NAC449.993. Diagnostic radiological services.

     1. Each ambulatory surgical center shall maintain diagnostic radiological services or have such services immediately available. Whether these services are provided directly or by contract, personnel capable of supervising the performance of the services must be available.

     2. If a center provides diagnostic radiological services directly, the center must have a full-time radiologist or a radiologist who works as a part-time consultant available to supervise the department of radiology and to interpret films.

     3. Only a person designated as qualified by the radiologist may operate the equipment for X-rays.

     4. Only the following persons may operate a fluoroscopy machine:

     (a) A physician or a podiatric physician licensed pursuant to chapter 635 of NRS;

     (b) A physician assistant, advanced practice registered nurse or certified registered nurse anesthetist if that person has at least 16 hours of documented training in radiation safety;

     (c) A radiologic technologist registered by the American Registry of Radiologic Technologists if the person is acting under the personal direction or written protocol of a physician and registrant of the fluoroscopy machine; and

     (d) A registered nurse or operating room technician if the person is acting under the direct supervision of a physician or surgeon who is present in the room at the time the fluoroscopy machine is used and the person has documented training in radiation safety as follows:

          (1) The applicable provisions of chapter 459 of NAC;

          (2) Orientation to field size;

          (3) Orientation to the energy used and the setting (kVp) to use on patients of varying sizes and pathology;

          (4) Orientation to the concept of “as low as is reasonably achievable,” as defined in NAC 459.0205;

          (5) The use of protective gloves, aprons, thyroid shields and glasses;

          (6) The use of particular machines and the operation of each type of machine;

          (7) Orientation to the concept of source to image distance;

          (8) Safety protocol for staff in the operating room and adjacent areas, including, without limitation, physicians, patients and operators;

          (9) The requirements for dosimetry and postings and the certificate and output measurements necessary to allow use of the fluoroscopy machine;

          (10) The appropriate use of high-level versus regular settings;

          (11) The relevance of pregnancy in the use of machines that produce radiation; and

          (12) An annual review of radiation safety.

     5. Examinations by X-ray must be ordered by the physician or podiatrist responsible for the care of the patient, and the order must contain a concise statement of the reason for the examination. Reports of these examinations must be signed by the reporting physician. The original report must be filed in the medical records of the patient, and a copy of the report must be kept in the radiology department.

     (Added to NAC by Bd. of Health, eff. 12-15-88; A by R049-99, 9-27-99; R181-09, 10-4-2013)