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I agree, and of course, I’m aware of the ODH regulations. I’m trying to discourage the site from moving in this direction, but the bean counters and management will likely not heed my warnings. Around the early 2000’s, another</div>
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<p class="MsoNormal"><span style="font-size:12.0pt">I agree, and of course, I’m aware of the ODH regulations. I’m trying to discourage the site from moving in this direction, but the bean counters and management will likely not heed my warnings. Around the
early 2000’s, another one of my cites received a Level 1 noncompliance, a cease-and-desist letter, and a follow up inspection after an ODH inspector asked a nurse if she ever presses these buttons, and she said “yes.” And knowing how some physicians think,
I have no doubt that eventually they’ll start asking nurses to change mag modes, etc. Also, and I verified this with ODH, the cardiologist will have to personally, with his own hand, select the protocol on the computer when the patient gets registered. And
the fact that the radiology director has been asking the ODH for clarification on the rules will paint a target on our backs at inspection time.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt">If they continue to move in this direction, I am considering asking them to remove me as IRRP.<o:p></o:p></span></p>
<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:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="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"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#A50021">Medical Physicist</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="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"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt;color:#A50021">440-463-7879</span><span style="font-size:12.0pt"><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"> Joshua Johnson <jjohnson@onephysics.com>
<br>
<b>Sent:</b> Friday, May 22, 2026 9:07 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<o:p></o:p></span></p>
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<p class="MsoNormal"><o:p> </o:p></p>
<p class="MsoNormal"><span style="font-size:11.0pt">You’re going to need to be very careful on that. I don’t see it being smooth at all. You do have the option of having nurses do minimal tasks for operation for cath only procedures. Like you said, most of
the button pushing would be done by the cardiologists outside of resetting the timer and any positioning buttons. I try to avoid having the nurses do anything on the list when possible out of fear that it would expand outside the bounds. I don’t like not having
an RT and have had facilities getting into trouble for having incorrect staff “operating the equipment” even when it’s only select procedures without an RT.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">I’m sure you know this already, but the nurses can:<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">(1) Move or position the patient;<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">(2) Move or position the fluoroscopic unit; and<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt">(3) Reset the audible signal on the cumulative radiation exposure timer.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.0pt"><o:p> </o:p></span></p>
<p class="MsoNormal"><i><span style="font-size:12.0pt;color:#002060;mso-ligatures:standardcontextual">Joshua Johnson, MS, DABR</span></i><span style="font-size:13.5pt;font-family:"Segoe UI",sans-serif;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
<p class="MsoNormal"><i><span style="font-size:12.0pt;color:#002060;mso-ligatures:standardcontextual"> </span></i><span style="font-size:12.0pt;color:black"><img width="193" height="78" style="width:2.0083in;height:.8166in" id="Picture_x0020_12404430" src="cid:image001.jpg@01DCE9CF.EAAB28E0"></span><span style="font-size:13.5pt;font-family:"Segoe UI",sans-serif;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
<p class="MsoNormal"><i><span style="font-size:12.0pt;color:#002060;mso-ligatures:standardcontextual">1681 W. Old Henderson Road</span></i><i><span style="font-family:"Calibri",sans-serif;color:#002060;mso-ligatures:standardcontextual"><o:p></o:p></span></i></p>
<p class="MsoNormal"><i><span style="font-size:12.0pt;color:#002060;mso-ligatures:standardcontextual">Columbus, OH 43220</span></i><span style="font-size:13.5pt;font-family:"Segoe UI",sans-serif;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
<p class="MsoNormal"><i><span style="font-size:12.0pt;color:#002060;mso-ligatures:standardcontextual">888-245-6672, Ext. 13 (phone)</span></i><span style="font-size:13.5pt;font-family:"Segoe UI",sans-serif;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Times New Roman",serif;mso-ligatures:standardcontextual"><a href="https://urldefense.com/v3/__https://webmail.sherweb2010.com/owa/redir.aspx?C=pyNgCk_yu0GEwD07Xredx9vbvKCRvc8IVeXl4Q-pA341bnmWVZfV16RKKBi83cQpft9lfs4qnCs.&URL=http*3a*2f*2fwww.ohiomedphys.com*2f__;JSUlJQ!!KGKeukY!zW_MWr1Wv3tTTs5hW4Guhd4OqN1h1VG_K9q6RB7MgzNhAa4Oowxl3HpfEItobh8ukgXW85KV9XSezqKh3mrMPvoyK1lGrU7JtvweZQ$" target="_blank"><i><span style="font-family:"Aptos",sans-serif;color:blue">www.ohiomedphys.com</span></i></a></span><span style="font-size:13.5pt;font-family:"Segoe UI",sans-serif;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
<p class="MsoNormal"><i><span style="font-size:12.0pt;color:#002060;mso-ligatures:standardcontextual"> </span></i><span style="font-size:13.5pt;font-family:"Segoe UI",sans-serif;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#002060;mso-ligatures:standardcontextual">Follow us: </span><span style="font-size:13.5pt;font-family:"Segoe UI",sans-serif;mso-ligatures:standardcontextual">
</span><a href="https://urldefense.com/v3/__https://www.linkedin.com/company/ohio-medical-physics-consulting__;!!KGKeukY!zW_MWr1Wv3tTTs5hW4Guhd4OqN1h1VG_K9q6RB7MgzNhAa4Oowxl3HpfEItobh8ukgXW85KV9XSezqKh3mrMPvoyK1lGrU4sGxef9w$"><span style="font-size:13.5pt;font-family:"Segoe UI",sans-serif;color:blue;text-decoration:none"><img border="0" width="30" height="25" style="width:.3083in;height:.2583in" id="Picture_x0020_1362945218" src="cid:image002.png@01DCE9CF.EAAB28E0" alt="linkedin"></span></a><span style="font-size:12.0pt;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 <<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<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">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<o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">Hi folks.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">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?<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual">Thanks<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p> </o:p></span></p>
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<p class="MsoNormal"><span style="font-size:11.0pt"> </span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="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"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;font-family:"Arial",sans-serif;color:#A50021">Medical Physicist</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
<p class="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"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:14.0pt;color:#A50021">440-463-7879</span><span style="font-size:12.0pt"><o:p></o:p></span></p>
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<p class="MsoNormal"><span style="font-size:14.0pt;color:#A50021"> </span><span style="font-size:12.0pt;mso-ligatures:standardcontextual"><o:p></o:p></span></p>
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