The scope of practice for diagnostic, therapeutic, and nuclear medicine includes routine tasks such as patient positioning, providing instruction to patients about the imaging procedure, verifying informed consent, and documenting the imaging procedure and radiographic image in the patient's medical record. Radiographic images produced may be in physical form, such as an X-ray film, or in digital format. The clarification of scope of practice for each type of radiologic technologist is as follows:

(1) Diagnostic. The procedures a diagnostic radiologic technologist performs include, but are not limited to:

(a) Standard radiographs or basic or conventional X-rays;

(b) Bone densitometry scans or dual-energy X-ray absorptiometry or DEXA scans;

(c) Mammography;

(d) Fluoroscopic procedures;

(e) Computed tomography or CT;

(f) Cardiovascular-interventional radiography; or

(g) Other imaging studies involving parenteral procedures, excluding those advanced imaging procedures identified in WAC 246-926-300.

Nothing in subsection (1) of this section shall be construed to require that a diagnostic radiologic technologist obtain national certification for computed tomography.

(2) Therapeutic. A therapeutic radiologic technologist is part of an interdisciplinary radiation therapy treatment team which may include, but is not limited to, radiologists, radiation oncologists, medical physicists, and nurses. A therapeutic radiologic technologist implements medical dosimetry treatment plans that include, but are not limited to:

(a) The use of imaging technologies for simulation and treatment planning;

(b) The use of standard radiographs or CT to confirm or reconfirm position targets for precise treatment delivery;

(c) The fabrication, and use, of individualized immobilization devices that assist in precision treatment delivery;

(d) External beam radiation therapy or teletherapy, using methods such as:

(i) 3-dimensional conformal radiation therapy;

(ii) Intensity-modulated radiation therapy;

(iii) Image-guided radiation therapy;

(iv) Tomotherapy;

(v) Proton therapy; or

(vi) Other charged particle beams;

(e) Participation in the delivery of internal radiation therapy or brachytherapy, under the supervision of a radiation oncologist. However, a therapeutic radiologic technologist cannot perform invasive, surgical procedures;

(f) Systemic radiation therapy, which uses radioactive substances such as radioactive iodine;

(g) Palliative radiation therapy, which is used to treat pain from bone metastases;

(h) Dosimetry, under the supervision of a medical physicist to design, calculate, and generate effective radiation dose distributions; or

(i) Diagnostic CT, provided the therapeutic radiologic technologist has successfully passed a national certification examination in computed tomography administered by the ARRT or NMTCB.

(3) Nuclear medicine. A nuclear medicine technologist prepares, stores, administers, and disposes of radiopharmaceuticals, which includes sealed and unsealed radioactive materials, for diagnostic, treatment, and research purposes in compliance with radioactive materials laws and rules. The procedures performed at the direction of a licensed practitioner include, but are not limited to:

(a) Nuclear imaging tests such as:

(i) Positron-emission tomography or PET;

(ii) Single photon emission computed tomography or SPECT;

(iii) Fusion, hybrid, or simultaneous scanning that combines positron-emission tomography with:

(A) Computed tomography, or PET/CT; or

(B) Magnetic resonance imaging, or PET/MRI;

(iv) Fusion, hybrid, or simultaneous scanning that combines single photon emission computed tomography with:

(A) Computed tomography or SPECT/CT; or

(B) Magnetic resonance imaging or SPECT/MRI;

(v) Planar imaging or dynamic imaging procedures;

(b) Assists in exercise and pharmacologic cardiac testing procedures;

(c) Assists in the preparation, management, and application of radionuclide therapy treatment;

(d) Collection and labeling of tissue or body fluid samples;

(e) Managing and proper disposal of biohazardous, chemical, or radioactive waste materials following applicable federal and state laws;

(f) Diagnostic computed tomography, provided the nuclear medicine technologist has successfully passed a national certification examination in computed tomography administered by the NMTCB or ARRT.