X Ray Equipment

REMOTE HEALTH ATLAS – Section 23: EQUIPMENT & OTHER ASSETS X-RAY EQUIPMENT









REMOTE HEALTH ATLAS

X-RAY EQUIPMENT

1. General Information

X-Ray facilities are not standard in all remote health centres. While local X-Ray facilities can

reduce the need for patient travel and contribute to improving client care and clinical

outcomes, there are also stringent criteria and significant costs involved in establishing and

maintaining these facilities. It is likely that only larger health centres will meet the criteria to

justify placement in the remote setting.

Remote Health supports the purchase of new X-Ray equipment that produces a digital image.

Traditional equipment reliant on wet processing of film is only supported if it is already

installed in health centres and is still in use.

In the Northern Territory legislation relating to the use and operation of radiographic

equipment includes the Radiation Protection Act and Radiation Protection Regulations.

Radiation Protection information, codes of practice, application forms and related information

are available on the Department of Health (DoH) Environmental Health - Radiation Protection

website, including:

- Radiation Protection Fact Sheet No 800 which provides a useful summary of the

Radiation Protection Act and Regulations

- Radiation Protection Information Sheet No. 802 which provides information on the

criteria to obtain a radiation licence to use a radiation apparatus in Diagnostic

Radiography, Therapy and Nuclear Medicine. This includes information on licensing

criteria and conditions of use for a Medical Practitioner or Registered Nurse.

Staff are not permitted to perform X-Rays unless they have a current license to use a

radiation source. Clients requiring complex or extensive X-Rays should be referred to a

hospital or directly to a radiologist.



2. Definitions

Computed Radiography (CR): the process of creating a diagnostic digital image from data

acquired with an imaging plate and reader.

Radiation Operator / Operator / Licensee: a person with a current licence issued under

section 27 of the Radiation Protection Act authorising the holder to participate in activities

related to a radiation source (X-Ray equipment).

Radiation Protection Plan: a plan containing the information prescribed by the Radiation

Protection Regulations authorising a health centre to possess a radiation source.

20mSv: the occupational dose limit per year for an operator averaged over five consecutive

years.

LSPN: the Location Specific Practice Number required by health centres in order to claim

Medicare benefits for radiological procedures.



3. Responsibilities

3.1 All Radiation Operators

 Only undertake radiological procedures at sites where there is a pending or current

certificate of compliance for a radiation place

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Endorsed by: Remote Executive Leadership Group

Release Date: April 2009 Next Review: October 2014

REMOTE HEALTH ATLAS – Section 23: EQUIPMENT & OTHER ASSETS X-RAY EQUIPMENT





 Undertake radiological procedures only if licensed to do so by DoH Environmental Health

- Radiation Protection

 Take all relevant steps to protect clients and/or staff in the vicinity of radiological

equipment

 Be aware of requirements under the Radiation Protection Plan

 In conjunction with the Primary Health Care Manager, ensure that all records of

compliance, licensing and registration of X-Ray equipment and other relevant matters are

maintained at the health centre

 Obtain personal radiation monitoring dosemeter and wear when operating X-Ray

equipment

3.2 Primary Health Care Manager (PHCM)

 Complete Registration for Radiation Source and Place online forms as detailed in 4.3.2

 In conjunction with the Radiation Operator, ensure that all records of compliance,

licensing and registration of X-Ray equipment and other relevant matters are maintained

at the health centre

 Ensure that X-Ray equipment is only operated by licensed operators

 Ensure that X-Ray equipment is stored in a secure room, inaccessible to the general

public

 Be aware of requirements under the Radiation Protection Plan and act upon these, if

required

3.3 All Health Centre Staff

 Familiarise themselves with safety procedures for staff and clients in the vicinity of X-Ray

equipment

3.4 Area Service Manager (ASM)

 Facilitate training for clinical staff selected to undertake radiological procedures in

consultation with the Director of Nursing and SRMP - Operations

3.5 Management / Remote Health Capital Equipment Group (RHCEG)

 Adhere to capital equipment purchasing arrangements where new equipment is

considered

3.6 Director Remote Health Branch

 Receive Personal Radiation Monitoring Reports of all RHB Radiation Operators and

disseminate to relevant ASMs

 Maintain the Remote Health Radiation Protection Plan per requirements in the Radiation

Protection Regulations



4. Procedure

4.1 Assessing Health Centre Capacity for X-Ray Equipment

When considering the procurement of X-Ray equipment it is important to consider that X-Ray

equipment is not viable in all situations. Having access to X-ray facilities does not necessarily

equate to improved access to better health services. Health centres proposing the purchase

of X-Ray equipment must seriously assess various significant considerations, including:

Physical capability of When assessing the capability of the health centre, consider that the room

the health centre utilised for X-Ray facilities:

~ must be large enough to accommodate an X-Ray table or examination

couch, a wall mounted cassette holder / bucky, chair for the client, a

mobile X-Ray machine, a computed radiography unit, small storage

area for positioning wedges and a small desk to hold computer

hardware

~ must comply with radiation shielding design standards in regard to

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Endorsed by: Remote Executive Leadership Group

Release Date: April 2009 Next Review: October 2014

REMOTE HEALTH ATLAS – Section 23: EQUIPMENT & OTHER ASSETS X-RAY EQUIPMENT





building construction for the X-Ray room, such as the thickness of

walls, whether lead lining is required, etc

~ preferably have an outside wall for the wall mounted cassettes / bucky

to be mounted, or able to be modified to meet radiation shielding

design standards

~ must be lockable.

An accredited assessor must assess whether the room meets the

appropriate radiation shielding design standards. See Certificate of

Compliance for a Radiation Place for requirements for the assessment

process.

Rooms that do not meet the requirements for certification will have to be

modified to meet these requirements, ideally prior to the purchase of X-

Ray equipment.

Information Technology Including utilisation of the Picture Archiving and Communication System

infrastructure and (PACS) for transmitting and retrieving X-Ray images

capability

Budget Costs of equipment, annual service and ongoing maintenance and

recurrent requirements such as training balanced against usual rates of

referral involving diagnostic radiology

Legislative and Ability to comply with requirements in an ongoing capacity

Accreditation

requirements

Staff (Medical / RAN) Stability of staff related to maintenance of licensed operators

4.2 Procurement of X-Ray Equipment

The basic equipment requirements include the X-Ray machine, CR reader, console and

imaging plates, and wall mounted cassette holder / bucky. A number of ancillary items will also

be required including:

- radiographic table or trolley or, if the room cannot accommodate this, an examination

couch

- a chair suitable for positioning clients

- positioning wedges / sandbags

- lead protection (see the OH&S Section for details)

- table or desk for computer hardware

- 2 x active computer ports with Internet Protocol (IP) addresses to enable connection

to PACS for transmitting and retrieving X-Ray images.

Ideally, prior to the purchase of X-Ray equipment a Certificate of Compliance for a Radiation

Place must be obtained.

X-Ray equipment is invariably deemed capital equipment, and therefore proposals for

purchase must be channelled via the Remote Health Capital Equipment Group by submitting a

request using the Capital Equipment Request Form.

Once approved and installed, a New Asset Advice Form needs to be completed and returned

to the Department of Business and Employment (DBE) – Asset Accounting. DBE will then

register the equipment as a Capital Equipment Item and forward out to the PHCM asset labels

to be applied to the X-Ray equipment.

4.3 Radiation Protection Regulatory Requirements

RHB abides by the requirements of the Radiation Protection Act and Regulations. Detailed

information, Codes of Practice and all forms related to diagnostic imaging are available on the

DoH Environmental Health - Radiation Protection website.

The following information provides the requirements for each health centre with X-Ray

facilities:

- Certificates of Compliance. See 4.3.1

Developed by: Quality & Safety Team Page 3 Reviewed: Sept 10, Oct 11,

Endorsed by: Remote Executive Leadership Group

Release Date: April 2009 Next Review: October 2014

REMOTE HEALTH ATLAS – Section 23: EQUIPMENT & OTHER ASSETS X-RAY EQUIPMENT





- Registration of Diagnostic X-Ray Equipment. See 4.3.2

- Licensing Requirements. See 4.3.3

4.3.1 Certificates of Compliance

A Certificate of Compliance is required for both the Radiation Place and Radiation Source.

These certificates must be renewed at least three yearly.

Certificate for a Radiation Place

When Remote Health Branch is considering the purchase of X-Ray equipment the building

plans of the proposed X-Ray room at the health centre and an estimation of X-Ray usage will

need to be assessed by an accredited assessor. If the room meets the appropriate standards,

the accredited assessor will issue a Certificate of Compliance for a Radiation Place.

To meet legislative requirements the Certificate of Compliance for a Radiation Place must be

displayed in a prominent location, such as on the wall of the X-Ray room.

All other license and registration applications must be accompanied by a copy of a Certificate

of Compliance for a Radiation Place. See Radiation Protection – Code of Practice: Certificate

of Compliance for a Radiation Place.

Certificate for a Radiation Source

Each radiation source must comply with applicable Australian Standards. The Certificate is a

letter clearly stating that the radiation source complies with applicable codes. The letter must

identify the codes, place and radiation source/s with make, model, serial number or any

appropriate identifier if it fully describes the radiation source.

The Certificate of Compliance must be placed near or with the unit. See Radiation Protection

– Code of Practice: Approved Form for Certificate of Compliance.

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4.3.2 Registration for Radiation Source and Place

All diagnostic X-Ray equipment must be registered. Registration is required once only and

there is no cost to DoH Remote Health. There are two registration online forms which must

be completed for each health centre with X-Ray facilities. These must be completed by the

PHCM and include:

- Registration for Radiation Source Online Form

- Registration for Radiation Place Online Form.

The first two fields in the Online Registration Forms should be completed per the example

provided below. The remaining fields should be completed with health centre specific details.



Owner * First name of Director, RHB Last name of Director, RHB First Name / Last Name



Co. Trading Name Health Centre, Remote Health Branch Company Name (if applicable



* Mandatory Reporting Field

4.3.3 Licensing Requirements

The Radiation Source and Operators must be licensed. All licences must be renewed at

least three yearly.

Licence to Possess a Radiation Source and Radiation Protection Plan

In accordance with the Radiation Protection Act and Regulations a Radiation Protection Plan

(RPP) is required. A RPP provides a comprehensive description of all operating or planned

radiation related procedures and is linked to a relevant licence to possess a radiation source.





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Please note, the Online Registration facility is currently unavailable. These forms should be completed and sent by e-mail or

fax to Radiation Protection to register a Source or Place.

Developed by: Quality & Safety Team Page 4 Reviewed: Sept 10, Oct 11,

Endorsed by: Remote Executive Leadership Group

Release Date: April 2009 Next Review: October 2014

REMOTE HEALTH ATLAS – Section 23: EQUIPMENT & OTHER ASSETS X-RAY EQUIPMENT





The Director Remote Health Branch is the designated person to hold the license to possess

a radiation source which includes the requirement to have a RPP for Remote Health. The

form Application and Guidelines for a Licence for a Radiation Related Activity in the Northern

Territory included in Radiation Protection Plan and Application for a Licence to Possess

should be completed and submitted.

Individual Licence to use a Radiation Source

All Medical Practitioners or Remote Area Nurses (RANs) who meet eligibility criteria to

become Radiation Officers must be licensed to use a radiation source. Eligibility criteria for

MOs and RANs differ but both include:

- national registration under the Health Practitioner Regulation National Law Act

- successful completion of training in performing radiographic procedures recognised

and approved by DoH Environmental Health - Radiation Protection.

Each individual Medical Practitioner or RAN who meets eligibility criteria must submit an

Application for a Licence to the Chief Health Officer to DoH Environmental Health - Radiation

Protection. Once the license is granted, staff may perform X-Rays:

- within the limitations of the licence conditions. See Radiation Protection Information

Sheet No. 802 Diagnostic Radiography, Therapy and Nuclear Medicine

- within the limitations of the available X-ray equipment

- within the competence of the operator.

4.4 Other Regulatory Requirements

4.4.1 Medicare Registration & Location Specific Practice Number

Health centres where diagnostic imaging procedures are performed, or bases from which

mobile diagnostic imaging is used (eg the Medical Practitioner home bases), must obtain a

Location Specific Provider Number (LSPN) by registering with Medicare (Diagnostic Imaging

Register) if the services are to be claimable.

For details see Diagnostic Imaging Accreditation Scheme. LSPN registration forms are

available on line. Information specific to the LSPN can be found in Location Specific Practice

Number Q&A.

The Remote Health Medicare Team will assist by ensuring that the LSPN is quoted on all

relevant Medicare Assignment of Benefit Forms. See Medicare – Diagnostic Radiology for

procedures that may be claimed.

4.4.2 Diagnostic Imaging Accreditation

To remain eligible for Medicare Benefit Claiming all health centres providing diagnostic

imaging services (X-Rays and ultrasounds) must gain accreditation against the Diagnostic

Imaging Accreditation Scheme Practice Accreditation Standards. For details see Diagnostic

Imaging Accreditation Scheme and the website of the Department of Health and Ageing

approved accreditor, Quality in Practice (QIP).

The following documentation is essential for any accreditation process and must be collated

and kept in a secure location at the health centre:

- equipment licence and registration numbers

- copies of the Radiation Protection Plan

- copies of the Certificate of Compliance for Radiation Place

- copies of the Certificate of Compliance for a Radiation Source

- an equipment inventory including the name of each relevant item of equipment, name

of the manufacturer and serial number as well as information on registration on the

(Medicare) Diagnostic Imaging Register, including LSPN

- certified copies of radiation operator’s licence



Developed by: Quality & Safety Team Page 5 Reviewed: Sept 10, Oct 11,

Endorsed by: Remote Executive Leadership Group

Release Date: April 2009 Next Review: October 2014

REMOTE HEALTH ATLAS – Section 23: EQUIPMENT & OTHER ASSETS X-RAY EQUIPMENT





- certified copies of radiation operator’s registration with the relevant National Health

Registration Board

4.5 Training Requirements

Medical Practitioners and RANs must undertake an approved course of training in

performing radiographic procedures as one of the requirements in obtaining a licence to use

a radiation source. In addition Radiation Operators must undertake appropriate training in

relation to the Picture Archiving and Communication System (PACS).

Medical Practitioners and Registered Nurses may conduct chest and extremity X-rays after

passing a remote operator’s course, which is available at Royal Darwin Hospital (RDH). This

is the preferred training for Remote Health Practitioners as it provides training on PACS and

NT legislation. Training provided at RDH includes:

- at least 40 hours practical component working with a registered radiographer at

Royal Darwin Hospital, and

- successful completion of a 3 hour examination.

For further details contact the Chief Radiographer at RDH on (08) 8922 8545.

The Radiographic Procedures Manual compliments the practical training and can also be

used as a reference for the Radiation Operator.

This training contributes to ongoing Continuing Professional Development (CPD) required for

registration with the relevant National Health Board. This training is also the equivalent of 30

Professional Development Points for Medical Practitioners with the Australian College of

Rural and Remote Medicine (ACRRM).

Note: Health Practitioners who undertake / have previously undertaken the course provided interstate

will continue to be accepted for an NT Radiation License.

4.6 Occupational Health and Safety

Operators must take all reasonable steps to ensure the safety of staff and clients when

operating X-Ray equipment.

4.6.1 Protective Devices

Protective devices for clients and staff must meet AS/NZS 4543.3:2000, Protective Devices

against Diagnostic Medical X-Radiation. RHB mandates a thickness of 0.5 mm of lead

equivalent for these devices.

Operators and anyone else who is required to stay in the room must wear protective devices

during radiological examination of clients. These devices should be designed so that they can

be put on and taken off without assistance. In remote health centres a protective apron must

be worn to protect the main part of the body of the operator, including gonad shielding. The

limited range of permitted radiological procedures in remote health centres precludes the need

for full body protection, gloves or masks.

Clients must be provided with protective devices as required, for example, abdominal

protection for women of childbearing age and gonad aprons for men. These devices should be

designed so that they can be easily applied, be properly placed and where necessary, fixed by

the clients themselves.

All protective devices must be maintained in good working condition and kept in appropriate

storage. Aprons must be hung on a strong hanger (some X-Ray units have a built in hanger).

Protective squares should be stored flat. Incorrect storage will reduce the protective qualities

of the devices.

All surfaces of protective devices must be cleaned with clean soapy water or with alcohol

wipes after they have been in contact with a client.





Developed by: Quality & Safety Team Page 6 Reviewed: Sept 10, Oct 11,

Endorsed by: Remote Executive Leadership Group

Release Date: April 2009 Next Review: October 2014

REMOTE HEALTH ATLAS – Section 23: EQUIPMENT & OTHER ASSETS X-RAY EQUIPMENT





4.6.2 Personal Radiation Monitoring Requirements

All operators of radiographic equipment in remote health centres must wear personal radiation

dosemeters during their first year of operation as an investigative measure to confirm that the

annual acceptable level is not exceeded. After the first year, and following consultation with

Management, further monitoring may not be required if the personal radiation dose has not

exceeded 1 mSv.

RHB requires radiation operators to register with Australian Radiation Services (ARS). In line

with Australian regulations, ARS will provide the radiation operator and Remote Health Branch

with a copy of all dose reports. A final copy will also be filed confidentially and remain at ARS

for 50 years. A copy of all dose results is also submitted to the National Dose Registry.

Operators are advised to maintain their personal radiation dose records.

The Personal Radiation Monitoring Service Registration Form should be utilised to register

with the ARS. In the first section of the form, give the contact details of the Director, Remote

Health Branch, PO Box 40596, Casuarina, NT 0811. Follow standard procurement processes

as per Internal Requisitions to purchase personal radiation dosemeters.

For details on management of radiation dosemeters, see the ARS website.

4.6.3 Preventing Accidental Exposure to X-Ray Beam

Mobile X-Ray equipment may be used in situations where additional staff or clients are in the

vicinity at the time of the procedure. If it is possible for staff and other clients or relatives to

leave the room, this should be encouraged. If there is any danger of exposure, the operator

must provide appropriate protective devices for those remaining in the room.

4.7 Picture Archiving and Communication System (PACS)

All NT Regional Hospitals have made the transition to digital diagnostic imaging. PACS is now

in place with provision for storage of Remote Health X-Ray images. The PACS system allows

transmission, storage, printing and retrieval of X-Ray images. All remote health X-Ray images

will now be transmitted to Alice Springs Hospital and Royal Darwin Hospital for a Radiologist

report and storage. Staff must fax the following information to the relevant hospital Radiology

Department:

- a Radiology Request, providing client and clinical history and noting ‘report only – see

PACS’ on the request form

- a Medicare Assignment Form signed by the client.

When a hard copy of an X-Ray report is received this should be scanned into the client’s

Primary Care Information System (PCIS) record and filed in the appropriate documents folder.

The original hard copy of the report must be placed in the storage archive box.

Education and training for PACS will be provided in RDH X-Ray training course.

Note: X-Ray images taken prior to the use of PACS and saved to an individual client identified CD,

must remain stored alphabetically in boxes of a suitable size, located in a secure place such as a

lockable filing cabinet or cupboard. For appropriate retention and disposal processes see Archiving &

Disposal of Records.

4.8 Billing, Reading and Reporting X-Rays

This section will be completed subject to procedures being finalised.

4.9 Repairs and Maintenance

Routine maintenance, quality checks and repairs are carried out by the contracted service

provider/s. Since different components of the equipment may come from different sources,

individual components may be serviced / repaired by different companies. Refer to health

centre records for details.





Developed by: Quality & Safety Team Page 7 Reviewed: Sept 10, Oct 11,

Endorsed by: Remote Executive Leadership Group

Release Date: April 2009 Next Review: October 2014

REMOTE HEALTH ATLAS – Section 23: EQUIPMENT & OTHER ASSETS X-RAY EQUIPMENT





5. Forms

Registration for Radiation Source Online Form

Registration for Radiation Place Online Form

Australian Radiation Services Personal Radiation Monitoring Service Application Form

Capital Equipment Request Form

Location Specific Practice Number (LSPN) Registration Forms

Application and Guidelines for a Licence for a Radiation Related Activity in the Northern

Territory included in Radiation Protection Plan and Application for a Licence to Possess

Application for a Licence to the Chief Health Officer



6. References and Supporting Documents

Related Atlas Items:

Capital Equipment Internal Requisitions

Medicare Benefit Claiming Medicare – Diagnostic Radiology

Urgent Minor Repairs

Remote Health Medicare - Diagnostic Radiology

PCIS User Reference Guide – Pathology and Radiology Requests

Radiation Protection Act

Radiation Protection Regulations

Australian Health Practitioner Regulation Agency

Health Practitioner Regulation National Law Act – applicable for Medical Practitioners & Registered Nurses

Health Practitioners Act – applicable for Radiographers

DoH Radiation Protection website

Radiographic Procedures Manual

Radiation Protection Fact Sheet No 800 - Radiation Protection

Radiation Protection Information Sheet No. 802 - Diagnostic Radiography, Therapy and Nuclear Medicine

DoH Radiation Protection Code of Practice

Certificate of Compliance for a Radiation Place

Approved Form for Certificate of Compliance

Australian Institute of Radiography

Australian Radiation Protection and Nuclear Safety Agency (ARPANSA)

National Directory for Radiation Protection, December 2009

Radiation Protection in the Medical Applications of Ionizing Radiation

Australian Radiation Services - provides the following information on request:

Quick Overview of the ARS Personal radiation Monitoring Service

Personal radiation Monitoring Service Information Sheet – Films

Standard Service Charges

Australian Government - Department of Health and Ageing

Diagnostic Imaging Accreditation Scheme

About Medicare and Diagnostic Imaging

Location Specific Practice Number Q&A

Quality in Practice

Australian Standards Online Premium - search by standard name or number:

AS/NZS 3200.1.3:1996 - Approval & Test Specifications for Medical Electrical

Equipment

AZ/NZS 4184.3.1:2002 - Evaluation and routine testing in medical imaging departments

AS/NZS 4543.3:2000 - Protective Devices against Diagnostic Medical X-Radiation



Developed by: Quality & Safety Team Page 8 Reviewed: Sept 10, Oct 11,

Endorsed by: Remote Executive Leadership Group

Release Date: April 2009 Next Review: October 2014