BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: AB 2720
A
AUTHOR: Spitzer
B
AMENDED: May 8, 2006
HEARING DATE: June 7, 2006
2
FISCAL: Business, Professions and Economic
Development/ 7
Appropriations
2
0
CONSULTANT:
Machi / ak
SUBJECT
Radiologic technology
SUMMARY
Makes changes to existing law relating to nuclear medicine
technologists and diagnostic radiologic technologists when
operating a positron emission tomography (PET) scan.
ABSTRACT
Existing law:
1.Establishes the Radiologic Health Branch within the
Department of Health Services (DHS) which is responsible
for licensing of radioactive materials, registration of
X-ray producing machines, certification of X-ray and
radioactive material users, inspection of facilities
using radiation, investigation of radiation incidents,
and surveillance of radioactive contamination in the
environment.
2.Requires certification or licensure for any person who
administers or uses diagnostic or therapeutic X-ray.
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Specifies examination requirements for obtaining a
radiologic technology certificate.
3.Requires certification for individuals performing nuclear
medicine technology. Requires passage of DHS
administered examination or submission of documentary
evidence of passing equivalent examination offered by the
Nuclear Medicine Technology Certification Board, American
Registry of Radiologic Technologists, or American Society
of Clinical Pathologists.
4.Defines nuclear medicine technology as technology applied
under the supervision of a physician and surgeon or
licensed clinical bioanalyst, when performing in vitro
procedures, pertaining to the utilization of
radiopharmaceuticals for diagnosis and treatment.
This bill:
1.Allows a person who has obtained certification in nuclear
medicine technology to perform a computerized tomography
(CT) scan only on a dual mode machine on which both a
nuclear medicine procedure, to include a PET scan, and a
CT scan if both conditions are met:
a. The person holds a current, valid certificate in CT
issued by the American Registry of Radiologic
Technologists, a similarly recognized organization, or
is a student, as specified; and,
b. The person is under the supervision of a person who
is an authorized user identified on a specific license
authorizing medical use of radioactive materials, as
specified.
2.Allows a person who holds a current, valid certificate in
diagnostic radiologic technology to perform a PET scan
only on a dual mode machine on which both a PET scan and
a CT scan may be performed if both of the following
conditions are met:
a. The person holds a current, valid certificate in
PET issued by the Nuclear Medicine Technology
Certification Board, or a similarly recognized
organization, or complies with the regulations issued
by DHS governing students of nuclear medicine
technology in order to obtain a current, valid
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certificate in PET issued by the Nuclear Technology
Certification Board; and,
b. The person is under the supervision of a person who
is an authorized user identified on a specific license
authorizing medical use of radioactive materials.
3.Makes a violation of this statute a misdemeanor and makes
a violator subject to disciplinary actions, as specified.
FISCAL IMPACT
According to the Assembly Appropriations Committee, no
state fiscal effect.
BACKGROUND AND DISCUSSION
Purpose of this bill
According to the author, this bill creates a mechanism to
allow licensed radiologic technologists and nuclear
medicine technologists to perform CT scans and PET scans on
dual mode equipment subject to specific training,
certification, and supervision standards. The author
points out that for several years machines have been
available that combine both PET and CT scan capability into
a hybrid unit. However, current law limits a radiologic
technologist to performing only procedures involving
ionizing radiation or CT scan, but not one involving
nuclear medicine, or PET scan. Similarly the law restricts
a nuclear medicine technologist to performing only
procedures involving nuclear medicine, or PET scans. To
eliminate the need to have both types of technologists
present when using one of these hybrid units in the dual
mode the consensus among all parties including physicians
and the technologists was to cross train the respective
technologist for this limited purpose.
Computerized axial tomography (CAT or CT)
A computerized axial tomography scan is more commonly known
by its abbreviated name, CAT scan or CT scan. It is an
X-ray procedure which combines many X-ray images with the
aid of a computer to generate cross-sectional views and, if
needed, three-dimensional images of the internal organs and
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structures of the body. A CAT scan is used to define
normal and abnormal structures in the body and/or assist in
procedures by helping to accurately guide the placement of
instruments or treatments. A large donut-shaped X-ray
machine takes X-ray images at many different angles around
the body. These images are processed by a computer to
produce cross-sectional pictures of the body. In each of
these pictures the body is seen as an X-ray "slice" of the
body, which is recorded on a film. This recorded image is
called a tomogram. "Computerized Axial Tomography" refers
to the recorded tomogram "sections" at different levels of
the body.
Imagine the body as a loaf of bread and you are looking at
one end of the loaf. As you remove each slice of bread,
you can see the entire surface of that slice from the crust
to the center. The body is seen on CAT scan slices in a
similar fashion from the skin to the central part of the
body being examined. When these levels are further "added"
together, a three-dimensional picture of an organ or
abnormal body structure can be obtained.
Positron emission tomography (PET)
PET imaging or PET scan is a diagnostic examination that
involves the acquisition of physiologic images based on the
detection of radiation from the emission of positrons.
According to the Mayo Clinic Website, a PET scan is a
specific type of imaging test that can help a doctor see
how the tissues and organs inside the body are functioning.
Unlike other scanning techniques, a PET scan does not
produce clear structural images of organs. Instead, it
shows images containing areas of more or less intense color
to provide information about chemical activity within
certain organs and tissues. This chemical activity may
indicate areas of disease not detected by other scanning
methods. In certain conditions, this may cause a doctor to
alter treatment plans. PET scanning is important in
determining neurological conditions, heart disease and the
spread of cancer.
Before the examination begins, a radioactive substance is
produced in a machine called a cyclotron and attached, or
tagged, to a natural body compound, most commonly glucose,
but sometimes water or ammonia. Once this substance is
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administered to the patient, the radioactivity localizes in
the appropriate areas of the body and is detected by the
PET scanner.
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Current DHS regulations
Current DHS Radiation Safety Advisory 00-1 includes
guidelines in the operation of dual imaging devices,
including PET scanners. The advisory states the following
circumstances these devices could be used and the required
personnel when operating them:
a.When a unit is operated as a nuclear medicine imaging
device, the individual operating the machine must be
certified as a nuclear medicine technologists operating
under the supervision of a physician user named on the
appropriate radioactive materials license;
b.When a unit is operated as a dual imaging device, it
constitutes a nuclear medicine technology procedure,
rather than a radiologic technology procedure, and a
nuclear medicine technologist is adequately certified to
perform the study and operate the device. This
determination is made because these situations include
the injection of radiopharmaceuticals; the device may use
radioactive material as point sources for transmission
scanning and attenuation correction; or the procedure
involves the greater potential for radiation safety
problems including dose to the patient, contamination of
areas, dose to personnel and public; or,
c.When a unit is operated as a radiologic technology
imaging device, the individual operating the machine must
be a certified Radiologic Technologist working under the
supervision of a certified Supervisor and Operator.
Arguments in support
The California Radiological Society states that this bill
attempts to address the current scarcity of radiologic
technologists and nuclear medicine technologists. In
addition, the American Registry of Radiologic Technology
and the Nuclear Medicine Technology Certification Board,
which certify radiologic technologists and nuclear medicine
technologists, have recognized the need for dually-trained
imaging technologists and have developed curriculums to
ensure that both technologists are sufficiently trained
when operating hybrid imaging units.
PRIOR ACTIONS
Assembly Floor: 76 - 0 Pass on Consent
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Assembly Appropriations:17 - 0 Do Pass as Amended to
Consent
Assembly Bus. & Prof.:10 - 0 Do Pass as Amended to Consent
Assembly Health: 12 - 0 Do Pass to Consent
POSITIONS
Support: Society of Nuclear Medicine, Pacific Southwest
Technologists
Chapter (sponsor)
California Medical Association
California Radiological Society
California Radiologic Technologists
Society of Nuclear Medicine
Oppose:None received.
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