Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 180 - CONTROL OF RADIATION
Chapter 6 - DIAGNOSTIC X RAYS IN THE HEALING ARTS
Section 180-6-003 - ADMINISTRATIVE CONTROLS

Universal Citation: 180 NE Admin Rules and Regs ch 6 ยง 003

Current through September 17, 2024

The registrant is responsible for directing the operation of the x-ray system or systems under the registrant's administrative control. The registrant or registrant's agent must assure that requirements of 180 NAC 6-003 are met in the operation of the x-ray system or systems.

003.01 HEALING ARTS USES OF X-RAY EQUIPMENT. The use of x-ray equipment for the intentional exposure of individuals for diagnosis or treatment must be by or under the supervision of one licensed to practice the healing arts in Nebraska.

003.02 VETERINARY USES OF X-RAY EQUIPMENT. The use of x-ray equipment in the practice of veterinary medicine must be by or under the supervision of an individual licensed to practice veterinary medicine in the State of Nebraska.

003.03 DENTAL USES OF X-RAY EQUIPMENT. The use of x-ray equipment for the exposure of individuals for dental diagnosis or treatment must be by or under the supervision of one licensed to practice dentistry in Nebraska.

003.04 X-RAY SYSTEM REQUIREMENTS. An x-ray system which does not meet the requirements of Title 180 must not be operated for diagnostic purposes.

003.05 OPERATOR REQUIREMENTS. Registrants must only allow individuals to operate:

(A) X-ray systems under the direction of healing arts practitioners who meet the requirements as specified in Neb. Stat. Rev. §§ 38-1901 to 1920, Medical Radiography Practice Act; and

(B) Dental x-ray systems who meet the requirements as specified in Neb. Rev. Stat. § 38-1131 to practice as dental hygienists, or Neb. Rev. Stat. § 38-1135 to practice as dental assistants.

003.06 TECHNIQUE CHART. A technique chart must be provided in the vicinity of the diagnostic x-ray system's control panel.

003.06(A) DIAGNOSTIC X-RAY EQUIPMENT. Except for dental radiation generating systems, a technique chart must include the following information for all examinations performed with that system:
(i) Patient's body part and anatomical size, or body part thickness, or age, for pediatrics;

(ii) Technique factors;

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

(iv) Source to image receptor distance (SID) to be used;

(v) Type and location of placement of gonad shielding to be used; and

(vi) Type and size of the film or film-screen combination to be used.

003.06(B) DENTAL RADIATION GENERATING EQUIPMENT. Registrants using dental radiation generating equipment must have a technique chart displayed in the vicinity of the x-ray machine's control panel.

003.07 WRITTEN SAFETY PROCEDURES. The registrant must create and make available to x-ray operators written safety procedures, to include patient holding and any restriction of the operating technique required for the safe operation of the particular x-ray system. The operator must be able to demonstrate familiarity with these procedures.

003.08 INDIVIDUALS PRESENT DURING A RADIOGRAPHIC EXPOSURE. 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 may be in the room during the radiographic exposure. Other than the patient being examined:

(A) Each individual must be positioned so that no part of the body will be struck by the useful beam unless protected by not less than 0.5 millimeter lead equivalent;

(B) The x-ray operator, other staff, ancillary personnel, and other persons required for the medical procedure must be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent; and

(C) Human patients who cannot be removed from the room must be protected from the direct scatter radiation by whole body protective barriers of not less than 0.25 millimeter lead equivalent or must be positioned so the nearest portion of the body is at least 2 meters from both the tube head and the nearest edge of the image receptor.

003.09 GONAD SHIELDING. Except for cases where gonad shielding would interfere with the diagnostic procedure, gonad shielding of not less than 0.5 millimeter lead equivalent must be used for human patients that have not passed the reproductive age during radiographic procedures where the gonads are in the useful beam.

003.10 EXPOSURE TO THE USEFUL BEAM. Individuals must not be exposed to the useful beam except for healing arts purposes unless the exposure has been specifically and individually ordered by a licensed practitioner of the healing arts. This provision prohibits deliberate exposure for the following purposes:

(A) Exposure to an individual for training, demonstration, or other non-healing-arts purposes; and

(B) Exposure to an individual for the purpose of healing arts screening except as authorized by 180 NAC 6-003.14.

003.11 EXPOSURE FOR RESEARCH PURPOSES. Radiation exposure to an individual for research is prohibited, except when the research has been approved by an institutional review board and is conducted under federal regulations for the protection of human subjects in research under 45 CFR § 46 (October 1, 2016 edition).

003.12 AUXILIARY SUPPORT. Auxiliary support must be used when a patient or film must be provided with supplemental support during a radiation exposure. The following requirements apply:

(A) When a patient or image receptor must be held in position during radiography, mechanical supporting or restraining devices must be used except in individual cases where the registrant has determined the devices used for holding are contraindicated. The written safety procedures, required by 180 NAC 6-003.07, must list projections where holding devices cannot be utilized;

(B) The human holder must be instructed in personal radiation safety and protected as required by 180 NAC 6-003.08;

(C) An individual must not be used routinely to hold film or patients;

(D) Written safety procedures, as required by 180 NAC 6-003.07, must indicate the requirements for selecting a holder and the procedure the holder must follow;

(E) In those cases where the patient must hold the film, except during intraoral examinations, any portion of the body other than the area of clinical interest struck by the useful beam must be protected by not less than 0.5 millimeter lead equivalent material; and

(F) Each registrant must have leaded protective aprons and protective gloves available in sufficient numbers to provide protection to all personnel who are involved with x-ray operations and who are not shielded.

003.13 PROCEDURES AND EQUIPMENT. Procedures and equipment designed to minimize patient and personnel exposure while providing the needed diagnostic information must be utilized. The following requirements apply:

(A) The speed of film or screen and film combinations must be the fastest speed consistent with the diagnostic objective of the examinations. Film cassettes without intensifying screens must not be used for any routine diagnostic radiological imaging, with the exception of veterinary radiography;

(B) The radiation exposure to the patient must be the minimum exposure required to produce images of good diagnostic quality;

(C) Portable or mobile x-ray equipment must be used only for examinations where it is not feasible to transfer the patient or patients to a stationary x-ray installation;

(D) X-ray systems subject to this chapter must not be used in procedures where the source to patient distance is less than 30 centimeters, except for veterinary systems; and

(E) If grids are used between the patient and the image receptor to decrease scatter to the film and improve contrast, the grid must be positioned properly and, if the grid is of the focused type, be the proper focal distance for the source to image distance (SID) being used.

003.14 HEALING ARTS SCREENING. An individual requesting to conduct a healing arts screening must submit information about the healing arts screening on a form provided by the Department. If any information submitted to the Department becomes invalid or outdated, the Department must be notified immediately.

003.15 X-RAY ROOM DOORS. Doors that are an integral part of room shielding must be closed during x-ray procedures and must be posted "Close door during x-ray procedures" or words having a similar intent.

003.16 INFORMATION AND MAINTENANCE RECORDS FOR X-RAY SYSTEMS. The registrant must maintain the following records on each x-ray system for inspection by the Department:

(A) The model and serial numbers of all certifiable components, and user's manuals for those components;

(B) The records of surveys, calibrations, maintenance, and modifications performed;

(C) The tube rating charts and cooling curves; and

(D) A copy of all correspondence with the Department regarding each x-ray system.

003.17 X-RAY UTILIZATION LOG. Except for registrants using only dental radiation generating equipment, registrants must maintain an x-ray log or chart containing the patient's identification, the type of examinations, the dates the examinations were performed, and the x-ray equipment operator's name.

003.18 SCALE DRAWING. Except for registrants using only dental radiation generating equipment or bone densitometers, a scale drawing must be available of the room where a stationary x-ray system is located. The drawing must indicate the use of areas adjacent to the room and an estimation of the extent of occupancy by an individual in those areas. The drawing must include:

(A) The results of a survey for radiation levels present at the operator's position and at pertinent points outside the room at specified test conditions; or

(B) The type and thickness of materials, or lead equivalency, of each protective barrier.

003.19 PLAN REVIEW. Except for registrants using only dental radiation generating equipment or bone densitometers, the following requirements apply:

(A) The floor plans and equipment arrangement of all new installations, modifications of existing installations, or any analysis of operating conditions that indicates an individual may receive a dose in excess of the limits prescribed in 180 NAC 4-005, 4-011 or 4-013, must be submitted within 30 days to an individual meeting the requirements of 180 NAC 2-005.04(C) for review and comment; and

(B) All permanent protective barriers must be constructed so the requirements of 180 NAC 4-005, 4-011, and 4-013 will be met.

003.20 X-RAY FILM PROCESSING. A registrant using radiographic film must have equipment for handling and processing radiographic film.

003.20(A) MANUALLY DEVELOPED FILM. The following requirements apply to film that is developed manually:
(i) Processing tanks must be constructed of mechanically rigid, corrosion resistant material; and

(ii) The temperature of solutions in the tanks must be maintained within the range of 60º Fahrenheit to 80º Fahrenheit (16º Celsius to 27º Celsius). Film must be developed according to the time-temperature relationships recommended by the film manufacturer, or, in the absence of those recommendations, with the following time chart:

Time-Temperature Chart

Thermometer

Reading

(Degrees)

Minimum Developing Time (Minutes)

ºCelsius

ºFahrenheit

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

3.5

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 must be used that indicate the actual temperature of the developer and signal the passage of a preset time appropriate to the developing time required.

(iv) The specified developer temperature and development time must be posted in the darkroom.

003.20(B) AUTOMATIC FILM PROCESSING. Films must be developed according to the time-temperature relationships recommended by the film manufacturer; in the absence of those recommendations, the film must be developed using the following chart:

Developer

Temperature

(Degrees)

Minimum Immersion Time (Seconds)

ºCelsius

ºFahrenheit

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

39.5

85

30

Immersion time only, no crossover time included.

003.20(C) FILM PROCESSING REQUIREMENTS. Processing deviations and the reason for the deviation from the requirements of 180 NAC 6-003.20 must be documented by the registrant.

003.20(D) DARKROOM REQUIREMENTS. Registrants must maintain a light-tight darkroom, as applicable, use proper safelights and safeguards, and evaluate darkroom integrity and daylight loading systems for film fog every six months and after a change that may impact film fog.
(i) Each darkroom, other than those used for dental, podiatric and veterinary purposes, must use proper safelights so that any film type exposed in a cassette to x-radiation sufficient to produce an optical density from 1 to 2 when processed must not suffer an increase in density greater than 0.1 when exposed in the darkroom for 2 minutes with all safelights on. If used, daylight film handling boxes must prevent fogging of the film.

003.20(E) FILM. Film must be stored in a cool, dry place and must be protected from exposure to stray radiation. Film in open packages must be stored in a light tight container.

003.20(F) FILM CASSETTES. Film cassettes and intensifying screens must be inspected periodically and must be cleaned and replaced as necessary to assure radiographs of good diagnostic quality.

003.20(G) OUTDATED FILM. Outdated x-ray film must not be used for diagnostic radiographs, except when the film has been stored according to the manufacturer's recommendations and a sample of the film passes a sensitometric test for normal ranges of base plus fog and speed.

003.20(H) FILM DEVELOPING SOLUTIONS. Film developing solutions must be prepared according to the directions given by the manufacturer and must be maintained in strength by replenishment or renewal, so full development is accomplished within the time specified by the manufacturer.

003.20(I) PASS BOXES. Pass boxes must be constructed to exclude light from the darkroom when cassettes are placed in or removed from the boxes. Pass Boxes must have adequate shielding from stray radiation to prevent exposure of undeveloped film.

003.20(J) ALTERNATIVE PROCESSING SYSTEMS. The use of daylight processing systems, laser processors, self-processing film systems, or other alternative processing systems will follow manufacturer's recommendations for image processing.

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