Download Conceptual Amendment to SB 219 General 1

Conceptual Amendment to SB 219
General
1- Definitions:
“Direct supervision” means supervision where the person providing supervision is present in the
room with the person being supervised or an adjacent room and immediately available to furnish
assistance and direction.
“Personal supervision” means supervision where the person providing supervision is present in
the room with the person being supervised.
“Radiation therapy” means the administration of ionizing radiation for therapeutic purposes.
“Radiography” means the making of a film or other record of an internal structure of the body by
passing X-rays or gamma rays through the body to act on film or other receptor of images.
“Radiologic imaging” means the use of ionizing radiation to diagnose or visualize a medical
condition.
“Radiologist” means a physician certified by or board-eligible to be certified for the American
Board of Radiology, the American Osteopathic Board of Radiology, the British Royal College of
Radiologists, or the Royal College of Physicians and Surgeons of Canada, or their successor
organizations, in radiology.
“Supervision” means assuming responsibility for and control of the technical aspects of
administering radiation for diagnostic or therapeutic purposes and the quality of those services,
and ensuring that radiation is administered safety, including, without limitation, ensuring that all
persons involved are adequately protected from radiation.
2. A person is prohibited from performing radiation therapy or radiologic imaging on humans
unless the person has obtained from the Division of Public and Behavioral Health of the
Department of Health and Human Services a full or limited certificate of authorization to operate
a source of ionizing radiation for the purposes of performing radiation therapy or radiologic
imaging or is exempt from the requirements of provisions of this bill placed in chapter 459 of
NRS pursuant to item 3.
3. A physician, podiatrist, chiropractor, chiropractor’s assistant certified pursuant to NRS
632.123, dentist, dental hygienist or another person working under the direct supervision of a
dentist is not subject to provisions of this bill placed in chapter 459 of NRS. The performance of
radiation therapy or radiologic imaging by such persons will be regulated by their respective
licensing boards.
4. The Division may adopt any regulations necessary to carry out the provisions of this bill
placed in chapter 459 of NRS and shall adopt regulations establishing fees for applying for and
issuance of certificates.
5. A full or limited certificate issued pursuant to the provisions of this bill placed in chapter 459
of NRS expires 2 years after the date of issue and must be renewed on or before that date.
Full Certificates
6. To obtain a full certificate of authorization to operate a source of ionizing radiation for the
purposes of performing radiation therapy or radiologic imaging, a person must:
a. Have successfully completed a course of study that meets the requirements of the Joint
Review Committee on Education in Radiologic Technology, the Joint Review Committee on
Nuclear Medicine Technology, their successor organizations, or another national accrediting
organization approved by the Division; and
b. Be certified by:
(1) The American Registry of Radiologic Technologists or its successor
organization in a primary pathway of radiography, nuclear medicine technology or radiation
therapy or meet any alternative standards prescribed by regulation of the Division; or
(2) The Nuclear Medicine Technology Certification Board or its successor
organization in nuclear medicine.
7. The Division shall adopt regulations to define the scope of practice of persons who hold full
certificates. Those regulations must be no less restrictive than the practice standards adopted by
the American Society of Radiologic Technologists or its successor organization.
Limited Certificates
8. “Bone densitometry” means the quantitative assessment of bone mass using single or dual
energy X-ray absorptiometry.
9. To obtain a limited certificate of authorization to operate a source of ionizing radiation for the
purposes of performing radiologic imaging, a person must have:
a. Completed a course of study in limited x-ray machine operation that incorporates the
Limited X-Ray Machine Operator Curriculum prescribed by the American Society of Radiologic
Technologists or its successor organization; and
b. Passed an examination for limited x-ray machine operators administered by the
American Registry of Radiologic Technologists or its successor organization; or
(1) If applying for limited certification in spine and extremity radiography, be
certified by the American Chiropractic Registry of Radiologic Technologists or its successor
organization;
(2) If applying for limited certification in podiatric radiography, be certified by
the American Society of Podiatric Medical Assistants or its successor organization; or
(3) If applying for limited certification in bone densitometry, be certified as a
clinical bone densitometry technologist or a certified densitometry technologist by the
International Society for Clinical Densitometry or its successor organization or have successfully
completed the examination for bone densitometry equipment operators administered by the
American Registry of Radiologic Technologists or its successor organization.
10. A person who has a limited certificate may only perform radiologic imaging only within the
scope of his or her limited certificate. The following limited certificates are available:
a. Chest radiography, which authorizes the holder to engage in radiography of the thorax,
heart and lungs.
b. Extremities radiography, which authorizes the holder to engage in radiography of the
upper and lower extremities, including the pelvic girdle.
c. Spine and extremity radiography, which authorizes the holder to engage in
radiography of the vertebral column and the upper and lower extremities, including the pelvic
girdle.
d. Skull and sinus radiography, which authorizes the holder to engage in radiography of
the skull and face.
e. Podiatric radiography, which authorizes the holder to engage in radiography of the
foot, ankle and lower leg below the knee.
f. Bone densitometry, which authorizes the holder to engage in the determination of bone
mass by measuring the radiation absorption of the bone.
11. The holder of a limited certificate may not perform procedures using contrast media,
mammography, fluoroscopy, nuclear medicine, or radiation therapy.
12. The Division shall adopt regulations to define the scope of practice of persons who hold
limited certificates. Those regulations must be no less restrictive than the practice standards
adopted by the American Society of Radiologic Technologists or its successor organization.
Radiologist Assistant
13. The holder of a full certificate who is certified by the American Registry of Radiologic
Technologists or its successor organization in the primary pathway of radiography and the postprimary pathway of Registered Radiologist Assistant or by the Certification Board of Radiology
Practitioner Assistants may practice as a radiologist assistant.
14. A radiologist assistant may perform activities relating to care and management of patients,
including radiologic imaging and interventional procedures guided by radiologic imaging, under
the direct supervision of a radiologist. A radiologist assistant may provide initial observations
concerning images of a patient to a supervising radiologist, but shall not interpret those images or
otherwise engage in the practice of medicine. The Division shall adopt regulations prescribing
the scope of practice of a radiologist assistant, which may be no less restrictive than the most
recent version of the Radiologist Assistant Practice Standards adopted by the American Society
of Radiologic Technologists or a successor organization.
Students
15. A person who does not meet the requirements of item 2 may operate a source of ionizing
radiation for the purposes of performing radiation therapy or radiologic imaging under the direct
supervision of a physician, chiropractor or podiatrist or person who holds a full certificate if the
person is operating a source of ionizing radiation for the purposes of performing radiation
therapy or radiologic imaging to qualify for any certification that is a prerequisite to obtain a full
or limited certificate.
16. A person may operate a source of ionizing radiation for the purposes of performing radiation
therapy or radiologic imaging outside of their scope of practice, as defined by the Division
pursuant to item 7 or 12, as applicable, under the direct supervision of a physician, chiropractor
or podiatrist or person who holds a full certificate and is certified by the appropriate national
accrediting organization to practice in that area if the person:
a. Is operating a source of ionizing radiation for the purposes of performing radiation
therapy or radiologic imaging outside his or her scope of practice to qualify for certification by a
national accrediting organization in that area; and
b. Registers with the Division before operating a source of ionizing radiation for the
purposes of performing radiation therapy or radiologic imaging outside his or her scope of
practice.
Provisional Certificates
17. A person who is appropriately certified by a national accrediting organization and is licensed
or certified in another state may be provisionally certified until:
a. He or she is granted a full or limited certificate by the Division;
b. His or her application for a full or limited certificate is denied by the Division; or
c. The expiration of one year after the date on which he or she is hired to operate a source
of ionizing radiation for the purposes of performing radiation therapy or radiologic imaging.
Provisional certification cannot be renewed.
Computed Tomography
18. “Computed tomography” means the process of producing sectional and three-dimensional
images using external ionizing radiation.
19. Before January 1, 2020, a person who holds a full certificate of authorization to operate a
source of ionizing radiation may perform computed tomography under the following conditions:
a. Except as provided in (c) and item 21, a certificate holder who is certified by the
American Registry of Radiologic Technologists or its successor organization in a primary
pathway of radiation therapy may only perform computed tomography for computed tomography
simulation.
b. Except as otherwise provided in (c) and item 21, a certificate holder who is certified
by the American Registry of Radiologic Technologists or the Nuclear Medicine Technology
Certification Board or their successor organizations in a primary pathway of nuclear medicine
may perform computed tomography only on a hybrid PET/CT or SPECT/CT unit and only for
attenuation correction.
c. Any holder of a full certificate who is certified by the American Registry of
Radiologic Technologists or Nuclear Medicine Technology Certification Board or their
successor organizations in computed tomography may perform computed tomography.
20. On or after January 1, 2020, except as otherwise provided in item 21, only a person who
holds a full certificate of authorization to operate a source of ionizing radiation and is certified by
the American Registry of Radiologic Technologists or Nuclear Medicine Technology
Certification Board or their successor organizations in computed tomography may perform
computed tomography.
21. A holder of a full certificate of authorization to operate a source of ionizing radiation who
does not meet the requirements of items 19 or 20, as applicable, may performing computed
tomography under the direct supervision of a physician, chiropractor or podiatrist or person who
is certified by the American Registry of Radiologic Technologists or Nuclear Medicine
Technology Certification Board or their successor organizations in computed tomography if the
person:
a. Is performing computed tomography to qualify for certification by the American
Registry of Radiologic Technologists or Nuclear Medicine Technology Certification Board or
their successor organizations in computed tomography; and
b. Registers with the Division before performing computed tomography.
Fluoroscopy
22. “Fluoroscopy” means the exposure of a patient to ionizing radiation in a fluoroscopy mode,
including the positions of the patient, positioning of the fluoroscopy equipment, and the selection
of exposure factors.
23. Fluoroscopy may only be performed by:
a. A radiologist assistant under the direct supervision of a radiologist; and
b. A person who holds a full certificate of authorization to operate a source of ionizing
radiation and is certified by the American Registry of Radiologic Technologists or its successor
organizations in a primary pathway of radiography under the direct supervision of a physician.
Mammography
24. “Mammography” means radiography of the breast to enable a physician to determine the
presence, size, location and extent of cancerous or potentially cancerous tissue in the breast.
25. The holder of a full certificate may perform mammography if he or she is certified in
mammography by the American Registry of Radiologic Technologists or its successor
organization.
26. A person who does not meet the requirements of item 25 may perform mammography under
the personal supervision of a physician or person who is certified in mammography by the
American Registry of Radiologic Technologists or its successor organization if the person:
a. Is performing mammography to qualify for certification in mammography by the
American Registry of Radiologic Technologists or its successor organization; and
b. Registers the Division before performing mammography.
27. NRS 457.184 will now additionally prohibit the owner, lessee or other responsible person
from allowing a radiation machine to be operated for mammography by a person who does not
meet the requirements of item 25 or 26.
Radiologic Imaging and Radiation Therapy Advisory Committee
28. The Radiologic Imaging and Radiation Therapy Advisory Committee will consist of seven
members, all of whom are voting members, appointed by the Governor. The Governor shall
appoint to the Committee:
a. One member who holds a full certificate of authorization to operate a source of
ionizing radiation and is certified by the American Registry of Radiologic Technologists or its
successor organization in a primary pathway of radiography.
b. One member who holds a full certificate of authorization to operate a source of
ionizing radiation and is certified by the American Registry of Radiologic Technologists or its
successor organization in a primary pathway of nuclear medicine.
c. One member who holds a full certificate of authorization to operate a source of
ionizing radiation and is certified by the American Registry of Radiologic Technologists or its
successor organization in a primary pathway of radiation therapy.
d. One member who holds a limited certificate of authorization to operate a source of
ionizing radiation.
e. One member who is a radiologist.
f. One member who is a physician, other than a radiologist, or a dentist, chiropractor, or
podiatrist.
g. One member who is a representative of the general public and is not a person described
in (a)-(f).
29. Initial appointments will be staggered- 1 member will be appointed to a term of 1 year, 3
members will be appointed to terms of 3 years, and 3 members will be appointed to terms of 3
years. Members serve terms of 3 years after initial appointments. No member may serve more
than 2 consecutive terms.
30. If a vacancy occurs for any other reason, the Governor shall appoint a person to fill the
vacancy.
31. Members of the Committee serve without compensation, except that each member and
Committee is entitled to receive the per diem allowance and travel expenses provided for state
officers and employees generally.
32. The Committee shall annually elect a chair, who must be a person described in (a)-(d) of item
28, and a vice chair.
33. The Committee shall hold at least two meetings each year to review any regulations adopted
or proposed pursuant to the provisions of this bill placed in chapter 459 of NRS and make
recommendations to the Division and the Legislature concerning radiation therapy or radiologic
imaging as it deems proper. The Committee may meet by telephone, videoconference or other
electronic means in accordance with chapter 241 of NRS (Open Meeting Law).
Disciplinary Action
34. The Division may deny, suspend, revoke, or refuse to renew a certificate issued pursuant to
the provisions of this bill placed in chapter 459 of NRS, impose limitations on the practice of a
holder of such a certificate, or impose a civil penalty of up to $1000 per violation if a person:
a. Obtains a certificate through fraud, misrepresentation, or concealment of material facts.
b. Engages in unprofessional conduct, as defined by regulations of the Division.
c. Is convicted of a crime involving moral turpitude, as defined by regulations of the
Division, or any crime which indicates that the person is unfit to engage in radiologic imaging or
radiation therapy.
d. Violation of any provision of the provisions of this bill placed in chapter 459 of NRS
or regulation adopted pursuant thereto.
e. Committing acts of malpractice, gross negligence, or incompetence while engaging in
radiologic imaging or radiation therapy.
f. Engaging in conduct that could result in harm or injury to the public.
g. Has disciplinary action imposed in another state against a license or certificate that is
equivalent to a certificate issued under the provisions of this bill placed in chapter 459 of NRS.
35. The Division may reinstate a license that has been revoked upon application at least 2 years
after the date of the revocation.
36. Violation of any provision of this chapter is a misdemeanor.
37. The Division may seek an injunction in district court to stop or prevent a violation of any
provision of this bill placed in chapter 459 of NRS or any regulation adopted pursuant thereto.
Grandfathering of Persons Currently Engaged In Radiation Therapy or Radiologic
Imaging
38. A person who is not certified under the provisions of this bill placed in chapter 459 of NRS
and is employed in a position where he or she is operating a source of ionizing radiation for the
purposes of performing radiation therapy or radiologic imaging on January 1, 2018, may
continue to do if he or she:
a. Registers with the Division in the form prescribed by the Division;
b. Does not change the scope of his or her practice;
c. Completes any continuing education required by the Division for the holder of a full
certificate; and
d. Practices only under the direct supervision of a physician, chiropractor, podiatrist, or
the holder of a full certificate.
Chiropractor’s Assistants
39. Insert in chapter 634 provisions stating that:
a. Chiropractor’s assistants can perform radiography within the scope of chiropractic if
they have successfully completed the training prescribed by regulation of the Chiropractic
Physicians’ Board.
b. A chiropractor’s assistant who does not meet the requirements of paragraph (a) may
perform radiography under the direct supervision of a chiropractor for the purposes of
performing radiography as part of the training prescribed by the Chiropractic Physicians’ Board
pursuant to that paragraph.
40. Add unauthorized radiography by a chiropractor’s assistant and allowing a chiropractor’s
assistant to engage in unauthorized radiography to the definition of “unprofessional conduct” for
which a chiropractor or chiropractor’s assistant can be disciplined in NRS 634.018.