• Contact Information:
  • Full name and address of physical location where room(s) located
  • Name, mailing address and phone for correspondence & design to be sent, if different from physical location of affected room
  • Name, address, and phone number of contact responsible for payment
  • Indication of type of project - new or renovation
• The purpose of the room, such as mammography, radiographic, fluoroscopic, angiography, CT, etc.
• Floor plan of the area, to scale, with dimensions legible on the plan. Adjacent areas must also be visible on the floor plan, including floors above and below the room to be shielded. Also, please indicate the location and dimensions of any windows or openings in the walls. Faxed documents are not acceptable due to the distortion inherent in transmission.
• The specific use of adjacent areas, such as offices, exam rooms, break areas, parking lots, closets, etc.
• Floor to ceiling height. If a drop ceiling is installed, please indicate this and denote the distance from the drop ceiling to the structural ceiling.
• The construction material and thickness of the walls in the room, including façade material used on exteriors. Please be sure to specify if concrete blocks are hollow or solid.
• Construction and thickness of the ceiling and floor, if the room has areas above and below that are occupied. Note that a room that has a roof where HVAC (heating, ventilating and air conditioning) maintenance can be performed is considered to be occupied.
• The actual or planned location of the x-ray equipment in the room, including the chest bucky, if a radiographic room. Please also provide the maximum height of the x-ray tube relative to the floor. For laterally mounted equipment, please indicate which side of the table the x-ray tube is on and the distance from the tube to the table centerline.
• The expected workload of the equipment, specified in terms of maximum patients per day, number of hours per day the facility is open and the number of days per week the facility is open.
• For CT equipment, the isoexposure plot provided by the manufacturer, to scale, with the technique factors used to derive the data. A top-down plot and side view plot are necessary. Faxed documents are not acceptable due to the distortion inherent in transmission.
• ¼” drawing of the room(s) which shall include:
• Equipment type (please include manufacturer and spec sheets of at all possible)
• Equipment position in the room
• Direction of the “beam”
• Location of Operator barrier (note - the operator barrier must be affixed to the floor and/or ceiling)
• Room distances and composition - distance from slab to slab (floor to ceiling) and composition or thickness of construction materials floor / ceiling slabs
• Description of all adjacent rooms and all areas below the floor and above the ceiling of the “shielded” room, relative to:
• Type (restroom, office, closet, etc.)
• Note - if above or below - indicate slab, basement, grade, roof above, etc.)
• Maximum occupancy of each room during use

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