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NO RADIOGRAPHY STANDARD
"INDEPENDENT PRACTICE"
MD SUPERVISION
MD COLLABORATION
FLUORO USE
X-RAY if not RT
ORDER
INTERPRET
NOTES
*
*
if trained
if trained
w/MD
no*
CRNP can order and perform under MD supervision
*
*
if trained
if trained
in scope
in scope
all operators of fluoro must be trained
*
no
no
in scope
in scope
APRNs can order and interpret independently; licensed practitioner does not include APRN
*
no
no
w/MD
no
determined by the APRN’s educational preparation and certification boundaries (also credentialing within hospitals); Any individual who performs fluoroscopic procedures is required to either hold a Licensed Technologist License or a Radiologic Technologist License; Licensed practitioner does not include APRN and only LP can interpret
*
no
no
w/MD
no
MDs need additional permit to use fluoro, radiography licensure to use x-ray
*
no
no*
can
can
They can order and interpret fluoroscopy. Cannot perform. In the process of revising regulations. Will likely have new regulations spring 2019.
*
can*
can*
in scope
can*
APRNs can order but regulations do not specify whether they can supervise, perform, or interpret. CT Nursing Scope of Practice says they may perform and interpret if they show competency depending on the site.
*
no
no
no
no
CRNAs are not within definition of "licensed practitioner" who can order/supervise radiation exposure. Although nursing states that the scope of an APRN includes, but is not limited to, performing acts of advanced assessment, diagnosing, prescribing and ordering.”
*
*
if trained
if trained
yes
yes
the NPs can "select, administer, and dispense therapeutic measures" which would allow NPs to order, perform, and interpret
*
no
no
no
no
Cannot supervise or order; all ionizing radiation must be performed by a licensed practitioner or a radiologic technology certificate holder. licensed practitioner definition does not include APRN.
*
if trained
if trained
can*
no
MD must supervise, cannot interpret; "If the delegating physician authorizes the APRN to order an X-ray, ultrasound or radiographic imaging test, the nurse protocol agreement shall contain provisions whereby such tests shall be read and interpreted by a physician
*
in scope
in scope
in scope
in scope
Nurse practitioners can order, interpret, or perform diagnostic, screening, and therapeutic examinations, tests and procedures
*
*
if trained
if trained
if trained
if trained
NPs can order, perform, and interpret according to Rule 400 of the Nursing Board Rules
*
no
no
no
no
not within their scope of practice; licensed practitioner does not include all APRNs only psychiatric ones
*
no
no
w/MD
no
Only radiologic technologists can perform fluoroscopy. Licensed practitioner includes APRNs.
*
no
if trained
if trained
if trained
APRNs can order and supervise fluoroscopy, but can't perform it.
*
no
no
w/MD
no
Not within their scope or practice. Can order, perform, and interpret only with physician supervision
*
if trained
no
yes
if trained
Board's opinion states APRNs can perform and supervise fluoroscopy; licensure in radiography or limited permit required to operate x-ray. The Board of Medical Imaging and Radiation Therapy which regulates the operators of the equipment has told their licensees that an APRN cannot supervise them.
*
no
no
w/MD
no
The use of fluoroscopy shall be limited to physicians. Radiography licensure to operate x-ray. APRNs with prescriptive authority can order and analyze data (which could include ordering and viewing radiographs in screening for gross abnormalities).
*
CRNAs yes
yes
NPs and CNMs
yes
NPs and CNMs can order, CRNAs can perform fluoroscopy, and APRNS can interpret images.
*
if trained
if trained
yes
yes
NPs can order, perform, and interpret laboratory and diagnostic tests
*
no
no
w/MD
no
Nurse midwives use and interpret ultrasound; radiographer license or limited permit required to operate x-ray
*
*
yes
yes
w/MD
no
mammo/CT credentialling only for x-ray operators
*
no
no
not in scope
yes
APRNs can interpret x-ray; radiography licensure required for x-ray use
*
if trained
if trained
w/MD
in scope
*
*
if trained
if trained
no
not specified
MD must order, but does not specify must supervise; Nursing board supports broad APRN scope with training and competency
*
no
no
yes
yes
radiography licensure or limited permit required to operate x-ray; APRN scope "(iii) ordering durable medical equipment, diagnostic treatments and therapeutic modalities, laboratory imaging and diagnostic tests, and supportive services, including, but not limited to, home healthcare, hospice, and physical and occupational therapy; (iv) receiving and interpreting results of laboratory, imaging, and/or diagnostic studies;"
*
if trained
if trained
can
not specified
CRNAs can PERFROM fluoroscopy after completing educational program and hands on training, but not supervise, only LP supervise, APRN is not within the definition.
*
*
if trained
if trained
can*
no
initiate x-ray orders; nothing on supervision 632.255 1b; must have MD radiologist to supervise and interpret films
*
no
no
not specified
no
Must be licensed to perform fluoroscopy and interpret images (limited x ray machine operators not permitted)
*
no
no
w/MD; initiate
no
MD Supervise & Order fluoro; LP definition does not include APRNs; need radiography license to operate x-ray; scope for APRN says "initiating laboratory and other diagnostic tests"
*
no
no
can*
not specified
Need radiographer license to operate x-ray or be an MD. CRNAs scope says can order "diagnostic tests"
*
no
no
yes
can*
RNs, LPNs, CNSs and NPs cannot legally operate a fluoroscope or other x-ray equipment. NPs may order x-rays and other imaging studies. LP definition does not include APRNs.
*
*
if trained
if trained
w/MD
w/MD
No radiography licensure law. APRN scope is broad so MDs can delegate. NPs can order, administer and dispense therapeutic tests under MD supervision.
*
no
no
can
can
Radiography license required to operate x-ray. Supervision of x-ray/fluoroscopy has to be from a healing arts practitioner (i.e. physician/vet/dentist) Nursing: "The term includes the following acts, which may not be deemed to include acts of medical diagnosis or treatment or the practice of medicine". NPs can order emergency x-rays
*
no
no
w/MD*
no*
Licensed practitioner does not include all APRN, cannot perform x-ray w/o radiographer license, cannot supervise x-ray, only LP can. "A clinical nurse specialist within the scope of practice of his or her collaborating physician and in accordance with the standard care arrangement" can order x-rays. In freestanding imaging centers interpretation must be by radiologist.
*
*
no
if trained
no
in scope
Types of radiographic tests are relegated to those trained in that area such as Radiologists, Rad. Techs, Radiology Assistants as the procedures are very scope specific especially for hospital liability. Oklahoma regulations require that all x-ray procedures be ordered and supervised by a Oklahoma licensed practitioner (i.e. M.D., D.O., D.C.).
*
if trained
if trained
not in scope
not in scope
CRNA can utilize fluoroscopy "in accordance with other applicable rules and regulations for diagnosis"; fluoro training required. Radiography licensure or limited permit required to operate x-ray. Health practitioner definition includes NP,CNM
*
if trained
if trained
w/MD* or no
no*
Scope CRNP: "(2) Order, perform and supervise diagnostic tests for patients and, to the extent the interpretation of diagnostic tests is within the scope of the CRNP’s specialty and consistent with the collaborative agreement, may interpret diagnostic tests." Supervision by a physician or state approved RT. Anyone in a hospital can operate any type of X-ray device, including fluoro devices, provided the operator is trained and has it written in their job description. Per DOH, only one certified ARRT is required to be on shift. A physician order is required in PA to perform any x-ray procedure as per 221.11 (NOTE) Regulations are in the process of revision. In addition to licensed practitioners, they are proposing that only ARRT, or those who have passed a state exam, be permitted to operate radiation producing pieces of equipment, consistent within any type of medical facility.
*
no
no
no*
not specified
Scope: (2) "Advanced practice registered nursing" means an independent and expanded scope of nursing in a role and population focus approved by the board of nurse registration and nursing education that includes the registered nurse scope of practice and may include, but is not limited to, performing acts of advanced assessment, diagnosing, prescribing and ordering." Radiography licensure required to operate x-ray. Exposure authorized by LP only and LP definition does not include APRN for supervision.
*
no
no
no
no
radiography licensure to operate x-ray; supervised by LP, LP does not include APRN
if trained
if trained
yes
yes
APRNs can order and interpret diagnostic procedures, radiography licensure required to operate x-ray
*
no
no
w/MD*
no
x-ray operators must be MDs or be certified
*
no
no
w/MD*
no
x-ray users must be MRT credentialled
*
no
no
not in scope
no
RT licensure required for all using x-ray
*
no
no
can
can
RT license required for x-ray use; additional training for fluoro. APRN scope written to include all
*
*
*
no
no
w/MD*
no
Scope depends on agreement with collaborating MD. ARRT certified or accredited program for operators. NPs with the equivalent of five years of full-time practice with a collaborating physician can practice independently.
*
in scope
in scope
in scope
in scope
APRNs can order, collect, perform, and interpret diagnostic tests; Licensed practitioners include nurses.
*
no
no
w/MD*
no
all x-ray use by licensed personnel only; MD order for imaging
*
in scope
in scope
in scope
in scope
LP includes NPs, APRNs "may order treatment, therapeutics, and testing", NPs as LP can operate, MD collaboration state
*
yes
yes
yes
yes
LP includes APRN. According to Board opinion, NPs can order, perform, supervise, and interpret imaging studies.
All mammography machines used in the conduct of mammography exam shall be operated only by a person approved by the FDA as meeting the qualifications for mammographers.
Each facility is inspected yearly to ensure they use only approved personnel.

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