6 Colo. Code Regs. § 1007-1-2-F
Each operator of a dual-energy x-ray absorptiometry system used on a living human shall meet the following education and experience requirements:
2F.1 Is certified or registered:
2F.1.1 As R.T.(R), R.T.(M), R.T.(N), R.T.(T), or CNMT; or
2F.1.2 By The International Society for Clinical Densitometry (ISCD), combined with or including the didactic radiation safety training in 2F.2.1.1, 2F.2.1.2 and 2F.2.1.3; or
2F.1.3 By A specialty board determined by the department to have substantially equivalent requirements for certification;
Or
2F.2 Is accepted by the Department as having satisfactorily completed:
2F.2.1 At least 30 hours of didactic training recognized by the Department that provided the minimum hours of instruction (as part of, or in addition to, specialty certificate and equipment operation training) in the specific subjects listed in 2F.2.1.1 through 2F.2.1.9:
RADIATION SAFETY:
2F.2.1.1 Basic X-Ray Physics-2 hours
(1) Structure of matter and the atom
(2) General description of production of x-rays
(3) X-ray emission, quantity and quality
(4) Function of filtration and effects it has on x-ray beam collimation
(5) Types of function of beam limiting devices
(6) Design, features and functions of x-ray tubes
(7) Circuitry of the x-ray machine
2F.2.1.2 Radiobiology-2 hours
(1) Effects of ionizing radiation to the human body
(2) Molecular and cellular radiobiology
(3) Factors that cause somatic and genetic damage
2F.2.1.3 Radiation Protection-5 hours
(1) ALARA
(2) Shielding materials
(3) Radiation quantity and units of measurement
(4) Basic interactions of x-ray with matter
(5) Primary and secondary scatter
(6) Importance of time, distance, shielding
(7) Maximum permissible dose: occupational and public
(8) Patient protection
(a) Patient instruction
(b) Comparison levels of radiation
(i) Natural background radiation
(ii) Central DXA
(iii) Peripheral DXA
2F.2.1.4 Basic Concepts-8 hours
(1) Osteoporosis
(a) World Health Organization definition and diagnostic criteria
(b) Primary vs. secondary
(c) Type I (postmenopausal) vs. Type II (senile)
(d) Risk factors
(i) Controllable (smoking, calcium intake, estrogen, medications)
(ii) Uncontrollable (heredity, race, gender, age, medical conditions)
(2) Bone physiology
(a) Functions of bone
(i) Structural support and protection
(ii) Storage of essential minerals
(b) Types of bone
(i) Cortical
(ii) Trabecular
(c) Bone remodeling cycle
(i) Resorption / formation
(ii) Osteoblasts/osteoclasts
(d) Bone health
(i) Nutrition
(ii) Exercise
(3) BMD testing methods (anatomical sites scanned, key advantages and disadvantages)
(a) Dual-energy X-ray Absorptiometry (DXA)
(b) Single X-ray Absorptiometry (SXA)
(c) Quantitative Ultrasound (QUS)
(d) Radiographic Absorptiometry (RA)
(4) Measuring BMD
(a) Basic statistical concepts
(i) Mean
(ii) Standard deviation
(iii) Coefficient of variation
(b) Reporting patient results
(i) BMD formula
(ii) Z-score
(iii) T-score
2F.2.1.5 Equipment Operation & Quality Control-6 hours
(1) Computer console
(a) Major components
(b) File management
(2) Fundamentals of x-ray energy production
(a) Properties of x-ray beam: quality (kVp), quantity (mA), duration/time (s)
(b) Filters and collimators
(c) X-ray energy production: single; dual
(3) Types of DXA systems
(a) Pencil beam systems
(b) Fan beam systems
(c) Cone beam systems
(4) Quality control
(a) Equipment safety (electrical, pinch points, emergency stop)
(b) Use of phantoms and/or calibration
(c) Troubleshooting
(i) Shift or drift
(ii) Pass / fail
(d) Record maintenance
(5) Determining quality in BMD
(a) Precision (definition)
(b) Accuracy (definition)
(c) Factors affecting accuracy and precision
(i) Scanner
(ii) Operator
(iii) Patient
2F.2.1.6 DXA Scanning of Finger and Heel (OS CALCIS)-1 hour
(1) Anatomy
(a) Regions of interest
(b) Bony landmarks
(c) Radiographic appearance
(2) Scan acquisition
(a) Patient instructions
(b) Patient positioning
(c) Evaluating pre-set scan parameters
(3) Scan analysis: BMD, T score, Z score
(4) Common problems
(a) Nonremovable artifacts
(b) Fractures or pathology
2F.2.1.7 DXA Scanning of Forearm-2 hours
(1) Anatomy
(a) Regions of interest
(b) Bony landmarks
(c) Radiographic appearance
(d) Adjacent structures
(2) Scan acquisition
(a) Patient instructions
(b) Patient positioning
(c) Evaluating pre-set scan parameters
(3) Scan analysis
(a) Accurate ROI placement
(b) BMC, area, and BMD
(c) T-score, Z-score
(4) Common problems
(a) Poor bone edge detection
(b) Nonremovable artifacts
(c) Variant anatomy
(d) Fractures or pathology
(5) Follow-up scans
(a) Unit of comparison: BMD, T-score
(b) Reproduce baseline study
2F.2.1.8 DXA Scanning of Lumbar Spine-2 hours
(1) Anatomy
(a) Regions of interest
(b) Bony landmarks
(c) Radiographic appearance
(d) Adjacent structures
(2) Scan acquisition
(a) Patient instructions
(b) Patient positioning
(c) Evaluating pre-set scan parameters
(3) Scan analysis
(a) Accurate ROI placement
(b) BMC, area, and BMD
(c) T-score, Z-score
(4) Common problems
(a) Poor bone edge detection
(b) Nonremovable artifacts
(c) Variant anatomy
(d) Fractures or pathology
(5) Follow-up scans
(a) Unit of comparison: BMD, T score
(b) Reproduce baseline study
2F.2.1.9 DXA Scanning of Proximal Femur-2 hours
(1) Anatomy
(a) Regions of interest
(b) Bony landmarks
(c) Radiographic appearance
(d) Adjacent structures
(2) Scan acquisition
(a) Patient instructions
(b) Patient positioning
(c) Evaluating pre-set scan parameters
(3) Scan analysis
(a) Accurate ROI placement
(b) BMC, area, and BMD
(c) T-score, Z-score
(4) Common problems
(a) Poor bone edge detection
(b) Nonremovable artifacts
(c) Variant anatomy
(d) Fractures or pathology
(5) Follow-up scans
(a) Unit of comparison: BMD, T-score
(b) Reproduce baseline study;
and
2F.2.2 At least 480 hours of clinical training during which time DXA examinations are performed only under direct supervision of a Colorado qualified bone densitometry equipment operator or other qualified trainer:
2F.2.3 Performance of the following imaging procedures (at least 30 examinations in total, with record of each examination kept on file):
2F.2.3.1 DXA scanning of the forearm-10 examinations;
2F.2.3.2 DXA scanning of the lumbar spine-10 examinations;
2F.2.3.3 DXA scanning of the proximal femur-10 examinations;
and
2F.2.4 A passing score on the American Registry of Radiologic Technologists (ARRT) Bone Densitometry Equipment Operator Examination.
and
2F.2.5 Has maintained a minimum of eighteen (18) hours continuing education every three years, documented by certificate(s) or other attestation(s) of satisfactory completion.
6 CCR 1007-1-2-F