Requirements for an x-ray room according to Sanpin. Requirements for an X-ray room according to Sanpin. Treatment room equipment

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 be aware 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 device and operation x-ray rooms, devices and 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 must 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 exclusive copies of X-ray diagnostic equipment are used, devoid of 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.

X-ray machine installed indoors dental office at 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 the 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 itself. 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 a clinic has several dental offices, and an 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.

X-ray department (office) not allowed placed in residential buildings and child care institutions. The exception is X-ray dental rooms (devices). Allowed to operate X-ray rooms in clinics built into residential buildings, if the vertically and horizontally adjacent rooms are not residential. It is allowed to place X-ray rooms in an extension to residential building, as well as in the basement floors, while the entrance to the X-ray department (office) must be separate from the entrance to the residential building.

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. X-ray rooms of infectious diseases, tuberculosis and obstetric departments of hospitals and, if necessary, fluorography rooms of emergency departments and outpatient departments are located separately.

An X-ray department serving only a hospital or only a clinic should be located in the end parts of the building. The department should not be walk-through. Entrances to the X-ray department for inpatient and outpatient department patients are separate.

The composition and area of ​​the general and special rooms of the X-ray room vary depending on the type and number of X-ray machines (from 16 to 45 sq.m.).

The surfaces of the walls and ceilings in the treatment room and control room should be smooth, easy to clean and allow wet cleaning. Finishing materials must have a sanitary and epidemiological certificate allowing their use in residential and public buildings.

The X-ray machine is placed in such a way that the primary beam of radiation is directed towards main wall, behind which there is a less visited room. The direct beam of radiation should not be directed towards the viewing window (control room, protective screen).

The control panel for X-ray machines is located in the control room.

To ensure the possibility of monitoring the patient's condition, an observation window and a speakerphone intercom are provided. It is permitted to use television and other video systems to monitor the patient.

To the number main physical and technical factors, which determine not only the radiation dose, but also the quality of the X-ray image, include:

skin-focal distance;

irradiation area;

primary beam filtration;

voltage applied to the X-ray tube;

exposition;

quality of X-ray film, intensifying screens and transillumination screen;

X-ray image processing technology;

the presence of a screening grid.

The amount of radiation exposure also depends on the characteristics of the patient’s body (the thickness of the tissue being examined and the depth of the location of the organs being examined).

Let's take a closer look at some of the listed patterns.

Skin-focal distance – the distance between the X-ray tube and the patient’s skin. Its increase is accompanied sharp decrease surface exposure dose (inversely proportional to the square of the distance). However, this also sharply reduces the output dose of radiation and, accordingly, the quality of the image on the film (screen) deteriorates. In addition, the irradiation area increases, which may be accompanied by an increase in the dose load on the gonads. Therefore, the skin focal length must be standardized for various types research and, as a rule, do not exceed 100 cm (except in individual cases).

Irradiation field area . With increasing size of the irradiation field increases not only the radiation exposure to the patient's skin, but also the gonadal dose. As the irradiation area increases, image quality deteriorates (its contrast decreases and blurriness increases) and scattered radiation in the patient’s body increases. Thus, to reduce radiation exposure and improve image quality, it is necessary to limit the irradiation area to a value that ensures the diagnostic significance of the study.

Filtration of the primary radiation beam . The beam of radiation emitted by the X-ray tube (i.e., the primary beam) has a continuous spectrum that contains radiation of various wavelengths, both short (hard X-rays) and long (soft X-rays). Predominantly hard radiation takes part in the formation of the final image. Soft radiation is predominantly scattered in the patient’s tissues, increasing its dose load, and at the same time deteriorating the image quality. Therefore, the long-wavelength component of the primary beam should be filtered, for which a filter made of aluminum or copper (2–4 mm thick) is installed at the output of the X-ray tube.

Voltage , supplied to the X-ray tube. Promotion it leads to decrease radiation exposure. This happens primarily due to the beneficially changing ratio between the input and output doses. In addition, the radiation becomes more “hard”, the current supplied to the tube decreases and the skin-focal distance increases. The image quality also improves. The voltage value is standardized for various types of research and changes only depending on the thickness and density of the transilluminated object.

Exposition is the amount of electricity passed through R-the handset during the shooting. Expressed in milliamps per second (mAs). Increase exposure leads to increase radiation exposure of patients. The choice of exposure is determined by many factors, the main of which are the thickness of the object, the radiation sensitivity of the X-ray film, the presence of a screening grating, the thickness of the filters, the amount of voltage used, etc.

The use of protective devices (screens) to protect radiation-sensitive organs has a great influence on the formation of radiation exposure in patients.

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 office and all further work with sources of ionizing radiation in dentistry is regulated by Sanitary Rules and Norms SANPIN 2.6.1.1192-03. It also establishes standards and requirements for lighting, ventilation, room area, handling x-ray equipment etc.

Project of an x-ray room in dentistry

If you decide to equip your dental clinic x-ray, then you must definitely understand that placement of x-ray machines directly to 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 two patients simultaneously in this X-ray treatment room. The pursuit of saving space will lead to clutter in the procedural x-ray room, and is unlikely to create coziness, tranquility and a comfortable stay for both patients and staff. And as already mentioned, placing an orthopantomograph in an office with dental chairs is simply unacceptable.

We can list endlessly the requirements for X-ray rooms in dentistry, including 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 X-ray room design to us.

X-ray room project - scope of work

If you are interested, we are ready to assist in obtaining and Sanitary and epidemiological report on the type of activity radiology.

What is included in a dental x-ray project?

I. Medical and technical specifications 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 information 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 with standards;
- b. Radiation safety calculation parameters;
- c. Climate requirements separate x-ray room or treatment room with x-ray;
- d. Lighting requirements in x-ray room;
- e. Requirements for water supply and sewerage in X-ray of the procedure room;
- f. Power requirements for x-ray equipment;
-g. Fire safety requirements;
- h. Waste disposal requirements;
- i. Requirements for the organization of x-ray examinations;
- j. Measures to prevent radiation accidents;
- k. Requirements for decommissioning an X-ray machine;
- 4. Conclusions.

III. Office plan with arrangement of technological equipment;

IV. Table for calculating the required additional protection enclosing structures;

V. Conditional diagram re-grounding circuit

VI. Plan for arrangement of cable channels and concrete foundations as necessary, depending on the X-ray machine;

VII. List of finishing of dental X-ray rooms;

VIII. Hardware Specification.

X-ray room project for dentistry, cost of work

Price for designing x-ray rooms (x-ray project)

The result of our work is an agreed project for an x-ray room

Additional/related services

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 Sanitary rules and standards, SanPiN 2.6.1.1192-03 “Hygienic requirements for the design and operation of X-ray rooms, devices 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. The treatment room must have a sink with hot and cold water supply.

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.

SanPin provisions define specific requirements for the condition of x-ray and dental rooms, based on concern for the health of patients. They are based on relevant federal laws. In addition to general cleaning and cleaning equipment after use, the rules establish safety parameters for patients and staff.

The rules developed in SanPin 2.6.1.1192-03 apply to all organizations using X-ray installations. Amended new rules were released in 2006. All medical centers must obey them, regardless of who owns them. The rules come into force at the stage of designing a house and are valid during the construction of a medical building, modernization of its parts and operation of offices.

One-time amount of radiation and motivation for radiography

Radiation doses for doctors and patients are subject to restrictions according to SanPin:

1. A radiologist has no right to receive a radiation dose of more than 20 m3 per 12 months. A dose of 50 m3 is acceptable, but the annual dosage must be maintained.
2. Women under 45 years of age should not take more than 1 m 3 x-ray per month.
3. A single dose for the patient being examined should be kept in the amount of no more than 1 m 3 in.

SanPin 2003 says that the patient receiving a dose of X-ray radiation must be justified. Motivation includes:

• if possible, use other diagnostic methods that do not involve irradiation of the patient;
• prescribing radiography only for serious indications;
• least choice dangerous species radiography;
• an unfavorable outcome of the disease should exceed the risk of an x-ray examination.

The same conditions apply when prescribing x-ray therapy. The benefit from it must be greater than the harm from radiation.

Concern for the safety of the subject

Minimizing harm to patients in SanPin contains the following provisions:

• examination of the patient in x-ray rooms is carried out on the direction of the doctor;
• the subject receives all the information about a single dose of X-ray irradiation and its possible negative consequences;
• X-ray equipment complies with established standards;
• the optimal dosage for the study is used;
• X-rays are carried out by specially trained personnel;
• the office is kept in proper condition;
• the rules for using the equipment are observed;
• The operation of the X-ray room is monitored.

Responsibility for the consequences of the examination lies with the radiologist. He decides whether x-rays can be taken. If, in his opinion, the referral for an x-ray is not justified, he has the right to refuse the examination.

Rules for placing x-ray units and establishing their functioning

There are strict requirements for the installation of X-ray machines in new centers in SanPin:

• the devices cannot be placed in residential buildings;
• It is recommended to organize special x-ray departments;
• X-ray rooms are installed at the end of the houses of medical centers or hospitals;
• at the top (on the next floor) there should be no rooms with the possibility of water leakage;
• X-rays should not be adjacent to the children's department and rooms for expectant mothers;
• cabinets should be used only for their intended purpose, there should be no other equipment there;
• The gaps between the radiologist's table, the protective screen, the X-ray machine, walls and windows are strictly regulated.

The floor covering in the radiography room must be antistatic and prevent sparks. It adapts to frequent washing With detergents. The walls are being finished matte materials so that there is no glare. The window is equipped with light protection. X-ray installation it is installed so that the beam of rays falls on the main wall.

X-ray machine

The wall partitions of the darkroom are finished with a tiled apron. When using static x-ray installations, it is recommended to organize work in two rooms - the control room and the examination room. A window is provided from the control room to the examination room for visual communication with the patient. The installation is located in the examination room, and in the control room there is a remote control and a screen.

Temperature and air exchange requirements

The temperature in the X-ray room according to SanPin is allowed to range from 18 to 22 degrees. Air extraction occurs once every 60 minutes. The influx of fresh air into the examination room occurs once every 20 minutes, in the control room - once every half hour. The intensity of lighting in the department is also regulated.

Concern for the safety of medical workers

Employees of the radiographic department are provided with radiation protection items. Employees over 17 years of age can conduct radiation examinations. Radiographers and technicians must undergo an annual physical examination. Expectant mothers at all stages and women breastfeeding a baby are not allowed to work with emitting equipment.

Operating conditions for dental offices with an X-ray machine

The room intended for x-rays in a dental clinic according to SanPin must have a minimum size of 8 m 2. In 60 minutes, old air is extracted three times and oxygen is supplied twice. The room temperature is allowed within 18 - 20 degrees. The equipment is registered with the Ministry of Health. The question of whether radiography can be performed is resolved simply - the clinic must have a licensing permit. Radiation protection items must be present in the office. Radiography is performed by a certified specialist.

After the end of the appointment time, all devices in the radiography room are turned off. A technician performs wet cleaning - wipes wall coverings, washes the floors. Trained personnel conduct disinfection measures with an X-ray machine and component materials.

Once a month it is necessary to carry out general cleaning with a 2% solution. acetic acid. General cleaning and the usual one cannot be carried out in the morning before the start of patients’ appointments - only in the evening.

The developed operating conditions for the radiography room ensure the safety of patients and staff. They cannot be neglected.