.11  Scope of Practice — Radiologist Assistant.

A. The scope of practice of a radiologist assistant includes the following activities to obtain the clinical history and physical examination of the patient:

(1) Review the patient's medical record to verify the appropriateness of a specific exam or procedure;

(2) Interview the patient to obtain, verify, or update medical history;

(3) Explain procedure to the patient or significant others, including a description of risks, benefits, alternatives, and follow-up;

(4) Obtain informed consent;

(5) Determine if the patient has followed instructions in preparation for the exam such as diet and premedications;

(6) Assess risk factors that may be contraindications to the procedure such as health history, medications, pregnancy, psychological indicators, and alternative medicines;

(7) Obtain and evaluate vital signs;

(8) Perform physical examination and analysis of data such as signs and symptoms, laboratory values, and significant abnormalities, as required by the imaging procedure to be conducted; and

(9) Report findings related to Regulation .10A(1)—(5) of this chapter to the supervising radiologist or radiation oncologist.

B. The scope of practice of a radiologist assistant includes the following general procedures:

(1) Apply ECG leads and recognize life threatening ECG abnormalities;

(2) Perform urinary catheterization;

(3) Perform venipuncture;

(4) Monitor IV for flow rate and complications;

(5) Position patient to perform required procedure, using immobilization devices and modifying technique as necessary;

(6) Assess patient's vital signs and levels of anxiety and pain and inform the radiologist or radiation oncologist when appropriate;

(7) Recognize and respond to medical emergencies, such as drug reactions, cardiac arrest, and hypoglycemia, and activate emergency response systems, including notification of the radiologist;

(8) Administer oxygen as prescribed;

(9) Operate a fixed/mobile fluoroscopic unit;

(10) Assure documentation of fluoroscopy time;

(11) Explain effects and potential side effects to the patient of the pharmaceutical required for the examination;

(12) Administer contrast agents as prescribed by the radiologist or radiation oncologist;

(13) Administer general medications, excluding radiopharmaceuticals and narcotic or sedating medications, as prescribed by the radiologist; and

(14) Monitor patient for side effects or complications of the pharmaceuticals.

C. The scope of practice of the radiologist assistant includes performing the following examinations and procedures, including contrast media administration, placement of needle or catheter, and operation of imaging equipment, under the immediate available direction of a radiologist or radiation oncologist:

(1) Upper GI;

(2) Esophagus;

(3) Small bowel studies;

(4) Barium enema;

(5) Evaluation of percutaneous gastric and enteric tubes;

(6) Swallowing study;

(7) Cystogram and voiding cystourethrogram; and

(8) Nasoenteric and oroenteric feeding tube placement.

D. The scope of practice of the radiologist assistant includes performing the following examinations and procedures, including contrast media administration, placement of needle or catheter, and operation of imaging equipment, under the on-site supervision of a radiologist or radiation oncologist:

(1) Joint injection and aspiration;

(2) Arthrogram, including conventional, CT, and MR;

(3) PICC placement;

(4) Paracentesis with appropriate image guidance;

(5) Thoracentesis with appropriate image guidance;

(6) Lumbar puncture under fluoroscopic guidance;

(7) Fistulogram; and

(8) Port injection.

E. On a case-by-case basis as specified in Regulation .12 of this chapter, the Board or its designee may approve a radiologist assistant to perform one or more of the following procedures under the level of supervision by a radiologist or radiation oncologist as specified in the request letter submitted by the radiologist or radiation oncologist and radiologist assistant:

(1) Lower extremity venography;

(2) Lumbar, thoracic, or cervical myelography;

(3) Non-tunneled venous central line placement;

(4) Venous catheter placement for dialysis;

(5) Breast needle localization;

(6) Ductogram (galactogram);

(7) T-tube cholangiogram;

(8) Retrograde urethrogram;

(9) Sinogram;

(10) Loopogram;

(11) Hysterosalpingogram; and

(12) Other specific procedures approved by the Board.

F. The scope of practice of a radiologist assistant includes the following post-imaging activities:

(1) Review of imaging procedures, making initial observations, and communicating observations only to the radiologist or radiation oncologist;

(2) Communication of radiologist's report to referring physician;

(3) Provision of radiologist-prescribed post-care instructions to patients;

(4) Performance of follow-up patient evaluation, and communication of findings to the radiologist or radiation oncologist;

(5) Documenting procedure in appropriate record, and documenting exceptions from established protocol or procedure;

(6) Writing patient discharge summary for review and co-signature by the radiologist or the radiation oncologist;

(7) Participating in quality improvement activities within radiology practice; and

(8) Assisting with data collection and review for clinical trials or other research.