Placement of the x-ray room. Placement of x-ray machines in a dental clinic. Other requirements for premises and equipment of X-ray rooms
Accommodation Requirements x-ray machines V dental clinic have some differences from other medical and preventive organizations using sources ionizing radiation, and are defined in section 5 SanPiN 2.1.3.2630-10 "Sanitary and epidemiological requirements for organizations engaged in medical activities."
Equipment selection and location
Depending on the used x-ray equipment in a dental clinic, X-ray examinations can be carried out both in a separate X-ray room and directly in the dental office (Figure 1).
Picture 1.
Dental devices with a conventional film without an intensifying screen, as well as panoramic devices and tomographs, are allowed to be placed only in the X-ray department (office), while aiming devices with digital image processing can be placed both in a separate X-ray room and in the doctor's office. dentist. At the same time, when installing more than one X-ray dental apparatus in the procedural room, the area of the room should increase depending on the type of apparatus, but not less than 4 m2 for each additional apparatus.
In a dental office (including those located in a residential building, including those adjacent to residential premises, subject to the requirements of radiation safety standards for the population within the premises in which X-ray dental examinations are carried out), an X-ray machine for targeted images with digital image receiver that does not require photolab processing and with a workload up to 40 (mA x min.) / week. Such equipment, among other things, includes portable X-ray machines that look like a camera.
If several devices for X-ray dental examinations are installed in the room, then the system for switching on the anode voltage should provide for the possibility of operating only one device at a time.
Advantage this equipment(portable devices) lies in the fact that during operation the device can be placed in any position in relation to the patient. This is convenient for working in extreme situations and when working with immobile patients, especially in situations where rendering medical care carried out outside the walls of the medical and preventive organization. When using the equipment in a medical and preventive organization, a portable X-ray machine is additionally equipped with a tripod and a remote control button. The requirements for this equipment are no different from the requirements for other models and types of dental x-ray machines. Unfortunately, we noticed some dishonesty of the sellers of such devices, who bring distorted information to the attention of buyers, assuring the latter that such devices can be used even without the use of an X-ray protective apron, because they are the safest in terms of X-ray radiation. Unfortunately, this is not the case at all and portable devices operate with the same anode voltage of 70 kV as most of classic sighting dental devices.
The placement of the X-ray machine in a separate X-ray room is carried out in accordance with the requirements of SanPiN 2.6.1.1192-03 "Hygienic requirements for the design and operation of X-ray rooms, apparatus and X-ray examinations." It is also necessary to remember about the Radiation Safety Standards (NRB-99/2009), approved by the Decree of the Chief State Sanitary Doctor of the Russian Federation of July 7, 2009 No. 47.
The X-ray machine is located in the treatment room (the room where the examinations are directly carried out) in such a way that the primary beam of radiation is directed towards main wall, behind which is located a less visited room. The direct radiation beam should not be directed towards the viewing window (protective screen control room). When placing an office on the first or basement floors, the windows of the treatment room are screened with protective shutters to a height of at least 2 m from the level of the blind area of the building. When placing x-ray room above the first floor at a distance from the treatment room to residential and office space of the neighboring building less than 30 m, the windows of the treatment room are screened with protective shutters to a height of at least 2 m from the level of the finished floor.
When more than one X-ray diagnostic apparatus is in the procedure room, a device is provided for blocking the simultaneous activation of two or more apparatuses.
In addition to the treatment room, where the X-ray machine itself is located, a control room is equipped, which can accommodate: a control panel for X-ray machines, an additional X-ray television monitor, an workstation of a radiologist and a radiologist.
To ensure the possibility of monitoring the patient's condition between the control room and the treatment room, a viewing window and a loudspeaker intercom are equipped. Minimum size a protective viewing window in the control room 24×30 cm. It is allowed to use television and other video systems to monitor the patient. The control room is mandatory only when using film equipment.
NOTE!!! In order to protect personnel, patients, as well as persons located in adjacent rooms and buildings from ionizing radiation, the X-ray room itself must be designed and constructed in such a way that walls, floors, ceilings, protective doors, viewing windows, shutters, etc. weaken the X-ray radiation to the required level. That is why the design of X-ray rooms has the right to be carried out by an organization that has the necessary license for the design of IRS.
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By submitting an application, you agree to the terms of processing and use of personal data.The X-ray machine in the dental office is for patient care only. this cabinet. The device can be located directly at the workplace of a dentist or in close proximity. Thus, the allocation of a separate treatment room and control room is not required. Therefore, it is not required additional space for placement of the X-ray device in a stomatologic office. Also, there are no additional requirements for lighting, ventilation, heating. Note that separate X-ray rooms should be provided with autonomous supply and exhaust mechanical ventilation.
In order to protect the patient's skin during X-ray procedures, the length of the tube of the X-ray dental device should provide a skin-focal distance of at least 10 cm for a device with rated voltage up to 70 kV and 20 cm at higher anode voltages.
Management of x-ray machines approved for use in the offices of a dentist is carried out in the room for conducting x-ray examination using remote control control at a distance of at least 2.5 m from the X-ray emitter, unless otherwise provided by the instruction manual for the equipment.
Since the X-ray machine, even located directly in the dentist's office, is a source of ionizing radiation, when placing the X-ray machine in the dental office, it is necessary to develop an X-ray machine layout in advance and calculate the radiation protection of staff workplaces, adjacent rooms, and other patients' accommodations ( if there may be other patients in the office during the X-ray examination), the adjacent territory.
NOTE!!! When working with X-ray equipment, radiation protection equipment and dosimetric control equipment are used.
We bring to your attention a number of thematic articles:
Article 6.3. Code Russian Federation on Administrative Offenses provides for punishment for violation of legislation in the field of ensuring the sanitary and epidemiological welfare of the population, expressed in violation of existing sanitary regulations and hygienic standards, failure to comply with sanitary and hygienic and anti-epidemic measures in the form of a warning or the imposition of an administrative fine on citizens in the amount of one hundred to five hundred rubles; for officials - from five hundred to one thousand rubles; on persons carrying out entrepreneurial activity without formation of a legal entity - from five hundred to one thousand rubles or an administrative suspension of activities for a period of up to ninety days; on legal entities- from ten thousand to twenty thousand rubles or an administrative suspension of activities for a period of up to ninety days.
Any medical worker can easily read the requirements for dental clinics and select a room suitable for this dental clinic for one or more chairs. As a rule, everyone does just that. It is also not difficult to prepare a room without developing some sections of project documentation, for example, VK, AR, EOM, etc.
We want to focus your attention on the development x-ray room project or as it is also called x-ray project. X-ray design cabinet and all further work with sources of ionizing radiation in dentistry is regulated by the Sanitary Rules and Regulations SANPIN 2.6.1.1192-03. It also establishes the norms, requirements for lighting, ventilation, floor space, handling of X-ray equipment, etc.
X-ray room project in dentistry
Nowadays, in almost every dental clinic exists x-ray room(s). Depending on the scale of the clinic, the number of medical services they provide, bandwidth, x-ray machines can be located both in a separate room and directly in the treatment rooms. Admittedly, this does not apply to everyone. x-ray units. For example, dental units can be located directly in the treatment rooms, while the area of the treatment room does not increase, and there are no orthopantomographs. They require a separate room.If you decide to equip your dental clinic x-ray, then you must understand that placement of x-ray machines directly in the treatment room may not always be the best solution, and sometimes even simply unacceptable. Only dental units can be placed directly in the treatment room. But, if you have more than one dental chair in your office, then most likely you will have to organize X-ray protective partitions to prevent exposure of one of the two patients who are simultaneously in this X-ray treatment room. The pursuit of space savings will lead to clutter in the procedural x-ray room, and is unlikely to create coziness, tranquility and comfort of stay, both for patients and staff. And as already mentioned, placing an orthopantomograph in an office with dental chairs is simply unacceptable.
You can endlessly list the requirements for x-ray rooms in dentistry, including and requirements for the design of x-ray rooms, To placement of x-ray machines, citing various excerpts from SANPIN, but The best decision ask a question design of x-ray rooms to us.
X-ray room project - scope of work
IN x-ray project includes:- inspection of the premises / set of premises (if necessary);
- development of medical and technical specifications for X-ray room project;
- development of the x-ray room project- specialized section of the Technological part of the project documentation, Technological solutions (TX);
- coordination in the GBUZ SPC of Medical Radiology of the Department of Health of the City of Moscow (for Moscow institutions) or in the GBUZ of the Moscow Region MONIKI im. M. F. Vladimirsky (for institutions of the Moscow region).
If you are interested, we are ready to assist in obtaining and Sanitary and epidemiological conclusion for the type of activity radiology.
What is included in the dental office x-ray project
B (specialized section of the Technological part of the project) for x-ray rooms in dentistry includes:I. Medical and technical assignment for the development of a project for an X-ray room in a dental clinic(document base for X-ray room design);
II. Explanatory note:
- 1. General data and requirements for compliance with the design of an x-ray room in dentistry regulatory framework;
- 2. Initial data for design;
- 3. Technological solutions:
- a. Requirements to technological equipment and compliance;
-b. Radiation safety calculation parameters;
- c. climate requirements separate x-ray room or treatment room with x-rays;
- d. lighting requirements for x-ray room;
- e. Requirements for water supply and sewerage in procedure room x-ray;
-f. Power requirements for x-ray equipment;
-g. fire safety requirements;
- h. Waste disposal requirements;
- i. Requirements for the organization of X-ray studies;
- j. Measures to prevent radiation accidents;
-k. Requirements for the decommissioning of the X-ray machine;
- 4. Conclusions.
III. Plan of the office with the arrangement of technological equipment;
IV. Calculation table required additional protection enclosing structures;
v. Conditional Schema re-ground loop
VI. Arrangement plan for cable channels and concrete foundations as needed, depending on the x-ray machine;
VII. Statement of interior decoration of x-ray rooms of dentistry;
VIII. Hardware Specification.
Project x-ray room for dentistry cost of work
Quoted development cost dental office x-ray project does not depend, like many others, on the number of X-ray machines in one room and already includes all the necessary approvals.Price for the design of X-ray rooms (X-ray project)
Price for x-ray room design at the dental clinic fixed. Do you want to stay in the same room? one or two dental x-ray installations? Get in touch, it will be one x-ray project, because there is only one room, and the indicated price will not change.The result of our work is an agreed project of an X-ray room
As a result of our work, you will receive a developed and agreed project documentation (x-ray project) for the placement of sources of ionizing radiation, which you will need to receive Sanitary and epidemiological conclusion for work with sources of ionizing radiation and the activity of radiology.Additional / related services
If you are interested or need, we are ready to:- develop other sections of project documentation;
- assist in obtaining a Sanitary and Epidemiological Conclusion for work with sources of ionizing radiation and a Sanitary and Epidemiological Conclusion for the type of activity - radiology.
The arrangement of a modern X-ray room includes several stages, starting with the preparation of the room itself. The planning of the office, the calculation of parameters and the technological arrangement are carried out by special services, preferably in tandem with an experienced radiologist.
The equipment of the X-ray room includes:
- arrangement of radiation protection,
- treatment room equipment
- photo lab equipment,
- equipment for the workplace of a doctor and laboratory assistant.
It is also desirable to have a separate room for storing film archives.
Arrangement of radiation protection
To ensure protection from penetrating X-ray radiation, the treatment room is finished with special X-ray protective materials throughout the entire area: walls, ceilings and floors, doors and windows. Barite plaster is used for walls or special X-ray protective gypsum panels, leaded materials with a certain lead equivalent - glass and metal sheets to protect doors and windows.
Procedural equipmentrooms
The list of basic equipment for the procedure room of the X-ray room:
- x-ray machine stationary for 2 or 3 workplaces (radiography, fluoroscopy, linear tomography),
- ward mobile device,
- dental x-ray machine for intraoral images or orthopantomograph,
- digital radiovisiograph (on request).
By sanitary standards the installation of one X-ray diagnostic complex for 2 or 3 workplaces requires an area of at least 6 sq. m, including the installation of an aiming dental apparatus. For additional installation orthopantomograph requires more than 8 sq. m area. For the installation and operation of the second apparatus, a room of 12 square meters is required. m.
In modern X-ray diagnostics, both film and digital X-ray systems with highly sensitive receivers are used, which improve the quality of studies and reduce the radiation load. Remote-controlled systems are used for remote fluoroscopy, which does not require light adaptation, and also reduces the radiation load on personnel.
The digital radiovisiograph is a wireless flat panel detector in cassette format that allows you to receive digital image using an analog x-ray machine.
Required additional equipment:
- mobile (screens) and individual means lead rubber protection, which includes: aprons, collars, gloves, skirts and aprons, hats, a set of protective plates and goggles. All personal protective equipment must have a factory marking and a lead equivalent of at least 0.3 mm,
- individual wearable dosimeters-radiometers for individual monitoring of personnel, they are periodically changed and sent to a special laboratory (to determine the possible radiation dose received),
- screw Chair,
- fixing chair for examination of children (on request).
If there are two X-ray machines, a special interlock must be installed to prevent the simultaneous activation of all the equipment.
X-ray complexes are placed in such a way that the main radiation beam is directed to the main wall.
In the absence of a specially allocated room, the control panel is located behind a B-40 type protective screen.
The X-ray room must be equipped with an autonomous supply and exhaust ventilation with an air exchange rate of at least 3 per hour.
The entrance door from the inside should be closed with a latch, and from the outside it should have a signal lamp for patients.
Equipment for a photo lab and a doctor's workplace
The photo laboratory of the X-ray room should be equipped with the following equipment:
- film processing unit manually(tankobaki) or processing machine for automatic processing of x-ray film,
- non-actinic developing lights with red (for green-sensitive film) or green (for blue-sensitive film) light,
- negatoscopes for viewing pictures,
- photo lab clock with timer,
- multiple cassette set standard sizes for film exposure
- electric cabinet for drying the developed film,
- x-ray film storage cabinet,
- Consumables: x-ray film, photoreagents, barium for fluoroscopy.
The photo laboratory should have cold and hot water supply, supply and exhaust ventilation.
The workplace of a radiologist is located in a separate room or combined with a control room. Equipped with:
- personal computer with application software package,
- fluoroscope (for viewing fluorograms),
- negatoscope,
- laser printer for printing digital pictures,
- an intercom for transmitting commands to the patient, a video device for monitoring the patient or a viewing window with X-ray protective glass.
TO additional equipment includes furniture: chairs and tables, filing cabinets.
The placement of the X-ray room and equipment in it is carried out on the basis of a project developed by an organization that has a license for the placement of sources of ionizing radiation (generating) and the design of radiation protection equipment.
The X-ray room, unlike other rooms of medical institutions, is not one room, but several rooms (rooms isolated from each other), each of which has its own purpose and corresponds in area to the established regulatory requirements, and also meets all other sanitary and hygiene requirements. We will focus on the latter in detail.
The X-ray room includes at least 3 isolated rooms, one of which serves as a treatment room (a room in which work is directly carried out using ionizing radiation sources), the second is a control room (a room in which the equipment that controls the IRS is located) and the third is an office doctor. Depending on the purpose of X-ray equipment or the specifics of the activity medical institution an x-ray room may include a darkroom, waiting room, undressing cabin, staff room, etc. ( detailed information about the types of X-ray rooms is described in the article "").
Appendix 5 to SanPiN 2.6.1.1192-03 establishes the composition and area of the X-ray rooms. So, based on the information in Appendix 5 to SanPiN 2.6.1.1192-03, we give below in table 1 the area of the treatment room with different x-ray machines, in table 2 the composition and area of the premises of the x-ray diagnostic room, in table 3 - the composition and area of \u200b\u200bthe rooms of the x-ray therapy room.
Table 1
Treatment room area with different x-ray machines
| X-ray machine | Area, sq. m (at least) | |
|---|---|---|
| The use of a wheelchair is envisaged | Wheelchair use not included | |
| X-ray diagnostic complex (RDC) with a full set of racks (PSSH, imaging table, imaging rack, imaging rack) | 45 | 40 |
| RDK with PSSH, rack of shots, tripod of shots | 34 | 26 |
| RDK with PSSh and universal stand-tripod, X-ray diagnostic apparatus with digital image processing | 34 | 26 |
| RDK with PSSh having remote control | 24 | 16 |
| Apparatus for X-ray diagnostics by X-ray method (image table, image stand, image stand) | 16 | 16 |
| Apparatus for X-ray diagnostics with a universal stand-tripod | 24 | 14 |
| Apparatus for close-range X-ray therapy | 24 | 16 |
| Apparatus for long-distance radiotherapy | 24 | 20 |
| Mammography machine | 6 | |
| Apparatus for osteodensitometry | 8 | |
table 2
The composition and area of the premises of the X-ray diagnostic room
| The name of a room | Area, sq. m (at least) |
|---|---|
| General premises of the department (office) | |
| Department manager's office | 12 |
| staff room | 10 (+3.5 sq. m. for each additional employee) |
| Results Review Room (Snapshots) | 6 |
| Barium Cooking Cabin | 3 |
| expected | 6 |
| Material | 8 |
| Spare parts pantry | 6 |
| Storage room for cleaning items | 3 |
| Temporary storage room for x-ray film (no more than 100 kg) | 6 |
| Staff personal hygiene room | 3 |
| Restrooms for staff and patients | 3 per cab |
| Computer | 12 |
| Engineering | 12 |
| X-ray room | |
| Fluorography room for mass examinations – procedural |
14 |
| Fluorography room for diagnostic images – procedural |
14 |
| X-ray diagnostic room using fluoroscopy and radiography (1,2 and 3 r.m.) – procedural 1 |
According to the table 1 |
| Room for X-ray diagnostics of diseases of the gastrointestinal tract (1 r.m.) – procedural |
According to the table 1 |
| Room for X-ray diagnostics using X-ray and / or tomography (1, 2 and 3 r.m.) – procedural 1 |
According to the table 1 |
| Room for X-ray diagnostics of breast diseases using mammography – procedural |
6 |
| Room for X-ray diagnostics of diseases of the genitourinary system (urological) – treatment room with drain |
According to the table 1 |
| Cabinet (box) for X-ray diagnostics of infectious departments - vestibule at the entrance to the box (gateway at the entrance to the box) |
1,5 |
| Topometry room (radiotherapy planning) – procedural |
According to the table 1 |
| X-ray operating unit | |
| 1. Block for diagnosing diseases of the heart and blood vessels – X-ray operating room |
48 |
| 2. Block for the diagnosis of diseases of the lungs and mediastinum – X-ray operating room |
32 |
| 3. Block for diagnosing diseases of the urogenital system – X-ray operating room |
26 |
| 4. Block for diagnosing diseases of the reproductive organs (mammary gland) – X-ray operating room |
8 |
| X-ray computed tomography room | |
| 1. CT room for head examination – procedural |
18 |
| 2. CT room for routine examination – procedural |
22 |
| 3. CT room for X-ray surgery – procedural |
36 |
* Not necessary.
** Not needed when using digital radiography and fluorography devices.
Table 3
The composition and area of the premises of the radiotherapy room
| The name of a room | Area, sq. m (at least) |
|---|---|
| 1. Near-distance radiotherapy room | |
| – treatment room with 2-3 emitters | 16 |
| – treatment room with 1 emitter | 12 |
| - control room | 9 |
| - doctor's office (examination) | 10 |
| - expected | 6 |
| 2. Room for long-range radiotherapy | |
| – procedural | 20 |
| - control room | 9 |
| - doctor's office (examination) | 10 |
| - expected | 6 |
The use of premises of a smaller area or a reduced set of premises is possible in cases where the equipment used, the organization of work, the number of personnel, etc. ensure compliance with general hygiene requirements (microclimate, bacterial contamination, sanitary and epidemiological regime, etc.).
According to the hygienic requirements of SanPiN 2.6.1.1192-03, it is advisable to place X-ray rooms centrally, as part of the X-ray department, at the junction of the hospital and the clinic. Separately, X-ray rooms of infectious diseases, tuberculosis and obstetric departments of hospitals and, if necessary, fluorography rooms of emergency departments and outpatient departments can be placed.
By general rule X-ray department (office) is not allowed to be placed in residential buildings and child care facilities. The exception is dental X-ray rooms (devices), the possibility of placing them in residential buildings is regulated by a special chapter of the rules SanPiN 2.6.1.1192-03, as well as the "Basic sanitary regulations ensuring radiation safety (OSPORB-99/2010" SP 2.6.1.2612-10 and Amendment 1 to SP 2.6.1.2612-10. It is not allowed to place dental X-ray machines with a film image sensor in residential buildings.
In dental and X-ray dental offices adjacent to residential apartments, it is allowed to place X-ray diagnostic devices with digital image processing, the total rated workload of which does not exceed 40 mA-min / week. (detailed information on this issue described in the article "Placement of X-ray equipment in a dental clinic").
It is allowed to operate X-ray rooms in polyclinics built into residential buildings, if the vertically and horizontally adjacent premises are not residential. It is also allowed to place X-ray rooms in an extension to residential building, as well as in basement floors, if the entrance to the X-ray department (office) is separate from the entrance to the residential building.
As stipulated in clause 3.3 of SanPiN 2.6.1.1192-03, an X-ray department serving only a hospital or only a clinic should be located in the end parts of the building. In this case, the branch should not be through. Entrances to the X-ray department for inpatients and outpatient departments are separate.
Important: by virtue of clause 3.4 of SanPiN 2.6.1.1192-03, it is not allowed:
- Place X-ray rooms under rooms where water can flow through the ceiling (pools, showers, latrines, etc.);
- Place the procedural X-ray room adjacent to the wards for pregnant women and children.
According to paragraph 2 of Appendix 7 to SanPiN 2.6.1.1192-03, the choice of premises that make up the X-ray room (department) is carried out by the administration of the medical institution together with the X-ray department (RRO) (or another organization similar in function to the RRO) of the region and is consistent with institution of sanitary and epidemiological supervision. At the same time, in relation to separate rooms x-ray room medical organization must be respected special requirements established by SanPiN 2.6.1.1192-03. However, in practice, there is no longer such approval of the selected premises with Rospotrebnadzor, and applications for approval of the location of the X-ray room are no longer submitted.
Treatment room - a specially equipped room in the X-ray room, in which an X-ray emitter is located and X-ray examinations or X-ray therapy are carried out.
According to paragraph 3.11 of SanPiN 2.6.1.1192-03, the height of the X-ray treatment room should ensure the functioning of technical equipment, for example, an X-ray emitter ceiling mount, a tripod, a television monitor, a shadowless lamp, etc. X-ray equipment with ceiling suspension emitter, screen capture device or X-ray image intensifier requires a room height of at least 3 m (2.6 meters according to the newer SanPiN 2.1.3.2630-10). Height treatment room X-ray therapy in the case of rotational irradiation should be at least 3 m. doorways- 0.9 × 1.8 m.
Requirements for the area of the procedure room, including depending on the X-ray machine, are given in tables 1, 2 and 3 above. At the same time, as stipulated in paragraph 3.9, the area of the procedure room can be adjusted in agreement with the body exercising federal sanitary and epidemiological supervision, taking into account the following requirements:
- The distance from the workplace of the personnel behind a small protective screen to the walls of the room is at least 1.5 m;
- The distance from the workplace of the personnel behind a large protective screen to the walls of the room is at least 0.6 m;
- The distance from the swivel table-tripod or from the image table to the walls of the room is at least 1.0 m;
- The distance from the photo rack to the nearest wall is at least 0.1 m;
- The distance from the X-ray tube to the viewing window is at least 2 m (for mammography and dental devices - at least 1 m);
- Technological passage for personnel between the elements of stationary equipment - at least 0.8 m;
- The area for placing a gurney for a patient is at least 1.5 × 2 m;
- Additional area in case of technological need to bring a wheelchair into the treatment room - 6 m 2.
In accordance with clause 3.30 of SanPiN 2.6.1.1192-03, in the procedural room, in addition to the procedural room for fluorography and X-ray surgery, it is planned to install a sink with a supply of cold and hot water. In the treatment room, designed for urological examinations, a viduar should be installed.
In the procedural room for the study of children, the presence of toys (which are washed in a soap and soda solution and disinfected) and distracting design is allowed.
Important: It is not allowed to place in procedural equipment, which is not included in the project, as well as carrying out work not related to X-ray studies.
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