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<regulation prefix="Regulation" num=".10" citation="COMAR 10.32.10.10" title_num="10" subtitle_num="32" chapter_num="10" heading="Scope of Practice — Nuclear Medicine Technology.">
  <paragraph num="A.">
    <text>The scope of practice of nuclear medicine technology includes the following:</text>
    <paragraph num="(1)">
      <text>Scope of practice for diagnostic in-vivo procedures and in-vitro procedures which includes:</text>
      <paragraph num="(a)">
        <text>Analysis and correlation of procedure request and clinical information provided by the referring physician or patient, or both, for determination of appropriate exam, extent, and scope;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Evaluation of the physical and emotional status of the patient with respect to the ability to undergo the procedure requested;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Immediate predose review of patient's identification, prescribed dose quantity and route of administration, and identification of the test agent designed to prevent dose misadministration;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Preparation of the appropriate radiopharmaceutical with measurement of dose activity;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Administration of appropriate diagnostic dose levels of radiopharmaceuticals;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Administration of nonradioactive pharmaceuticals utilized in conjunction with a nuclear medicine imaging or in-vivo procedure, for example, cholecystokinin, furosemide, vitamin B12, in accordance with hospital or facility procedures, excluding narcotic and sedating medication;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Selection of appropriate imaging or test parameters, or both;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>Obtaining images according to established protocols and any special views to optimize information as appropriate;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>Placement of patient in proper position using supportive materials and immobilizer as necessary;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Assuring appropriate image labeling as to patient identification, position, and appropriate anatomic land marks for each view;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>Evaluation of images or data, or both, for technical quality;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Recognition of unusual variances in the images or data, or both, caused by instrumentation malfunction and initiating appropriate action;</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Monitoring of patient and equipment during procedure for determination and application of any corrective actions necessary;</text>
      </paragraph>
      <paragraph num="(n)">
        <text>Monitoring of data collection and processing and performance of technical analysis of test results;</text>
      </paragraph>
      <paragraph num="(o)">
        <text>Preparation and performance of laboratory in-vivo nuclear medicine procedures, inclusive of the selection and operation of laboratory counting equipment, performance of calculations and data processing necessary for completion of lab procedures and the submission of results to the physician or licensee;</text>
      </paragraph>
      <paragraph num="(p)">
        <text>Oversight and application of image development; and</text>
      </paragraph>
      <paragraph num="(q)">
        <text>Performance of in-vitro testing of serum, plasma, or other body fluids using radio immunoassay, or similar ligand assay methods;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Scope of practice for handling radiopharmaceuticals which includes:</text>
      <paragraph num="(a)">
        <text>Preparation, by means of tagging, compounding, etc., in accordance with manufacturer's specifications;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Measurement and calculation of activity of radionuclides with a dose calibrator;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Application of radioactive decay calculations to determine required volume or unit form necessary to deliver the prescribed radioactive dose; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Recording of radiopharmaceutical information on a patient's permanent record;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Scope of practice for radionuclide therapy which includes:</text>
      <paragraph num="(a)">
        <text>Assisting licensed physician in the preparation and applications of therapeutic radionuclides;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Oversight of radiation safety practices related to the handling and administration of radiopharmaceuticals for therapy of patients;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Management of transportation and handling of therapeutic radiopharmaceuticals;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Calibration of therapeutic radiopharmaceuticals for dose accuracy; and</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Radiation monitoring, decontamination, disposal, and patient follow-up as appropriate and required;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Scope of practice for radiation safety which includes:</text>
      <paragraph num="(a)">
        <text>Maintenance of records of radioactive material receipt, use, storage, and disposal in accordance with regulatory requirements;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Oversight and enforcement of radiation safety policies, practices, and regulations regarding the possession and use of radioactive materials; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Performance of radiation safety procedures such as radiation survey and wipe testing of incoming radioactive shipments and facility fixtures;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>Operation of a hybrid nuclear medicine/CT device for a nondiagnostic attenuation correction CT without intravenous contrast; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Performing any other duties that the Board determines may be performed by a nuclear medicine technologist.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The scope of practice of a nuclear medicine technologist includes operation of a standalone CT or hybrid nuclear medicine/CT device for a diagnostic CT with or without intravenous contrast if the nuclear medicine technologist:</text>
    <paragraph num="(1)">
      <text>Has successfully passed the ARRT or NMTCB specialty exam for CT; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Administers contrast media after consultation with, and under the supervision of, a physician who is immediately and physically available.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>In order to meet the eligibility requirements to sit for the ARRT or the NMTCB post-primary CT examination, a licensed nuclear medicine technologist may perform all procedures involving diagnostic CT with or without intravenous contrast only under the direct supervision of a:</text>
    <paragraph num="(1)">
      <text>Licensed nuclear medicine technologist with the post-primary CT credential;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Licensed radiographer with the post-primary CT credential; or</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Licensed radiologist or radiation oncologist.</text>
    </paragraph>
  </paragraph>
</regulation>