TEXAS - MEDICAL STANDARDS GOVERNING SCREENING AND DIAGNOSTIC MEDICAL TESTING OFFICES

January 1, 2008

State laws and regulations that affect your medical practice

1. What is a diagnostic test?

Any medical service utilizing biomechanical, neurological, neurodiagnostic, radiological, vascular or any means, other than bioanalysis, intended to assist in establishing a medical diagnosis, for the purpose of recommending a course of treatment for the tested patient to be implemented by the treating practitioner or by the consultant.

2. What diagnostic procedures have been identified as dangerous or hazardous?

(1) Nuclear medicine studies;

(2) Administration of radio-pharmaceuticals, unless performed by an RN or physician assistant who is appropriately trained as authorized by the department's Bureau of Radiation Control for licensure of radioactive materials;

(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 (Limited Medical Radiologic Technologist) with a certificate issued in the cardiovascular category;

(6) Fluoroscopy and/or fluorography, unless performed by an LMRT with a certificate issued in the cardiovascular category, or by an RN or physician assistant who assists in the performance of the procedure under the supervision of a practitioner; and

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

(b) 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) Spine radiography, excluding lumbar oblique views performed by an RN or physician assistant who performs the procedure under the supervision of a practitioner;

(6) Shoulder girdle radiographs, excluding AP and lateral shoulder views, AP clavicle and AP scapula, unless performed by an RN or physician assistant who performs the procedure under the direction and supervision of a practitioner;

(7) Pelvic girdle radiographs, excluding AP or PA views;

(8) Sternum radiographs, unless performed by an RN or physician assistant who performs the procedure under the direction and supervision of a practitioner; and

(9) Radiographic procedures which utilize contrast media, unless performed by an RN or physician assistant who assists in the performance of the procedure under the supervision of a practitioner;

(10) Pediatric radiography, excluding extremities, unless performed by an RN or physician assistant who is appropriately trained or an LMRT with the appropriate category. 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.

( c ) Mammography: This radiologic procedure may only be performed by an MRT who meets the qualifications in rules relating to mammography. Mammography shall not be performed by an LMRT, an NCT, or any other person.

25 TX ADC § 143.16

3. What radiologic procedures may be performed by a non-certified technician?

(a) Bone densitometry utilizing a dual energy x-ray densitometer; or

(b) Chest, spine, extremities, abdomen, skull studies or other radiologic procedures utilizing standard film or film screen combinations and an x-ray tube that is stationary at the time of exposure; however, a registrant may not perform a procedure which has been identified as dangerous or hazardous.

( c ) A registrant, other than a physician assistant, shall perform all radiologic procedures under the direct supervision or instruction of a physician in the State of Texas.

(d) A supervising physician may not order, instruct, or direct a registrant to perform a radiologic procedure other than in compliance with applicable statutes and rules.

22 TX ADC s 194.5

4. What diagnostic procedures are authorized for use by chiropractic examiners?

(a) Physical examinations;

(b) Diagnostic imaging;

( c ) Laboratory examination;

(d) Electro-diagnostic testing;

(e) Sonography; and

(f) Other forms of testing and measurement.

25 TX ADC s 75.17

5. Which evaluation services require a license holder to obtain additional training or certification, in addition to the requirements of a basic chiropractic license?

Electro-neuro diagnostic testing (paraspinal surface electromyography excluded) requires additional clinical and didactic training.

22 TX ADC § 75.17

Copyright Kern Augustine Conroy and Schoppmann, P.C. Used with permission.