Chapter DHS 157

DHS 157.65(8)(a)1. 1. Successfully complete a minimum of 3 years of residency training in a radiation oncology program approved by the residency review committee of the accreditation council for graduate medical education or royal college of physicians and surgeons of Canada or the council on postdoctoral training of the American osteopathic association.

DHS 157.65(8)(a)2. 2. Pass an examination, administered by diplomates of the specialty board, that tests knowledge and competence in radiation safety, radionuclide handling, treatment planning, quality assurance, and clinical use of manual brachytherapy.

DHS 157.65 Note Note: Specialty boards whose certification processes have been recognized by the department, the NRC or an agreement state will be posted on the NRC’s web site at www.nrc.gov.

DHS 157.65(8)(b) (b) Has completed a structured educational program in basic radionuclide handling techniques applicable to the use of manual brachytherapy sources that includes all of the following:

DHS 157.65(8)(b)1. 1. Two hundred hours of classroom and laboratory training in all of the following areas:

DHS 157.65(8)(b)1.a. a. Radiation physics and instrumentation.

DHS 157.65(8)(b)1.b. b. Radiation protection.

DHS 157.65(8)(b)1.c. c. Mathematics pertaining to the use and measurement of radioactivity.

DHS 157.65(8)(b)1.d. d. Radiation biology.

DHS 157.65(8)(b)2. 2. Five hundred hours of work experience, under the supervision of an authorized user who meets the requirements in this subsection, s. DHS 157.61 (10), or equivalent NRC or agreement state requirements at a medical facility authorized to use byproduct materials under sub. (1), involving all of the following:

DHS 157.65(8)(b)2.a. a. Ordering, receiving and unpacking radioactive materials safely and performing the related radiation surveys.

DHS 157.65(8)(b)2.b. b. Checking survey meters for proper operation.

DHS 157.65(8)(b)2.c. c. Preparing, implanting and removing brachytherapy sources.

DHS 157.65(8)(b)2.d. d. Maintaining running inventories of material on hand.

DHS 157.65(8)(b)2.e. e. Using administrative controls to prevent a medical event involving the use of radioactive material.

DHS 157.65(8)(b)2.f. f. Using emergency procedures to control radioactive material.

DHS 157.65(8)(b)3. 3. Three years of supervised clinical experience in radiation oncology, under an authorized user who meets the requirements in this subsection, s. DHS 157.61 (10), or equivalent NRC or agreement state requirements, as part of a formal training program approved by the Residency Review Committee for Radiation Oncology of the Accreditation Council for Graduate Medical Education or the Royal College of Physicians and Surgeons of Canada or the Council on Postdoctoral Training of the American Osteopathic Association. The experience may be obtained concurrently with the supervised work experience required by subd. 2.

DHS 157.65(8)(b)4. 4. A written attestation under sub. (10) (a).

DHS 157.65(9) (9) Training for ophthalmic use of strontium-90. Except as provided in s. DHS 157.61 (10), a licensee shall require an authorized user of strontium-90 for ophthalmic radiotherapy to be a physician who meets any of the following requirements:

DHS 157.65(9)(a) (a) Is an authorized user under sub. (8) or equivalent NRC or agreement state requirement.

DHS 157.65(9)(b) (b) Has had classroom and laboratory training applicable to the use of strontium-90 for ophthalmic radiotherapy and a period of supervised clinical training in ophthalmic radiotherapy that includes all of the following:

DHS 157.65(9)(b)1. 1. Twenty-four hours of classroom and laboratory training that includes all of the following:

DHS 157.65(9)(b)1.a. a. Radiation physics and instrumentation.

DHS 157.65(9)(b)1.b. b. Radiation protection.

DHS 157.65(9)(b)1.c. c. Mathematics pertaining to the use and measurement of radioactivity.

DHS 157.65(9)(b)1.d. d. Radiation biology.

DHS 157.65(9)(b)2. 2. Supervised clinical training in ophthalmic radiotherapy under the supervision of an authorized user at a medical institution, clinic, or private practice that includes the use of strontium-90 for the ophthalmic treatment of 5 individuals. The supervised clinical training shall include all of the following:

DHS 157.65(9)(b)2.a. a. Examination of each person to be treated.

DHS 157.65(9)(b)2.b. b. Calculation of the dose to be administered.

DHS 157.65(9)(b)2.c. c. Administration of the dose.

DHS 157.65(9)(b)2.d. d. Follow up and review of each individual’s case history.

DHS 157.65(9)(b)3. 3. A written attestation under sub. (10) (b).

DHS 157.65(10) (10) Written attestation.

DHS 157.65(10)(a) (a) Manual brachytherapy sources. As required by sub. (8) (b) 4., a licensee shall require an authorized user of a manual brachytherapy source for the uses authorized under sub. (1) to have obtained written attestation, signed by a preceptor authorized user who meets the requirements in sub. (8), s. DHS 157.61 (10), or equivalent NRC or agreement state requirements, that the individual has successfully completed the requirements in sub. (8) (b) and is able to independently fulfill the radiation safety-related duties as an authorized user of manual brachytherapy sources for the medical uses authorized under sub. (1). The attestation must be obtained from any of the following:

DHS 157.65(10)(a)1. 1. A preceptor authorized user who meets the requirements in sub. (8), s. DHS 157.61 (10), or equivalent NRC or agreement state requirements.

DHS 157.65(10)(a)2. 2. A residency program director who affirms in writing that the attestation represents the consensus of the residency program faculty where at least one faculty member is an authorized user who meets the requirements in sub. (8), s. DHS 157.61 (10), or equivalent NRC or agreement state requirements and concurs with the attestation provided by the residency program director. The residency training program must be approved by the Residency Review Committee of the Accreditation Council for Graduate Medical Education or the Royal College of Physicians and Surgeons of Canada or the Council on Postdoctoral Training of the American Osteopathic Association and must include training and experience specified in sub. (8) (b).

DHS 157.65(10)(b) (b) Ophthalmic use of strontium-90. As required by sub. (9) (b) 3., a licensee shall require an authorized user for ophthalmic use of strontium-90 to have obtained written attestation, signed by a preceptor authorized user who meets the requirements in sub. (8) or (9), s. DHS 157.61 (10), or equivalent NRC or agreement state requirements, that the individual has successfully completed the requirements in sub. (9) (b) and is able to independently fulfill the radiation safety-related duties as an authorized user of strontium-90 for ophthalmic use.

DHS 157.65 History History: CR 01-108: cr. Register July 2002 No. 559, eff. — see Note at the start of the chapter; CR 06-021: am. (1) (intro.) and (6) (a) (intro.), r. and recr. (8) and (9), cr. (10) Register October 2006 No. 610, eff. 11-1-06; CR 09-062: am. (8) (b) 2. (intro.), 3., and (10) Register April 2010 No. 652, eff. 5-1-10; CR 22-015: am. (1) (a), (b), r and recr. (6), cr. (6m), am. (8) (intro.), (a) (intro.), 1., (b) 2. (intro.), 3., cr. (8) (b) 4., r. and recr. (9), renum. (10) (a) to (10) (a) (intro.) and am., cr. (10) (a) 1., 2., am. (10) (b) Register June 2023 No. 810, eff. 7-1-23; correction in (6m) (b) 2. made under ss. 13.92 (4) (b) 4. and 35.17, Stats., Register June 2023 No. 810.

DHS 157.66 DHS 157.66 Sealed sources for diagnosis.

DHS 157.66(1) (1) Use of sealed sources for diagnosis.

DHS 157.66(1)(a) (a) A licensee may use sealed sources that are not in medical devices for diagnostic medical uses if all of the following are met:

DHS 157.66(1)(a)1. 1. The sealed sources are approved in the sealed source and device registry for diagnostic medicine.

DHS 157.66(1)(a)2. 2. If the diagnostic medical uses are not explicitly listed in the sealed source and device registry, the sealed sources are used in accordance with the radiation safety conditions and limitations described in the sealed source and device registry.

DHS 157.66(1)(b) (b) A licensee may use medical devices containing sealed sources for diagnostic medical uses if all the following are met:

DHS 157.66(1)(b)1. 1. Both the sealed sources and medical devices are approved in the sealed source and device registry for diagnostic medical uses.

DHS 157.66(1)(b)2. 2. If the diagnostic medical uses are not explicitly listed in the sealed source and device registry, the diagnostic medical devices are used in accordance with the radiation safety conditions and limitations described in the sealed source and device registry.

DHS 157.66(1)(c) (c) Sealed sources and devices for diagnostic medical uses may be used for research in accordance with an active investigational device exemption application accepted by the U.S. Food and Drug Administration, and provided the requirements of s. DHS 157.61 (6) are met.

DHS 157.66(2) (2) Training for use of sealed sources for diagnosis. Except as provided in s. DHS 157.61 (10), a licensee shall require the authorized user of a diagnostic sealed source for use in a device authorized under sub. (1) to have received training in the use of the device for the uses requested. The licensee shall also require the authorized user to be a physician, dentist or podiatrist who meets any of the following requirements:

DHS 157.66(2)(a) (a) Is certified by a specialty board whose certification process includes all of the requirements in par. (b) and whose certification is recognized by the department, the NRC or an agreement state.

DHS 157.66 Note Note: Specialty boards whose certification processes have been recognized by the department, the NRC or an agreement state will be posted on the NRC’s web site at www.nrc.gov.

DHS 157.66(2)(b) (b) Has completed 8 hours of classroom and laboratory training in basic radionuclide handling techniques specifically applicable to the use of the device that includes all of the following:

DHS 157.66(2)(b)1. 1. Radiation physics and instrumentation.

DHS 157.66(2)(b)2. 2. Radiation protection.

DHS 157.66(2)(b)3. 3. Mathematics pertaining to the use and measurement of radioactivity.

DHS 157.66(2)(b)4. 4. Radiation biology.

DHS 157.66(2)(c) (c) Is an authorized user under s. DHS 157.63 (2), or equivalent NRC or agreement state requirements.

DHS 157.66 History History: CR 01-108: cr. Register July 2002 No. 559, eff. — see Note at the start of the chapter; CR 06-021: r. and recr. (2) Register October 2006 No. 610, eff. 11-1-06; CR 22-015: r. and recr. (1), am. (2) (intro.) cr. (2) (c) Register June 2023 No. 810, eff. 7-1-23.

DHS 157.67 DHS 157.67 Photon emitting remote afterloader, teletherapy and gamma stereotactic radiosurgery units.

DHS 157.67(1) (1) Use of a sealed source in a remote afterloader, teletherapy or gamma stereotactic radiosurgery unit.

DHS 157.67(1)(a) (a) A licensee shall use sealed sources in photon emitting remote afterloader units, teletherapy units or gamma stereotactic units for therapeutic medical uses that meet any of the following criteria:

DHS 157.67(1)(a)1. 1. Is approved in the sealed source and device registry.

DHS 157.67 Note Note: The sealed source and device registrations may be obtained from the manufacturer or by writing the department at: Department of Health Services, Radiation Protection Section, P.O. Box 2659, Madison WI 53701-2659.

DHS 157.67(1)(a)2. 2. In research involving photon-emitting remote afterloader units, teletherapy units, or gamma stereotactic radiosurgery units in accordance with an active effective investigational device exemption application accepted by the FDA provided the requirements of s. DHS 157.61 (6) (a) are met.

DHS 157.67 Note Note: The FDA requirements for investigational devices may be found at: http://www.fda.gov/radiation-emittingproducts/default.htm.

DHS 157.67(1)(b) (b) A licensee shall use photon-emitting remote afterloader units, teletherapy units, or gammastereotactic radiosurgery units that meet any of the following criteria:

DHS 157.67(1)(b)1. 1. Is approved in the sealed source and device registry to deliver a therapeutic dose for medical use. These devices may be used for therapeutic medical treatments that are not explicitly provided for in the sealed source and device registry, but must be used in accordance with radiation safety conditions and limitations described in the sealed source and device registry.

DHS 157.67(1)(b)2. 2. In research in accordance with an active investigational device exemption application accepted by the FDA and provided the requirements of s. DHS 157.61 (6) are met.

DHS 157.67(2) (2) Surveys of patients and human research subjects treated with a remote afterloader unit.

DHS 157.67(2)(a) (a) Before releasing a patient or a human research subject from licensee control, a licensee shall make a survey of the patient or the human research subject and the remote afterloader unit with a portable radiation detection survey instrument to confirm that the source has been removed from the patient or human research subject and returned to the safe shielded position.

DHS 157.67(2)(b) (b) A licensee shall retain a record of the surveys under s. DHS 157.71 (16).

DHS 157.67(3) (3) Installation, maintenance, adjustment and repair.

DHS 157.67(3)(a) (a) A person shall be specifically licensed by the department, NRC or another agreement state to install, maintain, adjust or repair a remote afterloader unit, teletherapy unit or gamma stereotactic radiosurgery unit that involves work on the source shielding, the source driving unit used to move the source or other electronic or mechanical component that could expose the source, reduce the shielding around the source or compromise the radiation safety of the unit or the source.

DHS 157.67(3)(b) (b) Except for low dose-rate remote afterloader units, only a person specifically licensed by the department, NRC or another agreement state may install, replace, relocate or remove a sealed source or source contained in other remote afterloader units, teletherapy units or gamma stereotactic units.

DHS 157.67(3)(c) (c) For a low dose-rate remote afterloader unit, only a person specifically licensed by the department, NRC or another agreement state, or an authorized medical physicist, shall install, replace, relocate or remove a sealed source contained in the unit.

DHS 157.67(3)(d) (d) A licensee shall retain a record of the installation, maintenance, adjustment and repair done on remote afterloader units, teletherapy units and gamma stereotactic radiosurgery units under s. DHS 157.71 (19).

DHS 157.67(4) (4) Safety procedures and instructions for remote afterloader, teletherapy and gamma stereotactic radiosurgery units.

DHS 157.67(4)(a) (a) A licensee shall do all of the following:

DHS 157.67(4)(a)1. 1. Secure the unit, console, console keys and the treatment room when unattended or not in use.

DHS 157.67(4)(a)2. 2. Permit only individuals approved by the authorized user, radiation safety officer or authorized medical physicist to be present in the treatment room during treatment with the source.

DHS 157.67(4)(a)3. 3. Prevent dual operation of more than one radiation producing device in a treatment room, if applicable.

DHS 157.67(4)(a)4. 4. Develop, implement and maintain written procedures for responding to an abnormal situation when the operator is unable to place the source in the shielded position or remove the patient or human research subject from the radiation field with controls from outside the treatment room. The procedure shall include all the following:

DHS 157.67(4)(a)4.a. a. Instructions for responding to equipment failures and the names of the persons responsible for implementing corrective actions.

DHS 157.67(4)(a)4.b. b. The process for restricting access to and posting signs in the proximity of the treatment area to minimize the risk of inadvertent exposure.

DHS 157.67(4)(a)4.c. c. The names and telephone numbers of the authorized users, the authorized medical physicist and the radiation safety officer to be contacted if the unit or console operates abnormally.

DHS 157.67(4)(b) (b) A copy of the procedures required by par. (a) 4. shall be physically located at the unit console.

DHS 157.67(4)(c) (c) A licensee shall post instructions at the unit console to inform the operator of both of the following:

DHS 157.67(4)(c)1. 1. The location of the procedures required by par. (a) 4.

DHS 157.67(4)(c)2. 2. The names and telephone numbers of the authorized users, the authorized medical physicist and the radiation safety officer to be contacted if the unit or console operates abnormally.

DHS 157.67(4)(d) (d) A licensee shall provide operational and safety instruction, initially and at least annually, at intervals not to exceed 13 months, to all persons who operate the unit, as appropriate to the person’s assigned duties, in all of the following: