36 CFR Part 1195 Standards for Accessible Medical Diagnostic Equipment - Preamble

M303 Diagnostic Equipment Used by Patients in a Wheelchair (Section-by-Section Analysis)

M303 in the final rule establishes the technical requirements for diagnostic equipment used by patients seated in a wheelchair, such as weight scales with wheelchair spaces and mammography equipment.

M303.1 General (Section-by-Section Analysis)

This is an introductory section.

M303.2 Wheelchair spaces (Section-by-Section Analysis)

This is an introductory section.

M303.2.1 Orientation (Section-by-Section Analysis)

The MDE NPRM proposed to require wheelchair spaces to be designed so that a patient in a wheelchair using diagnostic equipment would be oriented in the same direction that other non-wheelchair using patients using the equipment are typically oriented. NPRM, 77 FR at 6927. The Access Board received one comment about this requirement. The commenter, an accessibility consultant, recommended that patient positioning be addressed along with orientation of the wheelchair, noting that there are many cases where it is insufficient to simply position the user facing the same direction as a non-wheelchair user. The commenter asserted that body positioning is key for obtaining accurate results when using diagnostic devices, such as x-ray equipment, and recommends amending the rule text to require wheelchair spaces to be designed so that the patient orients and positions their body in the same position as someone who is not in a wheelchair. There was no recommendation from the MDE Advisory Committee on this requirement. The Access Board has retained the original requirement in the final rule. The Board did not include requirements for patient body positioning because the diagnostic equipment cannot override the position in which an individual is seated in his or her wheelchair. Wheelchairs often are contoured to fit the specific and unique needs of the user and to provide support where it is needed. However, the design of a wheelchair space often influences whether a wheelchair user can orient with respect to diagnostic components. For example, without knee and toe space beneath an optometrist diopter, the patient cannot look into the lens.

M303.2.2 Width (Section-by-Section Analysis)

The MDE NPRM proposed to require that diagnostic equipment used by patients seated in a wheelchair provide a wheelchair space that was at least 36 inches wide. There were no public comments and no MDE Advisory Committee recommendations regarding this requirement. Thus, the final rule retains the 36-inch wheelchair space width requirement. However, the Board added a new exception for wheelchair spaces on raised platforms, as discussed in Section IV.C.1. (Significant Changes – Width and Depth of Wheelchair Spaces), and discussed briefly below.

In the preamble to the MDE NPRM, the Access Board sought input on whether an exception to the width requirement was needed for wheelchair spaces on raised platforms. Multiple commenters responded to this provision and the MDE Advisory Committee recommended reducing the width requirement for wheelchair spaces on raised platforms. The Access Board has added an exception in the final rule that permits wheelchair spaces on raised platforms to be 32 inches wide minimum with edge protection no higher than 4 inches, measured from the platform surface.

M303.2.3 Depth (Section-by-Section Analysis)

The MDE NPRM proposed two wheelchair space depth requirements based on how the wheelchair user enters the space: for spaces entered from the front or rear, 48 inches deep minimum; and for spaces that can only be entered from the side, 60 inches deep minimum. In the preamble in the MDE NPRM, the Access Board noted it was considering increasing the minimum depth for wheelchair spaces entered from the front or rear to 58 inches and sought input in question 29 on whether the Access Board should increase this minimum depth requirement. NPRM, 77 FR at 6928.

The Access Board received eight comments in response to this question. Three commenters (two disability rights organizations and a state agency concerned with accessibility) recommended increasing the depth of front or rear entered spaces to 58 inches. The other five commenters (manufacturers, medical associations and accessibility consultants) recommended retaining the proposed requirement in the MDE NPRM of 48 inches minimum, raising concerns that the size of the rooms in which the diagnostic equipment are located are insufficient to provide additional space. The MDE Advisory Committee did not make recommendations regarding the general requirement for depth for wheelchair spaces, but did make recommendations regarding the depth of wheelchair spaces on raised platforms, which is discussed in above in Section IV.C.1. (Significant Changes – Width and Depth of Wheelchair Spaces).

First, the Access Board clarifies that this provision is not a clear space requirement for wheelchair approach, but is instead the wheelchair space integral to diagnostic equipment for a patient seated in a wheelchair, such as mammography equipment or wheelchair accessible scales. Second, based on the comments received and the absence of recommendations from the MDE Advisory Committee to change the proposed requirement, the Access Board has retained the MDE NPRM’s requirements for a minimum depth of 48 inches for wheelchair spaces entered from the front or rear, and a minimum depth of 60 inches for wheelchair spaces entered from the side. However, the Access Board has reorganized this provision into three separate requirements based on how the wheelchair space is entered, made an editorial change to clarify that front or rear entry is where the wheelchair space entry and exit is provided at only one end, and as discussed in Section IV.C.1. (Significant Changes – Width and Depth of Wheelchair Spaces), added an additional requirement to the depth provision for wheelchair spaces entered from the front or rear to permit a minimum of 40 inches if the wheelchair space provides pass-through from one end to the other.

M303.2.4 Equipment Clearances (Section-by-Section Analysis)

The MDE NPRM proposed knee and toe clearance for diagnostic equipment used by patients seated in wheelchairs to allow for components in the wheelchair space which the patient could approach successfully to use for its intended diagnostic purpose. The proposed requirements for equipment clearances paralleled the knee and toe clearance requirements from the 2004 ADA and ABA Accessibility Guidelines. The proposed rule provided one additional requirement for breast platforms on mammography equipment, proposing the knee and toe clearance under a breast platform to be 25 inches deep (proposed M303.2.4). The MDE NPRM preamble sought input with question 34 on whether the dimensions recommended by the Wheeled Mobility Anthropometry Project should be adopted.¹⁰ Three commenters responded. A manufacturer asserted that adopting a different requirement than what is already required under existing accessibility guidelines and standards would cause confusion and increase costs. A medical association asserted that to the best of their knowledge, imaging equipment already meets the Wheeled Mobility Anthropometry Project recommendations. The final commenter, a state agency concerned with accessibility, recommended adopting the new Wheeled Mobility Anthropometry Project recommendations. The MDE Advisory Committee only provided recommendations pertaining to the knee and toe clearance for mammography equipment.

The Access Board has determined that mammography equipment presents a unique challenge. Mammography equipment contains breast platforms which patients seated in wheelchairs must approach, and successfully maneuver their lower body under the platform enough to allow their chest to be flush with the leading edge of the platform. A separate set of equipment clearance requirements is necessary to address the unique positioning at mammography equipment. Therefore, in the final rule the Access Board has separated out the knee and toe clearance requirements into two provisions; breast platforms and other equipment. Breast platform requirements address the knee and toe clearance requirements for mammography equipment which is usable by patients seated in a wheelchair and is discussed in Section IV.C.2. (Significant Changes – Equipment Clearances for Breast Platforms). All other diagnostic equipment used by patients seated in a wheelchair must comply with the other equipment clearances requirements.

For all other equipment, the Access Board has decided to retain the original requirements in the proposed rule for knee and toe clearance. The Access Board is not persuaded to adopt the Wheeled Mobility Anthropometry Project recommendations for knee and toe clearances at this time. These recommendations represent a significant departure from the 2004 ADA and ABA Accessibility Guidelines. Therefore, the Board has elected in the final rule to retain the proposed provisions in the NPRM for knee and toe clearance for other equipment (M303.2.4.2). Due to the reorganization of the equipment clearances provision in the final rule, the knee and toe clearance requirements for the other equipment section have been renamed depth and height and relocated to M303.2.4.2. In addition, the Access Board has made an editorial change to the toe height requirement to clarify that the measurement is taken from the toe end of the wheelchair space.

M303.2.5 Surfaces (Section-by-Section Analysis)

The MDE NPRM proposed to require diagnostic equipment used by patients seated in a wheelchair to provide a wheelchair space with a surface that does not slope more than 1:48 in any direction. This provision is consistent with the 2004 ADA and ABA Accessibility Guidelines. There were no comments on this section and it was not addressed by the MDE Advisory Committee. There have been no changes made to this provision.

M303.2.6 Edge Protection (Section-by-Section Analysis)

The MDE NPRM proposed edge protection on the ramps leading up to the raised platform (proposed M303.3.3.4), but did not require edge protection on the raised platforms themselves. The Access Board received two comments and two recommendations from the MDE Advisory Committee regarding edge protection on raised platforms. As discussed in Section IV.C.5. (Significant Changes – Edge Protection), the final rule requires platforms with wheelchair spaces that are raised more than 1½ inches in height to provide a minimum 2-inch-high edge protection, measured from the surface of the platform, on each side of the platform not providing entry to or exit from the diagnostic equipment.

M303.3 Entry (Section-by-Section Analysis)

This is an introductory section.

M303.3.1 Vertical (Section-by-Section Analysis)

The MDE NPRM proposed that for equipment with a change in level at the entry to the wheelchair space, level changes of up to ¼ inch high are permitted to be vertical. This provision is consistent with the 2004 ADA and ABA Accessibility Guidelines. There were no comments on this section and it was not addressed by the MDE Advisory Committee. There have been no changes made to this provision.

M303.3.2 Beveled (Section-by-Section Analysis)

The MDE NPRM proposed that for equipment with a change in level at the entry to the wheelchair space, level changes greater than ¼ inch but not greater than ½ inch would be required to be beveled with a slope not steeper than 1:2. This provision is consistent with the 2004 ADA and ABA Accessibility Guidelines. There were no comments on this section and it was not addressed by the MDE Advisory Committee. There have been no changes made to this provision.

M303.3.3 Ramped (Section-by-Section Analysis)

The MDE NPRM proposed that for equipment with a change in level at the entry of a wheelchair space, level changes greater than ½ inch high would be required to be ramped and comply with technical requirements for running slope, cross slope, clear width, edge protection, and handrails. The Access Board received one comment on this provision. The commenter, a medical association, concurred with the requirement for handrails on diagnostic equipment with ramps over six inches in height. The MDE Advisory Committee only reviewed and gave recommendations on the portion of the provision addressing running slope. Therefore, the Access Board has retained the proposed requirements for cross slope, clear width, edge protection, and handrails in the final rule.

Regarding running slope, the MDE NPRM proposed that ramp runs have a running slope not steeper than 1:12. There were no comments on this section; however, as discussed in Section IV.C.3. (Significant Changes – Exception to Ramp Running Slope), the MDE Advisory Committee made a three-tiered recommendation for the allowable running slope. After careful consideration of the Advisory Committee’s recommendations, the Access Board has retained in the final rule the original requirement for running slope, but has added an exception that permits a running slope not steeper than 1:8 for ramp runs with a maximum height of 2½ inches. See Section IV.C.3. (Significant Changes – Exception to Ramp Running Slope) for a full discussion of the rationale for this exception.

M303.4 Components (Section-by-Section Analysis)

The MDE NPRM proposed to require diagnostic equipment used by patients seated in a wheelchair which has components that are used to examine specific body parts, be capable of examining those body parts of the patient while the patient is seated in a wheelchair. For example, an x-ray platform on which a patient places an arm or hand would have to be capable of examining the arm or hand of the patient while seated in a wheelchair. NPRM, 77 FR at 6930. There were no comments on this requirement and it was not addressed by the MDE Advisory Committee. There have been no changes made to this requirement.

M303.4.1 Breast Platform Adjustability (Section-by-Section Analysis)

The MDE NPRM proposed a mammography breast platform height range of 30 inches high minimum and 42 inches high maximum above the floor. The Access Board received three comments on this provision, and the MDE Advisory Committee made several recommendations for changes. As discussed above in the Section IV.C.4. (Significant Changes – Breast Platform Adjustability), the Access Board has revised this provision to require the breast platform to be continually adjustable from a low height of 26 inches to a high height of 42 inches above the floor and made an editorial change to the provision title changing it from height to adjustability.