NOTES ON MEDICAL FLUOROSCOPY

The Alaska regulations for radiation control, adopted July 16, 2008, include several changes related to the use of a fluoroscope in healthcare applications. For example, 7 AAC 18.120 specifies that if the device is capable of emitting ionizing at a rate that exceeds 200 millisieverts or 20 millirems per minute, the registrant must apply for authorization to operate the device on a form prescribed by the department. In 7 AAC 18.200(a) and (b) it reiterates previous regulations prohibiting the application of ionizing to an individual for other than a clinical purpose, and the use of a medical fluoroscope without image intensification is prohibited. 7 AAC 18.200(d) is a new restriction that prohibits using a medical fluoroscope simply to pre-position a patient for a procedure that does not ordinarily require fluoroscopy. 7 AAC 18.210 delineates the occupational exposure limits and includes categories not previously addressed in the old regulations. There is a clarification of the old training requirement in 7 AAC 18.420 where more specific guidance is provided as to the content of training that an operator must receive prior to operating a radiation producing device for medical purposes. Of particular importance is the new requirement that “All operators of medical fluoroscopic equipment shall receive a minimum of ten hours instruction in the safe operation of the fluoroscope” as defined in 7 AAC 18.420(c). This is in addition to the basic requirement for an individual to receive the basic operator training specified in 7 AAC 18.420(a) and (b). Licensed practitioners of the healing arts in Alaska, as defined in the regulations, are exempt from 7 AAC 18.420(a) and (b), but not 7 AAC 18.420(c). 7 AAC 18.440 is the fluoroscopic specific section of the regulations and contains several changes that the user should be aware of prior to commencing the operation of a medical fluoroscope. Quality control procedures are a component of the regulations due to the major effect these have on minimizing patient exposures. 7 AAC 18.450 contains specific quality control tests for facilities that use film, and in 7 AAC 18.450(x) there is provision for digital systems that may apply to fluoroscopic devices.

There are numerous printed resources that are valuable for study and most may be obtained by internet access. These include, but are not limited to the American Association of Physicists in Medicine (AAPM) Report No. 58, the California Fluoroscopy Syllabus, and NCRP Reports.