As of 1/1/19 all personnel utilizing and/or supervising fluoroscopy imaging equipment must have initial training in radiation safety and annual training thereafter.  A response from TJC about the requirements that staff will be expected to meet follows:

“The education requirement focuses on content that would address dose management and the operation of the types of fluoroscopy equipment, specifically make and model, physicians and staff will use”.

An informative and easy video series is available in AHEC.
Click HERE for more information.

Proposed TJC Standards Revision that Relate to Fluoroscopy and CT Services

The Joint Commission is revising standards to better address risks related to the provision of fluoroscopy and CT in the Ambulatory Care, Critical Access Hospital, Hospital, and Office-Based Surgery accreditation programs. The open comment period ended in April and the final revisions are forthcoming. The changes reflect The Joint Commission commitment to implementing Element(s) of Performance that supports the National Patient Safety Goals.

In HR.01.05.03 the proposed Elements of Performance address the importance of testing/maintenance of medical equipment, the education and ongoing training of individuals performing fluoroscopic and CT procedures utilizing ionizing radiation. Staff will be required to participate in education and training to maintain or increase their competency and must include annual training in radiation dose optimization techniques. The Joint Commission is revising standards to better address risks related to the provision of fluoroscopy and CT in the Ambulatory Care, Critical Access Hospital, Hospital, and Office-Based Surgery accreditation programs. The open comment period ended in April and the final revisions are forthcoming. The changes reflect The Joint Commission commitment to implementing Element (s) of Performance that supports the National Patient Safety Goals