Republic of the Philippines

Department of Health
lBUREAU OF HEALTH DEVICES AND TECHNOLOGY
l(former name: RADIATION HEALTH SERVICE)
San Lazaro Cpd., Rizal Avenue
Sta. Cruz, Manila, Philippines 1003
Telefax No. 711-6016 or 743-8301 loc. 3403 to 3406

Checklist of requirements of the Bureau of Health Devices and Technology that shall be fulfilled by theName of Facility

located atAddress

with x-ray license no. Valid Until

•1.0PERSONNEL

1.1The head of the x-ray facility who is the person-in-charge of the activities shall be the qualified physician as defined in
Administrative Order No. 35, s. 1994 of the Department of Health Name PRC No.1.2A fulltime x-ray/radiologic technologist who is
registered with the Professional Regulation Commission (PRC) shall be hired for each machine. Name PRC No.

1.3The Radiation Safety Officer who is either the head of the facility, a medical physicist or a chief radiologic or x-ray technologist
with at least ten years working experience who attended a course on radiation protection conducted by the RHS.Name PRC No.

•2.0X-RAY MACHINE

2.1The total filtration shall be indicated on the exterior source assembly at least 2.5 mm a1 equivalent.2.2A set of cones or fixed
diaphragms, or an adjustable collimator with light beam indication shall be provided. The cones or diaphragms shall be clearly
marked with the following field sizes and distances: 14 x 17 at 72 inches, 10 x 12 at 72 inches, 14 x 17 and 8 x 10 at 36 inches.2.3A
visible mark on the exterior source assembly indicating the location of the focal spot shall be provided.2.4The xray tube leakage
shall be reduced to a value not greater than 1 mGy(100 mrad) in one hour at one meter from the focus.2.5The control panel shall be
provided with positive audible/or visible indication of the production of x-rays whenever the tube is energized.2.6The control panel
shall be provided with devices (labeled control dials, push buttons and/or meters) for setting and/or indicating physical factors (such
as kVp, mA, exposure time, or mAs) used for exposure.2.7The radiographic exposure switch of the dead-man or spring loaded type
shall be provided.2.8A device that automatically terminates the radiographic exposure at the preset time interval or exposure at the
receptor shall be provided.

•3.0X-RAY EXAMINATION ROOM

3.1X-ray room size shall satisfy the following specifications:3.1.1x-ray room not equipped with table shall have a room size of at
least 2.5m x 3.0 m. For a transportable facility the width of the room shall be at least 2.0 m.3.1.2x-ray room equipped with
stationary patient table shall have a room size of at least 3.5m x 4.0m.3.1.3x-ray room equipped with tilting patient table shall have
a room size of at least 4.5m x 4.5m3.1.4for specialized facilities, the size of the x-ray examination room should be in accordance
with the specification of the x-ray equipment manufacturer3.2Door leading to the x-ray room must be lined with at least 1.5
mm(1/6 inch) thick lead sheet to a height of at least 2 meters from the floor/ground outside.3.3The base of the examination room
window/s shall be elevated to a height of at least 2 meters from the floor/ground outside the x-ray examination.3.4A red warning
light bulb that is automatically illuminated when the x-ray machine is switched on shall be installed outside the x-ray examination
room above the x-ray room door.3.5A warning notice shall be put outside the x-ray examination room door. It shall be made up of
a solid yellow equilateral triangle 180mm long on each side. At the center of the triangle is a black tre-foil sign for radiation. Under
the triangle are the words “X-RAY ROOM: DO NOT ENTER WHEN THE RED LIGHT IS ON”. The warning notice shall be
on a a 180 mm x 270 mm white background.3.6Adequate ventilation shall be provided inside the x-ray examination room.3.7The
room shall be provided with adequate shielding from scattered and transmitted x-rays.

•4.0DARKROOM

4.1Light leaks into the darkroom shall be corrected.4.2A light tight air outlet with an exhaust fan should be installed inside the
darkroom.4.3For manual processing, processing tanks consisting of master tank two(2) insert tanks made of stainless steel or fiber
glass shall be provided.4.4Separate paddles for the developer and fixer solutions shall be provided.4.5There should be an adequate
supply of fresh water.4.6A luminous interval timer/digital timer shall be provided.4.7A darkroom thermometer or digital
thermometer or alcohol thermometer shall be provided4.8A standard safelight with 10-15 watt light bulb shall be provided.4.9The
safelight housing shall be provided wiht a safelight filter made of glass or hard plastic, tinted with amber or red and which does not
fog a pre-exposed film within 45 seconds.4.10The safelight housing shall be installed not lower than 4 feet from the working table
and the processing tanks.4.11Unprocessed films shall be properly shielded in a cool dry place protected from x-rays. Films shall be
stored vertically on its end. This prevents marks on film because of pressure due to its weight.4.12Intensifying screens shall be kept
clean or replaced when necessary.

•5.0ACCESSORIES

5.1A set of contact gonad shields with a minimum lead equivalence of 1.5 mm lead shall be provided.5.2An upright gonadal shield
for chest examination with a minimum lead equivalence of 1.5 mm lead shall be provided.5.3A lead rubber apron, with lead
equivalence of 0.25 mm shall be provided.5.4A pair of lead rubber gloves/lead hand protector with lead equivalence of at least 0.25
mm shall be provided.5.5A caliper to measure the thickness of the patient shall be provided.5.6A fixed/movable protective barrier
to a height of at least 2 m from the floor shall be provided. For a fixed protective barrier it shall be made of 15.25cm (6 inches)
poured concrete or 1.50mm thick lead sheets. For a movable protective barrier it shall be made of 1.50mm thick lead
sheets.5.6.1The fixed/movable protective barrier shall be covered with a lead glass/acrylic viewing window with lead equivalence
of at least 1.5 mm.5.6.2If the fixed/movable protective barrier in item 5.6 has no opening for a lead glass/acrylic viewing window
then a mirror large enough and positioned in such a way that the operator can see the patient during the x-ray examination shall be
provided.

•6.0ADMINISTRATIVE REQUIREMENTS

6.1The owner/licensee shall ensure that the facility complies with the above requirements.6.2The owner/licensee shall provide film
badges or thermolumniscent dosemeter (TLD) badges to all radiation workers in the facility.6.3The head of of the facility shall
establish quality control program for the x-ray facility in accordance with the the Radiation Health Service of the Department of
Health protocol on quality control. He shall ensure that no unlicensed person operates the x-ray equipment.6.4The radiation safety
officer shall be responsible for the conduct of radiation safety program in the facility. He/she shall keep record of occupational
radiation doses received by the radiation workers in the facility. He/she shall ensure that no worker shall exceed the dose limit of 20
mSv per year averaged over a period of five (5) years.

•7.0OTHER IRREGULARITIES

7.1Cleanliness and orderliness of the whole x-ray facility shall be observed.7.2The following charts and tables, technical manuals,
and records shall be made available to the RHS health physics team during the conduct of radiation protection survey and
evaluation.7.2.1Radiographic technique charts per x-ray machine shall be provided.7.2.2X-ray tube rating and anode cooling charts
must be kept.7.2.3Operation manuals and circuit diagrams must be kept.7.2.4Time-temperature chart shall be
provided.7.2.5Records of maintenance and repair jobs of x-ray machine including mechanical and electircal safety programs must
be kept.7.2.6Records of film spoilage/rejects must be kept.7.2.7Records of preventive maintenance of automatic processors and
accessories must be kept.7.2.8Records of frequency of changing solutions or replenishment must be kept.7.2.9Files of written
results signed by the qualified physician as defined in A.O. 35, s.1994 of the Department of Health must be kept.7.2.10Records of
x-ray examinations performed with the corresponding written request must be kept.

•8.0GENERAL RECOMMENDATIONS

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Immediate processing of your license to operate an x-ray facility will be based upon your submission of the
following documents:
1.duly accomplished x-ray license application form 2.Notarized certificate of employment of radiologist and x-ray/radiologic
technologist3Certification of training of doctor if he/she is not a fellow/diplomate of the Philippine College/Board of Radiology
(PCR)4Photocopy of the PCR certificate of the radiologist (if diplomate or fellow)5Photocopy of PRC license and certificate of the
radiologist and x-ray/radiologic technologist6.Certificate of training in radiation protection of the radiologic/x-ray technologist if
he/she acts as Radiation Safety Officer7.notarized certificate of compliance8.proof of compliance (pictures, receipts, logbooks,
charts, etc.) with the above deficiencies9.license application fee(see attached) in the form of postal money order payable to the
Radiation Health Service, Department of Health 10.copy of business/mayor’s permit

RHS health physics team that conducted the radiation protection survey and evaluation:
Name & Position

DateName & Position

A copy of this report was received by:

Name & Position