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Ruling from Alabama
Department of Public Health X-Ray Orders by CRNP or CNM The State Health Officer, Donald Williamson, MD, issued clarification of ADPH Rule 420-3-26-.06 (3) (b) of the Alabama Radiation Protection Rules related to the Authorization of Medical X-rays to Patients by Certified Registered Nurse Practitioners (CRNPs), Certified Nurse Midwives (CNMs) and Physician Assistants (PAs). Rule 420-3-26-.06 (3) (b) states, in part: (b) Persons shall not be exposed to the useful beam except for healing arts purposes, each exposure of which has been authorized by a licensed practitioner of the healing arts. Rule 420-3-26-.02 (46) defines “healing arts” as follows: (46) “Healing arts” means the practice of medicine, dentistry, osteopathy, chiropractic, podiatry, and for non-humans veterinary medicine.” The interpretation does not prohibit the prescribing or ordering of x-rays by a CRNP, CNM or PA following a protocol prescribed by the licensed practitioner of the healing arts under whom the CRNP, CNM or PA is practicing, provided that the protocol (standing order) is followed. Radiographic procedures involving significantly greater radiation exposure, and greater risk to the patient, should be ordered only by a licensed practitioner of the healing arts after careful review of the patient’s condition and a determination of the need for the radiographic procedure. Less hazardous modalities such as ultrasound should be considered as alternatives to ionizing radiation. Examples of procedures requiring case-by-case approval of a licensed practitioner of the healing arts would include: · All flouroscopic procedures · All x-ray examinations of the torso with the exception of routine chest x-rays · All x-ray examinations on children except examination of the extremities · Any x-ray examination on a pregnant or possibly pregnant female. It is recognized that exceptions are occasionally necessary and protocols should provide for such. CRNPs, CNMs, and PAs can prescribe (order) radiographic examinations for patients following protocols established by the licensed practitioner of the healing arts under who they are practicing. Licensed practitioners of the healing arts must use care in delegating certain types of radiographic examinations which can deliver high doses of radiation to patients, especially flouroscopic examinations, radiographic examinations of the torso, of pregnant women, and children. |
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