<head><!-- BaNnErBlUrFlE-HeAdEr-start -->
<style>
#pfptBannertxvbz92 { all: revert !important; display: block !important;
visibility: visible !important; opacity: 1 !important;
background-color: #CFD3D7 !important;
max-width: none !important; max-height: none !important }
.pfptPrimaryButtontxvbz92:hover, .pfptPrimaryButtontxvbz92:focus {
background-color: #adb0b4 !important; }
.pfptPrimaryButtontxvbz92:active {
background-color: #8c8e91 !important; }
</style>
<!-- BaNnErBlUrFlE-HeAdEr-end -->
</head><!-- BaNnErBlUrFlE-BoDy-start -->
<!-- Preheader Text : BEGIN -->
<div style="display:none !important;display:none;visibility:hidden;mso-hide:all;font-size:1px;color:#ffffff;line-height:1px;height:0px;max-height:0px;opacity:0;overflow:hidden;">
Thank you so much! This is extremly helpful! Troy On Jul 15, 2025, at 12: 20 PM, Mary Ellen Jafari via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list@ lists. osu. edu> wrote: In case you haven’t heard, TJC is consolidating and revising</div>
<!-- Preheader Text : END -->
<!-- Email Banner : BEGIN -->
<div style="display:none !important;display:none;visibility:hidden;mso-hide:all;font-size:1px;color:#ffffff;line-height:1px;max-height:0px;opacity:0;overflow:hidden;">ZjQcmQRYFpfptBannerStart</div>
<!--[if ((ie)|(mso))]>
<table border="0" cellspacing="0" cellpadding="0" width="100%" style="padding: 16px 0px 16px 0px; direction: ltr" lang="en"><tr><td>
<table border="0" cellspacing="0" cellpadding="0" style="padding: 0px 10px 5px 6px; width: 100%; border-radius:4px; border-top:4px solid #8c8e91;background-color:#CFD3D7;"><tr><td valign="top">
<table align="left" border="0" cellspacing="0" cellpadding="0" style="padding: 4px 8px 4px 8px">
<tr><td style="color:#000000; font-family: 'Arial', sans-serif; font-weight:bold; font-size:14px; direction: ltr">
This Message Is From an External Sender
</td></tr>
<tr><td style="color:#000000; font-weight:normal; font-family: 'Arial', sans-serif; font-size:12px; direction: ltr">
This message came from outside your organization.
</td></tr>
</table>
<![if ie]><br clear="all"><![endif]>
<table align="right" border="0" cellspacing="0" cellpadding="0" style="padding: 4px 0px 4px 0px"><tr>
<td style="direction: ltr"> <a target="_blank" href="https://us-phishalarm-ewt.proofpoint.com/EWT/v1/KGKeukY!sKQZnUzhg0ZAypqQH24ENG9u82vXj-ZRMQzPJ_49eNshBAoNJ6ATl_KRnTxu6FTC2-N6dsUJ02AJKGHO03xG7P7ogFJuQaR-eW3_KxMElhkfDFT2Ye0$" style="mso-padding-alt: 7.5px; padding: 7.5px; border-radius: 2px; border: 1.5px solid #666666; "><strong style="font-weight: normal; color: #000000; text-decoration: none; font-family: 'Arial', sans-serif; font-size:14px; line-height: 40px; "> Report Suspicious </strong></a> </td>
</tr></table>
</td></tr></table>
</td></tr></table>
<![endif]-->
<![if !((ie)|(mso))]>
<div dir="ltr" lang="en" id="pfptBannertxvbz92" style="all: revert !important; display:block !important; text-align: left !important; margin:16px 0px 16px 0px !important; padding:8px 16px 8px 16px !important; border-radius: 4px !important; min-width: 200px !important; background-color: #CFD3D7 !important; background-color: #CFD3D7; border-top: 4px solid #8c8e91 !important; border-top: 4px solid #8c8e91;">
<div id="pfptBannertxvbz92" style="all: unset !important; float:left !important; display:block !important; margin: 0px 0px 1px 0px !important; max-width: 600px !important;">
<div id="pfptBannertxvbz92" style="all: unset !important; display:block !important; visibility: visible !important; background-color: #CFD3D7 !important; color:#000000 !important; color:#000000; font-family: 'Arial', sans-serif !important; font-family: 'Arial', sans-serif; font-weight:bold !important; font-weight:bold; font-size:14px !important; line-height:18px !important; line-height:18px">
This Message Is From an External Sender
</div>
<div id="pfptBannertxvbz92" style="all: unset !important; display:block !important; visibility: visible !important; background-color: #CFD3D7 !important; color:#000000 !important; color:#000000; font-weight:normal; font-family: 'Arial', sans-serif !important; font-family: 'Arial', sans-serif; font-size:12px !important; line-height:18px !important; line-height:18px; margin-top:2px !important;">
This message came from outside your organization.
</div>
</div>
<div id="pfptBannertxvbz92" style="all: unset !important; float: right !important; display: block !important; display: block; margin: 0px 0px 0px 16px !important; text-align: right !important; width: fit-content !important;">
<a id="pfptBannertxvbz92" href="https://us-phishalarm-ewt.proofpoint.com/EWT/v1/KGKeukY!sKQZnUzhg0ZAypqQH24ENG9u82vXj-ZRMQzPJ_49eNshBAoNJ6ATl_KRnTxu6FTC2-N6dsUJ02AJKGHO03xG7P7ogFJuQaR-eW3_KxMElhkfDFT2Ye0$"
style="all: unset !important; display: inline-block !important; text-decoration: none">
<div class="pfptPrimaryButtontxvbz92" style="display: inline-block !important; display: inline-block; visibility: visible !important; opacity: 1 !important; color: #000000 !important; color: #000000; font-family: 'Arial', sans-serif !important; font-family: 'Arial', sans-serif; font-size: 14px !important; font-weight: normal !important; text-decoration: none !important; border-radius: 2px !important; padding: 7.5px 16px !important; margin: 3px 0 3px 16px !important; white-space: nowrap !important; width: fit-content !important;
border: 1px solid #666666">
Report Suspicious
</div>
</a>
</div>
<div style="clear: both !important; display: block !important; visibility: hidden !important; line-height: 0 !important; font-size: 0.01px !important; height: 0px"> </div>
</div>
<![endif]>
<div style="display:none !important;display:none;visibility:hidden;mso-hide:all;font-size:1px;color:#ffffff;line-height:1px;max-height:0px;opacity:0;overflow:hidden;">ZjQcmQRYFpfptBannerEnd</div>
<!-- Email Banner : END -->
<!-- BaNnErBlUrFlE-BoDy-end -->
<html><body><div><div>Thank you so much! This is extremly helpful!<br></div><div><br></div><div>Troy </div><div><br></div><blockquote type="cite"><div>On Jul 15, 2025, at 12:20 PM, Mary Ellen Jafari via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list@lists.osu.edu> wrote:<br></div><div><br></div><div><br></div><div lang="EN-US" link="#467886" vlink="#96607D" style="word-wrap:break-word"><div style="display:none !important;display:none;visibility:hidden;mso-hide:all;font-size:1px;color:#ffffff;line-height:1px;height:0px;max-height:0px;opacity:0;overflow:hidden;">In case you haven’t heard, TJC is consolidating and revising its requirements effective 1/1/2026 to more closely align with CMS requirements. The EPs specific to imaging and radioactive materials will be in different sections and have<br></div><div style="display:none !important;display:none;visibility:hidden;mso-hide:all;font-size:1px;color:#ffffff;line-height:1px;max-height:0px;opacity:0;overflow:hidden;"><br></div><div class="WordSection1"><p class="MsoNormal">In case you haven’t heard, TJC is consolidating and revising its requirements effective 1/1/2026 to more closely align with CMS requirements. The EPs specific to imaging and radioactive materials will be in different sections and have
different reference numbers.<br></p><p class="MsoNormal">I don’t think there are any major changes in the content though.<br></p><p class="MsoNormal"> <br></p><p class="MsoNormal">As an example, the Environment of Care and Life Safety chapters have been replaced with a new Physical Environment (PE) chapter.<br></p><p class="MsoNormal"> <br></p><p class="MsoNormal">I have attached a very helpful document that lists each EP and its new location and number. I have also attached the new Hospital Accreditation Survey Process Guide which is the guide the surveyors use. The Hospital Radiologic Services
Evaluation Module starts on page 188. <br></p><p class="MsoNormal"> <br></p><p class="Default">One item that concerns me in the Hospital Radiologic Services Evaluation module is on page 192. It sounds like TJC is not on same page as AAPM, however I would think that as long as we are following our facility policy, we should be fine.<span style="color:windowtext"></span><br></p><p class="Default" style="margin-left:0in;text-indent:0in;mso-list:l0 level1 lfo1"><span style="mso-list:Ignore">•<span style="font-style: normal; font-variant: normal; font-size-adjust: none; font-kerning: auto; font-optical-sizing: auto; font-feature-settings: normal; font-variation-settings: normal; font-weight: normal; font-stretch: normal; line-height: normal;"><span class="font" style="font-family:"Times New Roman""><span class="size" style="font-size:7pt"> </span></span></span></span><i>Proper shielding is applied to a patient who is undergoing a procedure using ionizing radiation.</i><br></p><p class="MsoNormal"> <br></p><p class="MsoNormal">Mary Ellen<br></p><p class="MsoNormal"> <br></p><p class="MsoNormal"><span style=""><span class="font" style="font-family:Calibri, sans-serif"><span class="size" style="font-size:11pt">Mary Ellen Jafari, MS, DABR (D,N), MRSE, MRSO, FACR, FAAPM, CIIP</span></span></span><br></p><p class="MsoNormal"><span style=""><span class="font" style="font-family:Calibri, sans-serif"><span class="size" style="font-size:11pt">Chief Physicist and Regional Radiation Safety Officer</span></span></span><br></p><p class="MsoNormal"><span style=""><span class="font" style="font-family:Calibri, sans-serif"><span class="size" style="font-size:11pt"> </span></span></span><br></p><p class="MsoNormal"><span style=""><span class="font" style="font-family:Calibri, sans-serif"><span class="size" style="font-size:11pt">Kaiser Permanente</span></span></span><br></p><p class="MsoNormal"><span style=""><span class="font" style="font-family:Calibri, sans-serif"><span class="size" style="font-size:11pt">Southern California Permanente Medical Group Medical Imaging Technology and Informatics</span></span></span><br></p><p class="MsoNormal"><span style=""><span class="font" style="font-family:Calibri, sans-serif"><span class="size" style="font-size:11pt">199 S. Los Robles Ave., Pasadena CA 91101</span></span></span><br></p><p class="MsoNormal"><span style=""><span class="font" style="font-family:Calibri, sans-serif"><span class="size" style="font-size:11pt">626-430-1231 (office mobile)</span></span></span><br></p><p class="MsoNormal"><span style=""><span class="font" style="font-family:Calibri, sans-serif"><span class="size" style="font-size:11pt"><a href="mailto:Maryellen.Jafari@kp.org"><span style="color:#467886">Maryellen.Jafari@kp.org</span></a></span></span></span><br></p><p class="MsoNormal"> <br></p></div><p class="MsoNormal"><b><span style="line-height: 107%; color: blue;"><span class="font" style="font-family:Arial, sans-serif"><span class="size" style="font-size:8pt">NOTICE TO RECIPIENT:</span></span></span></b><span style="line-height: 107%; color: black;"><span class="font" style="font-family:Arial, sans-serif"><span class="size" style="font-size:8pt"><span style="mso-spacerun:yes"> </span>If you are not the intended recipient of this e-mail, you are prohibited from sharing, copying, or otherwise using or disclosing its contents.<span style="mso-spacerun:yes"> </span>If you have received this e-mail in error, please notify the sender immediately by reply e-mail and permanently delete this e-mail and any attachments without reading, forwarding or saving them. v.173.295<span style="mso-spacerun:yes"> </span>Thank you.</span></span></span><br></p><div><span><HAP_Prepub_CoP_Rewrite_Disposition_Jan2026.pdf></span><br></div></div></blockquote></div><div><br></div></body></html>