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Two questions for consideration by the list members These days, how often are the fluoroscope's technique settings adjusted after the procedure starts? If a tech is operating the foot-peddle and/or the gantry .. . How do they know what the primary</div>
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Two questions for consideration by the list members</div>
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These days, how often are the fluoroscope's technique settings adjusted after the procedure starts?</div>
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If a tech is operating the foot-peddle and/or the gantry ... How do they know what the primary physician needs at that moment?</div>
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<div id="divRplyFwdMsg" dir="ltr"><font face="Calibri, sans-serif" style="font-size:11pt" color="#000000"><b>From:</b> Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+sb2455=cumc.columbia.edu@lists.osu.edu> on behalf of Bob Kobistek via Intl_dxmedphys_wd_osu_list
<intl_dxmedphys_wd_osu_list@lists.osu.edu><br>
<b>Sent:</b> Friday, May 22, 2026 9:54 AM<br>
<b>To:</b> Wunderle, Kevin <Kevin.Wunderle@osumc.edu>; DxMedPhys List <intl_dxmedphys_wd_osu_list@lists.osu.edu><br>
<b>Subject:</b> [EXTERNAL] Re: [Intl_DxMedPhys] Tech - less cath labs</font>
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Thanks Kevin. As you may have already seen from my response to Josh’s response, I would consider resigning as their IRRP if they move in this direction. In facilities where I am IRRP, yet a consultant, I nonetheless assume I have ultimate</div>
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<p class="x_MsoNormal"><span style="font-size:12.0pt">Thanks Kevin.</span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt"> </span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt">As you may have already seen from my response to Josh’s response, I would consider resigning as their IRRP if they move in this direction. In facilities where I am IRRP, yet a consultant, I nonetheless assume
I have ultimate authority for oversight of their QC, radiation safety, and regulatory compliance. As you know, the ODH requires hospital administration to generate a letter granting the IRRP the authority to execute the duties.
</span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt"> </span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt">This may be the first time one of my actions is vetoed.
</span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt"> </span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt">The model you mentioned – 10 cath labs and 2 techs – is similar to what I’ve often seen in some surgery settings. I’m not opposed to that approach, but this site has only two cath labs.</span></p>
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<p class="x_MsoNormal"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"></span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt; font-family:"Arial",sans-serif; color:#A50021">Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)</span><span style="font-size:12.0pt"></span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt; font-family:"Arial",sans-serif; color:#A50021">Medical Physicist</span><span style="font-size:12.0pt"></span></p>
<p class="x_MsoNormal"><span style="font-size:22.0pt; font-family:"Castellar",serif; color:#A50021">RJK</span><span style="font-size:22.0pt; font-family:"Colonna MT"; color:#A50021">
</span><span style="font-size:14.0pt; color:#A50021">Medical Physics, Inc.</span><span style="font-size:12.0pt"></span></p>
<p class="x_MsoNormal"><span style="font-size:14.0pt; color:#A50021">440-463-7879</span><span style="font-size:12.0pt"></span></p>
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<p class="x_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"> Wunderle, Kevin <Kevin.Wunderle@osumc.edu>
<br>
<b>Sent:</b> Friday, May 22, 2026 9:12 AM<br>
<b>To:</b> Bob Kobistek <bob@rjkmedphys.com>; DxMedPhys List <intl_dxmedphys_wd_osu_list@lists.osu.edu><br>
<b>Subject:</b> RE: Tech - less cath labs</span></p>
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<p class="x_MsoNormal"><span style="font-size:11.0pt">Hey Bob,</span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt">At my former institution, this model was actually in place at their main campus. The regional hospitals with Cardiac Cath labs almost always had x-ray technologists running the fluoroscope, but at the main
campus, there were only approximately two x-ray technologists for roughly ten cath labs, and they generally did not operate the fluoroscope even when in cases, they were typically used as scrubbed procedure assistants.</span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt">Your concern is absolutely valid—if the physician is scrubbed in and performing the procedure, and there’s no technologist or trainee MD available to operate the fluoroscope, it begs the question: who is
actually managing it? In Ohio, as you know well, there’s that quasi exemption allowing specifically trained individuals in cardiac labs to perform limited fluoroscope operations. However, this is quite restricted—both in terms of who it applies to and the
range of functions they’re permitted to handle.</span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt">As the IRRP, this definitely presents a real challenge, since you’re ultimately responsible for daily oversight and ensuring compliance. From a consulting standpoint, this setup feels less than ideal, as
you probably don’t have the authority you’d need to truly enforce compliance—though I admit I could be wrong about your exact role.</span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt">Whatever the IRRP part of your contract is paying, it probably isn’t enough!</span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt">Best regards,</span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt">Kevin</span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt"> </span></p>
<p class="x_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" id="x_Picture_x0020_1" alt="The Ohio State University" style="width:2.3333in; height:.4666in" data-outlook-trace="F:1|T:1" src="cid:image001.png@01DCE9D0.D8AE6750"></span><span style="font-size:9.0pt; line-height:115%; font-family:"Arial",sans-serif; color:#333333"><br>
</span><b><span style="font-size:11.0pt; line-height:115%; font-family:"Times New Roman",serif; color:#BB0000; background:white">Kevin Wunderle, PhD, FAAPM, FACR</span></b><span style="font-size:11.0pt; line-height:115%; font-family:"Times New Roman",serif; color:#333333"><br>
Professor, Department of Radiology</span></p>
<p class="x_MsoNormal" style="line-height:115%; background:white"><span style="font-size:11.0pt; line-height:115%; font-family:"Times New Roman",serif; color:#333333">Diagnostic Medical Physicist<br>
395 W. 12th Avenue,</span></p>
<p class="x_MsoNormal" style="line-height:115%; background:white"><span style="font-size:11.0pt; line-height:115%; font-family:"Times New Roman",serif; color:#333333">Floor 4, Room 410</span></p>
<p class="x_MsoNormal" style="line-height:115%; background:white"><span style="font-size:11.0pt; line-height:115%; font-family:"Times New Roman",serif; color:#333333">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; color:blue; background:white">kevin.wunderle@osumc.edu</span></a></span><span style="font-size:11.0pt; line-height:115%; font-family:"Times New Roman",serif; color:#333333"></span></p>
<p class="x_MsoNormal" style="line-height:115%; background:white"><span style="font-size:11.0pt; line-height:115%; font-family:"Arial",sans-serif; color:#333333"> </span></p>
<p class="x_MsoNormal"><span style="font-size:11.0pt"> </span></p>
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<p class="x_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 <<a href="mailto:intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu">intl_dxmedphys_wd_osu_list-bounces@lists.osu.edu</a>>
<b>On Behalf Of </b>Bob Kobistek via Intl_dxmedphys_wd_osu_list<br>
<b>Sent:</b> Friday, May 22, 2026 8:50 AM<br>
<b>To:</b> DxMedPhys List <<a href="mailto:intl_dxmedphys_wd_osu_list@lists.osu.edu">intl_dxmedphys_wd_osu_list@lists.osu.edu</a>><br>
<b>Subject:</b> [Intl_DxMedPhys] Tech - less cath labs</span></p>
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<p class="x_MsoNormal"> </p>
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<p class="x_MsoNormal" style=""><span style="font-size:1.0pt; color:white">Hi folks. One of my sites is planning to eliminate X-ray technologists from their cath lab staff, which necessitates having the cardiologists press all the buttons. At this site, I am
the IRRP (In the Ohio language, a person like the RSO, but</span></p>
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<p class="x_MsoNormal"><span style="font-size:12.0pt">Hi folks. </span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt"> </span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt">One of my sites is planning to eliminate X-ray technologists from their cath lab staff, which necessitates having the cardiologists press all the buttons. At this site, I am the IRRP (In the Ohio language,
a person like the RSO, but for radiation-generating equipment and not RAM). Given that I have this responsibility, I’m concerned about cardiologists getting lazy and having the nurses press buttons, thereby resulting in a Level 1 violation. Have any of you
ever worked with a cath lab that had no techs? If so, how’d that work out?</span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt"> </span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt">Thanks</span></p>
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<p class="x_MsoNormal"><span style="font-size:12.0pt; font-family:"Arial",sans-serif; color:#A50021">Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC™)</span><span style="font-size:12.0pt"></span></p>
<p class="x_MsoNormal"><span style="font-size:12.0pt; font-family:"Arial",sans-serif; color:#A50021">Medical Physicist</span><span style="font-size:12.0pt"></span></p>
<p class="x_MsoNormal"><span style="font-size:22.0pt; font-family:"Castellar",serif; color:#A50021">RJK</span><span style="font-size:22.0pt; font-family:"Colonna MT"; color:#A50021">
</span><span style="font-size:14.0pt; color:#A50021">Medical Physics, Inc.</span><span style="font-size:12.0pt"></span></p>
<p class="x_MsoNormal"><span style="font-size:14.0pt; color:#A50021">440-463-7879</span><span style="font-size:12.0pt"></span></p>
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