A facility operating major medical equipment shall develop and implement: A quality assurance program in compliance with the guidelines outlined in COMAR 10.05.01.08; and Additional quality assurance requirements of this regulation. Scope. The quality assurance program shall apply to all personnel supervising or operating major medical equipment. Appropriate Use. The administrator shall develop a procedure to monitor referral and appropriate use for each procedure performed using the major medical equipment, ensuring that: Referrals are consistent with the health care practitioner's scope of practice as defined in the Health Occupations Article, Annotated Code of Maryland; The supervisor of major medical equipment is available to a referring health care practitioner to discuss appropriate use; and If the supervisor of major medical equipment questions the appropriateness of a requested procedure, the supervisor shall contact the referring health care practitioner for additional information relating to the appropriateness of using the equipment. When considering appropriate use, the supervisor of major medical equipment shall consider the patient's risks for undergoing specific testing, and the effectiveness of the particular equipment modality to aid in diagnosis. The supervisor of the major medical equipment shall monitor the quality assurance program to determine the effectiveness of the delivery of services.