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(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)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 HistoryHistory: 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 157.66DHS 157.66 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 NoteNote: 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 HistoryHistory: 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 157.67DHS 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 NoteNote: 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(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(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)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)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: DHS 157.67(4)(e)(e) A licensee shall ensure that operators, authorized medical physicists and authorized users participate in drills of the emergency procedures, initially and at least annually, at intervals not to exceed 13 months, thereafter. DHS 157.67(4)(g)(g) Prior to the first use for patient treatment of a new unit or an existing unit with a manufacturer upgrade that affects the operation and safety of the unit, a licensee shall ensure that vendor operational and safety training is provided to all individuals who will operate the unit. The vendor operational and safety training must be provided by the device manufacturer or by an individual certified by the device manufacturer to provide the operational and safety training. DHS 157.67(4)(h)(h) A licensee shall retain a copy of the procedures required by pars. (a) 4. and (d) 2. until the licensee no longer possesses the remote afterloader, teletherapy unit, or gamma stereotactic radiosurgery unit. DHS 157.67(5)(5) Safety precautions for remote afterloader, teletherapy and gamma stereotactic radiosurgery units. DHS 157.67(5)(a)(a) A licensee shall control access to the treatment room by a door at each entrance. DHS 157.67(5)(b)(b) A licensee shall equip each entrance to the treatment room with an electrical interlock system that accomplishes all the following: DHS 157.67(5)(b)1.1. Prevents the operator from initiating the treatment cycle unless each treatment room entrance door is closed. DHS 157.67(5)(b)2.2. Causes the source to be shielded promptly when an entrance door is opened. DHS 157.67(5)(b)3.3. Prevents the source from being exposed following an interlock interruption until all treatment room entrance doors are closed and the source on-off control is reset at the console. DHS 157.67(5)(c)(c) A licensee shall require any person entering the treatment room to assure, via appropriate radiation monitors, that radiation levels have returned to ambient levels. DHS 157.67(5)(d)(d) Except for low-dose remote afterloader units, a licensee shall construct or equip each treatment room with viewing and intercom systems to permit continuous observation of the patient or the human research subject from the treatment console during irradiation. DHS 157.67(5)(e)(e) For licensed activities where sources are placed within the patient’s or human research subject’s body, a licensee shall only conduct treatments that allow for expeditious removal of a decoupled or jammed source. DHS 157.67(5)(f)1.1. For medium dose-rate and pulsed dose-rate remote afterloader units, require all the following: DHS 157.67(5)(f)1.a.a. An authorized medical physicist and either an authorized user or a physician, under the supervision of an authorized user, who has been trained in the operation and emergency response for the unit to be physically present during the initiation of all patient treatments involving the unit. DHS 157.67(5)(f)1.b.b. An authorized medical physicist and either an authorized user or a person under the supervision of an authorized user who has been trained to remove the source applicator in the event of an emergency involving the unit to be immediately available during continuation of all patient treatments involving the unit. DHS 157.67(5)(f)2.2. For high dose-rate remote afterloader units, require all the following: DHS 157.67(5)(f)2.a.a. An authorized user and an authorized medical physicist to be physically present during the initiation of all patient treatments involving the unit. DHS 157.67(5)(f)2.b.b. An authorized medical physicist and either an authorized user or a physician, under the supervision of an authorized user, who has been trained in the operation and emergency response for the unit to be physically present during continuation of all patient treatments involving the unit. DHS 157.67(5)(f)3.3. For gamma stereotactic radiosurgery units, require an authorized user and an authorized medical physicist to be physically present throughout all patient treatments involving the unit. DHS 157.67(5)(f)4.4. Notify the radiation safety officer or his or her designee and an authorized user immediately if the patient or human research subject has a medical emergency or if the patient dies.
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