Program Director's Power Point Presentation

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  • An overview of each legislative bill will be individually presented.
  • The VDH X-ray inspectors, already have statutory authority to inspect X-ray facilities during reasonable hours. Mammography services are regulated by both VDH and the FDA. VDH under contract with FDA, inspects mammography facilities annually that are fully accredited by the ACR. Provisionally accredited facilities are not inspected and all inspections are announced. Radiological Health staff have identified the lack of inspections at provisionally accredited facilities as a program weakness as exemplified by the Shenandoah Mobile Mammography incident. In this incident the facility was provisionally accredited several times, and committed health care and wire fraud as they continued to provide mammography services after their certificate was revoked.
  • The intent of this legislation is to reduce the number of patient call backs due to radiographs of poor diagnostic quality, and repeat the exam before the patient leaves the facility; however, the radiologist is not required to provide a diagnostic interpretation while the patient is at the facility, therefore there may be patient call backs for additional views unrelated to image quality.
  • Dr. Ham had served on the Radiation Advisory Board, and was very active in Health Physics. A copy of the resolution is enclosed. Below is a photo of Mrs. Ham and daughter, Elspeth receiving a copy of the resolution.
  • This legislation legitimizes the role of the nuclear medicine technologists. The Board of Pharmacy interpreted their statute to mean that only physicians could order radiopharmaceuticals
  • Delegate Katzen’s budget amendment request in 2000 to provide start up funding for NRC Agreement State status was not approved. HB 2655 passed in 1999, authorized VDH to collect fees for licensing and inspections of radioactive materials, and to issue civil penalties for violations.
  • Senator Watkins introduced a bill that specifically recognizes the radon proficiency programs administered by the National Environmental Health Association and the National Radon Safety Board. The VDH will not need to promulgate regulations to implement this legislation, which will become effective on July 1, 2001, if passed by the General Assembly and signed into law.
  • Much of the equipment that the COPN program regulates, the Radiological Health Program also regulates to protect public health and safety. The Joint Commission on Health Care had recommended a licensure program to protect public health and safety for the equipment being deregulated.
  • Many changes have occurred in the way radioactive materials and radiation producing machines are regulated in the decade since the Radiation Protection Regulations were last revised. The Code of Virginia provides for the state’s radiation protection regulations to be consistent with other states and the nation. The NRC made significant changes in the radiation protection standards in 1992, and Part 35- Medical Use in 2000.
    There are several sections of the Code of Virginia that have never been implemented, such as bonding and surety requirements, in addition to recent legislative changes.
  • Guidance documents provide our constituents suggestions as how best to comply with the Radiation Protection Regulations. In some cases the Regulations do not address a specific situation, such as bone densitometers, which did not exist when the regulations were last revised.
  • General Funds are state funds, federal funds are from either federal grants or contracts. Special funds are state funds devoted to the exclusive use of a project. In our case, the Department of Emergency passes through funds from Virginia Power to maintain an environmental monitoring program at the two nuclear power stations, and reimbursement of equipment purchased for emergency preparedness activities associated with the two nuclear power stations.
  • The Program received and additional FTE form the Home Health Program that was abolished. This position is assigned to the Radon Project.
    The Program also lost its secretary, Pat Hayden, and was replaced by Ms. Marie Harris, who also came to use via the Home Health Program.
    The Program converted a clerical position into a Specialist position, which was filled by Ryan Paris, who was a wage employee with the Program for several years. The clerical position vacated by April Henley is now filled by an Office Temp
    The Program also lost three wage employees, Jack Newman, J.C. Carter, and Cherrie Church during the year, only the latter wage position has been recruited for.
  • These are the primary program activities.
  • The VDH regulates natural occurring and accelerator produced radioactive materials. There is increasing usage of accelerator produced radioisotopes particularly in nuclear medicine, and the use X-ray fluorescent analyzers for testing for lead in paint.
    NRC regulates the by-product, source, and special nuclear materials. There are approximately 370 NRC licensees in Virginia.
  • This slide provides key information regarding the number of X-ray machines and facilities registered with VDH.
    The bone densitometer using the patient’s fingers has grown in popularity as a screening tool for osteoporosis. The Board of Medicine requires the operator to be licensed (M.D., or limited licensure as a Radiological Technologist)
  • Overview of the number of X-ray machines in various healing arts settings.
  • This slide shows the number of state owned X-ray machines, such as in the State Prisons, Mental Hospitals, and State Hospitals. VDH locations are the local health departments.
    The Grand Total of 15,186 are all active X-ray machines used in the healing arts. There are additional machines that are inactive, or are classified as industrial/research that bring the total to almost 17,000 machines.
  • The Radiological Health staff have a very close working relationship with the Department of Emergency Management (DEM), formerly Department of Emergency Services. The Code of Virginia requires VDH to coordinate emergency preparedness and training activities with DEM. Our efforts have included providing technical assistance and staffing to provide training to the local jurisdictions in preparation for federal evaluated exercises.
    NRC has issued a final rule that requires the States to consider the deployment and use of Potassium Iodine by the general public in the event of a nuclear power accident where significant quantities of radio-iodine has been released.
    The current State Plan considers its; however, the plan only authorizes KI for emergency workers, and institutionalized individuals. Evacuation is considered the preferable protective action recommendation.
  • The DOT exemptions are issued for shipments that are considered normal “non-hazardous shipments” involving either municipal waste or scrap metal that arrive at a facility with radiation monitoring equipment and the shipment causes the monitor to alarm. The shipment is then considered hazardous and should have shipping papers that specify the radioisotope and activities, and the vehicle should also be placarded. In these circumstances, this is impossible, so the state radiation control program has authority to issue an exemption from these requirements.
  • The slide presents an overview of the hot topics in the radon project.
    There has been increased awareness of radon as a public health issue. Radon professionals have been particularly interested in the obsolescence of the state radon proficiency requirements. Many radon professionals are seeking a legislative change to update the State Code.
  • Radiological Health staff are conducting a scaled down environmental monitoring program from the one that was supported by the U.S. NRC for several decades until 1998. This activity basically maintains capabilities necessary for emergency response activities.
  • Non ionizing radiation is not addressed in the State Code; however, that does not stop the citizen inquires the program receives concerning UV radiation from tanning lamps; health effects from the radiation from microwave ovens, microwave towers, and cell phones; and health effects from magnetic fields from MRI.
  • Program Director's Power Point Presentation

    1. 1. Radiological Health Year 2000 in Review
    2. 2. Legislation 2000 General Assembly • HB1487 Mammography-inspections • HB1488 Mammography- film • HJR 403- On the death of William T. Ham, Jr • SB 679- Health professions; pharmacy. • HB 2655 (1999) No appropriation for NRC Agreement State startup funds.
    3. 3. HB1487 Mammography Inspection of facilities where mammography services are performed. Requires the Board of Health to make scheduled and unannounced inspections of facilities and physicians' offices that perform mammography services to ensure compliance with the laws, regulations or conditions specified by the Board. The Board currently inspects X-ray machines on a regular basis and has the general power to enter any property housing an entity which is permitted, licensed or certified by the Board.
    4. 4. HB 1488 Mammography Requires the Board of Health to establish guidelines to require that licensed facilities or physicians' offices that perform mammography services to the patient, prior to departure, to develop the film to ensure the quality and integrity of the film.
    5. 5. HJR 403- On the death of William T. Ham, Jr.
    6. 6. SB 679- Health professions; pharmacy. Defines radiopharmaceutical as "any drug that exhibits spontaneous disintegration of unstable nuclei with the emission of nuclear particles or photons" (with certain exceptions) and establishes precise requirements for dispensing radiopharmaceuticals in terms of the containers, the prescription data, and physician and patient specifications. Also defines a nuclear medicine technologist and provides a definition for scope of duties under a qualified nuclear pharmacist.
    7. 7. HB 2655 (1999) No appropriation for NRC Agreement State startup funds.
    8. 8. 2001 Session SB 838 Health; radon proficiency listings. Authorizes the Board of Health to list and accept as proficient, to offer screening, testing or mitigation for radon, persons acceptable to the United States Environmental Protection Agency, the National Radon Measurement Proficiency Program of the National Environmental Health Association or the National Radon Safety Board Certified Radon Professional Program or any other proficiency program acceptable to the Board. This bill revises and updates acceptable radon proficiency credentials. Current law only provides for proficiency listing by the Environmental Protection Agency. The EPA has, however, discontinued the National Radon Proficiency Program and has not designated a successor program.
    9. 9. Certificate of Public Need (COPN) Joint Commission on Health Care •Eliminate COPN, with exceptions •Recommendations for protecting public health and safety for machines/services not under COPN •recommendations for evaluating e affects of eliminating COPN •Applies to CT, MRI, lithotripters, radiation therapy, and gamma knife
    10. 10. Regulations Proposed changes will include: • NRC's revisions to the Radiation Protection Standards in 1992 and again in 2000 • Legislative changes made in 1999, 2000, and if applicable 2001 • Adopt the latest version of the State Suggested Regulations • Implement sections of the State Code that have not been implemented, specifically bonding and surety requirements.
    11. 11. Guidance Documents • X-ray film retention • XRF users • X-ray dosimetry • Inspections of bone densitometers and operator licensure • Usage of US DOT exemptions for Waste and Scrap metal shipments
    12. 12. Funding SFY 2000 SFY2001 General Funds 671,853 701,059 Federal Funds Mammography 158,358 164,893 EPA-radon 56,668 60,000 EPA- "Tools for 60,000 60,000 Schools" Special Funds DEM Environmental 18,000 18,000 Monitoring Other DEM- reimbursement 50,000 38,000 for emergency prep.
    13. 13. Staffing • 14 FTEs • 1 wage • 1 Office Temp Turn-over •2 full time staff •3 wage staff
    14. 14. Activities • Radioactive Materials • X-ray • Emergency Planning • Emergency/Incident Response • Radon • Environmental Monitoring • Non-Ionizing
    15. 15. Radioactive Materials Licensing & Inspections Total Licenses 209 New Licenses 14 Terminated Licenses 10 Amendments 108 Renewals 72 Inspections 70 Violations 8 Misadministrations 0 Lost or Stolen Sources 1 Reciprocity Requests 13 Close out Reviews 9
    16. 16. X-ray Machines • ~ 17,000 X-ray machines(including industrial) • ~5,000 facilities • 191 Private Inspectors • 221 active mammography facilities(includes 4 provisionally accredited) • Bone densitometers increasingly popular
    17. 17. X-ray Machines by Type Bone density 271 Chiropractic 492 Dental 9,619 Hospital 1,686 Medical 1,507 Podiatry 218 Veterinary 780
    18. 18. X-ray Machines by Type in State Facilities Dental 221 Hospital 179 Medical 48 Veterinary 33 VDH-Dental 115 VDH-Medical 17 Grand Total 15,186
    19. 19. Emergency Preparedness • Staff assisted DEM with training the local jurisdiction participants • Providing support to DEM such as calibrating pocket dosimeters, ordering equipment. • Last FEMA evaluated exercise was on December 5, 2000 at North Ann, next exercise is in June 26, 2001 at Surry • Staff participated in terrorist exercise with NRC and FBI in table top exercise in Lynchburg in April, 2000 • Observed nuclear exercise at Newport News Shipyard; also toured new facility for handling refueling operations. • NRC issues new rule on December 21, 2000 regarding stockpiling KI for public
    20. 20. Emergency/Incident Response • US DOT exemptions for scrap metal (7) and municipal waste shipments(0) and responds to returned shipments (4&3). • City of Chesapeake closed primary road due to a low activity source in a tool shed in a residential area. • BWXT- leak in handling pool that probably existed for several years. • Westmoreland County- Board of Supervisors requested technical assistance for public hearing regarding restrictive zoning ordinance for industrial park that forbid all radioactive materials. NRC also attended.
    21. 21. Radon • Dept. of Housing and Community Development adopted on voluntary basis the radon resistant construction techniques in EPA designated Zone One localities. Chesterfield County will be one of the first to adopt this ordinance. • EPA issued preliminary radon in drinking water standard. VDH recommends to Governor to use the Multi-Media Mitigation approach • EPA misses its Congressional mandate to publish Drinking Water Rule for Radon in Water in August, 2000. Anticipate after February, 20001 • Radon Proficiency Requirements • Radon professionals are concerned, more media attention, more citizen requests for information
    22. 22. Environmental Monitoring EPA issues new radionuclide standards in drinking water December, 2000. New rule modifies standard for Uranium currently no limit, now 30 micro grams/liter, and now separate measurements for Ra-226 and Ra- 228. Expect separate standard for Ra-224 in next rule making. Radiological Health staff concludes DCLS apparently swapped environmental samples after control site was reported to have significant radiological levels, and the settling pond was later to have significantly lower than normal levels. Radiological Health staff observes the environmental collections at the two shipyards, Newport News, and the Navy. Monitor at two Power Stations, BWXT- no environmental releases detected
    23. 23. Non Ionizing Tanning Beds Staff received about 24 citizen inquiries in the past year and half regarding tanning beds. There were two complaints of customer injury, which were referred to the FDA for follow up. There was also a parent's complaint that his 15 yr. old daughter was able to tan at a tanning facility without his permission. The rest were from tanning bed operators asking about the regulation of tanning facilities. The main concerns with respect to the tanning machines are: malfunctions of the timers, and replacement of the tanning lamps with improper lamps that do not match the machine's timer. Cellular Telephones Citizen concern regarding radio-frequency emissions and possible association with brain tumors. The British government recently issued guidance that recommends the restriction children's use of use cellular telephones. Soon afterwards there were two scientific reports that concluded there were no positive correlation between cell phone use and brain

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