Washington: radiation safety rules for fluoroscopy teams

Yes, per the NRC list (41 Agreement States; Washington is not on the non-Agreement list).

Chapter 246-225 WAC, "Radiation Protection - X-Rays in the Healing Arts". General requirements are in WAC 246-225-020 and fluoroscopy rules in WAC 246-225-050. Chapter 246-221 WAC (Radiation Protection Standards) applies to both licensees and registrants. Related chapters are 246-220 and 246-222. WAC 246-225-020 was last amended in 1994 and WAC 246-225-050 effective 1/9/94.

No explicit ALARA requirement for occupational dose addressed to X-ray registrants was found. WAC 246-221-005 and 246-220-007 are addressed to licensees. Registrants must use procedures and equipment "designed to minimize patient and personnel exposure" (WAC 246-225-020(2)(l)). DOH's practice is unconfirmed.

Where ALARA lives in Washington: In a shared rule and in X-ray-specific language. Explicit ALARA text is in the shared chapters (246-221-005, 246-220-007) and is worded for licensees. The X-ray-specific registrant duty is the "minimize... personnel exposure" language in 246-225-020(2)(l), which does not use the term ALARA. Dose limits and monitoring rules followed by registrants sit in the shared chapter. (WAC 246-220-007; WAC 246-221-005; WAC 246-225-020(2)(l))

50 mSv (5 rem) TEDE per year. Alternative organ limit is 500 mSv.

150 mSv (15 rem) per year. Washington has not adopted a lower limit such as 20 mSv.

500 mSv (50 rem) shallow dose to skin and extremities per year.

5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy.

Generally, adults likely to exceed 10% of the annual limits must be monitored, and declared pregnant women likely to exceed 1 mSv. For fluoroscopy, everyone operating a fluoroscope or working in the room during operation must wear a dosimeter regardless of expected dose. Extremity dosimeters are required if the hands could be exposed to the primary beam.

The badge is worn at the collar outside the apron. Lens monitoring uses the collar or an unshielded spot nearer the eye. The fetal badge goes at the waist under the apron. Two badges are allowed if each is labeled by body location. Deep-dose equivalent is used unless an NRC- or DOH-approved effective dose method is used; no named method appears in the rule text.

Aprons or whole-body barriers of at least 0.25 mm lead equivalent are required, and at least 0.5 mm for body parts in the useful beam. Fluoroscopy scatter drapes or curtains of at least 0.25 mm are required in addition. Thyroid shields and eyewear are not required by name, but DOH may require additional protective devices.

not found

Engineered radiation protection systems are not addressed by name. The current rule allows whole-body protective barriers instead of aprons. The draft rules would keep barrier options and add a variance process (WAC 246-225B-080); these draft provisions are not law.

A health care practitioner licensed under Title 18 RCW, a certified radiologic technologist, or a registered X-ray technician. Radiologist assistants may operate fluoroscopy under general supervision, with direct supervision for listed exams. Only licensed practitioners may authorize exposure. The draft rule would require operation by a licensed health care provider.

There is no state fluoroscopy permit and no required physician training hours were found. Operators must be adequately instructed and able to demonstrate competence. Technologists need the American Registry of Radiologic Technologists (ARRT) exam, and their scope includes fluoroscopic procedures. No continuing education requirement was found. The draft rule would require annual training that includes ALARA.