry phantom placed on the patient couch or support device without additional attenuation materials present; and

(c) Radiation dose measurements shall be performed with a calibrated dosimetry system. The calibration of such system shall be traceable to a national standard, or cross-calibrated with a dosimetry system whose calibration is traceable to a national standard. Records of these calibrations shall be readily available for review upon inspection. The dosimetry system shall have been calibrated within the preceding two years.

(d) Requirements of paragraphs (C)(5)(a) and (C)(5)(b) of this rule may be satisfied by an alternative nationally-recognized standard for CT dosimetry. If an alternate dosimetry method is used, a radiation expert shall document the procedures in the written quality assurance program.

(D) Cone beam computed tomography (CBCT) scanners and hybrid imaging systems with the exception of CBCT units integrated with linear accelerators shall comply with the following rules:

(1) Under the guidance of a radiation expert, handlers of CBCT units shall develop and implement a written quality control testing program to include test procedures, test frequencies, and tolerance limits.

(2) The written quality control program must include an annual testing component to be performed by a radiation expert. This annual testing component must be performed upon installation of new CBCT units and annually thereafter, not to exceed fourteen months.

(3) The annual tests to be performed by a radiation expert must include an assessment of radiation dose and an evaluation of image quality.

(4) Records of all quality control tests shall be documented and retained between inspections.

(5) CBCT scanners are exempt from paragraphs (B)(2) and (C)(5) of this rule.

(6) SPECT/CT and PET/CT units used exclusively for hybrid imaging shall be in compliance with paragraph (B)(2) of this rule if protocols used to scan the head satisfy the limits of paragraph (B)(2)(a) of this rule and protocols used to scan the abdomen satisfy the limits of paragraph (B)(2)(b) of this rule.

(E) Micro-CT units equipped with an x-ray tube enclosure designed to exclude personnel from its interior during x-ray generation shall be exempt from paragraphs (A) to (D) of this rule, and shall comply with the requirements set forth in paragraph (H)(2) of rule 3701:1-68-03 of the Administrative Code.

(F) Mobile CT radiation-generating equipment permanently mounted on a base with wheels or castors for moving while completely assembled and not used in one place are exempt from paragraphs (I)(4) and (I)(5) of rule 3701:1-66-02 of the Administrative Code.

Replaces: 3701:1-66-10

Effective: 07/01/2014
R.C. 119.032 review dates: 02/01/2019
Promulgated Under: 119.03
Statutory Authority: 3748.04
Rule Amplifies: 3748.04
Prior Effective Dates: 2/15/2001, 2/15/05, 4/15/09

3701:1-66-11 Bone densitometry radiation-generating equipment.

For the purposes of this rule, "bone densitometry equipment" means radiation-generating equipment intended for the medical purpose of quantifying bone density and mineral content by x-ray measurements through the bone and adjacent tissues. In addition to the applicable rules in Chapters 3701:1-38 and 3701:1-66 of the Administrative Code, handlers of bone densitometry equipment shall comply with the following:

(A) Handlers of bone densitometry equipment shall assure that the equipment is certified by the manufacturer in accordance with the requirements of 21 C.F.R. 1010.2 , as published in the April 1, 2012, Code of Federal Regulations, and maintained in accordance with the manufacturer's specifications.

(B) In addition to other applicable radiation safety requirements in Chapters 3701:1-38 and 3701:1-66 of the Administrative Code, handlers of bone densitometry equipment shall comply with the following:

(1) The operator shall be positioned at least one meter ( 3.3 feet) from the primary beam or behind a protective barrier containing a minimum of 0.25 millimeter of lead equivalent materials.

(2) Operators of bone densitometry equipment shall possess an Ohio radiologic license in accordance with rules in Chapter 3701-72 of the Administrative Code.

(C) In addition to other applicable quality assurance requirements in rules 3701:1-66-02 and 3701:1-66-04 of the Administrative Code, handlers of bone densitometry equipment shall comply with the following:

(1) The quality assurance program shall include quality control test records which shall be maintained between inspections and shall include the following:

(a) A list of the tests to be performed as specified by the manufacturer;

(b) The frequency of performance as specified by the manufacturer;

(c) The acceptability limits for each test as specified by the manufacturer; and

(d) A brief description of the procedures and test equipment to be used for each test.

(2) Maintain a readily available copy of the manufacturer's operating manual.

(3) The operator shall advise the patient that the bone densitometry examination is a type of x-ray procedure.

Effective: 02/01/2014
R.C. 119.032 review dates: 10/09/2013 and 02/01/2019
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 , 3748.20 , 3748.22 , 3748.99
Prior Effective Dates: 2/15/2001, 2/1/05, 4/15/09

3701:1-66-12 [Rescinded]Industrial radiography and irradiation devices utilizing radiation-generating equipment.

Effective: 05/01/2012
R.C. 119.032 review dates: 12/30/2011
Promulgated Under: 119.03
Statutory Authority: 3748.04
Rule Amplifies: 3748.04
Prior Effective Dates: 2/15/2001, 5/17/04, 10/1/09, 6/20/10

3701:1-66-13 [Rescinded]Industrial analytical radiation-generating equipment.

Effective: 05/01/2012
R.C. 119.032 review dates: 12/30/2011
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, 6/1/06, 8/1/11

3701:1-66-14 [Rescinded]Other than megavoltage therapeutic radiation-generating equipment.

Effective: 01/14/2011
R.C. 119.032 review dates: 08/20/2010
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

3701:1-66-15 [Rescinded]Megavoltage therapeutic radiation-generating equipment.

Effective: 01/14/2011
R.C. 119.032 review dates: 08/20/2010
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

3701:1-66-17 [Rescinded]Industrial particle accelerator.

Effective: 05/01/2012
R.C. 119.032 review dates: 12/30/2011
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, 6/1/06, 9/1/2011