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1
The ASRT Practice Standards

for Medical Imaging and
Radiation Therapy
©2021 American Society of Radiologic Technologists. All rights reserved. Reprinting all or part of this
document is prohibited without advance written permission of the ASRT. Send reprint requests to the ASRT
Publications Department, 15000 Central Ave. SE, Albuquerque, NM 87123-3909.
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2 Table of Contents
3Preface........................................................................................................................................................3
4 Format.....................................................................................................................................................3
5Introduction.................................................................................................................................................5
6 Definition.................................................................................................................................................5
7 Education and Certification...................................................................................................................11
8Medical Imaging and Radiation Therapy Scope of Practice.......................................................................18
9Standards...................................................................................................................................................23
10 Standard One – Assessment..................................................................................................................23
11 Standard Two – Analysis/Determination................................................................................................26
12 Standard Three – Education..................................................................................................................30
13 Standard Four – Performance...............................................................................................................33
14 Standard Five – Evaluation....................................................................................................................38
15 Standard Six – Implementation.............................................................................................................41
16 Standard Seven – Outcomes Measurement..........................................................................................43
17 Standard Eight – Documentation...........................................................................................................45
18 Standard Nine – Quality.........................................................................................................................48
19 Standard Ten – Self-Assessment............................................................................................................50
20 Standard Eleven – Collaboration and Collegiality..................................................................................52
21 Standard Twelve – Ethics.......................................................................................................................54
22 Standard Thirteen – Research, Innovation and Professional Advocacy.................................................56
23Advisory Opinion Statements....................................................................................................................58
24 Guidance for the Communication of Clinical and Imaging Observations and Procedure Details by
25 Radiologist Assistants to Supervising Radiologists.................................................................................59
26 Medication Administration in Peripherally Inserted Central Catheter Lines or Ports With a Power
27 Injector*†..............................................................................................................................................66
28 Medication Administration Through New or Existing Vascular Access*†..............................................69
29 Placement of Personal Personnel Radiation Monitoring Devices..........................................................72
30 Use of Postexposure Shuttering, Cropping and Electronic Masking in Radiography.............................75
31Glossary.....................................................................................................................................................79
32
33
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34 Preface
35These practice standards serve as a guide for the medical imaging and radiation therapy
36profession. These standards define the practice and establish general criteria to determine
37compliance. Practice standards are authoritative statements established by the profession,
38through evidentiary documentation, for evaluating the quality of practice, service and education
39provided by individuals within the profession.
40Practice standards can be used by individual facilities to develop job descriptions and practice
41parameters. Those outside the profession can use the standards as an overview of the role and
42responsibilities of individuals within the profession.
43The medical imaging and radiation therapy professional and any individual who is legally
44authorized to perform medical imaging or radiation therapy must be educationally prepared and
45clinically competent as a prerequisite to professional practice. The individual should, consistent
46with all applicable legal requirements and restrictions, exercise individual thought, judgment and
47discretion in the performance of the procedure. Federal and state statutes, regulations,
48accreditation standards and institutional policies could dictate practice parameters and may
49supersede these standards.
50Format
51The ASRT Practice Standards for Medical Imaging and Radiation Therapy are divided into five
52sections:
53  Introduction – defines the practice and the minimum qualifications for the education and
54 certification of individuals in addition to an overview of the specific practice.
55  Medical Imaging and Radiation Therapy Scope of Practice – delineates the parameters of
56 the specific practice.
57  Standards – incorporate patient assessment and management with procedural analysis,
58 performance and evaluation. The standards define the activities of the individual
59 responsible for the care of patients and delivery of medical imaging and radiation therapy
60 procedures; in the technical areas of performance, such as equipment and material
61 assessment safety standards and total quality management; and in the areas of education,
62 interpersonal relationships, self-assessment and ethical behavior.
63  Glossary – defines terms used in the practice standards document.
64  Advisory Opinion Statements – provide explanations of the practice standards and are
65 intended for clarification and guidance for specific practice issues.
66The standards are numbered and followed by a term or set of terms that describes the standards.
67The next statement is the expected performance of the individual when performing the procedure
68or treatment. A rationale follows and explains why an individual should adhere to the particular
69standard of performance.
70  Criteria – used to evaluate an individual’s performance. Each standard is divided into
71 two parts: the general criteria and the specific criteria. Both should be used when
72 evaluating performance.
73  General Criteria – written in a style that applies to medical imaging and radiation therapy
74 professionals and should be used for the appropriate area of practice.
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75  Specific Criteria – meet the needs of the individuals in the various areas of professional
76 performance. Although many areas of performance within medical imaging and radiation
77 therapy are similar, others are not. The specific criteria were developed with these
78 differences in mind.
79Within this document, all organizations are referenced by their abbreviation and spelled out
80within the glossary.
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81 Introduction
82Definition
83The medical imaging and radiation therapy profession comprises health care professionals
84identified as a bone densitometry technologist, cardiac-interventional and vascular-interventional
85technologist, computed tomography technologist, limited x-ray machine operator, magnetic
86resonance technologist, mammographer, medical dosimetrist, nuclear medicine technologist,
87quality management technologist, radiation therapist, radiographer, radiologist assistant or
88sonographer who are educationally prepared and clinically competent as identified by these
89standards.
90Furthermore, these standards apply to health care employees who are legally authorized to
91perform medical imaging or radiation therapy and who are educationally prepared and clinically
92competent as identified by these standards.
93The complex nature of disease processes involves multiple imaging modalities. Medical imaging
94and radiation therapy professionals are vital members of a multidisciplinary team that forms a
95core of highly trained health care professionals, who each bring expertise to the area of patient
96care. They play a critical role in the delivery of health services as new modalities emerge and the
97need for medical imaging and radiation therapy procedures increases.
98Medical imaging and radiation therapy integrates scientific knowledge, technical competence and
99patient interaction skills to provide safe and accurate procedures with the highest regard to all
100aspects of patient care. A medical imaging and radiation therapy professional recognizes elements
101unique to each patient, which is essential for the successful completion of the procedure.
102Medical imaging and radiation therapy professionals are the primary liaison between patients,
103licensed practitioners and other members of the support team. These professionals must remain
104sensitive to the needs of the patient through good communication, patient assessment, patient
105monitoring and patient care skills. As members of the health care team, medical imaging and
106radiation therapy professionals participate in quality improvement processes and continually
107assess their professional performance.
108Medical imaging and radiation therapy professionals think critically and use independent,
109professional and ethical judgment in all aspects of their work. They engage in continuing
110education to include their area of practice to enhance patient care, safety, public education,
111knowledge and technical competence.
112Bone Densitometry
113The practice of bone densitometry is performed by health care professionals responsible for the
114administration of ionizing radiation for diagnostic, therapeutic or research purposes. A bone
115densitometry technologist performs bone densitometry procedures and acquires and analyzes
116data needed for diagnosis at the request of and for interpretation by a licensed practitioner.
117Bone densitometry technologists independently perform or assist the licensed practitioner in the
118completion of densitometric procedures.
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119Cardiac-Interventional and Vascular-Interventional Technology

120The practice of cardiac-interventional and vascular-interventional technology is performed by
121health care professionals responsible for the administration of ionizing radiation for diagnostic,
122therapeutic or research purposes. A cardiac-interventional and vascular-interventional
123technologist performs radiographic, fluoroscopic and other procedures and acquires and analyzes
124data needed for diagnosis at the request of and for interpretation by a licensed practitioner.
125Cardiac-interventional and vascular-interventional technologists independently perform or assist

126the licensed practitioner in the completion of cardiac-interventional and vascular-interventional
127technology procedures. Cardiac-interventional and vascular-interventional technologists prepare,
128administer and document activities related to medications and radiation exposure in accordance
129with federal and state laws, regulations or lawful institutional policy.
130Computed Tomography
131The practice of computed tomography is performed by health care professionals responsible for
132the administration of ionizing radiation for diagnostic, therapeutic or research purposes. A
133computed tomography technologist performs computed tomography and molecular imaging
134procedures and acquires and analyzes data needed for diagnosis, interpretation and the
135performance of interventional and therapeutic procedures at the request of and for interpretation
136by a licensed practitioner.
137Computed tomography technologists independently perform or assist the licensed practitioner in

138the completion of computed tomography and molecular imaging procedures. Computed
139tomography technologists prepare, administer and document activities related to medications and
140radiation exposure in accordance with federal and state laws, regulations or lawful institutional
141policy.
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142Limited X-ray Machine Operator

143The operation of x-ray equipment in a limited scope is performed by health care employees
144responsible for the administration of ionizing radiation for diagnostic purposes. A limited x-ray
145machine operator performs radiographic procedures within the limited scope of practice and
146acquires and analyzes data needed for diagnosis at the request of and for interpretation by a
147licensed practitioner.
148Limited x-ray machine operators are individuals other than a radiographer who perform static
149diagnostic radiographic images on selected anatomical sites. Limited x-ray machine operators
150perform their duties under the direction of a licensed practitioner, radiographer or, when
151indicated, a medical physicist.
152Magnetic Resonance
153The practice of magnetic resonance is performed by health care professionals responsible for the
154use of radiofrequencies within a magnetic field for diagnostic, therapeutic or research purposes.
155A magnetic resonance technologist performs magnetic resonance and molecular imaging
156procedures and acquires and analyzes data needed for diagnosis at the request of and for
157interpretation by a licensed practitioner.
158Magnetic resonance technologists independently perform or assist the licensed practitioner in the
159completion of magnetic resonance and molecular imaging procedures. Magnetic resonance
160technologists prepare, administer and document activities related to medications in accordance
162Mammography
163The practice of mammography is performed by health care professionals responsible for the
164administration of ionizing radiation and multi-frequency sound waves for diagnostic,
165therapeutic or research purposes. A mammographer performs breast imaging procedures and
166acquires and analyzes data, including mammographic and sonographic images needed for
167diagnosis, at the request of and for interpretation by a licensed practitioner.
168Mammographers independently perform or assist the licensed practitioner in the completion of

169mammographic and sonographic breast imaging procedures. Mammographers prepare,
170administer and document activities related to medications and radiation exposure in accordance
172Medical Dosimetry
173The practice of medical dosimetry is performed by health care professionals responsible for
174designing a treatment plan for use in the administration of ionizing radiation for the purpose of
175treating diseases, primarily cancer. Medical dosimetrists independently perform duties and
176complete responsibilities under the supervision of qualified medical physicists and radiation
177oncologists. Medical dosimetrists generate an optimal treatment plan and ensure the appropriate
178transfer of data that the radiation therapist will use to treat the patient. Medical dosimetrists
179maintain a commitment to a high degree of accuracy, thoroughness and safety.
180Medical dosimetrists must maintain a high degree of accuracy in treatment planning

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181optimization, treatment techniques and positioning. Medical dosimetrists assist the radiation
182oncologist in localizing the treatment area, generate a treatment plan and actively communicate
183with the radiation oncology team to enable and ensure the appropriate transfer of information.
184Nuclear Medicine
185The practice of nuclear medicine is performed by health care professionals responsible for the
186administration of ionizing radiation (radioactive material and computed tomography),
187nonionizing radiation and adjunctive medications for diagnostic, therapeutic or research
188purposes. Radioactive materials, medications and imaging and nonimaging equipment are used
189in nuclear medicine and molecular imaging to study various organs, body systems and samples
190to aid in the diagnosis, treatment and treatment planning of various pathological conditions. A
191nuclear medicine technologist performs nuclear medicine and molecular imaging procedures or
192therapies and acquires and analyzes data at the request of and for interpretation by a licensed
193practitioner and under the supervision of an authorized user. Nuclear medicine technologists also
194administer the prescribed radionuclide therapy to the patient at the request and under the
195supervision of an authorized user.
196Nuclear medicine technologists independently perform or assist the licensed practitioner and
197authorized user in the completion of nuclear medicine and molecular imaging procedures and
198treatments. Nuclear medicine technologists prepare, administer and document activities related to
199ionizing radiation (radioactive material and computed tomography), nonionizing radiation,
200medications and radiation exposure in accordance with federal and state laws, regulations or
201lawful institutional policy.
202Quality Management
203The practice of quality management is performed by health care professionals responsible for the
204identification, measurement, control and improvement of the various core processes that will
205ultimately lead to improved medical imaging and radiation therapy department performance.
206Today’s medical imaging and radiation therapy departments involve multiple modalities,
207creating an interdisciplinary team. The quality management technologist is a member of the
208health care team, which includes clinicians, management, support staff and customers.
209Quality management has four main components: quality planning, quality control, quality
210assurance and quality improvement. Quality management focuses on the means to achieve image
211and service quality. A quality management technologist combines all of these components to
212ensure efficient and effective patient care.
213Quality management technologists independently perform or assist the medical physicist in the
214completion of quality control procedures. Quality management technologists prepare, administer
215and document activities related to all facets of quality management in accordance with federal
216and state laws, regulations or lawful institutional policy.
217Radiation Therapy
218The practice of radiation therapy is performed by health care professionals responsible for the
219administration of high doses of ionizing radiation for the purpose of treating pathologies,
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220primarily cancer. A radiation therapist acquires and analyzes data in preparation for patient
221treatment, uses various imaging technologies to localize the treatment area, participates in
222treatment planning and performs radiation therapy procedures as prescribed and supervised by a
223radiation oncologist.
224Radiation therapists are the primary liaison between patients and other members of the radiation
225oncology team. They also provide a link to other health care providers, such as social workers
226and dietitians. Radiation therapists must remain sensitive to the needs of the patient through good
227communication, patient assessment, patient monitoring and patient care skills. Radiation therapy
228often involves daily treatments extending over several weeks using highly sophisticated
229equipment. It requires thorough initial planning as well as constant patient care and monitoring.
230Radiography
231The practice of radiography is performed by health care professionals responsible for the
232administration of ionizing radiation for diagnostic, therapeutic or research purposes. A
233radiographer performs a full scope of radiographic and fluoroscopic procedures and acquires and
234analyzes data needed for diagnosis at the request of and for interpretation by a licensed
235practitioner.
236Radiographers independently perform or assist the licensed practitioner in the completion of

237radiographic and fluoroscopic procedures. Radiographers prepare, administer and document
238activities related to medications and radiation exposure in accordance with federal and state laws,
239regulations or lawful institutional policy.
240Radiologist Assistant
241A radiologist assistant is an advanced-practice radiographer who practices under the supervision
242of a radiologist and enhances patient care in radiology services. As a member of the radiologist-
243directed team, the radiologist assistant performs invasive and noninvasive procedures at the
244request of and for interpretation by a licensed practitioner.
245Radiologist assistants act as liaisons between patients, radiographers, radiologists and other
246members of the health care team. Radiologist assistants remain sensitive to the physical, cultural
247and emotional needs of patients through good communication, comprehensive patient
248assessment, continuous patient monitoring and advanced patient care skills.
249Radiologist assistants maintain their radiographer credentials; therefore, both the radiologist
250assistant and radiography sections of the practice standards should be consulted when seeking
251practice information for the radiologist assistant. The clinical activities are delegated by the
252supervising radiologist in accordance with federal and state laws, regulations and lawful
253institutional policies.
254Sonography
255The practice of sonography is performed by health care professionals responsible for the
256administration of multi-frequency sound waves and other techniques for diagnostic, therapeutic
257or research purposes. A sonographer performs sonographic and molecular imaging procedures
258and acquires and analyzes data needed for diagnosis at the request of and for interpretation by a
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259licensed practitioner.
260Sonographers independently perform or assist the licensed practitioner in the completion of

261sonographic and molecular imaging procedures. Sonographers prepare, administer and document
262activities related to medications in accordance with federal and state laws, regulations or lawful
263institutional policy.
264Education and Certification

265The individual must be educationally prepared and clinically competent as a prerequisite to
266professional practice. Only medical imaging and radiation therapy professionals who have
267completed the appropriate education and training as outlined in these standards should perform
268medical imaging and radiation therapy procedures.
269Medical imaging and radiation therapy professionals performing multiple modality hybrid
270imaging should be registered by certification agencies recognized by the ASRT and be
271educationally prepared and clinically competent in the specific modality(ies) they are responsible
272to perform. Medical imaging and radiation therapy professionals performing diagnostic
273procedures in more than one imaging modality will adhere to the general and specific criteria for
274each area of practice.
275To maintain certification(s), medical imaging and radiation therapy professionals must complete
276appropriate continuing education requirements to sustain their expertise and awareness of
277changes and advances in practice.
279Only medical imaging and radiation therapy professionals who have completed the appropriate
280education and obtained certification(s) as outlined in these standards should perform bone
281densitometry procedures.
282Bone densitometry technologists prepare for their roles on the interdisciplinary team by meeting
283postprimary examination eligibility criteria as determined by the ARRT
284Those passing the ARRT bone densitometry postprimary examination use the additional
285credential (BD).
286The ISCD is another certifying agency. Individuals with a primary medical imaging or radiation
287therapy certification who pass the ISCD certified bone densitometry technologist examination
288use the additional credential CBDT.
289Cardiac-Interventional and Vascular-Interventional Technology

291education and obtained certification(s) as outlined in these standards should perform cardiac-
292interventional and vascular-interventional procedures.
293Cardiac-interventional and vascular-interventional technologists prepare for their roles on the

294interdisciplinary team by meeting postprimary examination eligibility criteria as determined by the
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295ARRT or CCI
296Those passing the ARRT cardiac-interventional, cardiovascular- interventional or vascular-

297interventional radiography postprimary examinations use the additional credentials (CI), (CV) or
298(VI), respectively.
299CCI is another certifying agency. Individuals with primary certification in radiography who pass
300the CCI cardiovascular invasive specialist examination as a postprimary certification use the
301additional credential RCIS.
304education and obtained certification(s) as outlined in these standards should perform computed
305tomography and molecular imaging procedures.
306Computed tomography technologists prepare for their roles on the interdisciplinary team by
307meeting postprimary examination eligibility criteria as determined by the ARRT or NMTCB.
308Those passing the ARRT or NMTCB computed tomography postprimary examination use the
309additional credential (CT).
311Limited x-ray machine operators prepare for their roles on the interdisciplinary team in several
312ways. Various education and training programs for limited x-ray machine operators exist
313throughout the United States.
314Many states require the completion of a program of study prior to administering a state licensure
315exam for limited x-ray machine operators. Several states use some or all of the Limited Scope of
316Practice in Radiography state licensing exams developed by the ARRT. States that administer an
317exam and issue a license or certification may use various terminologies to designate a limited x-
318ray machine operator. Limited x-ray machine operators shall only perform ionizing radiation
319procedures within their limited scope of practice.
322education and obtained certification(s) as outlined in these standards should perform magnetic
323resonance and molecular imaging procedures.
324Magnetic resonance technologists prepare for their role on the interdisciplinary team by meeting
325primary or postprimary examination eligibility criteria as determined by the ARRT.
326
327Those passing the ARRT magnetic resonance primary examination use the credential R.T.(MR).
328Those passing the ARRT magnetic resonance postprimary examination use the additional
329credential (MR).
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330Mammography
332education and obtained certification(s) as outlined in these standards should perform
333mammography and breast sonography procedures.
334Mammographers prepare for their roles on the interdisciplinary team by meeting postprimary
335examination eligibility criteria as determined by the ARRT.
336Those passing the ARRT mammography postprimary examination use the additional credential
337(M).
338Those passing the ARRT breast sonography postprimary examination use the additional
339credential (BS).
342education and obtained certification(s) as outlined in these standards should perform medical
343dosimetry procedures.
344Medical dosimetrists prepare for their roles on the interdisciplinary team by meeting the
345examination eligibility criteria established by the MDCB. Those passing the medical dosimetry
346examination use the credential CMD.
347Nuclear Medicine
349education and obtained certification(s) as outlined in these standards should perform nuclear
350medicine and molecular imaging procedures or therapies.
351Nuclear medicine technologists prepare for their roles on the interdisciplinary team by meeting
352examination eligibility criteria as determined by the ARRT or NMTCB. Those passing the ARRT
353examination use the credential R.T.(N). Those passing the NMTCB examination use the
354credential CNMT.
355Those passing the NMTCB nuclear cardiology, positron emission tomography or radiation safety
356specialty examinations use the additional credentials NCT, PET or NMTCB (RS), respectively.
359education and obtained certification(s) as outlined in these standards should perform quality
360management procedures.
361Quality management technologists prepare for their roles on the interdisciplinary team by
362meeting postprimary examination eligibility criteria as determined by the ARRT
363Those passing the ARRT quality management postprimary examination use the additional
364credential (QM).
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367education and obtained certification(s) as outlined in these standards should perform radiation
368therapy procedures.
369Radiation therapists prepare for their roles on the interdisciplinary team by meeting examination
370eligibility criteria as determined by the ARRT.
371Those passing the ARRT radiation therapy examination use the credential R.T.(T).
372Radiography
374education and obtained certification(s) as outlined in these standards should perform
375radiographic and fluoroscopic procedures.
376Radiographers prepare for their roles on the interdisciplinary team by meeting examination
377eligibility criteria as determined by the ARRT.
378Those passing the ARRT radiography examination use the credential R.T.(R).
380Only radiographers who have completed the appropriate education and obtained certification(s)
381as outlined in these standards should perform radiologist assistant procedures.
382Radiologist assistants prepare for their roles as advanced-practice radiographers in medical

383imaging by meeting examination eligibility criteria as determined by the ARRT.
384Those passing the registered radiologist assistant examination use the additional credential
385R.R.A.
386Sonography
388education and obtained certification(s) as outlined in these standards should perform sonographic
389and molecular imaging procedures.
390Sonographers prepare for their roles on the interdisciplinary team by meeting primary or
391postprimary examination eligibility criteria as determined by the ARDMS, ARRT or CCI. Those
392passing the ARDMS examination(s) use the credentials RDCS, RDMS, RMSKS or RVT. Those
393passing the ARRT primary examination use the credential R.T.(S) or R.T.(VS). Those passing
394the CCI examination(s) use the credentials RCCS, RCS, RPhS or RVS.
395Those passing the ARRT breast sonography, sonography or vascular sonography postprimary
396examinations use the additional credentials (BS), (S) or (VS), respectively.
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397 Medical Imaging and Radiation Therapy Scope of Practice

398Scopes of practice delineate the parameters of practice and identify the boundaries for practice.
399A comprehensive procedure list for the medical imaging and radiation therapy professional is
400impractical because clinical activities vary by the practice needs and expertise of the individual.
401As medical imaging and radiation therapy professionals gain more experience, knowledge and
402clinical competence, the clinical activities may evolve.
403The scope of practice of the medical imaging and radiation therapy professional includes:
404  Administering medications enterally, parenterally, through new or existing vascular access
405 or through other routes as prescribed by a licensed practitioner.*†
406  Administering medications with an infusion pump or power injector as prescribed by a
407 licensed practitioner.*†
408  Applying principles of ALARA to minimize exposure to patient, self and others.
409  Applying principles of patient safety during all aspects of patient care.
410  Assisting in maintaining medical records, respecting confidentiality and established
411 policy.
412  Corroborating a patient’s clinical history with procedure and ensuring information is
413 documented and available for use by a licensed practitioner.
414  Educating and monitoring students and other health care providers.*
415  Evaluating images for proper positioning and determining if additional images will
416 improve the procedure or treatment outcome.
417  Evaluating images for technical quality and ensuring proper identification is recorded.
418  Identifying and responding to emergency situations.
419  Identifying, calculating, compounding, preparing and/or administering medications as
420 prescribed by a licensed practitioner.*†
421  Performing ongoing quality assurance activities.
422  Performing venipuncture as prescribed by a licensed practitioner.*†
423  Postprocessing data.
424  Preparing patients for procedures.
425  Providing education.
426  Providing optimal patient care.
427  Receiving, relaying and documenting verbal, written and electronic orders in the patient’s
428 medical record.
429  Selecting the appropriate protocol and optimizing technical factors while maximizing
430 patient safety.
431  Starting, maintaining and/or removing intravenous access as prescribed by a licensed
432 practitioner.*†
433  Verifying archival storage of data.
434  Verifying informed consent for applicable procedures.*
436  Performing bone densitometry procedures as prescribed by a licensed practitioner.
* Excludes limited x-ray machine operator

† Excludes medical dosimetry
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437Cardiac-Interventional and Vascular-Interventional

438  Assisting licensed practitioner with fluoroscopic and specialized interventional
439 radiography procedures.
440  Maintaining intra-arterial access as prescribed by a licensed practitioner.
441  Panning the procedure table during image production.
442  Participating in physiologic monitoring of patients.
443  Performing cardiovascular diagnostic/interventional procedures as prescribed by a
444 licensed practitioner.
445  Performing manual and mechanical hemostasis, including the use of vascular closure
446 devices, as prescribed by a licensed practitioner.
447  Performing noninterpretive fluoroscopic procedures as prescribed by a licensed
448 practitioner.
449  Placing, maintaining and removing peripherally inserted central catheters as prescribed
450 by a licensed practitioner.
452  Assisting a licensed practitioner with interventional computed tomography procedures.
453  Performing computed tomography and molecular imaging procedures as prescribed by a

456  Assisting a licensed practitioner or radiographer during static radiographic procedures.
457  Performing diagnostic radiographic procedures within the limited scope of practice as
458 prescribed by a licensed practitioner.
459
461
462  Applying principles of magnetic resonance safety to minimize risk to patient, self and
463 others.
464  Assisting the licensed practitioner with magnetic resonance interventional procedures.
465  Performing magnetic resonance and molecular imaging procedures as prescribed by a
467  Selecting appropriate pulse sequences with consideration given to established protocols
468 and other factors influencing data acquisition parameters.
469Mammography
470  Imaging pathologic breast specimens as prescribed by a licensed practitioner.
471  Performing breast ultrasound procedures as prescribed by a licensed practitioner.
472  Performing mammographic procedures per facility policy or as prescribed by a licensed
473 practitioner.
474  Performing or assisting with clinical breast examination.

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476  Designing and generating optimal treatment plans in collaboration with a radiation
477 oncologist.
478  Evaluating treatment plans for accuracy.
479  Monitoring doses to normal tissues within the irradiated volume to ensure tolerance
480 levels are not exceeded.
481  Obtaining and incorporating patient data from medical imaging procedures or manual
482 methods to be used in simulation, treatment planning, treatment delivery and quality
483 assurance.
484  Participating in brachytherapy treatment planning and delivery.
485  Participating in simulation under the supervision of a radiation oncologist.
486  Performing dosimetric calculations.
487  Performing or assisting with the fabrication of patient immobilization and other treatment
488 devices.
489  Transferring and documenting treatment planning data according to departmental policy.
490Nuclear Medicine
491  Performing hybrid imaging, including PET-CT and SPECT-CT, for emission,
492 transmission, and attenuation correction, anatomical location and for use in radiation
493 therapy treatment planning when performed within hybrid imaging as prescribed by a
494 licensed practitioner and under the supervision of an authorized user.
495  Performing nuclear medicine and molecular imaging procedures or therapies as
496 prescribed by a licensed practitioner and under the supervision of an authorized user.
497  Procuring, identifying, calculating, preparing and/or administering ionizing radiation
498 (radioactive material and computed tomography) and nonionizing radiation as prescribed
499 by a licensed practitioner and under the supervision of an authorized user.
501  Coordinating, performing and monitoring quality control procedures for all types of
502 equipment.
503  Creating policies and procedures to meet regulatory, accreditation and fiscal
504 requirements.
505  Determining and monitoring exposure factors and/or procedural protocols in accordance
506 with ALARA principles and age-specific considerations.
507  Ensuring adherence to accreditation, federal, state and local regulatory requirements.
508  Facilitating change through appropriate management processes.
509  Facilitating performance improvement processes.
510  Facilitating the department’s quality assessment and improvement plan.
511  Performing physics surveys independently on general radiographic and fluoroscopic
512 equipment, with medical physicist oversight.
513  Providing assistance to staff for image optimization, including patient positioning, proper
514 equipment use and image critique.
515  Providing input for equipment and software purchase and supply decisions when
516 appropriate or requested.
517  Providing practical information regarding quality management topics.
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518  Serving as a resource regarding regulatory, accreditation and fiscal requirements.

519  Supporting and assisting a medical physicist with modality physics surveys.
521  Constructing/preparing immobilization, beam directional and beam-modification devices.
522  Delivering radiation therapy treatments as prescribed by a radiation oncologist.
523  Detecting and reporting significant changes in patients’ conditions and determining when
524 to withhold treatment until the radiation oncologist is consulted.
525  Monitoring doses to normal tissues within the irradiated volume to ensure tolerance
526 levels are not exceeded.
527  Participating in brachytherapy procedures.
528  Performing simulation, localization, treatment planning procedures and dosimetric
529 calculations as prescribed by a radiation oncologist.
530  Using imaging technologies for the explicit purpose of simulation, treatment planning
531 and treatment delivery as prescribed by a radiation oncologist.
532Radiography
533  Assisting the licensed practitioner with fluoroscopic and specialized radiologic
534 procedures.
535  Performing diagnostic radiographic and noninterpretive fluoroscopic procedures as
536 prescribed by a licensed practitioner.
538  Assessing, monitoring and managing patient status, including patients under minimal and
539 moderate sedation.
540  Assisting with data collection and review for clinical trials or other research.
541  Communicating the supervising radiologist’s report to the appropriate health care
542 provider consistent with the ACR Practice Guidelines for Communication of Diagnostic
543 Imaging Findings.
544  Completing patient history and physical.
545  Emphasizing patient safety and verifying procedure appropriateness by analyzing and
546 incorporating evidenced-based practices for optimal patient care.
547  Evaluating images for completeness and diagnostic quality and recommending additional
548 images.
549  Obtaining images necessary for diagnosis and communicating initial observations to the
550 supervising radiologist. The radiologist assistant does not provide image interpretation as
551 defined by the ACR.
552  Participating in or obtaining informed consent.
553  Participating in quality improvement activities within the radiology practice.
554  Performing or assisting with invasive or noninvasive imaging procedures as delegated by
555 the radiologist who is licensed to practice and has privileges for the procedure being
556 performed by the radiologist assistant.
557  Providing follow-up patient evaluation.
558  Reviewing variances identified through preprocedural evaluation that may influence the
PS 17
Draft
559 expected outcome with the supervising radiologist prior to the procedure.
560Sonography
561  Collaborating with a licensed practitioner in the performance of sonographic
562 interventional procedures.
563  Ensuring equipment parameters for diagnostic and interventional procedures are of
564 optimal technical and administrative quality as requested by a licensed practitioner.
565  Performing diagnostic, interventional and molecular imaging sonographic procedures as
566 prescribed by a licensed practitioner or during appropriate educational activities.

PS 18
Effective June 23, 2019
567 Standards
568Standard One – Assessment
569The medical imaging and radiation therapy professional collects pertinent data about the patient,
570procedure, equipment and work environment.
571Rationale
572Information about the patient’s health status is essential in providing appropriate imaging and
573therapeutic services. The planning and provision of safe and effective medical services relies on
574the collection of pertinent information about equipment, procedures and the work environment.
575The medical imaging and radiation therapy professional:
576General Criteria
577  Assesses and maintains the integrity of medical supplies.
578  Assesses any potential patient limitations for the procedure.
579  Assesses factors that may affect the procedure.
580  Assesses patient lab values, medication list and risk for allergic reaction(s) prior to
581 procedure and administration of medication.*†
582  Confirms that equipment performance, maintenance and operation comply with the
583 manufacturer’s specifications.
584  Determines that services are performed in a safe environment, minimizing potential
585 hazards.
586  Maintains restricted access to controlled areas.
587  Obtains and reviews relevant previous procedures and information from all available
588 resources and the release of information as needed.
589  Participates in ALARA, patient and personnel safety, risk management and quality
590 management activities.
591  Recognizes signs and symptoms of an emergency.
592  Verifies appropriateness of the requested or prescribed procedure, in compliance with the
593 clinical indication and protocol.
594  Verifies patient identification.
595  Verifies that protocol and procedure manuals include recommended criteria and are
596 reviewed and revised.
597  Verifies that the patient has consented to the procedure.
598  Verifies the patient’s pregnancy status.
599Specific Criteria
601  Assesses patient compliance with prescribed treatment as it relates to the procedure.

603Refer to general criteria.
PS 19

607  Develops and maintains standardized exposure technique guidelines for all equipment.
608  Maintains and performs quality control on radiation safety equipment.
610  Assesses patient for factors that may contribute to anxiety or claustrophobia.
611  Identifies and removes items that may affect patient’s safety, damage the equipment or
612 affect the image quality.
613  Screens patient and others for potential magnetic resonance contraindications, either
614 within the body or on their person, prior to entering the magnet room.
615Mammography
616  Assesses the need for alternative procedures based on the patient’s age, hormonal status
617 and the presence of surgical implants.
618  Assists in setting policy and procedures in the facility to meet certification and
619 accreditation standards specific to breast imaging.
620  Establishes all required quality assurance and quality control test criteria.
622  Assesses the patient’s need for information and reassurance.
623  Reviews patient history for previous therapeutic treatments.
624Nuclear Medicine
625  Complies with regulations and federal and state laws to minimize radiation exposure
626 levels.
627  Maintains and performs quality control on radiation safety equipment according to
628 regulatory agencies.
629  Performs area monitoring and surveys to assess radiation exposure levels and
630 contamination sites.
631  Verifies the patient’s lactation or breastfeeding status.
632  Verifies the patient’s menstrual cycle.
634  Assesses policies, protocols and guidelines to improve safety, efficiency and patient care,
635 and identify the potential impact to the facility.
636  Identifies the customers served by medical imaging and radiation therapy.
637  Identifies the processes used in customer service.
638  Monitors compliance with universal precautions and standard precautions.
639  Uses consistent and appropriate techniques to gather relevant information.

PS 20
641  Assesses the patient’s need for information and reassurance.
642  Identifies and/or removes objects that could interfere with prescribed treatment.
643  Inspects beam modifying and immobilization devices prior to use.
644  Monitors and assesses patients throughout the treatment course and follow-up visits.
645  Monitors doses to normal tissues.
646  Monitors side effects and reactions to treatment.
647  Monitors treatment unit operation during use.
648  Recognizes the patient’s need for referral to other care providers, such as a social worker,
649 nurse or dietitian.
650  Reviews beam shaping devices prior to treatment delivery.
651  Reviews treatment protocol criteria and assesses conditions affecting treatment delivery.
652  Reviews treatment record prior to treatment or simulation.
653Radiography
654  Develops and maintains standardized exposure technique guidelines for all equipment.
655  Maintains and performs quality control on radiation safety equipment.
656  Reviews digital images for the purpose of monitoring radiation exposure.
658  Assesses the patient’s level of anxiety and pain and informs the supervising radiologist.
659  Interviews patient to obtain, verify and update medical history.
660  Observes and assesses a patient who has received minimal and moderate sedation.
661  Performs and documents a radiology-focused physical examination, analyzes data and
662 reports findings to the supervising radiologist.
663Sonography

PS 21
665
666Standard Two – Analysis/Determination
667The medical imaging and radiation therapy professional analyzes the information obtained
668during the assessment phase and develops an action plan for completing the procedure.
669Rationale
670Determining the most appropriate action plan enhances patient safety and comfort, optimizes
671diagnostic and therapeutic quality and improves efficiency.
673General Criteria
674  Consults appropriate medical personnel to determine a modified action plan.
675  Determines that all procedural requirements are in place to achieve a quality procedure.
676  Determines the appropriate type and dose of contrast media to be administered based on
677 established protocols.*†
678  Determines the course of action for an emergent situation.
679  Determines the need for and selects supplies, accessory equipment, shielding, positioning
680 and immobilization devices.
681  Employs professional judgment to adapt procedures to improve diagnostic quality or
682 therapeutic outcomes.
683  Evaluates and monitors services, procedures, equipment and the environment to determine
684 if they meet or exceed established guidelines, and revises the action plan.
685  Selects the most appropriate and efficient action plan after reviewing all pertinent data and
686 assessing the patient’s abilities and condition.

691  Analyzes and determines action plans in conjunction with the cardiovascular team.
693  Reviews the patient’s medical record and the licensed practitioner’s request to determine
694 optimal scanning protocol for clinical indication.

696  Analyzes images to determine the use of appropriate imaging parameters.
697  Analyzes the results of assessment activities as directed.
698  Develops, maintains and makes available optimal exposure technique guidelines for all
699 radiographic equipment.
PS 22
700  Verifies that exposure indicator data for digital radiographic systems has not been altered
701 or modified and is included in the DICOM header and on images exported to media.
703  Reviews the patient’s medical record and licensed practitioner’s request to determine
704 optimal imaging parameters for clinical indications.
705  Selects appropriate imaging coil.
706Mammography
709  Gathers and analyzes pertinent data relevant to the treatment planning and delivery
710 process.
711  Participates in reviewing patient treatment parameters and dose records to ensure
712 treatment does not exceed the prescribed dose or normal tissue tolerances.
713  Recommends the appropriate immobilization devices and positioning aids for simulation
714 and treatment.
715  Recommends when to hold treatment until a radiation oncologist is notified.
716  Reviews the treatment record and verifies calculations before and/or after treatment
717 delivery.
718  Verifies the treatment summary and the mathematical accuracy of the prescription.
719Nuclear Medicine
720  Determines radiopharmaceutical dosage based on protocol, patient’s age, weight, medical
721 and physical status.
722  Evaluates results of quality control testing on radioactive material.
723  Reviews the patient’s medical record and the examination request to determine optimal
724 procedure parameters for clinical indications.
725  Selects appropriate data acquisition equipment and accessories to perform the procedure.
727  Assesses and prioritizes the current processes to improve quality while focusing on issues
728 needing immediate response.
729  Assesses proposed changes to minimize organizational disruption during implementation.
730  Clarifies current steps in a process to minimize redundancy, reordering and improving
731 service flow.
732  Creates an effective action plan after reviewing all pertinent data while assessing possible
733 options, fiscal impact and ease of implementation.
734  Develops methods for minimizing hazards associated with medical imaging and radiation
735 therapy procedures.
736  Develops monitoring metrics.
737  Establishes benchmarks and quality indicators to assess quality management issues.

PS 23
738  Monitors and develops methods to improve customer satisfaction.

739  Monitors federal and state laws, regulations and accreditation standards that affect quality
740 management in medical imaging and radiation therapy.
742  Determines when to contact the radiation oncologist or licensed practitioner regarding
743 patient side effects or questions.
744  Determines when to withhold treatment until a radiation oncologist is contacted.
745  Ensures the appropriate imaging technique is chosen for image-guided radiation therapy
746 procedures.
747  Participates in decisions about appropriate simulation techniques and treatment positions.
748  Reviews doses daily to ensure that treatment does not exceed prescribed dose, normal
749 tissue tolerance or treatment protocol constraints.
750  Reviews patient treatment plan and prescription prior to initial treatment delivery.
751  Reviews patient treatment records prior to each treatment for prescription or treatment
752 procedure changes.
753  Reviews treatment record, calculations and/or treatment plan for accuracy prior to
754 treatment delivery.
755  Reviews verification images prior to treatment.
756  Verifies the mathematical accuracy of the prescription and the daily treatment summary.
757  Verifies treatment planning and machine quality assurance has been performed prior to
758 each treatment.
759Radiography
760  Analyzes images to determine the use of appropriate imaging parameters.
761  Develops, maintains and makes available optimal exposure technique guidelines for all
762 radiographic and fluoroscopic equipment.
763  Verifies that exposure indicator data for digital radiographic systems has not been altered
764 or modified and is included in the DICOM header and on images exported to media.
766  Reviews the patient’s medical record and the licensed practitioner’s request to determine
767 optimal imaging procedure for clinical indications.
768Sonography
769  Monitors the patient’s need for information and reassurance throughout the procedure.
770  Selects appropriate equipment and scanning techniques to optimize the procedure.
771

PS 24
772
773Standard Three – Education
774The medical imaging and radiation therapy professional provides information about the
775procedure and related health issues according to protocol; informs the patient, public and other
776health care providers about procedures, equipment and facilities; and acquires and maintains
777current knowledge in practice.
778Rationale
779Education and communication are necessary to establish a positive relationship and promote safe
780practices. Advancements in the profession and optimal patient care require additional knowledge and
781skills through education.
783General Criteria
784  Advocates for and participates in continuing education related to area of practice, to
785 maintain and enhance clinical competency.
786  Advocates for and participates in vendor specific applications training to maintain
787 clinical competency.
788  Educates the patient, public and other health care providers about procedures, the
789 associated biological effects and radiation protection.
790  Elicits confidence and cooperation from the patient, the public and other health care
791 providers by providing timely communication and effective instruction.
792  Explains effects and potential side effects of medications.*†
793  Maintains credentials and certification related to practice.
794  Provides accurate explanations and instructions at an appropriate time and at a level the
795 patient and their care providers can understand; addresses questions and concerns
796 regarding the procedure.
797  Provides information on certification or accreditation to the patient, other health care
798 providers and the public.
799  Provides information to patients, health care providers, students and the public
800 concerning the role and responsibilities of individuals in the profession.
801  Provides pre-, peri- and post-procedure education.
802  Refers questions about diagnosis, treatment or prognosis to a licensed practitioner.

807  Maintains competency in the use of diagnostic and interventional devices.
808

PS 25
810  Maintains knowledge of the most current practices and technology used to minimize
811 patient dose while producing diagnostic quality images.

816  Provides magnetic resonance safety education to patient, health care providers and others.
817Mammography
818  Displays MQSA certificate(s) of compliance.
819  Educates the patient about the need for adequate compression to achieve a quality
820 mammogram and instructs the patient to communicate if the compression becomes
821 intolerable.
822  Educates the patient about the risk factors for breast cancer and the benefits of early
823 detection.
824  Educates the patient about the value and use of additional projections and alternative
825 breast imaging procedures.
827  Explains the role and function of the medical dosimetrist in the overall treatment course.
828  Reviews the treatment plan with the patient as requested by a radiation oncologist.
829Nuclear Medicine
830  Ensures radiation safety instruction information and limitations are provided to the
831 patient following therapeutic procedures.
832  Provides instruction to the patient and others regarding the reduction of radiation
833 exposure during and after the procedure.
835  Addresses questions and concerns regarding quality management.
836  Develops and provides educational resources to improve the understanding of quality
837 management in medical imaging and radiation therapy.
838  Investigates and implements practices that enhance a safe environment.
840  Anticipates a patient’s need for information and provides it throughout the treatment
841 course.
842  Instructs other health care providers about radiation protection procedures.
843  Instructs patient in the maintenance of treatment markings.
PS 26
844  Provides information and instruction on proper skin care, diet and self-care procedures.
845Radiography
849  Provides precare and postcare instructions to the patient under the supervision of a
850 radiologist.
851Sonography
852  Educates patients and other health care professionals of the potential exposure risks
853 associated with nonmedical entrepreneurial or entertainment 2D/3D/4D sonographic
854 procedures.
855  Educates patients and other health care professionals that the use of 2D/3D/4D
856 sonography for nonmedical entrepreneurial or entertainment purposes is an unethical
857 practice.

PS 27
858Standard Four – Performance
859The medical imaging and radiation therapy professional performs the action plan and quality
860assurance activities.
861Rationale
862Quality patient services are provided through the safe and accurate performance of a deliberate
863plan of action. Quality assurance activities provide valid and reliable information regarding the
864performance of equipment, materials and processes.
866General Criteria
867  Adheres to radiation safety rules and standards.
868  Administers contrast media and other medications only when a licensed practitioner is
869 immediately available to ensure proper diagnosis and treatment of adverse events.*†
870  Administers first aid or provides life support.†
871  Applies principles of aseptic technique.†
872  Assesses and monitors the patient’s physical, emotional and mental status.
873  Consults with medical physicist or engineer in performing and documenting quality
874 assurance tests.
875  Explains to the patient each step of the action plan as it occurs and elicits the cooperation
876 of the patient.
877  Immobilizes patient for procedure.
878  Implements an action plan.
879  Maintains current information on equipment, materials and processes.
880  Modifies the action plan according to changes in the clinical situation.
881  Monitors the patient for reactions to medications. *†
882  Participates in safety and risk management activities.
883  Performs ongoing quality assurance activities and quality control testing.
884  Performs procedural timeout.
885  Positions patient for anatomic area of interest, respecting patient ability and comfort.
886  Uses accessory equipment.
887  Uses an integrated team approach.
888  When appropriate, uses personnel radiation monitoring device(s) as indicated by the
889 radiation safety officer or designee.
890  Works aseptically in the appropriate environment while preparing, compounding and
891 dispensing sterile and nonsterile medication.*†
894  Applies the concepts of accuracy and precision in bone densitometry.
895  Confirms patient position matches the selected scan parameters.
896  Scans alternate sites when indicated.
PS 28

898  Coordinates and manages the collection and labeling of tissue and fluid specimens.
899  Monitors electrocardiogram (ECG), blood pressure, respiration, oxygen saturation, level
900 of consciousness and pain pre-, peri- and post-procedure.
902  Confirms patient position matches the selected scanning orientation parameters.
904  Determines optimum placement of electrocardiogram (ECG) electrodes and correctly
905 identifies ECG wave trigger.
906  Optimizes technical factors to minimize radiation exposure to the patient while
907 maintaining diagnostic image quality.
908  Uses radiation shielding devices.

910  Routinely reviews patient exposure records and reject analyses as part of the quality
911 assurance program.
912  Uses appropriate uniquely identifiable pre-exposure radiopaque markers for anatomical
913 and procedural purposes.
914  Uses pre-exposure collimation and proper field-of-view selection.
916  Ensures that anyone who is pregnant is not in the magnetic resonance scanner bore or
917 scan room during actual data acquisition or scanning, unless medically necessary.
918  Identifies appropriate cardiac or respiratory triggers.
919  Monitors the patient’s specific absorption rate and other factors related to patient heating.
920  Positions imaging coil.
921  Provides hearing protection to patient and others.
922  Uses appropriate positioning and/or insulation materials to protect the patient from
923 excessive heating and burns.
924Mammography
925  Applies appropriate radiopaque markers to the breast to indicate anatomic landmarks,
926 including nipples, scars and lumps.
928  Ensures correct annotation of images.
929  Exercises clinical judgment in the application of adequate compression to acquire a
930 quality mammographic image.
931  Informs the patient of the right to receive a lay summary result in accordance with
932 MQSA.

PS 29
934  Adheres to established best practice protocols, guidelines and radiation oncologist
935 directives.
936  Calculates treatment unit parameters and doses to treatment volumes and points of
937 interest.
938  Collaborates with the radiation therapist and medical physicist to fabricate individualized
939 immobilization, custom blocks and other beam-modifying devices.
940  Collaborates with the radiation therapist, medical physicist and radiation oncologist
941 regarding the simulation process and procedures.
942  Demonstrates safe handling, storing and disposal of brachytherapy sources.
943  Develops a manual or computer-generated brachytherapy treatment plan as prescribed by
944 a radiation oncologist.
945  Develops a treatment plan as prescribed by a radiation oncologist.
946  Ensures an independent machine-setting check is completed before treatment is
947 delivered.
948  Makes the recommendation to discontinue patient treatment until equipment is operating
949 properly.
950  Prepares and positions the patient for simulation and treatment using appropriate
951 positioning aids and immobilization devices.
952  Prepares or assists in preparing brachytherapy sources and equipment.
953  Reviews simulation images with the radiation therapist, medical physicist and radiation
954 oncologist.
955  Reviews treatment planning data for accuracy and appropriateness prior to input into the
956 patient’s treatment record and initial treatment.
957Nuclear Medicine
958  Administers radioactive material enterally, parenterally or through new or existing
959 vascular access devices or through other routes as prescribed by a licensed practitioner
960 and under the supervision of an authorized user.
961  Coordinates and manages the collection and labeling of tissue and fluid specimens,
962 including radiolabeling.
963  Demonstrates safe handling, receipt, storage and disposal of radioactive materials.
964  Determines optimum placement of electrocardiogram (ECG) electrodes and correctly
965 identifies ECG wave trigger and/or pattern.
966  Follows USP standards for immediate use of sterile radiopharmaceuticals.
967  Maintains security of radioactive material.
968  Manipulates a radiopharmaceutical unit dose and performs dose pooling.
969  Monitors shielding effectiveness.
970  Uses radiation detecting equipment.
971  Uses radiation shielding devices.
972  Wears a ring badge on the dominant hand, with the label facing the radiation source.
973  Works aseptically in the appropriate environments while preparing, compounding,
974 dispensing and repackaging sterile and nonsterile radiopharmaceuticals in compliance
975 with USP and FDA standards.
PS 30
977  Assesses process flow.

978  Collects and analyzes data using the standard tools associated with quality management.
979  Identifies variables and implements changes to improve quality.
980  Investigates sentinel events and continuously monitors measurements to minimize risk.
981  Uses knowledge to modify current practices.
983  Achieves precision patient alignment using imaging and external markings.
984  Assists the radiation oncologist in determining the optimum treatment field to cover the
985 target volume.
986  Calculates monitor units and treatment times.
987  Consults with medical physicist and/or engineer in performing and documenting the
988 quality assurance checks.
989  Creates and manages simulation and verification images.
990  Demonstrates safe handling, storage and disposal of brachytherapy sources.
991  Exports data to treatment planning systems.
992  Makes the decision to discontinue patient treatment until equipment is operating properly.
993  Monitors the patient visually and aurally during treatment.
994  Monitors the treatment console during treatment.
995  Obtains radiation oncologist’s approval of simulation images prior to initiation of
996 treatment.
997  Performs clinically indicated treatment imaging and motion management techniques.
998  Performs quality assurance checks on simulator, treatment unit and appropriate
999 equipment.
1000  Prepares or assists in preparing brachytherapy sources and equipment.
1001  Uses knowledge of biological effects of ionizing radiation on tissue to minimize radiation
1002 dose to normal tissues.
1003  Verifies that only the patient is in the treatment room prior to initiating treatment or any
1004 imaging procedures.
1005Radiography
1007  Routinely reviews patient exposure records and reject analyses as part of the quality
1008 assurance program.
1009  Uses appropriate uniquely identifiable pre-exposure radiopaque markers for anatomical
1010 and procedural purposes.
1011  Uses pre-exposure collimation and proper field-of-view selection.
1013  Administers medications as approved by the supervising radiologist.
1014  Administers minimal and moderate sedation as prescribed by the supervising radiologist.
1015  Collects and documents tissue and fluid specimens.
1016  Monitors patient’s physical condition during the procedure and responds to changes in
1017 patient vital signs, hemodynamics and level of consciousness.
PS 31
1018  Participates in quality reporting measures for the purpose of improved patient care.
1019  Recognizes and responds to medical emergencies, activates emergency response systems
1020 and provides advanced life support intervention.
1021Sonography
1023  Recognizes sonographic appearance of normal and abnormal tissue structures and
1024 physiological data.

PS 32
1025Standard Five – Evaluation
1026The medical imaging and radiation therapy professional determines whether the goals of the
1027action plan have been achieved, evaluates quality assurance results and establishes an
1028appropriate action plan.
1029Rationale
1030Careful examination of the procedure is important to determine that expected outcomes have
1031been met. Equipment, materials and processes depend on ongoing quality assurance activities
1032that evaluate performance based on established guidelines.
1034General Criteria
1035  Communicates the revised action plan to appropriate team members.
1036  Completes the evaluation process in a timely, accurate and comprehensive manner.
1037  Develops a revised action plan to achieve the intended outcome.
1038  Evaluates images for optimal demonstration of anatomy of interest.
1039  Evaluates quality assurance results.
1040  Evaluates the patient, equipment and procedure to identify variances that might affect the
1041 expected outcome.
1042  Identifies exceptions to the expected outcome.
1043  Measures the procedure against established policies, protocols and benchmarks.
1044  Validates quality assurance testing conditions and results.
1047  Evaluates and identifies unexpected serial bone mineral density changes.
1048  Reviews previous scan(s) and reanalyzes as necessary.
1049  Reviews T-scores and Z-scores to modify the action plan.

1051  Evaluates access site for complications requiring intervention or further treatment.

1058Mammography
PS 33
1059  Collaborates with the lead interpreting physician and medical physicist to maintain
1060 equipment and comply with federal and state regulations and guidelines.
1061  Evaluates required quality control tests before breast imaging is performed.
1062  Reviews the inspection and medical physicist’s reports to assess the quality of the breast
1063 imaging equipment’s performance.
1065  Acquires data necessary to perform accurate patient protocol plans and participates in
1066 implementation of the plan.
1067  Ensures treatment parameters have been transferred correctly to the oncology information
1068 system.
1069  Reviews treatment calculations and ensures the validity of the treatment plan.
1070  Reviews treatment variances and assists in determining possible causes and solutions.
1071Nuclear Medicine
1072  Consults with a licensed practitioner to confirm diagnostic completeness.
1073  Reviews procedure to determine if additional images or data will enhance the diagnostic
1074 value.
1076  Confirms data is accurate and complete.
1077  Evaluates customer satisfaction.
1078  Evaluates measured processes and results against established policies, protocols,
1079 guidelines and benchmarks.
1080  Evaluates sentinel events to minimize risk.
1082  Checks treatment calculations and/or treatment plan.
1083  Compares verification images to simulation images using anatomical landmarks or
1084 fiducial markers.
1085  Evaluates the patient daily for any side effects, reactions and therapeutic responses.
1086  Performs treatment chart checks.
1087  Reviews treatment discrepancies, determines causes and assists with the action plan.
1088  Reviews verification images for quality and accuracy.
1089  Verifies the accuracy of the patient setup prior to treatment delivery.
1090  Verifies treatment console readouts and settings prior to initiating treatment and upon
1091 termination of treatment.
1092Radiography
PS 34
1096Sonography

PS 35
1098Standard Six – Implementation
1099The medical imaging and radiation therapy professional implements the revised action plan
1100based on quality assurance results.
1101Rationale
1102It may be necessary to make changes to the action plan based on quality assurance results to
1103promote safe and effective services.
1106  Adjusts imaging parameters, patient procedure or additional factors to improve the
1107 outcome.
1108  Bases the revised plan on the patient’s condition and the most appropriate means of
1109 achieving the expected outcome.
1110  Implements the revised action plan.
1111  Notifies the appropriate health care provider when immediate clinical response is
1112 necessary, based on procedural findings and patient condition.
1113  Obtains assistance to support the quality assurance action plan.
1114  Takes action based on patient and procedural variances.


1126Mammography
1127  Initiates procedures only when breast imaging equipment meets quality assurance and
1128 quality control requirements, and results are in compliance.

PS 36
1130  Develops additional treatment plans to achieve an optimal dose distribution.

1131  Ensures accuracy in the transfer and documentation of treatment parameters, according to
1132 departmental policies.
1133  Reviews and implements treatment field changes indicated on simulation or verification
1134 images as directed by a radiation oncologist.
1136  Employs devices to minimize radiation levels.
1137  Manages radioactive contamination and uses decontamination procedures.
1138  Performs additional images or data collections as needed.
1140  Develops policies, protocols and guidelines in collaboration with other health care
1141 providers.
1143  Collaborates with radiation oncologists, medical physicists and medical dosimetrists to
1144 compensate for treatment inaccuracies.
1145  Establishes congruence between verification images and simulation images, digitally
1146 reconstructed radiographs and/or treatment volumes as defined by the radiation
1147 oncologist.
1148  Formulates recommendations for process improvements to minimize treatment
1149 discrepancies.
1150  Implements treatment plan or treatment field changes as directed by the radiation
1151 oncologist.
1152  Reports deviations from the standard or planned treatment.
1153Radiography
1157Sonography

PS 37
1159Standard Seven – Outcomes Measurement
1160The medical imaging and radiation therapy professional reviews and evaluates the outcome of
1161the procedure according to quality assurance standards.
1162Rationale
1163To evaluate the quality of care, the medical imaging and radiation therapy professional compares
1164the actual outcome with the expected outcome. Outcomes assessment is an integral part of the
1165ongoing quality management action plan to enhance services.
1168  Assesses the patient’s physical, emotional and mental status prior to discharge.
1169  Determines that actual outcomes are within established criteria.
1170  Evaluates the process and recognizes opportunities for future changes.
1171  Measures and evaluates the results of the revised action plan.
1172  Reviews all data for completeness and accuracy.
1173  Reviews and evaluates quality assurance processes and tools for effectiveness.
1174  Reviews the implementation process for accuracy and validity.
1175  Uses evidence-based practice to determine whether the actual outcome is within
1176 established criteria.


1188Mammography
1189  Prepares the annual medical outcomes audit and provides results to the lead interpreting
1190 physician.
PS 38
1196  Assesses differences between expected and actual outcomes.
1197  Assesses implemented changes for improvement.
1198  Develops methods to demonstrate continuous improvement.
1199  Develops strategies for maintaining improvement.
1200  Evaluates the effectiveness of and supports changes to processes.
1201  Performs procedural analysis.
1203  Monitors patient status during procedures, throughout the treatment course and for
1204 follow-up care.
1205Radiography
1208  Performs follow-up patient evaluation and communicates findings to the supervising
1209 radiologist.
1210Sonography

PS 39
1212Standard Eight – Documentation
1213The medical imaging and radiation therapy professional documents information about patient
1214care, procedures and outcomes.
1215Rationale
1216Clear and precise documentation is essential for continuity of care, accuracy of care and quality
1217assurance.
1220  Archives images or data.
1221  Documents diagnostic, treatment and patient data in the medical record in a timely,
1222 accurate and comprehensive manner.
1223  Documents medication administration in patient’s medical record. *†
1224  Documents procedural timeout.
1225  Documents unintended outcomes or exceptions from the established criteria.
1226  Maintains documentation of quality assurance activities, procedures and results.
1227  Provides pertinent information to authorized individual(s) involved in the patient’s care.
1228  Records information used for billing and coding procedures.
1229  Reports any out-of-tolerance deviations to the appropriate personnel.
1230  Verifies patient consent is documented.

1235  Documents administered medications.
1236  Documents or assists in documenting patient medical history related to the procedure.
1237  Documents radiation exposure parameters and initiates further action as needed.
1238  Documents use of sedation.
1239  Maintains documentation for tracking implantable devices.
1241  Documents the use of shielding devices and proper radiation safety practices.

1243  Documents radiation exposure.

PS 40
1247Mammography
1248  Documents and provides evidence of quality assurance and quality control outcomes
1249 according to established guidelines.
1251  Reports any treatment variances in accordance with departmental, institutional and
1252 national quality assurance guidelines.
1254  Documents dose and route of administered radiopharmaceutical or radionuclide therapy
1255 in the patient medical record.
1256  Documents instrumentation quality testing procedures and maintains results for review.
1257  Documents radioactive materials quality testing procedures and maintains results for
1258 inspection.
1259  Documents the implementation, evaluation and modification of the radiation safety plan
1260 under the authority of the radiation safety officer.
1261  Maintains records of the receipt, administration and disposal of radioactive materials.
1263  Documents goals and outcomes based on data analysis.
1264  Documents process flow variances and justifies exceptions.
1265  Documents steps used to improve processes.
1266  Maintains institutional policies, protocols and guidelines by continuously evaluating
1267 compliance issues.
1268  Provides reports as required by institutional policy, accrediting bodies and federal and
1269 state regulations.
1271  Documents radiation exposure parameters.
1272  Maintains imaging and treatment records according to institutional policy.
1273  Reports any treatment discrepancies to appropriate personnel in accordance with
1274 departmental, institutional and regulatory requirements.
1275Radiography
1276  Documents fluoroscopic time.
1277  Documents radiation exposure.
1280  Communicates and documents radiologist’s order to other health care providers.
1281  Documents administration of medications.
PS 41
1282  Documents and assists radiologist in quality reporting measures for the purpose of
1283 improved patient care.
1284  Documents use of minimal and moderate sedation.
1285  Reports clinical and imaging observations and procedure details to the supervising
1286 radiologist.
1287Sonography
1288  Documents initial impressions and technical data.
1289  Records interval changes in sonographic findings compared to previous imaging.
1290 

PS 42
1291Standard Nine – Quality
1292The medical imaging and radiation therapy professional strives to provide optimal care.
1293Rationale
1294Patients expect and deserve optimal care during diagnosis and treatment.
1297  Adheres to standards, policies, statutes, regulations and established guidelines.
1298  Anticipates, considers and responds to the needs of a diverse patient population.
1299  Applies professional judgment and discretion while performing the procedure.
1300  Collaborates with others to elevate the quality of care.
1301  Participates in ongoing quality assurance programs.
1304  Advocates that facilities determine precision error and calculate the least significant
1305 change.


1313  Advocates the need for a minimum of one registered magnetic resonance technologist
1314 and one trained magnetic resonance safety personnel as the standard for safe and efficient
1315 delivery of magnetic resonance procedures.
1316Mammography

PS 43
1321  Performs procedures in accordance with the NRC and/or in agreement with state
1322 regulations.
1324  Verifies the achievement of goals and identifies exceptions.
1326  Performs procedures in accordance with the NRC and/or in agreement with state
1327 regulations.
1328  Promotes patient safety by performing external beam treatments with a minimum of two
1329 registered radiation therapists.
1330Radiography
1334Sonography

PS 44
1336Standard Ten – Self-Assessment
1337The medical imaging and radiation therapy professional evaluates personal performance.
1338Rationale
1339Self-assessment is necessary for personal growth and professional development.
1342  Assesses personal work ethics, behaviors and attitudes.
1343  Evaluates performance, applies personal strengths and recognizes opportunities for
1344 educational growth and improvement.
1345  Recognizes hazards associated with their work environment and takes measures to
1346 mitigate them.


1355  Investigates avenues to continue progress to become a registered radiographer.
1358Mammography
PS 45
1368Radiography
1372Sonography

PS 46
1374Standard Eleven – Collaboration and Collegiality
1375The medical imaging and radiation therapy professional promotes a positive and collaborative
1376practice atmosphere with other members of the health care team.
1377Rationale
1378To provide quality patient care, all members of the health care team must communicate
1379effectively and work together efficiently.
1382  Develops and maintains collaborative partnerships to enhance quality and efficiency.
1383  Informs and instructs others about radiation safety.
1384  Promotes understanding of the profession.
1385  Shares knowledge and expertise with others.


1397Mammography

PS 47
1407Radiography
1411Sonography

PS 48
1413Standard Twelve – Ethics
1414The medical imaging and radiation therapy professional adheres to the profession’s accepted
1415ethical standards.
1416Rationale
1417Decisions made and actions taken on behalf of the patient are based on a sound ethical
1418foundation.
1421  Accepts accountability for decisions made and actions taken.
1422  Acts as a patient advocate.
1423  Adheres to the established ethical standards of recognized certifying agencies.
1424  Adheres to the established practice standards of the profession.
1425  Delivers patient care and service free from bias or discrimination.
1426  Provides health care services with consideration for a diverse patient population.
1427  Reports unsafe practices to the radiation safety officer, regulatory agency or other
1428 appropriate authority.
1429  Respects the patient’s right to privacy and confidentiality.


1441Mammography

PS 49
1448  Promotes and monitors adherence to radiation safety standards.
1451Radiography
1455Sonography
1456  Opposes participation in sonographic procedures for the purpose of nonmedical
1457 entrepreneurial application or entertainment contrary to the tenets of ethical medical
1458 practice.

PS 50
1459Standard Thirteen – Research, Innovation and Professional Advocacy
1460The medical imaging and radiation therapy professional participates in the acquisition and
1461dissemination of knowledge and the advancement of the profession.
1462Rationale
1463Participation in professional organizations and scholarly activities such as research, scientific
1464investigation, presentation and publication advance the profession.
1467  Adopts new best practices.
1468  Investigates innovative methods for application in practice.
1469  Monitors changes to federal and state law, regulations and accreditation standards
1470 affecting area(s) of practice.
1471  Participates in data collection.
1472  Participates in professional advocacy efforts.
1473  Participates in professional societies and organizations.
1474  Pursues lifelong learning.
1475  Reads and evaluates research relevant to the profession.
1476  Shares information through publication, presentation and collaboration.


1488Mammography

PS 51
1498Radiography
1502Sonography
1503  Advocates for an ergonomically safe working environment, based on evidence-based
1504 practices, to mitigate the risk of work-related musculoskeletal disorders.
1505 

PS 52
1506 Advisory Opinion Statements

1507Advisory opinion statements provide explanations of the practice standards.
1508ASRT issues advisory opinions to clarify what constitutes appropriate practice and offer
1509guidance for specific practice issues.
1510The profession holds medical imaging and radiation therapy professionals responsible and
1511accountable for rendering safe, effective clinical services to patients and for judgments exercised
1512and actions taken in the course of providing those services. The advisory opinion statements
1513assist medical imaging and radiation therapy professionals in safe practice.
1514The medical imaging and radiation therapy professional’s performance should be evidence-based
1515and consistent with federal and state laws, regulations, established standards of practice and
1516facility policies and procedures.
1517The ASRT recognizes the use of GRADE for measuring the quality of evidence and strength in
1518recommendations for the development of advisory opinion statements.
1519Each medical imaging and radiation therapy professional must exercise prudent judgment when
1520determining whether the performance of a given act is within the scope of practice for which the
1521individual is licensed, if applicable within the jurisdiction in which the person is employed,
1522educationally prepared and clinically competent to perform.
1523

PS 53
1524 Guidance for the Communication of Clinical and Imaging Observations and
1525 Procedure Details by Radiologist Assistants to Supervising Radiologists
1526After research of evidentiary documentation the ASRT issued opinions contained herein.
1527Advisory Opinion
1528It is the opinion of the ASRT based on evidentiary documentation and where federal or state law
1529and/or institutional policy permits that:
1530 1. Communication of clinical and imaging observations and procedure details by the
1531 radiologist assistant to the supervising radiologist is an integral part of radiologist assistant
1532 practice. Without clear, consistent, appropriate and ascribed communication between
1533 members of the radiology team, there is a possibility of inadequate patient care,
1534 incomplete reports and diminished departmental productivity. To create a safe and
1535 productive radiology environment, communication between the radiologist assistant and
1536 supervising radiologist must be free-flowing, consistent and relevant to the patient
1537 examination or procedure. This communication can take many forms, including verbal,
1538 written and electronic correspondence. These communications may be included and taken
1539 into consideration by the radiologist in creating a final report. However, initial clinical and
1540 imaging observations and procedure details communicated from the radiologist assistant
1541 to the radiologist are only intended for the radiologist’s use and do not substitute for the
1542 final report created by the radiologist. These communications should be considered and
1543 documented as “initial clinical and imaging observations or procedure details.”
1544 2. While assisting radiologists in the performance of imaging procedures or during the
1545 performance of procedures under radiologist supervision, the radiologist assistant must be
1546 able to communicate and document procedure notes, observations, patient responses and
1547 other types of information relevant to the radiologist’s interpretation and creation of the
1548 final report. Radiologist assistants do not independently “report findings” or “interpret”
1549 by dictation or by any other means; and to avoid any confusion, these terms should not be
1550 used to refer to the activities of the radiologist assistant. However, radiologist assistants
1551 may add to the patient record (following the policies and procedures of the facility) in a
1552 manner similar to any other dependent nonphysician practitioner. Radiologist assistants
1553 who are authorized to communicate initial observations to the supervising radiologist
1554 using a voice recognition dictation system or other electronic means must adhere to
1555 institutional protocols ensuring that initial observations can be viewed or accessed only
1556 by the supervising radiologist. Initial clinical or imaging observations or procedure
1557 details created by the radiologist assistant resulting from the radiologist assistant’s
1558 involvement in the performance of the procedure that are included in the final report
1559 should be carefully reviewed by the supervising radiologist and should be incorporated at
1560 the supervising radiologist’s discretion.
1561GRADE: Strong
1562Definitions
1563See glossary.
1564Evidentiary Documentation
PS 54
1565Current Literature
1566Not applicable
1567Curricula
1568  Radiologist Assistant Curriculum (ASRT, 2015)
1569

PS 55
1570QUALITY OF EVIDENCE: High
1571Certification Agency Entry-Level Clinical Activities

1572  Registered Radiologist Assistant Entry-Level Clinical Activities (ARRT, 2018)
1573 The document states that radiologist assistants may “Review imaging procedures, make
1574 initial observations, and communicate observations ONLY [emphasis added] to the
1575 radiologist; record initial observations of imaging procedures following radiologist
1576 approval; communicate radiologist’s report to appropriate health care provider consistent
1577 with the ACR Practice Parameter for Communication of Diagnostic Imaging Findings.”
1578Certification Agency Content Specifications

1579Not applicable
1581Scopes of Practice and Practice Standards Reference

1582  Scope of Practice
1583 o Communicating the supervising radiologist’s report to the appropriate health care
1584 provider consistent with the ACR Practice Guidelines for Communication of
1585 Diagnostic Imaging Findings.
1586 o Evaluating images for completeness and diagnostic quality and recommending
1587 additional images.
1588 o Obtaining images necessary for diagnosis and communicating initial observations to
1589 the supervising radiologist. The radiologist assistant does not provide image
1590 interpretation as defined by the ACR.
1591 o Providing follow-up patient evaluation.
1592  The ASRT Practice Standards for Medical Imaging and Radiation Therapy
1593 o Performs and documents a radiology-focused physical examination, analyzes data and
1594 reports findings to the supervising radiologist. (Standard One, radiologist assistant
1595 only)
1596 o Performs follow-up patient evaluation and communicates findings to the supervising
1597 radiologist. (Standard Seven, radiologist assistant only)
1598 o Reports clinical and imaging observations and procedure details to the supervising
1599 radiologist. (Standard Eight, radiologist assistant only)
1600 o Maintains documentation of quality assurance activities, procedures and results.
1601 (Standard Eight, General Criteria)
1602 o Documents diagnostic, treatment and patient data in the medical record in a timely,
1603 accurate and comprehensive manner. (Standard Eight, General Criteria)
1604 o Communicates and documents a radiologist’s order to other health care providers.
1605 (Standard Eight, radiologist assistant only)
1606 o Documents and assists radiologist in quality reporting measures for the purpose of
1607 improved patient care. (Standard Eight, radiologist assistant only)

PS 56
1609Federal and State Statute References

1610Not applicable
1611Other
1612Not applicabl

PS 57
1613
1614

PS 58
1615 Medication Administration in Peripherally Inserted Central

1616 Catheter Lines or Ports With a Power Injector*†
1617After research of evidentiary documentation the ASRT issued the opinions contained herein.
1621Medical imaging and radiation therapy professionals can access and/or use an FDA approved:
1622 1. Peripherally inserted central catheter (PICC) line by inserting an approved connective
1623 device. The PICC line must be designated for use with power injectors. Manufacturer
1624 guidelines regarding infusion rate and pressure must be followed.
1625 2. Port by inserting an approved non coring needle. The port must be designated for use
1626 with power injectors. Manufacturer guidelines regarding infusion rate and pressure must
1627 be followed.
1628GRADE: Strong
1629Definitions
1630See glossary.
1631
1634Not applicable
1635Curricula
1636  Computed Tomography Curriculum (ASRT, 2018)
1637  Magnetic Resonance Curriculum (ASRT, 2020)
1638  Nuclear Medicine Technology Competency-Based Curriculum Guide (SNMMI, 2015
1639 Amended April 2020)
1640  Radiography Curriculum (ASRT, 2017)
1643
1645  Components of Preparedness (NMTCB, 2020)
1646  Computed Tomography (ARRT, 2017)
1647  Positron Emission Tomography (PET) Specialty Examination Content Outline (NMTCB,
1648 2016)
1649  Vascular Interventional Radiography (ARRT, 2017)

PS 59

1653 o Administering medications enterally, parenterally, through new or existing vascular
1654 access or through other routes as prescribed by a licensed practitioner.*†
1655 o Administering medications with an infusion pump or power injector as prescribed by a
1656 licensed practitioner.*†
1657 o Identifying, calculating, compounding, preparing and/or administering medications as

1661Not applicable
1662Other
1663Not applicable
1664

PS 60
1665 Medication Administration Through New or Existing Vascular Access*†
1670 1. It is within the scope of practice for medical imaging and radiation therapy professionals
1671 to access and administer medications through new or existing vascular access by an
1672 approved method of administration (e.g., hand injection, power injection, slow push,
1673 bolus, infusion) as prescribed by a licensed practitioner.
1674GRADE: Strong
1675Definitions
1676  access – The process of inserting an approved connective device through the access point
1677 of an existing vascular access device to deliver intravenous (IV) fluids or medication.
1678  existing vascular access – Peripheral or central vascular implanted devices or external
1679 access lines that include, but are not limited to, peripherally inserted central catheter
1680 lines, intravenous lines, central lines and ports.
1683  ACR Committee on Contrast Media. ACR Manual on Contrast Media. American College
1684 of Radiology; 2020. Accessed September 4, 2020.
1685  American College of Radiology. ACR practice parameter for performing and interpreting
1686 diagnostic computed tomography (CT). Revised 2017. Accessed November 30, 2018.
1687  American College of Radiology. ACR practice parameter for performing and interpreting
1688 magnetic resonance imaging (MRI). Revised 2017. Accessed November 30, 2018.
1689  American College of Radiology. ACR-SPR practice parameter for the use of
1690 intravascular contrast media. Revised 2017. Accessed November 30, 2018.
1691  Rockwell D. A competency for central line use in radiology. J Radiol Nurs.
1692 2008;27(2):84. doi:10.1016/j.jradnu.2008.04.016
1694Curricula
1695  Cardiac-Interventional and Vascular-Interventional Curriculum (ASRT, 2019)
1696  Computed Tomography Curriculum (ASRT, 2018)
1697  Magnetic Resonance Curriculum (ASRT, 2020)
1698  Mammography Curriculum (ASRT, 2018)
1699  National Education Curriculum for Sonography (JRC-DMS, 2016)
1701 Amended April 2020)
1702  Radiation Therapy Curriculum (ASRT, 2019)
1* Excludes limited x-ray machine operator
PS 61


1708  Computed Tomography (ARRT, 2017)
1709  Examination Overview: Registered Cardiovascular Invasive Specialist (CCI, 2019)
1710  Magnetic Resonance Imaging (ARRT, 2020)
1711  Nuclear Medicine Technology (ARRT, 2017)
1712  Radiography (ARRT, 2017)
1713  Registered Radiologist Assistant (ARRT, 2018)
1714  Vascular-Interventional Radiography (ARRT, 2017)

1718 o Administering medications enterally, parenterally, through new or existing vascular
1719 access or through other routes as prescribed by a licensed practitioner.*†
1720 o Identifying, calculating, compounding, preparing and/or administering medications as
1722 o Performing venipuncture as prescribed by a licensed practitioner.*†
1723 o Starting, maintaining and/or removing intravenous access as prescribed by a licensed
1724 practitioner.*†

1727Not applicable
1728Other
1729Not applicable

PS 62
1730 Placement of Personnel Radiation Monitoring Devices
1731After research of evidentiary documentation, the ASRT issued opinions contained herein.
1735 1. Radiation workers wear a personnel radiation monitoring device outside of protective
1736 apparel with the label facing the radiation source at the level of the collar.
1737 2. In specific cases, a whole-body monitor may be indicated. This monitor should be worn
1738 at the waist inside of protective apparel with the label facing the radiation source.
1739 3. In some cases, a ring monitor may be indicated. This monitor should be worn on the hand
1740 likely to receive the highest exposure with the label facing the radiation source.
1741GRADE: Strong
1742Definitions
1743See glossary.
1746  Bushong S. Occupational radiation dose management. In: Radiologic Science for
1747 Technologists: Physics, Biology, and Protection. 12th ed. Elsevier; 2020: 547 - 549.
1748  By standards number: 1910.1096(d)(3)(i) – ionizing radiation. Occupational Safety and
1749 Health Administration website. Accessed November 30, 2018.
1750  Gilmore D, Watersham-Rich K. Radiation safety in nuclear medicine. In: Nuclear
1751 Medicine and PET/CT: Technology and Technique. 8th edition. Elsevier; 2016:116.
1752  Statkiewicz-Sherer MA, Visconti PJ, Ritenour ER, Welch-Haynes K. Radiation
1753 monitoring. In: Radiation Protection in Medical Radiography. 8th ed. Elsevier; 2018:75-
1754 92.
1756Curricula
1757  Bone Densitometry Curriculum (ASRT, 2019)
1758  Limited X-ray Machine Operator Curriculum (ASRT, 2020)
1760 Amended April 2020 )
1761  Radiation Therapy Curriculum (ASRT, 2019)

PS 63
1766  Cardiac-Interventional Radiography (ARRT, 2017)

1768  Limited Scope of Practice in Radiography (ARRT, 2018)
1769  Nuclear Medicine Technology (ARRT, 2017)
1770  Radiation Therapy (ARRT, 2017)
1772  Registered Radiologist Assistant (ARRT, 2018)
1773  Vascular-Interventional Radiography (ARRT, 2017)

1776Not applicable

1778  § 19.12 Instruction to Workers (NRC, 2018)
1779  § 20.1208 Dose Equivalent to an Embryo/Fetus (NRC, 2018)
1780  § 20.1502 Conditions Requiring Individual Monitoring of External and Internal
1781 Occupational Dose (NRC, 2018)
1782  Regulatory Guide 8.34: Monitoring Criteria and Methods to Calculate Occupational
1783 Radiation Doses (NRC, 1992)
1784  Regulatory Guide 8.36: Radiation Dose to the Embryo/Fetus (NRC, 2018)
1785  Regulatory Guide 8.7: Instructions for Recording and Reporting Occupational Radiation
1786 Exposure Data (NRC, 2016)
1788Other
1789  AAPM Report No. 58: Managing the Use of Fluoroscopy in Medical Institutions.
1790 Appendix A: Radiation Safety/Quality Assurance Program

PS 64
1792 Use of Postexposure Shuttering, Cropping and

1793 Electronic Masking in Radiography
1798 1. It is within the scope of practice of a radiologic technologist to determine and apply
1799 appropriate pre-exposure collimation to individual projections of examinations to comply
1800 with the principle of ALARA. Postexposure shuttering, cropping, electronic collimation
1801 or electronic masking to eliminate the visibility of large regions of brightness are
1802 acceptable, where automatic processing fails to do so.
1803 2. It is outside of the scope of practice of a radiologic technologist to use postexposure
1804 shuttering, cropping, electronic collimation or electronic masking to eliminate any
1805 anatomical information. This information is a part of the patient’s permanent medical
1806 record and should therefore be presented to the licensed practitioner to determine whether
1807 the exposed anatomy obtained on any image is significant or of diagnostic value.
1808 3. It is outside the scope of practice of a radiologic technologist to use postexposure
1809 shuttering, cropping, electronic collimation or electronic masking to duplicate and use
1810 any acquired image for more than one prescribed view or projection on any exam.
1811 Facilities acquiring digital images are legally required to retain information in the
1812 DICOM information of each image that identifies the selected view or projection at the
1813 time of image acquisition. Using the same acquired image to represent two different
1814 prescribed views or projections is a falsification of the information in the patient medical
1815 record and imaging study made available to the licensed practitioner.
1816GRADE: Strong
1817Definitions
1818See glossary.
1821  American College of Radiology. ACR-AAPM-SIIM-SPR practice parameter for digital
1822 radiography. Revised 2017.
1823  Bomer J, Wiersma-Deijl L, Holscher HC. Electronic collimation and radiation protection
1824 in paediatric digital radiography: revival of the silver lining. Insights Imaging.
1825 2013;4(5):723-727. doi:10.1007/s13244-013-0281-5
1826  Carroll QB. Radiography in the Digital Age. 3rd ed. Charles C Thomas; 2018.
1827  Carter C, Vealé B. Digital Radiography and PACS. 3rd ed. Elsevier; 2019.
1828  Chalazonitis AN, Koumarianos D, Tzovara J, Chronopoulos P. How to optimize
1829 radiological images captured from digital cameras, using the Adobe Photoshop 6.0
1830 program. J Digit Imaging. 2003;16(2):216-229.
1831  DeMaio DN, Herrmann T, Noble LB, et al; American Society of Radiologic
1832 Technologists. Best practices in digital radiography. Published 2019.
PS 65
1833  Don S, Macdougall R, Strauss K, et al. Image Gently campaign back to basics initiative:
1834 ten steps to help manage radiation dose in pediatric digital radiography. AJR Am J
1835 Roentgenol. 2013;200(5):W431-W436. doi:10.2214/AJR.12.9895
1836  Fauber TL, Dempsey MC. X-ray field size and patient dosimetry. Radiol Technol.
1837 2013;85(2):155-161.
1838  Fauber TL. Radiographic Imaging and Exposure. 5th ed. Elsevier; 2017.
1839  Goske MJ, Charkot E, Herrmann T, et al. Image Gently: challenges for radiologic
1840 technologists when performing digital radiography in children. Pediatr Radiol.
1841 2011;41(5):611-619. doi:10.1007/s00247-010-1957-3
1842  Lo WY, Puchalski SM. Digital image processing. Vet Radiol Ultrasound. 2008;49(1
1843 suppl 1):S42-S47. doi:10.1111/j.1740-8261.2007.00333.x
1844  Russell J, Burbridge BE, Duncan MD, Tynan J. Adult fingers visualized on neonatal
1845 intensive care unit chest radiographs: what you don’t see. Can Assoc Radiol J.
1846 2013;64(3):236-239. doi:10.1016/j.carj.2012.04.004
1847  Seeram E. Digital Radiography: An Introduction. Cengage Learning; 2011.
1848  Uffmann M, Schaefer-Prokop C. Digital radiography: the balance between image quality
1849 and required radiation dose. Eur J Radiol. 2009;72(2):202-208.
1850 doi:10.1016/j.ejrad.2009.05.060
1851  Willis CE. Optimizing digital radiography of children. Eur J Radiol. 2009;72(2):266-273.
1852 doi:10.1016/j.ejrad.2009.03.003
1853  Zetterberg LG, Espeland A. Lumbar spine radiography—poor collimation practices after
1854 implementation of digital technology. Br J Radiol. 2011;84(1002):566-9.
1855 doi:10.1259/bjr/74571469
1857Curricula
1858  Limited X-ray Machine Operator Curriculum (ASRT, 2020)

1861  Limited Scope of Practice in Radiography (ARRT, 2018)

1865 o Applying principles of ALARA to minimize exposure to patient, self and others.
1866 o Selecting the appropriate protocol and optimizing technical factors while maximizing
1867 patient safety.
1868  The ASRT Practice Standards for Medical Imaging and Radiation Therapy
1869 o Participates in ALARA, patient and personnel safety, risk management and quality
1870 management activities. (Standard One, General Criteria)
1871 o Employs professional judgment to adapt procedures to improve diagnostic quality or
1872 therapeutic outcomes. (Standard Two, General Criteria)
1873 o Analyzes images to determine the use of appropriate imaging parameters. (Standard

PS 66
1874 Two, limited x-ray machine operator and radiography only)

1875 o Verifies that exposure indicator data for digital radiographic systems has not been
1876 altered or modified and is included in the DICOM header and on images exported to
1877 media. (Standard Two, limited x-ray machine operator and radiography only)
1878 o Adheres to radiation safety rules and standards. (Standard Four, General Criteria)
1879 o Positions patient for anatomic area of interest, respecting patient ability and comfort.
1880 (Standard Four, General Criteria)
1881 o Uses pre-exposure collimation and proper field-of-view selection. (Standard Four,
1882 limited x-ray machine operator and radiography only)
1883 o Evaluates images for optimal demonstration of anatomy of interest. (Standard Five,
1884 General Criteria)
1885 o Adheres to the established practice standards of the profession. (Standard Twelve,
1886 General Criteria)

1889Not applicable
1890Other
1891Not applicable
1892

PS 67
1893 Glossary
1894The glossary is an alphabetical list of defined terms or words specifically found in the ASRT
1895Practice Standards for Medical Imaging and Radiation Therapy. The terms or words have
1896meaning that might not be general knowledge. The definitions are formulated using evidentiary
1897documentation and put into place following extensive review and subsequent approval. The
1898glossary is not all-inclusive. New terms and new usage of existing terms will emerge with time
1899and advances in technology.
1900AAPM – American Association of Physicists in Medicine

1901ACR – American College of Radiology
1902advanced-practice radiographer – A registered technologist who has gained additional
1903knowledge and skills through the successful completion of an organized program or radiologic
1904technology education that prepares radiologic technologists for advanced-practice roles and has
1905been recognized by the national certification organization to engage in advanced-practice
1906radiologic technology.
1907adverse event – Any undesirable experience associated with the use of a medical product in a
1908patient.
1909ALARA – Acronym for “as low as (is) reasonably achievable,” which means making every
1910reasonable effort to maintain exposures to radiation as far below the dose limits as practical,
1911consistent with the purpose for which the licensed activity is undertaken, while taking into
1912account the state of technology, the economics of improvements in relation to state of
1913technology, the economics of improvements in relation to benefits to the public health and safety
1914and other societal and socioeconomic considerations, and in relation to the use of nuclear energy
1915and licensed materials in the public interest. The ASRT recognizes the concept of ALARA to
1916include energies used for magnetic resonance and sonographic imaging.
1917anatomic (anatomical) landmarks – Bones or other identifiable points that are visible or
1918palpable and indicate the position of internal anatomy.
1919archive (archival) –The storage of data in either hard (film) or soft (digital) form.
1920ARDMS – American Registry for Diagnostic Medical Sonography
1921ARRT – American Registry of Radiologic Technologists
1922artifact – Extraneous information on the image that interferes with or distracts from image
1923quality.
1924ASRT – American Society of Radiologic Technologists
1925authorized user – A physician, dentist or podiatrist who meets the requirements as defined by
1926the United States Nuclear Regulatory Commission.
1927beam-modification devices – Devices that change the shape of the treatment field or
1928distribution of the radiation at (tissue) depth.
1929brachytherapy –A method of treatment that involves the temporary or permanent placement of
1930radiation source(s) (isotopic or electronic) inside or immediately adjacent to a tumor-bearing
1931region.
PS 68
1932CCI – Cardiovascular Credentialing International

1933change management – Systematic approach to preparing for, implementing and sustaining a
1934change in process.
1935clinical – Pertaining to or founded on actual observations and treatments of patients.
1936clinically competent – The ability to perform a clinical procedure in a manner that satisfies the
1937demands of a situation, as assessed and documented by a qualified individual.
1938compounding medication – The combining, mixing, pooling or otherwise altering of a
1939conventionally manufactured drug in response to or anticipation of a medication order.
1940compounding radiopharmaceutical – The combining, mixing, pooling or otherwise altering of
1941a conventionally manufactured radiopharmaceutical or synthesizing/formulating a
1942radiopharmaceutical from bulk drug substances and radionuclides.
1943contrast media – A substance administered during a medical imaging procedure for the purpose
1944of enhancing the contrast between an internal structure or fluid and the surrounding tissue.
1945cropping – The process of selecting and removing a portion of the image.
1946custom blocks – Devices designed to shape the radiation field.
1947DICOM – Acronym for “Digital Imaging and Communications in Medicine.” The DICOM
1948standards are a complex set of instructions to exchange and present medical image information.
1949dose distribution – Spatial representation of the magnitude of the dose produced by a source of
1950radiation. It describes the variation of dose with position within an irradiated volume.
1951dosimetric calculations – Computation of treatment unit settings, monitor units, treatment times
1952and radiation doses to anatomical areas of interest.
1953educationally prepared – The successful completion of didactic and clinical education
1954necessary to properly perform a procedure in accordance with accepted practice standards.
1955electronic masking – Electronic collimation or cropping of the digital radiographic image that
1956occurs during postprocessing of the acquired image and does not alter the size of the irradiated
1957field.
1958FDA – U.S. Food and Drug Administration.
1959fiducial markers – Fixed reference points against which other objects can be measured. They
1960may be placed internally, at skin surface or fixed externally to the patient.
1961GRADE – Grading of Recommendations Assessment, Development and Evaluation
1962hybrid imaging – The combination of imaging technologies that allows information from
1963different modalities to be presented as a single set of images.
1964image-guided radiation therapy – A process of using various imaging technologies to localize
1965the target and critical tissues and, if needed, reposition the patient just before or during the
1966delivery of radiotherapy.
1967imaging technologies – Technologies using ionizing and nonionizing radiation to visualize
1968physiological processes, internal structures and fiducial markers, both anatomical and
1969nonanatomical.
PS 69
1970immobilization device – Device that assists in maintaining or reproducing the position while
1971limiting patient movement.
1972initial observation – Assessment of technical image quality with pathophysiology correlation
1973communicated to a radiologist.
1974interpretation – The process of examining and analyzing all images within a given procedure
1975and integration of the imaging data with appropriate clinical data in order to render an
1976impression or conclusion set forth in a formal written report composed and signed by a licensed
1977practitioner.
1978interventional procedures – Invasive medical imaging guidance methods used to diagnose
1979and/or treat certain conditions.
1980ISCD – International Society for Clinical Densitometry
1981JRC-DMS – Joint Review Committee on Education in Diagnostic Medical Sonography
1982least significant change ‒ The least amount of bone mineral densitometry change that can be
1983considered statistically significant.
1984licensed practitioner – A medical or osteopathic physician, chiropractor, podiatrist or dentist
1985who has education and specialist training in the medical or dental use of radiation and is deemed
1986competent to perform independently or supervise medical imaging or radiation therapy
1987procedures by the respective state licensure board.
1988MDCB – Medical Dosimetrist Certification Board
1989medical physicist – An individual who is competent to practice independently in the safe use of
1990x-rays, gamma rays, electron and other charged particle beams, neutrons, radionuclides, sealed
1991radionuclide sources, ultrasonic radiation, radiofrequency radiation and magnetic fields for
1992diagnostic and therapeutic purposes. An individual is considered competent to practice in the
1993field of medical physics if the individual is certified by the appropriate recognized certification
1994organization.
1995medication – Any chemical substance intended for use in the medical diagnosis, cure, treatment
1996or prevention of disease.
1997minimal sedation (anxiolysis) – A drug-induced state during which patients respond normally
1998to verbal commands. Although cognitive function and coordination may be impaired, ventilatory
1999and cardiovascular functions are unaffected.
2000moderate sedation – A drug-induced depression of consciousness during which patients
2001respond purposefully to verbal commands, either alone or accompanied by light tactile
2002stimulation. No interventions are required to maintain a patent airway, and spontaneous
2003ventilation is adequate. Cardiovascular function is usually maintained.
2004molecular imaging - A noninvasive, diagnostic imaging technology that enables visualization,
2005characterization and measurement of biologic processes at the molecular and cellular levels.
2006Molecular imaging techniques may be applied to computed tomography, magnetic resonance,
2007nuclear medicine, optical imaging, PET-CT, sonography and spectroscopy.
2008monitor units – Unit of output measure used for linear accelerators, sometimes indicated with
2009the abbreviation MU. Accelerators are calibrated so that 1 MU delivers 1 cGy for a standard

PS 70
2010reference field size at a standard reference depth at a standard source to calibration point.
2011MQSA – Mammography Quality Standards Act
2012NECS – National Education Curriculum for Sonography
2013NMTCB – Nuclear Medicine Technology Certification Board
2014noninterpretive fluoroscopic procedures – Use of fluoroscopic imaging under the direction of
2015a licensed practitioner for purposes other than interpretation.
2016normal tissue tolerance – Radiation tolerance levels of healthy organs near or within the
2017radiation treatment fields.
2018NRC – U.S. Nuclear Regulatory Commission
2019panning – Movement of the procedure table during image production to maintain visualization
2020of an anatomic region of interest.
2021personnel radiation monitoring devices – Devices designed to be worn or carried by an
2022individual for the purpose of measuring the dose of radiation received.
2023physics survey – Performing equipment testing, evaluating the testing results and completing a
2024formal written report of results. The written survey report, validated by a medical physicist,
2025contains sufficient information to document that each test was conducted according to local,
2026federal or state requirements and includes an assessment of corrective actions and
2027recommendations for improvements.
2028postprocessing – Computerized processing of data sets after acquisition to create a diagnostic or
2029therapeutic image.
2030procedure – Specific course of action intended to result in an imaging study, treatment or other
2031outcome.
2032processing – Manipulation of the raw data just after acquisition.
2033protocol – The plan for carrying out a procedure, scientific study or a patient’s treatment
2034regimen.
2035quality assurance – Activities and programs designed to achieve a desired degree or grade of
2036care in a defined medical, nursing or health care setting or program. Sometimes indicated with
2037the abbreviation QA.
2038quality control – The routine performance of techniques used in monitoring or testing and
2039maintenance of components of medical imaging and radiation therapy equipment. This includes
2040the interpretation of data regarding equipment function and confirmation that corrective actions
2041are/were taken. Sometimes indicated with the abbreviation QC.
2042radiation oncologist – A physician who specializes in using radiation to treat cancer.
2043radiation protection – Prophylaxis against injury from ionizing radiation. The only effective
2044preventive measures are shielding the operator, handlers and patients from the radiation source;
2045maintaining appropriate distance from the source; and limiting the time and amount of exposure.
2046radioactive material – A substance composed of unstable atoms that decay with the
2047spontaneous emission of radioactivity. Includes radiopharmaceuticals, unsealed sources (open,
2048frequently in liquid or gaseous form) and sealed sources (permanently encapsulated, frequently
PS 71
2049in solid form).

2050radiobiology – The study of the effects of radiation on living organisms.
2051radiography – The process of obtaining an image for diagnostic examination using x-rays.
2052sentinel event – An unexpected occurrence involving death or serious physical or psychological
2053injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The
2054phrase “or the risk thereof” includes any process variation for which a recurrence would carry a
2055significant chance of a serious adverse outcome.
2056setup – Arrangement of treatment parameters used in preparation for delivering radiation
2057therapy; includes patient positioning data, field alignment information and equipment
2058configurations.
2059shuttering – A postprocessing technique that may be used to eliminate ambient light around an
2060image for the sole purpose of improving the quality of the displayed image. It should not be used
2061as a substitute for insufficient collimation of the irradiated field.
2062simulation – A process using imaging technologies to plan radiation therapy so that the target
2063area is precisely located and marked; the mockup procedure of a patient treatment with medical
2064imaging documentation of the treatment portals.
2065SNMMI – Society of Nuclear Medicine and Molecular Imaging
2066static – Any medical image that is fixed or frozen in time.
2067supervising radiologist – A board-certified or board-eligible radiologist who oversees duties of
2068the radiologist assistant and has appropriate clinical privileges for the procedure performed by
2069the radiologist assistant.
2070timeout – Preprocedural pause to conduct a final assessment that the correct patient, site and
2071procedure are identified.
2072tolerance levels (doses) – The maximum radiation dose that may be delivered to a given
2073biological tissue at a specified dose rate and throughout a specified volume without producing an
2074unacceptable change in the tissue.
2075treatment calculations – See dosimetric calculations.
2076treatment field (portal) – Volume of tissue exposed to radiation from a single radiation beam.
2077treatment planning – The process by which dose delivery is optimized for a given patient and
2078clinical situation. It encompasses procedures involved in planning a course of radiation
2079treatment, including simulation through completion of the treatment summary.
2080treatment record – Documents the delivery of treatments, recording of fractional and
2081cumulative doses, machine settings, verification imaging and the ordering and implementation of
2082prescribed changes.
2083T-score – Number of standard deviations the individual’s bone mineral density is from the
2084average bone mineral density for gender-matched young normal peak bone mass.
2085USP – United States Pharmacopeia
2086vascular access device – Apparatus inserted into the peripheral or central vasculature for
2087diagnostic or therapeutic purposes.
PS 72
2088vascular closure device ‒ Active or passive medical devices used to achieve hemostasis after a
2089cardiovascular or endovascular procedure that requires catheterization.
2090venipuncture – The transcutaneous puncture of a vein by a sharp rigid stylet or cannula carrying
2091a flexible plastic catheter or by a steel needle attached to a syringe or catheter.
2092verification images – Images produced to confirm accurate treatment positioning and accurate
2093treatment portals.
2094Z-score – Number of standard deviations the individual’s bone mineral density is from the
2095average bone mineral density for age- and gender-matched reference group.

PS 73

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1

The ASRT Practice Standards

119Cardiac-Interventional and Vascular-Interventional Technology

125Cardiac-interventional and vascular-interventional technologists independently perform or assist

137Computed tomography technologists independently perform or assist the licensed practitioner in

142Limited X-ray Machine Operator

168Mammographers independently perform or assist the licensed practitioner in the completion of

180Medical dosimetrists must maintain a high degree of accuracy in treatment planning

236Radiographers independently perform or assist the licensed practitioner in the completion of

260Sonographers independently perform or assist the licensed practitioner in the completion of

264Education and Certification

289Cardiac-Interventional and Vascular-Interventional Technology

293Cardiac-interventional and vascular-interventional technologists prepare for their roles on the

296Those passing the ARRT cardiac-interventional, cardiovascular- interventional or vascular-

310Limited X-ray Machine Operator

382Radiologist assistants prepare for their roles as advanced-practice radiographers in medical

397 Medical Imaging and Radiation Therapy Scope of Practice

* Excludes limited x-ray machine operator

437Cardiac-Interventional and Vascular-Interventional

455Limited X-ray Machine Operator

* Excludes limited x-ray machine operator

518  Serving as a resource regarding regulatory, accreditation and fiscal requirements.

* Excludes limited x-ray machine operator

575The medical imaging and radiation therapy professional:

602Cardiac-Interventional and Vascular-Interventional

606Limited X-ray Machine Operator

* Excludes limited x-ray machine operator

* Excludes limited x-ray machine operator

666Standard Two – Analysis/Determination

672The medical imaging and radiation therapy professional:

690Cardiac-Interventional and Vascular-Interventional

695Limited X-ray Machine Operator

* Excludes limited x-ray machine operator

738  Monitors and develops methods to improve customer satisfaction.

* Excludes limited x-ray machine operator

782The medical imaging and radiation therapy professional:

806Cardiac-Interventional and Vascular-Interventional

* Excludes limited x-ray machine operator

812Limited X-ray Machine Operator

* Excludes limited x-ray machine operator

858Standard Four – Performance

865The medical imaging and radiation therapy professional:

897Cardiac-Interventional and Vascular-Interventional

909Limited X-ray Machine Operator

* Excludes limited x-ray machine operator

977  Assesses process flow.

* Excludes limited x-ray machine operator

1025Standard Five – Evaluation

1033The medical imaging and radiation therapy professional:

1050Cardiac-Interventional and Vascular-Interventional

1054Limited X-ray Machine Operator

* Excludes limited x-ray machine operator

1098Standard Six – Implementation

1104The medical imaging and radiation therapy professional:

1118Cardiac-Interventional and Vascular-Interventional

1122Limited X-ray Machine Operator

* Excludes limited x-ray machine operator

1130  Develops additional treatment plans to achieve an optimal dose distribution.

* Excludes limited x-ray machine operator

1159Standard Seven – Outcomes Measurement

1166The medical imaging and radiation therapy professional:

1180Cardiac-Interventional and Vascular-Interventional

1184Limited X-ray Machine Operator