X-ray room is normal. Placement of X-ray equipment in a dental clinic. Start and end of work in the X-ray room

Very often there is a situation when the construction of a clinic, including an x-ray room, begins before the owner of the clinic finds the right specialist on design. Therefore, at a certain stage, many questions arise about what is possible and what is not. Of course, it is better to hire a competent specialist who will calculate radiation protection and develop a design for placing an X-ray machine as early as possible. But if for some reason you started without it, be sure to take into account the requirements that the X-ray room must meet.

All requirements for the premises in which x-ray examinations are carried out are specified in the Sanitary Rules and Standards, SanPiN 2.6,1.1192-03 “Hygienic requirements for the design and operation of x-ray rooms, apparatus and the conduct of x-ray examinations.”

Here we draw your attention to the main ones:

1. In dental clinics located in residential buildings, it is allowed to install digital X-ray machines and devices that work with a highly sensitive image receiver (without a darkroom). In this case, the room in which X-ray dental examinations are carried out must comply with the requirements of radiation safety standards.

2. The area of ​​the cabinet for placing a dental sighting device (digital) must be at least 6 sq. m, for an orthopantomograph (digital) - at least 8 sq. m, for two devices - at least 12 sq. m.

3. There should be no rooms with high humidity. If located above residential apartment, then there should be no toilets, showers or bathrooms above the X-ray room. There may be corridors, kitchens and living rooms.

4. The width of the doorway must be at least 0.9 m.

5. The door from the treatment room to the corridor should open towards the corridor.

6. The door from the control room (console) to the treatment room should open towards the treatment room.

7. When there is more than one X-ray diagnostic device in the room, a device is provided to block the simultaneous activation of two or more devices.

8. All open metal devices (in the clinic, most often these are heating radiators) must be insulated using protective screens.

9. The surfaces of the walls and ceiling in the X-ray room must be smooth, easy to clean and allow wet cleaning.

10. It is allowed to use as a flooring material ceramic tiles (ceramic granite) or antistatic linoleum.

11. In the treatment room there must be a sink with hot and cold water.

12. System supply and exhaust ventilation in the X-ray room must be autonomous. The exhaust should be carried out from two zones - upper and lower, in a ratio of 50%; inflow - in the upper zone. The air exchange rate per hour should be at least 3 for exhaust and 2 for inflow.

Please note that this information should in no way be considered as advice to do everything yourself, without resorting to the help of specialists.

Requirements and rules for using x-rays in the dental office.

Do I need to obtain permission to install this equipment?

Yes, we should. It is necessary to invite a specialist from the Center for State Sanitary and Epidemiological Supervision on radiation hygiene, who supervises the use of sources ionizing radiation to coordinate installation in the clinic premises. On the basis of Federal Law dated 01/09/96 N 3-FZ “On Radiation Safety of the Population” and Federal Law dated 03/30/99 N 52-FZ “On Sanitary and Epidemiological Welfare of the Population”, without permission from the State Sanitary and Epidemiological Service for installation, the cabinet is closed and imposed administrative liability in the form of a fine.

Which dental x-ray machine should I buy?

You should know that not all types of dental X-ray machines can be used in clinics located in residential buildings. This depends on the purpose of the device, its workload and the nominal value of the anode voltage. Restrictions on these parameters are specified in SanPiN 2.6.1.802−99 " Hygienic requirements to the construction and operation of X-ray rooms, devices and the conduct of X-ray examinations.” Currently, dental X-ray systems with image recording on film are being replaced by more modern computer systems with digital image recording methods.

The digital dental radiography system allows you to conduct research using solid-state X-ray detectors inserted into the oral cavity. This system is often called . It allows you to reduce the patient’s radiation dose by 2–4 times.

Another type of dental X-ray machines - orthopantomographs - cannot be placed in the premises of a dental clinic adjacent to residential premises.

What documents should be provided to you by the manufacturer when selling dental x-ray equipment?

X-ray machines from various manufacturers, both domestic and foreign, must have a sanitary and epidemiological certificate from the Department of State Sanitary and Epidemiological Surveillance and a registration certificate from the Ministry of Health of Russia.

A database of X-ray machines registered with the Russian Ministry of Health is available at the Center for Standardization and Certification of the Russian Ministry of Health.

However, there are cases when dental clinics use exclusive copies of X-ray diagnostic equipment that lack the listed documents. In this case, this X-ray machine must undergo radiation hygiene tests. Tests must be carried out only by an organization accredited for these types of work.

How and where to install an X-ray machine?

One of the following options for placing the X-ray machine is possible: the X-ray machine is installed in a separate room, the area of ​​which must be at least 6 square meters. Otherwise, the patient will receive an unreasonably high radiation dose.

The X-ray machine is installed in the dental office near the dental chair. In this case, the office area must be at least 14 square meters. Regardless of the chosen option, the room where it will be placed will now be called an X-ray room or an X-ray dental room.

Who can you trust to develop a technological project for an X-ray room?

Not every design, and subsequently construction, organization has the right to carry out such work. In accordance with Federal law“On radiation safety of the population”, Art. 10, a license is required for the relevant types of activities with sources of ionizing radiation, and therefore the annex to the license must contain a record of the technological design (construction) of healthcare institutions and specifically medical X-ray rooms. The same applies to the dental clinic. She must have a license giving her the right to carry out all types of dental care(therapy, surgery, orthopedics), including X-ray and dental examinations.

What must be reflected in the technological part of the project from the point of view of radiation safety?

First of all, the calculation of stationary radiation protection of all premises located horizontally and vertically adjacent to the X-ray dental room. Project working drawings should show the placement of the x-ray machine, indicate the thickness, material and lead equivalent of existing guardrails and interfloor ceilings, placement of mobile radiation protection equipment, indicating the required protection efficiency, as well as ventilation and lighting requirements.

If a separate X-ray room (without a dental chair) is selected, to protect personnel performing X-ray dental examinations, it is necessary to either install an X-ray protective screen made of material with the required lead equivalent, or move the X-ray machine control panel (anode voltage switch button) to a separate room (control room). In any case, it must be possible to monitor the patient through a protective viewing window or the room must be equipped with a television camera. If the power button is located outside the office, it is necessary to exclude the possibility of access to it by random persons.

To protect the patient from x-ray radiation, it is imperative to purchase and use a special protective apron dental, protective cape (cape) and collar.

If the X-ray machine is located in a dental office located on the ground floor, and the distance to neighboring buildings is less than 30 m, the windows must be screened with protective shutters to a height of at least 2 m from the floor level.

Depending on its design (mobile or stationary), the X-ray machine should be placed in such a way that the X-ray beam falls in the direction of rooms where people spend less time and the number of people is small.

If the clinic has several dental offices, and the X-ray machine is installed in one of them, then a stationary placement of the X-ray machine is necessary to avoid its possible movement to other rooms that do not have appropriate stationary or mobile radiation protection equipment.

Due to the wide range of modern building materials, on the one hand, and the different capabilities of dental clinics, on the other hand, for the manufacture of stationary protection, you should choose those that have reliable structural protective properties. There are cases when the cabinet is made from materials protective properties which are unknown. This may cause additional difficulties in the calculation and assessment of radiation protection.

It should be noted that actually existing Construction Materials protective fences and interfloor ceilings in most cases provide the necessary attenuation factor for x-ray radiation, and residents of apartments located adjacent to the x-ray dental room will not be exposed to doses exceeding the dose limit for the population. Moreover, the calculation of radiation protection is carried out in such a way that the requirements of radiation safety standards for the population living adjacent to the premises where X-ray dental examinations are carried out are observed within these premises, and with a significant margin.

In some cases, these adjacent residential premises are occupied by the owners of dental clinics themselves, which sometimes serves as a compelling argument for the population regarding the reliability of radiation safety. It is especially important to know the material and thickness of interfloor ceilings in old residential buildings, since they often have preserved wooden floors. Since wood is practically transparent to X-ray radiation, in this case it becomes necessary to create a special protective ceiling in the X-ray dental room.

The next stages are organizational measures in relation to employees who will conduct X-ray dental examinations. These employees, in accordance with sanitary rules are called “Group A personnel”, and those people who do not themselves work with, but are in the area of ​​​​exposure to x-ray radiation (other dentists, nurses) are called “Group B personnel”.

• Firstly, medical staff, classified as Group A personnel, must undergo a medical examination, after which the conclusion of the medical commission must note not only that the person being examined is practically healthy, but also that he has no contraindications for working with a source of ionizing radiation.
• Second, these medical personnel must be trained in radiation safety. X-ray procedures can be performed either by a radiographer or radiographer who has the appropriate certificate. Usually, problems with this contingent do not arise, since the training program for these specialists includes issues of ensuring radiation safety. It is more difficult when X-ray dental examinations are carried out by a dentist or nurse who have appropriate certificates in these specialties. Perfect option, when the doctor has a dentist certificate and a radiologist certificate.
• Thirdly, it is necessary to conclude an agreement with an accredited organization to monitor individual radiation doses of personnel conducting X-ray dental examinations.

The arrangement of a modern X-ray room includes several stages, starting with the preparation of the room itself. The planning of the room, calculation of parameters and technological arrangement are carried out by special services, preferably in tandem with an experienced radiologist.

The X-ray diagnostic room equipment includes:

• arrangement of radiation protection,
• treatment room equipment,
• photo laboratory equipment,
• equipment for the doctor's and laboratory assistant's workplace.

It is also advisable to have a separate room for storing film archives.

Arrangement of radiation protection

To provide protection from penetrating X-ray radiation, the treatment room is finished with special X-ray protective materials over 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.

Treatment room equipmentrooms

List of basic equipment for the X-ray room procedure room:

• stationary X-ray machine for 2 or 3 workstations (radiography, fluoroscopy, linear tomography),
• ward mobile device,
• dental x-ray machine for intraoral images or orthopantomograph,
• digital radiovisiograph (on request).

By sanitary standards to install one x-ray diagnostic complex for 2 or 3 workplaces, an area of ​​at least 6 square meters is required. m, including installation of a targeted dental apparatus. For additional installation orthopantomograph requires more than 8 square meters. m area. For installation and operation of the second device, 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 research and reduce the radiation load. Remote-controlled complexes are used for remote fluoroscopy, which does not require light adaptation, and also reduces the radiation load on personnel.

A digital radiovisiograph is a wireless flat-panel detector in cassette format that allows you to obtain digital image using an analog X-ray machine.

Required additional equipment:

• mobile (screens) and individual means lead rubber protection, the set of which includes: aprons, collars, gloves, skirts and aprons, caps, a set of protective plates and safety glasses. All personal protective equipment must have factory markings 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 examining children (on request).

If there are two X-ray machines, a special blocker must be installed to prevent the simultaneous activation of all equipment.

X-ray complexes are placed in such a way that the main radiation beam is directed at the main wall.

In the absence of a specially designated room, the control panel is located behind a B-40 type protective screen.

The X-ray room must be equipped with independent supply and exhaust ventilation with an air exchange rate of at least 3 per hour.

The entrance door must be latchable from the inside and have a warning light for patients on the outside.

Equipping a photo laboratory and a doctor’s workplace

The X-ray laboratory must be equipped with the following equipment:

• film processing plant manually(tank tanks) or developing 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,
• darkroom clock with timer,
• a set of several cassettes standard sizes for exposing film,
• electrical cabinet for drying developed film,
• cabinet for storing X-ray film supplies,
• Consumables: X-ray film, photo reagents, barium for fluoroscopy.

The photo laboratory must have cold and hot water supply, supply and exhaust ventilation.

The radiologist's workplace is located in separate room or combined with a control room. Equipped with:

• personal computer with a package of application programs,
• fluoroscope (for viewing fluorograms),
• negatoscope,
• laser printer for printing digital images,
• 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, cabinets for storing documentation.

X-ray rooms have been used for quite a long time to diagnose many diseases of the human body. The most common branches of medicine in which X-rays are used are surgery, traumatology, therapy, urology, gastroenterology, dentistry and many other fields cannot do without such an important device. X-ray rooms are opened not only in hospitals, so it is important to know what requirements must be met when placing individual X-ray rooms and whether there is a license for an X-ray room.

All requirements are contained in the specialized SNiP “Hygienic requirements for the design and operation of X-ray rooms, devices and the conduct of X-ray examinations.” We will look at them:

The X-ray room can be installed in both residential and non-residential buildings. When placing an office in a residential building, it must have a special finish that will serve to reduce the level of radiation or completely absorb it.

The minimum area of ​​the X-ray room must be at least 6 m2 if a dental sighting device will be used. If an orthopantomograph is installed, a room of more than 8 m2 is required. And if you plan to install several devices, then the area must be calculated taking into account 6 m2 for each device.

When placing the x-ray in multi-storey building One of the main conditions for its placement is the absence of rooms with increased humidity on the floors above. No toilets, bathrooms, etc.

The minimum doorway for entering the X-ray room must be more than 90 cm.

The door must open outward, that is, into the corridor.

There must be a resistor that does not allow all the X-ray equipment in the room to be turned on at the same time, if there are two or more devices.

Everything metal objects in the office, including pipes and radiators, must be protected with protective screens.

The walls of the X-ray room cannot be covered with wallpaper; they must be covered with washable materials.

The floor is covered with tiles or linoleum.

The office must have a sink with cold as well as hot water.

The X-ray room must be equipped with an autonomous hood, which must operate independently of the ventilation of the entire building.

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The equipping of the X-ray room and the placement of equipment in it is carried out according to a project developed by an organization that has a license that allows it to design radiation protection equipment and place generating sources of ionizing radiation.

An X-ray room is a complex of rooms, each of which has a specific purpose. All premises and equipment placed in them are subject to a number of regulatory and technical requirements, which will be discussed below.

Requirements for premises for placing X-ray machines

X-ray rooms (other than x-ray and dental rooms) are not allowed to be installed in residential buildings, as well as in the buildings of children's institutions. X-ray rooms are allowed to be located in clinics that operate in residential buildings, if the adjacent premises are non-residential. Also, the X-ray room can be located in an annex or in ground floor residential building, if it has a separate entrance.

Rooms with X-ray equipment are located, if possible:

• centrally - in the form of x-ray units or departments at the junction of the clinic and the hospital (with the exception of x-ray rooms for tuberculosis, infectious diseases and obstetrics, and sometimes fluorography rooms);
• in the end parts of the building;
• isolated from rooms from which water can flow (showers, swimming pools, treatment rooms);
• isolated from wards for children and pregnant women.

The X-ray room should not be walk-through. The entrance to it is equipped separately from the entrance to the clinic or hospital.

Requirements for the composition and area of ​​the X-ray room

The X-ray room includes at least 3 isolated rooms:

• the procedural room, where the X-ray machine is located and work is performed with it;
• X-ray equipment control room;
• doctor's office.

The office may also include a darkroom, undressing and waiting rooms, a staff room, etc.

Area requirements individual species X-ray room premises are set out in Appendix 5 to SanPiN 2.6.1.1192-03.

This table presents the area requirements for treatment rooms depending on the type of X-ray machine used.

Here you can see the requirements for the composition and area of ​​the X-ray diagnostic room.

* Not necessary.

** Not required when using equipment for digital fluorography and radiography.

And this table presents data on the composition and area of ​​​​the premises of the X-ray therapy room.

Requirements for the X-ray room procedure

A procedure room is an X-ray room in which a source of ionizing radiation is located and X-ray procedures and studies are performed.

When designing a procedure room for an x-ray diagnostic or x-ray therapy room, the following requirements must be taken into account:

• The distance between the walls of the room and the employee’s workplace behind a protective screen (small) should be 1.5 meters.
• The distance between the walls of the room and the employee’s workplace behind the protective screen (large) should be from 0.6 meters.
• There should be a distance of at least 1 meter between the turntable-tripod or imaging table and the walls of the room. There should be at least 10 centimeters from the photo stand to the nearest wall.
• The minimum distance between the viewing window and the X-ray tube is 2 meters. For dental and mammography machines, this figure is reduced to 1 meter.
• Between the elements of the stationary equipment of the office there must be a technical passage for personnel with a width of at least 0.8 meters. A space of at least 1.5x2 meters is allocated for placing gurneys for patients. For the import of gurneys and other technological needs There must be at least 6 m2 of free space in the treatment room.

The treatment room must have a sink with hot and cold water supply (the requirements do not apply to treatment rooms fluorography and X-ray operating). For rooms where urological X-ray examinations are carried out, there is also a requirement for the mandatory placement of visual instruments.

Requirements for a photo lab

The X-ray laboratory must have a “dark room”. If it has a developing machine, it is also necessary to equip a “light room” where dry photographs will be cropped, sorted and labeled.

Requirements for the minimum area of ​​the “dark room” of the darkroom:

• for small format photographs ---- 6 m2;
• for large format photographs ---- 8 m2.

Between the equipment of the “dark room” there must be passages for personnel at least 1 meter wide. The doorway should have a width of 0.9-1 meter.

Light tiles are used to decorate the walls of the darkroom next to the sink and photo processing device. Height tiled apron- at least 2 meters from the floor. The remaining sections of the walls should be finished with materials that are subject to repeated wet cleaning.

The entrance door, window and transfer hatch in the darkroom should be protected with light-proof curtains (so that photographic materials are not exposed to light).

The use of digital equipment eliminates the need to equip x-ray room darkroom.

Other requirements for premises and equipment of X-ray rooms

The floor of the darkroom premises should be made of artificial or natural materials with electrical insulating qualities.

The floor in the preoperative, X-ray operating room, and darkroom must be waterproof, spark-free, and antistatic (when using linoleum, its base must be grounded).

The doors from the darkroom, as well as from the control room and the treatment room, open “towards the exit”; from the control room to the treatment room - towards the treatment room (to facilitate evacuation).

The ceiling and walls of the X-ray room must be smooth and resistant to frequent washing, not giving light glare.

All materials used in the decoration of the X-ray room must have sanitary and epidemiological certificates authorizing their use in public and residential buildings.

It is advisable to orient the windows in the X-ray room to the northwest. Darkening systems are installed on the window of the fluoroscopy room to protect from sunlight.

When the anode voltage is turned on at the entrance to the treatment room and the control room of the X-ray room, the “Do not enter!” sign should automatically light up. white-red color. It is located above the door or at a height of 1.6-1.8 meters from the floor.

The air flow into the X-ray room should be in the upper zone, and the exhaust should be 50% (+-10%) from below and from above.

When constructing new X-ray rooms, the design includes autonomous ventilation. In premises that are already in use (except for computed tomography departments and x-ray departments of infectious diseases hospitals), it is possible to use general supply and exhaust ventilation systems. Air conditioning may be installed in rooms with X-ray equipment.

Detailed requirements for air exchange, temperature conditions, illumination of X-ray diagnostic and X-ray therapy rooms are set out in Appendix 6 to SanPiN 2.6.1.1192-03.