State and Federal Requirements demand that any equipment that produces ionzing radiation when energized (i.e. an x-ray tube) must be surveyed by a physicist every year or so, depending on the design and function of the unit. Most diagnostic x-ray units are surveyed annually, but some (including bone densitometers, dental and veterinary units) can be done every three years. The purpose is to ensure that the equipment is within legal compliance for operation, because ionizing radiation is considered a carcinogen (i.e. a health hazard). So, there must be an assurance that there is a clear efficacy to its use in a healthcare practice. This must be performed by a state-registered private x-ray inspector.

As a diagnostic medical physicist, I have acquired this certification for examining x-ray units. I am currently certified in the Commonwealth of Virginia, The District of Columbia, and the state of Maryland. My testing includes basic state x-ray survey testing, but I often will go beyond this to also look at the imaging process and other associated processes in the diagnostic process. This is because these state and federal agencies do not mandate that the images be any good - they are only concered with minimizing radiation exposure to the patient and the operator. Many facilities will have a well-reviewed system with quality control and feedback from the directing physicians to their radiologic technologists, but some facilities may have room for improvement or have questions on how to make the most of their system. X-ray machines are like cars - each have their own personality. Finding or verifying the optimal performance parameters is one of the basic tasks I try to take on with every unit.

Some of the advanced imaging modalities, including Computed Tomography (CT) and Mammography, are often the focus of accreditation bodies, and a state survey is folded into the accreditation process. Unless the healthcare provider is looking to accredit their practice, a state survey is all that is needed to stay legally compliant. Once again, it is my goal to give basic service to all parts of the imaging chain, but accreditation requires a more exhaustive set of tests.

If you are a healthcare provider, it is your responsibility that every x-ray unit is operating within state and federal guidelines, and is being surveyed by a certified private x-ray inspector. Having occupational dose records, QC and maintence logs available help ensure a smooth review of your program. Depending on your unit, this review could take as little as an hour or as long as half a day or more, so plan carefully how you want to make time available for a proper review of your unit.

Finally, remember that the job of your physicist is to do several things: not only is he/she going to verify your unit is operating within state and federal law independently of a field service engineer, but also to ensure that there is an adequate radiation safety program surrounding the use of the unit. It is a good opportunity to ask questions of your physicist on such things as technique optimization, image quality, safety, emerging standards and regulations, and/or advancements in medical practice. Our job is to stay current with x-ray unit use, and we should be able to address your questions. If you are interested in providing quality healthcare, we are here to make sure your equipment is not an impediment in your practice, but a tool to provide you with the information you need.