<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".11" citation="COMAR 10.32.10.11" title_num="10" subtitle_num="32" chapter_num="10" heading="Scope of Practice — Radiologist Assistant.">
  <paragraph num="A.">
    <text>The scope of practice of a radiologist assistant includes the following activities to obtain the clinical history and physical examination of the patient:</text>
    <paragraph num="(1)">
      <text>Review the patient's medical record to verify the appropriateness of a specific exam or procedure;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Interview the patient to obtain, verify, or update medical history;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Explain procedure to the patient or significant others, including a description of risks, benefits, alternatives, and follow-up;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Obtain informed consent;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Determine if the patient has followed instructions in preparation for the exam such as diet and premedications;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Assess risk factors that may be contraindications to the procedure such as health history, medications, pregnancy, psychological indicators, and alternative medicines;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Obtain and evaluate vital signs;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>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</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Report findings related to Regulation .10A(1)—(5) of this chapter to the supervising radiologist or radiation oncologist.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The scope of practice of a radiologist assistant includes the following general procedures:</text>
    <paragraph num="(1)">
      <text>Apply ECG leads and recognize life threatening ECG abnormalities;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Perform urinary catheterization;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Perform venipuncture;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Monitor IV for flow rate and complications;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Position patient to perform required procedure, using immobilization devices and modifying technique as necessary;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Assess patient's vital signs and levels of anxiety and pain and inform the radiologist or radiation oncologist when appropriate;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Recognize and respond to medical emergencies, such as drug reactions, cardiac arrest, and hypoglycemia, and activate emergency response systems, including notification of the radiologist;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Administer oxygen as prescribed;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Operate a fixed/mobile fluoroscopic unit;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Assure documentation of fluoroscopy time;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Explain effects and potential side effects to the patient of the pharmaceutical required for the examination;</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Administer contrast agents as prescribed by the radiologist or radiation oncologist;</text>
    </paragraph>
    <paragraph num="(13)">
      <text>Administer general medications, excluding radiopharmaceuticals and narcotic or sedating medications, as prescribed by the radiologist; and</text>
    </paragraph>
    <paragraph num="(14)">
      <text>Monitor patient for side effects or complications of the pharmaceuticals.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Upper GI;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Esophagus;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Small bowel studies;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Barium enema;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Evaluation of percutaneous gastric and enteric tubes;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Swallowing study;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Cystogram and voiding cystourethrogram; and</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Nasoenteric and oroenteric feeding tube placement.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Joint injection and aspiration;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Arthrogram, including conventional, CT, and MR;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>PICC placement;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Paracentesis with appropriate image guidance;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Thoracentesis with appropriate image guidance;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Lumbar puncture under fluoroscopic guidance;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Fistulogram; and</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Port injection.</text>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>Lower extremity venography;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Lumbar, thoracic, or cervical myelography;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Non-tunneled venous central line placement;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Venous catheter placement for dialysis;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Breast needle localization;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Ductogram (galactogram);</text>
    </paragraph>
    <paragraph num="(7)">
      <text>T-tube cholangiogram;</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Retrograde urethrogram;</text>
    </paragraph>
    <paragraph num="(9)">
      <text>Sinogram;</text>
    </paragraph>
    <paragraph num="(10)">
      <text>Loopogram;</text>
    </paragraph>
    <paragraph num="(11)">
      <text>Hysterosalpingogram; and</text>
    </paragraph>
    <paragraph num="(12)">
      <text>Other specific procedures approved by the Board.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The scope of practice of a radiologist assistant includes the following post-imaging activities:</text>
    <paragraph num="(1)">
      <text>Review of imaging procedures, making initial observations, and communicating observations only to the radiologist or radiation oncologist;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Communication of radiologist's report to referring physician;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Provision of radiologist-prescribed post-care instructions to patients;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Performance of follow-up patient evaluation, and communication of findings to the radiologist or radiation oncologist;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Documenting procedure in appropriate record, and documenting exceptions from established protocol or procedure;</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Writing patient discharge summary for review and co-signature by the radiologist or the radiation oncologist;</text>
    </paragraph>
    <paragraph num="(7)">
      <text>Participating in quality improvement activities within radiology practice; and</text>
    </paragraph>
    <paragraph num="(8)">
      <text>Assisting with data collection and review for clinical trials or other research.</text>
    </paragraph>
  </paragraph>
</regulation>