OAR 333-106-0205
Fluoroscopic X-ray Systems Requirements: Activation of the Fluoroscopic Tube

(1) X-ray production in the fluoroscopic mode shall be controlled by a device which requires continuous pressure by the fluoroscopist for the entire time of any exposure. When recording serial fluoroscopic images, the fluoroscopist shall be able to terminate the X-ray exposure(s) at any time, but means may be provided to permit completion of any single exposure of the series in process.
(2) Proper training in the operation of fluoroscopic X-ray equipment is required for all operators and shall include but not be limited to the following:
(a) Principles and operation of the fluoroscopic X-ray machine:
(A) Generating X-rays;
(B) kVp and mA;
(C) Image intensification;
(D) High level control versus standard operating mode;
(E) Magnification (multi-field);
(F) Automatic Brightness Control (ABC);
(G) Pulsed versus continuous X-ray dose rates;
(H) Image recording modes;
(I) Imaging Systems (TV and Digital); and
(J) Contrast, noise and resolution.
(b) Radiation units:
(A) Traditional units;
(B) SI units; and
(C) Dose Area Product.
(c) Typical fluoroscopic outputs:
(A) Patient skin entrance dose;
(B) Standard Roentgen per minute (R/min) dose rates; and
(C) High level/Boost enable Roentgen per minute (R/min) dose rates.
(d) Dose reduction techniques for fluoroscopy:
(A) Collimation;
(B) X-ray tube and image intensifier placement;
(C) Patient size versus technique selection;
(D) Grid use;
(E) Last image hold;
(F) Additional beam filtration;
(G) Gantry angles;
(H) Use of spacer cone; and
(I) Pulsed fluoroscopy.
(e) Factors affecting personnel dose:
(A) Patient dose;
(B) Scatter radiation;
(C) Tube and image intensifier placement; and
(D) Time, distance and shielding.
(f) Protective devices:
(A) Lead aprons and gloves;
(B) Thyroid collars;
(C) Protective glasses;
(D) Leaded drapes;
(E) Bucky slot cover; and
(F) Protective shields/barriers.
(g) Radiation exposure monitoring:
(A) Personnel monitors;
(B) Placement of personnel monitors; and
(C) Occupational and non-occupational dose limits.
(h) Biological effects of X-ray radiation:
(A) X-rays and particulate matter;
(B) Absorption variables (field size, dose rate, as an example);
(C) Scatter radiation;
(D) Cell sensitivity;
(E) Acute effects; and
(F) Latent effects.
(i) Applicable regulations:
(A) Federal; and
(B) Oregon Administrative Rules for the Control of Radiation to include, but not limited to, chapter 333, divisions 101, 103, 106, 111 and 120.
(3) The operation of fluoroscopic equipment shall be performed by a properly trained operator. The following categories of operators are considered to have met the training requirements in section (2) of this rule:
(a) Radiologists currently licensed in Oregon;
(b) Non-radiologist practitioners who have successfully completed a training program from an Authority approved resource or have been operating fluoroscopic equipment prior to April 11, 2005;
(c) Radiologic technologists who have a permanent or temporary license from the Oregon Board of Medical Imaging (OBMI) to practice radiography;
(d) Physician assistants who have a fluoroscopy permit from the Oregon Board of Medical Imaging;
(e) R.P.A.s and R.R.A.s who are licensed by the OBMI; and
(f) Students currently enrolled in an approved school of Radiologic Technology as defined in ORS 688.405 (Definitions for ORS 688.405 to 688.605).
(4) Supervision requirements for operators of fluoroscopic equipment. The operation of fluoroscopic equipment by properly trained operators must comply with the following supervisory requirements:
(a) Radiologists may operate fluoroscopic equipment with no supervision.
(b) Non-radiologist practitioners who have had proper training in the use and operation of fluoroscopic X-ray equipment may operate fluoroscopic equipment without supervision provided that the registrant arranges to have a radiologist or medical or health physicist assist in:
(A) Developing fluoroscopic and radiation safety policies and procedures;
(B) Conducting an on-site practical evaluation of the non-radiologist practitioner’s knowledge of radiation safety practices and ability to operate the fluoroscopic equipment; and
(C) At least annually, review the registrant’s fluoroscopy program. The review includes an evaluation of the fluoroscopic on-times Quality Assurance reports, condition of fluoroscopic equipment and compliance with current rules. The registrant shall correct any deficiencies noted by the review.
(c) Radiologic technologists who have a permanent or temporary license from the OBMI to practice radiography may operate fluoroscopic equipment under the personal or direct supervision of a radiologist or the personal supervision of a non-radiologist practitioner who has had proper training in the use and operation of fluoroscopic X-ray equipment.
(d) An APRN who has obtained an OBMI Limited Fluoroscopy Supervision Permit may provide personal supervision to radiologic technologists who have a permanent or temporary license issued from the OBMI to operate fluoroscopic equipment.
(e) Physician assistants with fluoroscopy permits may operate fluoroscopic equipment if:
(A) The supervising physician with whom the physician assistant has entered into a practice agreement is in the room where the fluoroscopic procedure is taking place at the time that the procedure is taking place; or
(B) The supervising physician with whom the physician assistant has entered into a practice agreement is in the building where the fluoroscopic procedure is taking place, and a radiographer with a license from the Oregon Board of Medical Imaging is in the room where the procedure is taking place, at the time that the procedure is taking place.
(f) R.R.A.s or R.P.A.s may operate fluoroscopic equipment under the direct supervision of a radiologist.
(g) Physician assistants licensed with the Oregon Medical Board while completing specific clinical experience pre-requisites to become eligible to take the OBMI fluoroscopy permit examination, may operate fluoroscopy equipment under personal supervision of the physician assistant’s supervising physician, licensed radiologist, licensed radiographer or medical physicist.
(h) Students currently enrolled in an approved school of radiologic technology as defined in ORS 688.405 (Definitions for ORS 688.405 to 688.605), may operate fluoroscopic equipment under the personal supervision of a radiologist or an R.T. while in the clinical phase of training.
(5) The operation of fluoroscopic equipment is restricted to the healing arts exclusively for the purpose of localization and to assist physicians in obtaining images for diagnostic purposes.
(6) Overhead fluoroscopy is not to be used as a positioning tool for radiographic examinations except for those fluoroscopic examinations specified in the registrant’s written policies/procedures for fluoroscopy.
(7) All images formed by the use of fluoroscopy shall be viewed, directly or indirectly, and interpreted by a radiologist, cardiologist, non-radiologist practitioner or other qualified specialist. R.R.A.s and R.P.A.s may issue a preliminary report; however, the final report must be issued by their supervising radiologist.
(8) Written procedures for fluoroscopic X-ray equipment operators shall be available at the worksite and include:
(a) A list of all individuals who are permitted to operate fluoroscopic X-ray equipment at the facility;
(b) A list of the fluoroscopic X-ray equipment that each operator is qualified to operate;
(c) Written procedures regarding the set up and operation of each fluoroscopic X-ray machine registered to the facility;
(d) Written radiation safety procedures pertaining to the use and operation of fluoroscopy; and
(e) The name and title of the individual who is responsible for overseeing the fluoroscopy program.
(9) Facilities shall determine, or cause to be determined, the typical patient entrance exposure rate for their most common fluoroscopic examinations. The determination shall be made using an attenuation block as described in OAR 333-106-0005 (Definitions) using measurement protocol in compliance with OAR 333-106-0210 (Fluoroscopic X-ray Systems Requirements: Fluoroscopic Entrance Exposure Rates) and expressed in Roentgens per minute (R/min.) or milliRoentgens per minute (mR/min.). In addition, these entrance exposure rates shall be posted in the room where fluoroscopic examinations are conducted so that they are readily available to administrators, X-ray operators, patients and practitioners.
(10) Facilities that utilize fluoroscopy shall maintain a record of the cumulative fluoroscopic exposure time used for each examination. The record must indicate the patient’s name, the type of examination, the date of the examination, the fluoroscopist’s name, the fluoroscopic room in which the examination was done and the total cumulative fluoroscopic on-time for each fluoroscopic examination and:
(a) Established cumulative fluoroscopic on-time benchmarks for at least two (if applicable) of the most common types of fluoroscopic examinations performed at the facility’s site in each of the following categories:
(A) Routine procedures performed on adults;
(B) Routine procedures performed on children;
(C) Orthopedic procedures performed in surgery;
(D) Urologic procedures performed in surgery;
(E) Angiographic procedures performed; and
(F) Interventional cardiac studies.
(b) Develop and perform periodic (not to exceed 12-month intervals) quality assurance studies to determine the status of each individual fluoroscopist’s cumulative on-time in relation to the fluoroscopic benchmarks established for individual fluoroscopic examinations;
(c) Take appropriate action when the established benchmarks are consistently exceeded. The registrant must review the results of the cumulative fluoroscopic on-time Quality Assurance Study and take corrective action regarding those individuals who have exceeded the benchmarks established by the registrant for a particular procedure more than 10 percent of the total times the individual performed the procedure during the study period. Documentation of the registrant’s review, as well as any corrective actions taken, must be available for Authority review and provided upon Authority request. Corrective actions, at a minimum, include:
(A) Notification of the individual; and
(B) Recommendation that the individual undergo additional coaching and training in the safe use of fluoroscopic equipment in order to assist them in reducing their cumulative fluoroscopic on-times.

Source: Rule 333-106-0205 — Fluoroscopic X-ray Systems Requirements: Activation of the Fluoroscopic Tube, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=333-106-0205.

333‑106‑0001
Purpose and Scope 333‑106‑0005
Definitions 333‑106‑0010
Administrative Controls 333‑106‑0015
General Requirements: Technique Chart 333‑106‑0020
General Requirements: Written Rules and Procedures 333‑106‑0025
General Requirements: Protection of Patients and Personnel 333‑106‑0035
General Requirements: Deliberate Exposures Restricted 333‑106‑0040
General Requirements: Patient Holding and Restraint 333‑106‑0045
General Requirements: Use of Best Procedures and Equipment 333‑106‑0050
General Requirements: Personnel Monitoring 333‑106‑0055
General Requirements: X-ray Operator Training 333‑106‑0060
General Requirements: Radiation Use and Safety Instructor Qualifications 333‑106‑0101
General Requirements: Diagnostic X-ray Systems 333‑106‑0105
General Requirements: Information and Maintenance Record and Associated Information 333‑106‑0110
General Requirements: Plan Review 333‑106‑0120
General Requirements: Information on Radiation Shielding for Plan Reviews — Optional 333‑106‑0130
General Requirements: Design Requirements for an Operator’s Booth 333‑106‑0201
Fluoroscopic X-ray Systems 333‑106‑0205
Fluoroscopic X-ray Systems Requirements: Activation of the Fluoroscopic Tube 333‑106‑0210
Fluoroscopic X-ray Systems Requirements: Fluoroscopic Entrance Exposure Rates 333‑106‑0215
Fluoroscopic X-ray Systems Requirements: Fluoroscopic Barrier Transmitted Radiation Rate Limits 333‑106‑0220
Fluoroscopic X-ray Systems Requirements: Fluoroscopic Indication of Potential and Current 333‑106‑0225
Fluoroscopic X-ray Systems Requirements: Fluoroscopic Source-to-Skin Distance 333‑106‑0230
Fluoroscopic X-ray Systems Requirements: Fluoroscopic Timer 333‑106‑0235
Fluoroscopic X-ray Systems Requirements: Mobile Fluoroscopes 333‑106‑0240
Fluoroscopic X-ray Systems Requirements: Fluoroscopic Control of Scattered Radiation 333‑106‑0245
Fluoroscopic X-ray Systems Requirements: Fluoroscopic Radiation Therapy Simulation Systems 333‑106‑0301
Additional Requirements for Radiographic Machines: Beam Limitation for Radiographic Systems Other Than Fluoroscopic, Dental Intraoral, Veterinary Systems, or Computed Tomography(CT) 333‑106‑0305
Additional Requirements for Radiographic Machines: Radiation Exposure Control Devices 333‑106‑0310
Additional Requirements for Radiographic Machines: Source-to-Skin Distance 333‑106‑0315
Additional Requirements for Radiographic Machines: Exposure Reproducibility 333‑106‑0320
Additional Requirements for Radiographic Machines: Radiation from Capacitor Energy Storage Equipment in Standby Status 333‑106‑0325
Additional Requirements for Radiographic Machines: Intraoral Dental Radiographic Systems 333‑106‑0345
Purpose and Scope 333‑106‑0350
Computed Tomography X-ray Systems: Definitions 333‑106‑0355
CT Equipment Requirements 333‑106‑0360
Computed Tomography X-ray Systems: Facility Design Requirements 333‑106‑0361
Computed Tomography X-ray Systems: Radiation Protection Surveys 333‑106‑0362
Computed Tomography X-ray Systems: Operating Procedures and Conditions of Operation 333‑106‑0363
Computed Tomography X-ray Systems: Quality Control Program 333‑106‑0364
Computed Tomography X-ray Systems: Initial and Annual Qualified CT Medical Physicist Scanner Performance Evaluations 333‑106‑0366
Computed Tomography X-ray Systems: Dose Limits 333‑106‑0367
Computed Tomography X-ray Systems: Records and Report Retention 333‑106‑0368
Computed Tomography X-ray Systems: Qualified CT Medical Physicist 333‑106‑0369
Computed Tomography X-ray Systems: Report and Notification of a CT Medical Event 333‑106‑0370
Computed Tomography X-ray Systems: Operator Requirements 333‑106‑0601
Veterinary X-ray Systems: Veterinary Medicine Radiographic Installations Additional Requirements 333‑106‑0700
Mammography Requirements: Mammography X-Ray Systems Definitions 333‑106‑0710
Mammography Requirements: Equipment Standards 333‑106‑0720
Mammography Requirements: Quality Assurance Program 333‑106‑0730
Mammography Requirements: Additional Requirements 333‑106‑0735
Mammography Requirements: Breast Density Notification 333‑106‑0750
Mammography Requirements: Mammography Personnel Qualifications
Last Updated

Jun. 8, 2021

Rule 333-106-0205’s source at or​.us