Physician Assistants Authorized to Operate Fluoroscopic X-ray Systems and to Perform

Fluoroscopic Procedures (1) Definitions Applicable to 263 CMR 5.07. (a) Fluoroscopy means a technique for generating x-ray images and presenting them simultaneously and continuously as visible images. Fluoroscopy has the same meaning as the term "radioscopy" in the standards of the International Electrotechnical Commission. (b) Fluoroscopic Procedure means a radiological imaging study using fluoroscopic guidance. (c) Supervising Physician, for the purpose of 263 CMR 5.07, means a physician holding an unrestricted full license in the Commonwealth who: 1. is board-certified in radiology or has been trained in the subjects identified in 105 CMR 120.405(K): Operator Qualifications; 2. signs mutually developed and agreed upon fluoroscopic practice guidelines as required under 263 CMR 5.07(4) and 243 CMR 2.08(6): Physician Assistants Authorized to Operate Fluoroscopic X-ray Systems with each physician assistant authorized to operate fluoroscopic x-ray systems whom such physician supervises; and 3. reviews the physician assistant's performance of fluoroscopic procedures at least once every three months and provides ongoing direction to the physician assistant regarding such procedures or, pursuant to 263 CMR 5.07(4)(d) and 243 CMR 2.08(6): Physician Assistants Authorized to Operate Fluoroscopic X-ray Systems, temporarily delegates such review and direction to another physician holding an unrestricted full license in the Commonwealth who meets the requirements of 243 CMR 2.08(6)(a)2: Supervising Physician. (d) Physician assistant authorized to operate fluoroscopic x-ray systems means a physician assistant who has submitted documentation to the facility where the physician assistant works demonstrating that he or she meets the requirements set out in 105 CMR 120.405(K)(2): Operator Qualifications. (2) A physician assistant who holds a full license issued by the Board pursuant to M.G.L. c. 112, § 9I and 263 CMR 3.00: Licensing of Individual Physician Assistants may operate fluoroscopic x-ray systems and perform fluoroscopic procedures in accordance with 263 CMR 5.07, provided that he or she: (a) has been authorized to operate fluoroscopic x-ray systems pursuant to 105 CMR 120.405(K): Operator Qualifications; (b) engages in the operation of fluoroscopic x-rays systems and the performance of fluoroscopic procedures in compliance with the requirements of 105 CMR 120.405(K): Operator Qualifications, 263 CMR 5.07, and 243 CMR 2.08(6): Physician Assistants Authorized to Operate Fluoroscopic X-ray Systems; and (c) has otherwise complied with 263 CMR 2.00 through 6.00. (3) Physician Supervision of a Physician Assistant Authorized to Operate Fluoroscopic X-ray Systems. A supervising physician shall review the performance of fluoroscopic procedures by, and provide ongoing direction to, a physician assistant authorized to operate fluoroscopic x-ray systems in accordance with written fluoroscopic practice guidelines mutually developed and agreed upon with the physician assistant pursuant to M.G.L. c. 112, § 9E, 263 CMR 5.07 and 243 CMR 2.08(6): Physician Assistants Authorized to Operate Fluoroscopic X-ray Systems. Such practice guidelines shall be developed, signed, and dated by both parties prior to any fluoroscopic practice by the physician assistant pursuant to such guidelines. In addition, a physician who is board-certified in radiology or who meets the requirements set forth in 105 CMR 120.405(K): Operator Qualifications shall supervise the physician assistant each time the physician assistant operates a fluoroscopic x-ray system. The level of supervision necessary for each procedure shall be identified in the written practice guidelines. (a) A supervising physician shall provide supervision to the physician assistant authorized to operate fluoroscopic x-ray systems as necessary, taking into account the education, training, and experience of the physician assistant, the nature and scope of the physician assistant's practice, and the availability to the physician assistant of clinical back-up by physicians, to ensure that the physician assistant is operating the fluoroscopic x-ray systems in accordance with accepted standards of medical practice. (b) A supervising physician shall sign written fluoroscopic practice guidelines only with those physician assistants for whom such physician is able to provide the supervision required by 263 CMR 5.07(3) and 243 CMR 2.08(6)(b): Physician Supervision of a Physician Assistant Authorized to Operate Fluoroscopic X-ray Systems, taking into account factors including, but not limited to, geographical proximity, practice setting, volume and complexity of the patient population, and the experience, training and availability of the supervising physician and the physician assistant. (4) Development, Approval, and Review of Fluoroscopic Practice Guidelines for a Physician Assistant Authorized to Operate Fluoroscopic X-ray Systems. A physician who supervises a physician assistant authorized to operate fluoroscopic x-ray systems shall do so in accordance with written fluoroscopic practice guidelines mutually developed and agreed upon with the physician assistant, and signed and dated by both parties. The supervising physician and the physician assistant shall review, initial, and date such practice guidelines annually. The practice guidelines may be revised at any time upon written agreement by the supervising physician and physician assistant; any such changes shall be initialed and dated by both parties at the time of revision. In all cases, the practice guidelines shall: (a) identify the supervising physician by name; (b) identify by name each physician who shall provide supervision of the physician assistant's operation of a fluoroscopic x-ray system, and describe each physician's qualifications to provide such supervision, as set out in 263 CMR 5.07(1)(c) and 243 CMR 2.08(6)(b): Physician Assistants Authorized to Operate Fluoroscopic X-ray Systems; (c) provide that supervision by a supervising physician shall be required whenever a physician assistant operates a fluoroscopic x-ray system and that a supervising physician shall be readily available, which means a supervising physician must be present in the facility at the time of the operation of the fluoroscopic x-ray system; (d) include a defined mechanism for the delegation of supervision to another physician who is qualified to operate fluoroscopic x-ray systems pursuant to 105 CMR 120.405(K): Operator Qualifications including, but not limited to, the duration and scope of the delegation; (e) describe the nature of the supervising physician's practice and practice location; (f) specifically describe the nature and scope of the physician assistant's practice; (g) identify the type(s) of procedure(s) in which the physician assistant will operate fluoroscopic x-ray systems, including any limitations on the physician assistant's operation of fluoroscopic x-ray systems; (h) include a defined mechanism to monitor the physician assistant's operation of fluoroscopic x-ray systems and performance of fluoroscopic procedures, including documentation of review of such operation and procedures by the supervising physician at least once every three months; (i) describe the procedure for providing clinical back-up support to the physician assistant in an emergency situation; and (j) conform to 105 CMR 120.405(K): Operator Qualifications, 263 CMR 5.07, and 243 CMR 2.08(6): Physician Assistants Authorized to Operate Fluoroscopic X-ray Systems. (5) The Board may request at any time an opportunity to review the written fluoroscopic practice guidelines under which a supervising physician provides supervision to a physician assistant authorized to operate fluoroscopic x-ray systems. A physician assistant's failure to have developed fluoroscopic practice guidelines consistent with the requirements of 263 CMR 5.07, or failure to provide such guidelines to the Board upon request, may be a basis for disciplinary action against the physician assistant's license. The Board may require changes in fluoroscopic practice guidelines if it determines that the guidelines do not comply with 263 CMR 5.07 and accepted standards of medical practice. The Board may disapprove fluoroscopic practice guidelines in their entirety if it determines that the supervising physician is not able to provide adequate supervision to the physician assistant authorized to operate fluoroscopic x-ray systems. (6) The Board may request at any time documentation of review by the supervising physician of the physician assistant's fluoroscopic practice as set out in 263 CMR 5.07(4)(h) and 243 CMR 2.08(6)(a)2.c.: Physician Assistants Authorized to Operate Fluoroscopic X-ray Systems. Failure to provide such documentation to the Board upon request may be a basis for disciplinary action against the physician assistant's license. (7) At least four hours of the continuing education required as a condition for license renewal pursuant to 263 CMR 3.05(3): Renewal of Registration shall be directly related to fluoroscopic imaging.