I agree that a substantial revision to Virginia’s radiation protection regulations (12VAC5-481) is needed.  Over time, the regulations governing radiation therapy have accumulated inconsistencies, ambiguities, and provisions that no longer align well with modern clinical practice.

However, it is not yet clear whether a full repeal of 12VAC5-481 and replacement with a new chapter (12VAC5-482) is the most appropriate path forward. Whether repeal-and-replace is justified depends critically on the scope, structure, and clarity of the revised regulations.
If the changes are incremental or limited in scope, a targeted revision may be preferable to a full replacement.

There are numerous issues in the current regulations that warrant correction; the following are provided as a few representative examples.

First, the current regulations incorporate radioactive material (RAM)–style language into therapeutic x-ray requirements. For example, requirements for a “Written Directive” are applied to therapeutic x-ray machines. In clinical radiation oncology practice, treatment is authorized through a physician-approved treatment prescription and treatment plan, not through a RAM-style written directive. Revised regulations should reflect accepted clinical workflows and terminology appropriate to external beam radiation therapy.

Second, the applicability of the current regulations is unclear.  For example, for therapeutic x-rays produced by a medical linear accelerator, it is ambiguous whether both the Part IX “Particle Accelerator” provisions and the Part XV “Therapeutic Radiation Machines” provisions apply simultaneously. This ambiguity leads to inconsistent interpretation and enforcement. Any revised regulations should be explicit regarding scope and applicability, clearly stating which sections apply to which technologies.

Third, the current regulations (12VAC5-481-2230) require therapeutic x-ray vaults to be equipped with an independent radiation monitoring system. This requirement raises significant clinical and operational concerns. Modern treatment vault safety is ensured primarily through door interlocks, in-room radiation indicators, and emergency-off systems, and the regulations should reflect that reality. Forbidding patient treatment when these independent monitoring systems inevitably fail causes far more harm than any potential added safety benefit from such systems. Furthermore, requiring annual calibration of a device whose functional purpose is simply to indicate beam on/off status provides little safety value, while device failure can unnecessarily interrupt patient treatments.

While no substitute regulatory text for 12VAC5-481 has yet been published, it should be noted that direct or near-verbatim adoption of the current CRCPD Suggested State Regulations for the Control of Radiation (SSRCRs) would require careful evaluation, as several unresolved issues remain in the model language.

The examples below are intended to be illustrative rather than exhaustive.

For example, the CRCPD definition of a Quality Management Program differs substantially from widely accepted quality management frameworks (e.g., ISO 9000 series). The CRCPD definition focuses primarily on identifying deficiencies and deviations, rather than on continuous improvement and process control.

Additionally, CRCPD Part X, Section X.7(u), requires that therapeutic treatment facilities either be accredited by an external organization or undergo an audit described in the appendices. The audit process described in the associated materials extends beyond regulatory requirements and functions more like an accreditation checklist.
Any audit requirement included in Virginia regulations should be strictly limited to verifying compliance with explicit regulatory provisions and should not incorporate extra-regulatory expectations.

CRCPD Part X, Section X.3(d), requires professional certification for Qualified Medical Physicists. However, certification boards require clinical experience for eligibility.
Without an explicit grace period or transitional pathway, newly graduated physicists cannot legally practice long enough to obtain the experience required for certification, creating an unintended workforce barrier.

Finally, CRCPD Part X, Section X.8(b), requires calibration at electronic brachytherapy source energies. Such calibration energies are not provided by Accredited Dosimetry Calibration Laboratories (ADCLs), rendering this requirement impractical and unenforceable in its current form.

Given the number of unresolved issues within both the existing regulations and the CRCPD framework, and the inherent challenges associated with revising complex clinical regulations, any proposed replacement regulations should be accompanied by a substantial public comment period prior to adoption. This will help ensure that the final regulations are clear, implementable, and aligned with safe and effective clinical practice.