Current through Register 1531, September 27, 2024
(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 atleast 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.
