South Carolina: radiation safety rules for fluoroscopy teams

Yes. South Carolina is an NRC Agreement State. Its radioactive-materials rule is R.61-63 (Title A).

S.C. Code Ann. Regs. 61-64, X-Rays (Title B). Part III covers Standards for Protection Against Radiation (RHB 3.1-3.30). Part IV covers Use of X-Rays in the Health Professions, including RHB 4.2 general safety and RHB 4.9 fluoroscopic systems. Radioactive-materials licensees follow the separate R.61-63 Part III.

Yes. X-ray registrants must use procedures and engineering controls to keep occupational and public doses ALARA. They also need a written radiation protection program, a Radiation Safety Officer and investigative limits.

Where ALARA lives in South Carolina: In X-ray-specific rules. The registrant ALARA duty is in R.61-64 (Title B) RHB 3.3.2. Licensees have a separately worded duty in R.61-63 RHA 3.4.2. RHB 3.5 applies Title A dose-limit rules to registrants that are also licensees. In this research's reading, an NRC compatibility change would directly affect R.61-63, while changing R.61-64 would require a separate SCDES rulemaking. (R.61-64 RHB 3.3.2 and RHB 3.5; R.61-63 RHA 3.1 and RHA 3.4.2)

5 rem (0.05 Sv), or 50 mSv, TEDE per year.

15 rem (0.15 Sv), or 150 mSv. South Carolina has not adopted the International Commission on Radiological Protection (ICRP) 20 mSv lens limit.

Shallow dose of 50 rem (0.5 Sv), or 500 mSv, to the skin or any extremity.

0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. An extra badge worn under the apron is available on request and must be read at least monthly.

Individual monitoring is required for anyone likely to exceed 10% of the applicable limits. All personnel working with medical fluoroscopic equipment must be monitored regardless of expected dose. Dosimeters are read at least quarterly, returned within 45 days, and processed by a National Voluntary Laboratory Accreditation Program (NVLAP)-accredited processor.

A single badge is worn at the collar outside the apron. With one collar badge, effective dose = deep dose × 0.3. With two badges, effective dose = 1.5 × waist badge under the apron + 0.04 × neck badge outside the apron. The radiation safety officer (RSO) may choose effective dose as the record, subject to semi-annual observation visits, and SCDES may revoke its use. Guidance B2 says the outside badge is the permanent record when two badges are worn.

Staff must be protected from scatter by aprons or whole-body barriers of at least 0.25 mm lead equivalent. Body parts in the useful beam need at least 0.5 mm lead equivalent. Facilities must have enough aprons and gloves. Fluoroscopy also requires at least 0.25 mm lead equivalent drapes or curtains against scatter. Thyroid shields and eyewear for staff are not addressed.

Aprons and gloves must be checked at least annually for cracks and holes. Checks are documented and records kept for 2 years or until the next inspection, whichever is later. The method is not specified.

Engineered systems are not addressed by name. RHB 4.2.9.2 accepts whole-body protective barriers of at least 0.25 mm lead equivalent as an alternative to aprons, and RHB 4.9.13.7 allows a protected area instead of an apron for vertical fluoroscopic systems. Whether this covers engineered systems is this research's reading, not the agency's.

Only licensed practitioners or SCRQSA-certified technologists working under a licensed practitioner's direction may operate X-ray equipment. Only licensed practitioners may use fluoroscopy to position a patient. Others may use fluoroscopy only with a licensed practitioner physically in the room. PAs, NPs and CRNAs need the SCRQSA Limited Practice Radiographer, Fluoroscopy certificate, and the presence rule appears to apply to them (this research's reading). Students and residents may operate under supervision without a certificate.

Technologists need an SCRQSA certificate (ARRT-certified technologists qualify without an exam) and 24 hours of continuing education (CE) every 2 years. PAs, NPs and CRNAs need 40 hours of didactic and 40 hours of clinical fluoroscopy training, a letter from the supervising radiologist, a passing American Registry of Radiologic Technologists (ARRT) Fluoroscopy exam (75%) and 8 hours of CE every 2 years; this has applied since Sept. 1, 2023. Registrants must document facility-specific training. No physician fluoroscopy training requirement was found.