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   The Division of Environmental Health licenses, certifications, and permits

Learn more about the Division of Environmental Health

Technical and Professional Information

All X-ray machines are required to be registered through the Washington State Business Licensing Services (DOR).

Enforcement of WAC 246-225-020(2)(l)

WAC 246-225-020 (2) (1) - "Procedures and auxiliary equipment designed to minimize personnel and patient exposure commensurate with the needed diagnostic information shall be utilized."

This requirement will be applied to cases of very high patient exposure from radiographic exams using computed radiography (CR) and digital radiography (DR) technology. 

Using the measurement of entrance skin exposure (ESE) for an anteroposterior (AP) lumbar spine exam provides an example of when this rule could be cited as a violation requiring correction.

1. A CR imaging system is 800 mR or more (many CR systems are rated or set up as "200 speed" and therefore may easily require twice as much exposure as standard film screen at 300-400 mR, which would mean a typical CR system might very well be 600-800 mR. Note that we will bring a high number (e.g., 600-800 mR) to the facility's attention and suggest they investigate ways to reduce it.

2. A DR imaging system is 500 mR or more (except older Canon detectors).

•  If we are citing a facility for an exposure above the limit of 800 for CR and 500 for DR, we must emphasize that image quality must not be compromised, and that they should consult with their medical physicist, radiologist, biomed-engineering and vendors to maintain image quality at the desired level while reducing exposure to the lowest practicable level. In some cases, there could be other reasons for a high patient exposure, e.g.,  HVL,  grid type and ratio; tabletop material attenuation, kVp accuracy; and mA linearity problems. We eliminate these first.

• We have the flexibility to measure and report an ESE for AP LS of greater than 500 for DR or greater than 800 for CR and not cite.  If there are valid circumstances that might not allow a facility to achieve these limits it will be documented.

NOTE: These values of 500 and 800 are purposely set high, so that:

1. we can be comfortable and confident in making the citation and calling for correction, and;

2. the facility is provided a broad and reasonable playing field in which to conduct imaging, so that they have flexibility and choice.

Lead Apron Inspections

Washington State WAC 246 requires leaded aprons to be worn by operators of fluoroscopes and mobile X-ray units.  The rule does not require periodic checking of the leaded garments for cracks or flaws.

Several accrediting organizations require periodic testing of leaded aprons in hospitals and clinics, but there are no specifications.  It is only required that inspections are performed and documented.

The Washington State Office of Radiation Protection recommends using only a visual check for cracks or flaws.  It is not recommended to use  radiography or fluoroscopy to check leaded garments. It is a waste of resources and a needless exposure risk to periodically fluoroscope or radiograph leaded aprons. 

For suggested protocols regarding leaded apron checks go to the Health Physics Society, Ask the Experts.

• How Long Does a Typical Lead Apron Last?

• Lead Apron Inspection

Record Retention of X-Rays

Medical (Hospitals)

Keep for a period of no less than 10 years following the most recent discharge of the patient; except the records of minors which should be kept for no less than 3 years following the age of 18 or 10 years following discharge; whichever is longer RCW 70.41.190.

Medical records for employees must be kept for as long as the employee works for you plus 30 years; unless the employee works for less than one year and you provide the records to the employee when they leave employment WAC 296-802-20005.

Dental

Keep for a period of 5 years WAC 246-817-310.

Chiropractic

Keep for 5 years WAC 246-808-650.

Podiatry

Keep for a minimum of seven years after treatment is rendered WAC 246-922-260.

CRCPD Committee on Medical Practice (H-3) recommends retention of records for a period of 7 years for adults, or for minors until the age of majority plus 7 years.

Temporary Use of X-Ray Equipment

The Department of Health must be notified about the use of ALL X-ray units being brought from out of state into Washington state for temporary use WAC 246-224-0110.

• At least 3 business days prior to in-state use notify the Department of Health and give:

  1. The nature, duration, and scope of use.

  2. The exact location where the radiation machine is to be used.

• All medical or dental X-ray units used in a practice must be registered regardless of the number of days used.

• If it is not a medical or dental X-ray (i.e. industrial, vet, etc.) and will not be used more than 60 calendar days total per year, the unit need not be registered.

• ALL X-ray units must comply with applicable regulations.

X-Ray Machine and Lead Apron Disposal

X-ray machines may contain lead, (and sometimes beryllium and/or PCB contaminated oil). Use of a commercial X-ray company or recycler to ensure proper disposal of  X-ray units and/or lead aprons is recommended. The facility must permanently disable the X-ray machines before transferring them to a vendor or recycler.

Note: Contact the local waste disposal site. Each county has different disposal requirements.

• Washington State Department of Ecology Hazardous Waste Service Directory

External Links

The American Association of Physicists in Medicine

American College of Radiology

Cone Beam Computed Tomography (CBCT)

Conference of Radiation Control Program Directors

Health Physics Society

Radiation-Emitting Products (FDA)

Washington State Chiropractic Association

Washington State Dental Association

Washington State Hospital Association

Washington State Medical Association

Washington State Veterinary Medical Association

Links to external resources are provided as a public service and do not imply endorsement by the Washington State Department of Health.

Contact Information

X-Ray Control Section
P.O. Box 47827
Olympia, WA 98504-7827

Phone 360-236-3236

In-State Toll Free 1-800-299-9729

FAX 360-236-2266

Olympia X-Ray Staff:

Bellevue X-Ray Staff:

Kent X-Ray Staff:

Spokane X-Ray Staff:

Yakima X-Ray Staff: