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<p class="MsoNormal"><span style="font-size:11.0pt">Hi Nima,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">There is an easy answer to convincing administration of best practice and answering the question you pose of “that’s fine, but is it in the state regs?” and my answer would be to defer to the institution’s
lawyers / legal department. Normally I would avoid the legal department at all costs, they typically bog everything down, but in a case where an individual or department does not want to follow best practices or skirt around a grey area, I would engage the
legal department. They will likely enlighten those involved as to the potential costs of not following standards and/or best practices, both in safety and money.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">A different topic, but similar vein, there are no state regs limiting radiation dose to patients, but if an institution delivers 20 Gy of skin dose to a patient and didn’t follow best practices, proper risk
mitigation, and/or standard of care there will be a cost, even though the state might not have an explicit threshold…<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">All the best,<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Kevin<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal" style="line-height:115%;background:white"><span style="font-size:9.0pt;line-height:115%;font-family:"Arial",sans-serif;color:#333333"><img width="224" height="45" style="width:2.3333in;height:.4687in" id="Picture_x0020_1" src="cid:image001.png@01DC222D.B5A27D70" alt="The Ohio State University"><span style="mso-ligatures:standardcontextual"><br>
</span></span><b><span style="font-size:11.0pt;line-height:115%;font-family:"Times New Roman",serif;color:#BB0000;background:white;mso-ligatures:standardcontextual">Kevin Wunderle, PhD, FAAPM, FACR</span></b><span style="font-size:11.0pt;line-height:115%;font-family:"Times New Roman",serif;color:#333333;mso-ligatures:standardcontextual"><br>
Professor, Department of Radiology<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:115%;background:white"><span style="font-size:11.0pt;line-height:115%;font-family:"Times New Roman",serif;color:#333333;mso-ligatures:standardcontextual">Diagnostic Medical Physicist<br>
395 W. 12th Avenue,<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:115%;background:white"><span style="font-size:11.0pt;line-height:115%;font-family:"Times New Roman",serif;color:#333333;mso-ligatures:standardcontextual">Floor 4, Room 424<o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:115%;background:white"><span style="font-size:11.0pt;line-height:115%;font-family:"Times New Roman",serif;color:#333333;mso-ligatures:standardcontextual">Columbus, OH, 43210<br>
216-245-5513 Mobile<br>
</span><span style="color:black"><a href="mailto:kevin.wunderle@osumc.edu"><span style="font-size:11.0pt;line-height:115%;font-family:"Times New Roman",serif;background:white;mso-ligatures:standardcontextual">kevin.wunderle@osumc.edu</span></a></span><span style="font-size:11.0pt;line-height:115%;font-family:"Times New Roman",serif;color:#333333;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
<p class="MsoNormal" style="line-height:115%;background:white"><span style="font-size:11.0pt;line-height:115%;font-family:"Arial",sans-serif;color:#333333;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"> Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu>
<b>On Behalf Of </b>Nima Kasraie via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b> Tuesday, September 9, 2025 2:59 PM<br>
<b>To:</b> intl_dxmedphys_wd_osu_list@lists.osu.edu<br>
<b>Subject:</b> Re: [Intl_DxMedPhys] Are shielding surveys for replacements required?<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
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<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white">These questions that I ask over the years often have a common theme: how do you convince admins of a “good practice” when there is spotty/hazy/confusing regulatory
coverage on it. Like, how do you respond to “that’s fine, but is it in the state<o:p></o:p></span></p>
</div>
<p class="MsoNormal"><span style="font-size:11.0pt">These questions that I ask over the years often have a common theme: how do you convince admins of a “good practice” when there is spotty/hazy/confusing regulatory coverage on it.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Like, how do you respond to “that’s fine, but is it in the state regs?”?
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">In the case of NM and CT, JC is often equivocally clear, but for e.g. fluoro, I’m not very pleased (as a QMP) having to constantly go to battle and put up an offensive to establish the need for implementing
certain safeguards or good practices. Some things should be obvious. In my mind, in an ideal world, the word of a QMP should be enough. I shouldn’t have to pull out a string of regulations and standards and flash them at everybody to convince them that certain
things are needed. <o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">One time, a client told me that they did not need a shielding inspection for their SPECT-CT upgrade, because “GE has provided it to us”.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Thanks to all.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">Nima<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
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<p class="MsoNormal"><b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">From:</span></b><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"> Intl_dxmedphys_wd_osu_list <</span><a href="mailto:intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu</span></a><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">>
<b>On Behalf Of </b>John Sadler via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b> Tuesday, September 9, 2025 12:17 PM<br>
<b>To:</b> Eugene Mah <</span><a href="mailto:eugenemah@gmail.com"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">eugenemah@gmail.com</span></a><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">><br>
<b>Cc:</b> </span><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu"><span style="font-size:11.0pt;font-family:"Calibri",sans-serif">intl_dxmedphys_wd_osu_list@lists.osu.edu</span></a><span style="font-size:11.0pt;font-family:"Calibri",sans-serif"><br>
<b>Subject:</b> Re: [Intl_DxMedPhys] Are shielding surveys for replacements required?<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
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<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white">Even if it is not regulatory, it is good practice. Not only does it confirm that the shielding is adequate, but it can also detect irregularities with the system.
John Sadler, MS, DABR Licensed Medical Physicist Mobile 214-924-0046 John. Sadler@</span><span style="font-size:1.0pt;font-family:"Arial",sans-serif;color:white"> </span><span style="font-size:1.0pt;color:white"><o:p></o:p></span></p>
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<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white"><o:p> </o:p></span></p>
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<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white">Even if it is not regulatory, it is good practice. Not only does it confirm that the shielding is adequate, but it can also detect irregularities with the system.
John Sadler, MS, DABR Licensed Medical Physicist Mobile 214-924-0046 John.</span><span style="font-size:1.0pt;font-family:"Arial",sans-serif;color:white"> </span><span style="font-size:1.0pt;color:white">Sadler@</span><span style="font-size:1.0pt;font-family:"Arial",sans-serif;color:white"> </span><span style="font-size:1.0pt;color:white">mac.</span><span style="font-size:1.0pt;font-family:"Arial",sans-serif;color:white"> </span><span style="font-size:1.0pt;color:white">com<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">Even if it is not regulatory, it is good practice.<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">Not only does it confirm that the shielding is adequate, but it can also detect irregularities with the system. <o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">John Sadler, MS, DABR<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">Licensed Medical Physicist<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">Mobile 214-924-0046<o:p></o:p></span></p>
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<p class="MsoNormal"><a href="mailto:John.Sadler@mac.com"><span style="font-size:12.0pt">John.Sadler@mac.com</span></a><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
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<p class="MsoNormal" style="margin-bottom:12.0pt"><span style="font-size:12.0pt">On Sep 9, 2025, at 10:45</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif"> </span><span style="font-size:12.0pt">AM, Eugene Mah via Intl_dxmedphys_wd_osu_list
<</span><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu"><span style="font-size:12.0pt">intl_dxmedphys_wd_osu_list@lists.osu.edu</span></a><span style="font-size:12.0pt">> wrote:<o:p></o:p></span></p>
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<o:p></o:p></span></p>
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<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;color:white">South Carolina regulations require a new shielding plan and shielding evaluation whenever a new x-ray system is installed or replaces an existing system. Eugene
--------------------------------------------------------------------- Eugene Mah,<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">South Carolina regulations require a new shielding plan and shielding evaluation whenever a new x-ray system is installed or replaces an existing system.<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif">Eugene<o:p></o:p></span></p>
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<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Courier New"">---------------------------------------------------------------------<br>
Eugene Mah, Ph.D., DABR </span><a href="mailto:eugenemah@gmail.com" target="_blank"><span style="font-size:12.0pt;font-family:"Courier New"">eugenemah@gmail.com</span></a><span style="font-size:12.0pt;font-family:"Courier New""><br>
Medical Physicist </span><a href="mailto:maheug@musc.edu" target="_blank"><span style="font-size:12.0pt;font-family:"Courier New"">maheug@musc.edu</span></a><span style="font-size:12.0pt;font-family:"Courier New""><br>
"For I am a Bear of Very Little<br>
Brain, and long words Bother<br>
Charleston, SC 29425 me." - Winnie the Pooh<br>
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<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt">On Mon, Sep 8, 2025 at 2:39</span><span style="font-size:12.0pt;font-family:"Arial",sans-serif"> </span><span style="font-size:12.0pt">PM Nima Kasraie via Intl_dxmedphys_wd_osu_list <</span><a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu"><span style="font-size:12.0pt">intl_dxmedphys_wd_osu_list@lists.osu.edu</span></a><span style="font-size:12.0pt">>
wrote:<o:p></o:p></span></p>
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<p class="MsoNormal" style="mso-line-height-alt:.75pt"><span style="font-size:1.0pt;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<o:p></o:p></span></p>
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<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt">Hi all,</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt">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><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt">TJC says yes.
</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt">But what about the states?</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt">For example, in
<b><span style="color:#EE0000">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><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt">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><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt">I find it hard to accept that the state wouldn’t have any specific language on this issue.</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt">Nima</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
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<p align="right" style="margin-bottom:0in;text-align:right"><b><span style="font-size:17.0pt;font-family:"Helvetica",sans-serif;color:#004C97;letter-spacing:-2.25pt">UT</span></b><b><span style="font-size:17.0pt;font-family:"Helvetica",sans-serif;color:#004C97">
Southwestern</span></b><span style="font-size:10.0pt;font-family:"Times New Roman",serif">
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<p align="right" style="margin:0in;text-align:right"><span style="font-size:13.0pt;font-family:"Helvetica",sans-serif;color:#636466">Medical Center</span><span style="font-size:10.0pt;font-family:"Times New Roman",serif"><o:p></o:p></span></p>
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<p align="right" style="margin-top:3.75pt;text-align:right"><span style="font-size:10.0pt;font-family:"Helvetica",sans-serif;color:#636466">The future of medicine, today.</span><span style="font-size:10.0pt;font-family:"Times New Roman",serif"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
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