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RULE §194.17Dangerous or Hazardous Procedures

(a) General. This section identifies radiologic procedures which are dangerous or hazardous and may only be performed by a practitioner, medical radiologic technologist (MRT) or limited medical radiologic technologist (LMRT). A person trained under §194.13 of this chapter (relating to Mandatory Training Programs for Non-Certified Technicians) is not an MRT, LMRT or otherwise certified under the Act and shall not perform a dangerous or hazardous procedure identified in this section unless expressly permitted by this section.

(b) Dangerous procedures. Except as otherwise provided in this chapter, the list of dangerous procedures which may only be performed by a practitioner or MRT are:

  (1) nuclear medicine studies to include positron emission tomography (PET);

  (2) administration of radio-pharmaceuticals; administration does not include preparation or dispensing except as regulated under the authority of the Texas State Board of Pharmacy;

  (3) radiation therapy, including simulation, brachytherapy and all external radiation therapy beams including Grenz rays:

  (4) computed tomography (CT) or any variation thereof;

  (5) interventional radiographic procedures, including angiography, unless performed by an LMRT with a certificate issued in the cardiovascular category;

  (6) fluoroscopy unless performed by an LMRT with a certificate issued in the cardiovascular category; and

  (7) cineradiography (including digital acquisition techniques), unless performed by an LMRT with a certificate issued in the cardiovascular category.

(c) Hazardous procedures. Unless otherwise noted, the list of hazardous procedures which may only be performed by a practitioner or MRT are:

  (1) conventional tomography;

  (2) skull radiography, excluding anterior-posterior/posterior-anterior (AP/PA), lateral, Townes, Caldwell, and Waters views;

  (3) portable x-ray equipment;

  (4) spine radiography, excluding AP/PA, lateral and lateral flexion/extension views;

  (5) shoulder girdle radiographs, excluding AP and lateral shoulder views, AP clavicle and AP scapula;

  (6) pelvic girdle radiographs, excluding AP or PA views;

  (7) sternum radiographs; and

  (8) radiographic procedures which utilize contrast media;

  (9) pediatric radiography, excluding extremities, unless performed by an LMRT with the appropriate category. Pediatric studies must be performed with radioprotection so that proper collimation and shielding is utilized during all exposures sequences during pediatric studies. If an emergency condition exists which threatens serious bodily injury, protracted loss of use of a bodily function or death of a pediatric patient unless the procedure is performed without delay, or if other extenuating circumstances deemed by the practitioner exist, a pediatric radiographic procedure is also excluded. The emergency condition or extenuating circumstance must be documented by the ordering practitioner in the patient's clinical record and the record must document that a regularly scheduled MRT, LMRT, RN or physician assistant is not reasonably available to perform the procedure.

(d) Performance of a hazardous procedure by an LMRT. An LMRT may perform a radiologic procedure listed in subsection (c) of this section only if the procedure is within the scope of the LMRT's certification, as described in §194.6 of this chapter (relating to Procedural Rules and Minimum Eligibility Requirements for Applicants for a Certificate or Placement on the Board's Non-Certified Technician General Registry).

(e) Performance of a dangerous or hazardous procedure by a practitioner. This section does not authorize a practitioner to perform a radiologic procedure which is outside the scope of the practitioner's license.

(f) Dental radiography. This section does not apply to a radiologic procedure involving a dental x-ray machine, including panarex or other equipment designed and manufactured only for use in dental radiography.

(g) Mammography. In accordance with the Health and Safety Code, §401.421 et seq, mammography is a radiologic procedure which may only be performed by an MRT who meets the qualifications set out in 25 TAC Chapter 289 (relating to Radiation Control) of the Radiation Control Program rules specific to mammography. Mammography shall not be performed by an LMRT, an NCT, or any other person.

(h) Student performance of dangerous or hazardous procedures. The procedures identified in this section are not considered dangerous and hazardous for purposes of §601.056(a) of the Act if the person performing the procedures is a student enrolled in a program which meets the minimum standards adopted under §601.056 of the Act and if the person is performing radiologic procedures in an academic or clinical setting as part of the program. Therefore, such students may perform these procedures in such settings. Students may not perform procedures in an employment setting.

Source Note: The provisions of this §194.17 adopted to be effective April 3, 2017, 42 TexReg 1763; amended to be effective March 27, 2018, 43 TexReg 1867

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