<head><!-- BaNnErBlUrFlE-HeAdEr-start -->
<style>
#pfptBanner3od715g { all: revert !important; display: block !important;
visibility: visible !important; opacity: 1 !important;
background-color: #CFD3D7 !important;
max-width: none !important; max-height: none !important }
.pfptPrimaryButton3od715g:hover, .pfptPrimaryButton3od715g:focus {
background-color: #adb0b4 !important; }
.pfptPrimaryButton3od715g:active {
background-color: #8c8e91 !important; }
html:root, html:root>body { all: revert !important; display: block !important;
visibility: visible !important; opacity: 1 !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;">
Hi Nima, I think I misunderstood the emphasis of your question on fluoro. I agree with what everyone else has said, obviously. To my knowledge and understanding, TJC requires you to follow your state regulations for fluoro. For a unit replacement</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!vYQd06pLqUgq47n5H2ev2L7kDEQabE1XJQmuS0OKZQc-LVFGxrs7mD57c_5ASeD2GIqJy3zH4s_umAYa7nYgidNH4KII7fGWTX9u_xy4NdiOJGXDWgU9bveAUsVpcoxUS-4EDEQI8SN5Im5CrQ$" 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="pfptBanner3od715g" 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="pfptBanner3od715g" style="all: unset !important; float:left !important; display:block !important; margin: 0px 0px 1px 0px !important; max-width: 600px !important;">
<div id="pfptBanner3od715g" 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="pfptBanner3od715g" 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="pfptBanner3od715g" 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="pfptBanner3od715g" href="https://us-phishalarm-ewt.proofpoint.com/EWT/v1/KGKeukY!vYQd06pLqUgq47n5H2ev2L7kDEQabE1XJQmuS0OKZQc-LVFGxrs7mD57c_5ASeD2GIqJy3zH4s_umAYa7nYgidNH4KII7fGWTX9u_xy4NdiOJGXDWgU9bveAUsVpcoxUS-4EDEQI8SN5Im5CrQ$"
style="all: unset !important; display: inline-block !important; text-decoration: none">
<div class="pfptPrimaryButton3od715g" 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 -->
<div dir="ltr"><div>Hi Nima,</div><div><br></div><div>I think I misunderstood the emphasis of your question on fluoro. I agree with what everyone else has said, obviously. To my knowledge and understanding, TJC requires you to follow your state regulations for fluoro. For a unit replacement where they did not renovate the walls, I almost always perform a scatter survey, but sometimes I will make a note if the previous survey was truly adequate that no change in public dose is expected. I then attach that memo to the previous survey/area monitors report/etc and file it with the reports for the new equipment.</div><div><br></div><div>Thanks,</div><div><br></div><div>Mike</div><br></div><br><div class="gmail_quote"><div dir="ltr" class="gmail_attr">On Mon, Sep 8, 2025 at 3:03 PM Nima Kasraie <<a href="mailto:Nima.Kasraie@utsouthwestern.edu" target="_blank">Nima.Kasraie@utsouthwestern.edu</a>> wrote:<br></div><blockquote class="gmail_quote" style="margin:0px 0px 0px 0.8ex;border-left:1px solid rgb(204,204,204);padding-left:1ex"><div>
<div lang="EN-US">
<div>
<p class="MsoNormal"><span style="font-size:11pt">Hi Mike,<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt">I looked thru it. It didn’t find anything specifically about fluoro rooms being upgraded needing a radiation shielding survey performed. That one passage about “</span><span style="font-family:"Times New Roman",serif;background:yellow">Any
changes in design or<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-family:"Times New Roman",serif;background:yellow">shielding which affects radiation exposure levels adjacent to those rooms, requires prior approval by RC</span><span style="font-family:"Times New Roman",serif">”
is confusing because it starts out with Radiation Therapy. And then, I thought RC isn’t involved with DX?<span style="background:yellow"><u></u><u></u></span></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt">All the passages I’ve found are written in a general tone or way that leaves room for interpretation.<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt">It seems the only thing that can be construed in the regs is (as Laura mentioned) writing a
<b>statement</b> in your reports that the dose to the public will be lower than a certain amount.<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt">But do you necessarily need a survey measurement for that (the way NCRP 147 says)?<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt">Nima<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt">P.S. I didn’t find the JC document that mentions fluoro either. It’s CT and NM , but not fluoro?<u></u><u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<p class="MsoNormal"><span style="font-size:11pt"><u></u> <u></u></span></p>
<div style="border-width:1pt medium medium;border-style:solid none none;border-color:rgb(225,225,225) currentcolor currentcolor;padding:3pt 0in 0in">
<p class="MsoNormal"><b><span style="font-size:11pt;font-family:"Calibri",sans-serif">From:</span></b><span style="font-size:11pt;font-family:"Calibri",sans-serif"> Mike Nimmo <<a href="mailto:mike.t.nimmo@gmail.com" target="_blank">mike.t.nimmo@gmail.com</a>>
<br>
<b>Sent:</b> Monday, September 8, 2025 2:13 PM<br>
<b>To:</b> Nima Kasraie <Nima.Kasraie@UTSouthwestern.edu><br>
<b>Cc:</b> <a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank">intl_dxmedphys_wd_osu_list@lists.osu.edu</a><br>
<b>Subject:</b> Re: [Intl_DxMedPhys] Are shielding surveys for replacements required?<u></u><u></u></span></p>
</div>
<p class="MsoNormal"><u></u> <u></u></p>
<div>
<p class="MsoNormal"><span style="font-size:1pt;color:white">Hi Nima, It is in the Title 25 Texas Administrative Code Chapter 133, Hospital Licensing rules. Attached. Thanks, On Mon, Sep 8, 2025 at 1:</span><span style="font-size:1pt;font-family:"Arial",sans-serif;color:white"> </span><span style="font-size:1pt;color:white">38
PM Nima Kasraie via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list@</span><span style="font-size:1pt;font-family:"Arial",sans-serif;color:white"> </span><span style="font-size:1pt;color:white">lists.</span><span style="font-size:1pt;font-family:"Arial",sans-serif;color:white"> </span><span style="font-size:1pt;color:white">osu.</span><span style="font-size:1pt;font-family:"Arial",sans-serif;color:white"> </span><span style="font-size:1pt;color:white">edu>
wrote:</span><span style="font-size:1pt;font-family:"Arial",sans-serif;color:white"> </span><span style="font-size:1pt;color:white"><u></u><u></u></span></p>
</div>
<div>
<p class="MsoNormal"><span style="font-size:1pt;color:white"><u></u><u></u></span></p>
</div>
<div>
<div>
<p class="MsoNormal">Hi Nima,<u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal">It is in the Title 25 Texas Administrative Code Chapter 133, Hospital Licensing rules. Attached.<u></u><u></u></p>
</div>
<div>
<p class="MsoNormal"><u></u> <u></u></p>
</div>
<div>
<p class="MsoNormal">Thanks,<u></u><u></u></p>
</div>
</div>
<p class="MsoNormal"><u></u> <u></u></p>
<div>
<div>
<p class="MsoNormal">On Mon, Sep 8, 2025 at 1:38<span style="font-family:"Arial",sans-serif"> </span>PM Nima Kasraie via Intl_dxmedphys_wd_osu_list <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu" target="_blank">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>> wrote:<u></u><u></u></p>
</div>
<blockquote style="border-width:medium medium medium 1pt;border-style:none none none solid;border-color:currentcolor currentcolor currentcolor rgb(204,204,204);padding:0in 0in 0in 6pt;margin-left:4.8pt;margin-right:0in">
<div>
<div>
<p class="MsoNormal"><span style="font-size:1pt;color:white">Hi all, If you replace a fluoro room with a similar model and vendor with no changes to room shielding and walls, do you still need to do a shielding survey, legally
speaking? TJC says yes. But what about the states? For example, in Texas, I<u></u><u></u></span></p>
</div>
<div>
<div>
<p class="MsoNormal"><span style="font-size:11pt">Hi all,</span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt">If you replace a fluoro room with a similar model and vendor
<b>with no changes to room shielding and walls</b>, do you still need to do a shielding survey,
<b>legally speaking</b>?</span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt">TJC says yes.
</span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt">But what about the states?</span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt">For example, in
<b><span style="color:rgb(238,0,0)">Texas</span></b>, I find no mention of the state regs where they<b>
</b>compel a shielding survey for diagnostic X-ray/fluoroscopy rooms. It’s not in TAC 289.227, nor any of the adopted rules I could find.</span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt">But if the state doesn’t ask for it, can they expect a post-installation shielding confirmation—especially for high-dose fluoro rooms—even if that
expectation isn't explicitly stated in 227?</span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt">I find it hard to accept that the state wouldn’t have any specific language on this issue.</span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt">Nima</span><u></u><u></u></p>
<p class="MsoNormal"><span style="font-size:11pt"> </span><u></u><u></u></p>
</div>
<p class="MsoNormal"><u></u> <u></u></p>
<div class="MsoNormal" align="center" style="text-align:center">
<hr size="2" width="100%" align="center">
</div>
<table border="0" cellspacing="3" cellpadding="0">
<tbody>
<tr>
<td style="padding:0in">
<p align="right" style="margin-bottom:0in;text-align:right"><b><span style="font-size:17pt;font-family:"Helvetica",sans-serif;color:rgb(0,76,151);letter-spacing:-2.25pt">UT</span></b><b><span style="font-size:17pt;font-family:"Helvetica",sans-serif;color:rgb(0,76,151)">
Southwestern</span></b> <u></u><u></u></p>
</td>
</tr>
<tr>
<td style="padding:0in">
<p align="right" style="margin:0in;text-align:right"><span style="font-size:13pt;font-family:"Helvetica",sans-serif;color:rgb(99,100,102)">Medical Center</span><u></u><u></u></p>
</td>
</tr>
<tr>
<td style="padding:0in">
<p align="right" style="margin-top:3.75pt;text-align:right"><span style="font-size:10pt;font-family:"Helvetica",sans-serif;color:rgb(99,100,102)">The future of medicine, today.</span><u></u><u></u></p>
</td>
</tr>
</tbody>
</table>
</div>
</div>
</blockquote>
</div>
<div>
<p class="MsoNormal"><br clear="all">
<u></u><u></u></p>
</div>
<p class="MsoNormal"><br>
<span>-- </span><u></u><u></u></p>
<div>
<p class="MsoNormal">Mike Nimmo<u></u><u></u></p>
</div>
</div>
</div>
</div></blockquote></div><div><br clear="all"></div><br><span class="gmail_signature_prefix">-- </span><br><div dir="ltr" class="gmail_signature">Mike Nimmo</div>