[Intl_DxMedPhys] Tech - less cath labs

[Bob Kobistek]

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 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.

This may be the first time one of my actions is vetoed.

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.


Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC(tm))
Medical Physicist
RJK Medical Physics, Inc.
440-463-7879

From: Wunderle, Kevin <Kevin.Wunderle at osumc.edu>
Sent: Friday, May 22, 2026 9:12 AM
To: Bob Kobistek <bob at rjkmedphys.com>; DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu>
Subject: RE: Tech - less cath labs

Hey Bob,

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.

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.

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.

Whatever the IRRP part of your contract is paying, it probably isn't enough!

Best regards,
Kevin

[The Ohio State University]
Kevin Wunderle, PhD, FAAPM, FACR
Professor, Department of Radiology
Diagnostic Medical Physicist
395 W. 12th Avenue,
Floor 4, Room 410
Columbus, OH, 43210
216-245-5513 Mobile
kevin.wunderle at osumc.edu<mailto:kevin.wunderle at osumc.edu>


From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list-bounces at lists.osu.edu>> On Behalf Of Bob Kobistek via Intl_dxmedphys_wd_osu_list
Sent: Friday, May 22, 2026 8:50 AM
To: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu<mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
Subject: [Intl_DxMedPhys] Tech - less cath labs

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
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 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?

Thanks


Robert J. Kobistek, MS, FACR, DABR, MRSE(MRSC(tm))
Medical Physicist
RJK Medical Physics, Inc.
440-463-7879

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