BILL ANALYSIS                                                                                                                                                                                                    







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          |Hearing Date:June 26, 2006     |Bill No:AB                |
          |                               |2720                      |
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               SENATE COMMITTEE ON BUSINESS, PROFESSIONS AND ECONOMIC  
                                     DEVELOPMENT
                             Senator Liz Figueroa, Chair

                        Bill No:        AB 2720Author:Spitzer
                        As Amended:  May 8, 2006 Fiscal:  Yes

          
          SUBJECT:    Radiologic technology.
          
          SUMMARY:  Authorizes nuclear medicine technologists and  
          diagnostic radiologic technologists to operate dual mode  
          equipment used to perform computerized tomography (CT)  
          scans and positron emission tomography (PET) scans when the  
          equipment is performing both types of scans in the dual  
          mode.

          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  
            equipment and specifies examination requirements for  
            obtaining a radiologic technology certificate.

          3)  Requires certification for individuals performing  
            nuclear medicine technology and the passage of a DHS  
            administered examination or submission of documentary  
            evidence of passing an equivalent examination offered by  
            the   Nuclear Medicine Technology Certification Board,  
            American Registry of Radiologic Technologists, or  





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            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 that pertain to the utilization of  
            radiopharmaceuticals for the diagnosis and treatment of  
            disease in humans.

          This bill:

          1)  Allows a person who has obtained certification in  
            nuclear medicine technology to perform a 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  
            of the following 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.

                      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 certificate in PET issued by the  
                  Nuclear Technology Certification Board.

                      b)  The person is under the supervision of a  
                  person who is an authorized user identified on a  
                  specific license authorizing medical use of  





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                  radioactive materials, as specified.

          3)  Makes a violation of these provisions a misdemeanor and  
            makes a violator subject to disciplinary actions, as  
            specified.

          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee there would be no state fiscal impact as a result  
          of the passage of this measure.

          COMMENTS:
          
          1.Purpose.  According to the Author, this bill creates a  
            mechanism to allow diagnostic 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 diagnostic radiologic technologist to performing  
            only procedures involving ionizing radiation or CT scans,  
            but not one involving nuclear medicine, or PET scans.   
            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.



          2.Background.  Current DHS regulations include guidelines  
            in the operation of dual imaging devices, including PET  
            scanners.  The regulation describes the following  
            circumstances under which these devices can be used and  
            who can operate 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  
            technologist 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  





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            procedure, and a nuclear medicine technologist is  
            adequately certified to perform the study and operate the  
            device.  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. 
          
            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 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.

            A positron emission tomography 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.

          3.Arguments in Support.  This measure is sponsored by the  
             Society for Nuclear Medicine, Pacific Southwest  
            Technologist Chapter.   Proponents state that technicians  
            who operate "hybrid" diagnostic imaging machines that can  
            perform both PETs and CTs should not have to be licensed  
            as both a nuclear medicine technologist and a radiologic  
            technologist and there are a limited number of  
            individuals who have both licenses.  However, individuals  
            who perform both PETs and CTs must be adequately trained  
            to provide both services.  In response to this situation,  
            the industry put forth a proposal to cross train nuclear  
            medicine technologists and radiologic technologists to  





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            perform both types of scans.  In addition, the American  
            Registry of Radiologic Technology and the Nuclear  
            Medicine Technology Certification Board, which certify  
            radiologic technologists and nuclear medicine  
            technologists, respectively, 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.  
             
            AB 2720 implements this consensus proposal.   


          SUPPORT AND OPPOSITION:
          
           Support:                                                 
                  Society of Nuclear Medicine, Pacific Southwest  
                  Technologist                                         
                                                                       
                            Chapter (Sponsor)
                    California Medical Association
                    California Radiological Society
                    California Society of Radiologic Technologists
                    Society of Nuclear Medicine
                                       
            Opposition:  None Received.


          Consultant: George Cate