What you need to do to complete the new requirements:

• ASAP: Prepare a “Written Statement of Assurance” for every CA / unlicensed individual currently taking x-rays in your office [Sample].

• Once you complete the “Written Statement of Assurance” for every unlicensed staff taking x-rays in your office, they will have until March 13, 2027 (approximately three years), to complete a required 40-hour training program.

See below for more details and answers to Frequently Asked Questions.

If you have CAs in the office who operate ionizing radiation equipment (i.e., take x-rays), a new State of Michigan requirement could affect your practice.

The new Rules, promulgated by the Michigan Occupational Safety and Health Administration (MIOSHA), adopt American Registry of Radiologic Technologists (ARRT) standards for staff members who take x-ray images.

How Could This Affect My Practice?

If you use CAs, licensed/registered health providers whose scope of practice does not include the performance or taking of x-rays, or other qualified, unlicensed personnel or to take x-rays, they are bound by these new requirements. These individuals will need a “written statement of assurance” [more information here and below] in their file as soon as possible.

If you, as a chiropractor who is licensed to practice in Michigan, or another licensed chiropractor, take all x-rays in your clinic, the new Rule will not affect you at all, as “the performance, ordering, or use of x-ray” is within Michigan’s Chiropractic Scope of Practice [(see MCL §333.16401(1) (e)(ii)(D)], and, according to the Rule, nothing within the Rule “shall be construed to limit or affect in any respect, the… practice of individuals properly licensed under Article 15 of the public health code… with respect to their professions and scope of practice.”

What Are the New Rules?

The Rules create four types of qualifications: Active, Temporary, Limited, and Conditional. Most CAs and other non-professionals who take x-Rays will fall into the latter two categories, so that is what we will focus on here.

Limited status is reserved for individuals who have successfully completed a 40-hour training program relevant to the radiologic science within the limited scope of practice. This training must include both clinical and didactic components.

Conditional status for individuals can occur during the three (3) years immediately following the effective date of the rules (March 13, 2024). Individuals that do not meet the requirements of active, temporary, or limited status shall be considered qualified, contingent upon a written statement of assurance that the individual is “competent to apply machine-produced ionizing radiation to human beings.” As of March 13, 2027, conditional status will no longer be recognized by the State of Michigan.

What Do I Need to Do TODAY? Written Statement of Assurance

If you have CAs in your office that you feel meet this conditional status, each of them must complete a statement of assurance as soon as possible. The statement of assurance must:

• State that the operator is competent to apply machine-produced ionizing radiation to human beings;
• State the nature of the equipment and procedures the individual is competent to utilize;
• Be signed and dated by a licensed practitioner in the facility; and,
• Be kept on file and made available for inspection by the Michigan Department of Labor and Economic Opportunity (LEO).

Next Steps: 40-Hour Training Program

After March 13, 2027, conditional status will no longer be recognized by the State of Michigan. Every individual with conditional status, if they wish to continue utilizing x-ray machines for diagnostic, therapeutic, or research purposes after March 13, 2027, must have completed a 40-hour training program.

The MAC is currently developing a 40-hour training program, as well as the required continuing education that will be needed to keep limited status current upon completion of the 40-hour training program. Stay tuned for more information as it becomes available.

Sources / Additional Information

• Michigan Department of Labor and Economic Opportunity, Radiation Safety Section, Ionizing Radiation Rules Governing the Use of Radiation Machines, Part 5. Operator Qualifications
• Michigan Department of Labor and Economic Opportunity’s FAQ X-Ray Operator Qualification Rules as Patients

FAQ’s Regarding the NEW Limited Radiology Requirements

Introduction

In July, we informed you about NEW State of Michigan Rules, promulgated by the Michigan Occupational Safety and Health Administration (MIOSHA), that if you have CAs in your office who operate ionizing radiation equipment (i.e., take x-rays), will affect your practice.

The new rules adopt American Registry of Radiologic Technologists (ARRT) standards for staff members who take x-ray images. If you use CAs, licensed/registered health providers whose scope of practice does not include the performance or taking of x-rays, or other qualified, unlicensed personnel to take x-rays, they are bound by these new requirements.

For our original article on these Rules, and the requirements you will need to fulfill in order for CAs to take x-rays beyond the March 13, 2027 certification date, click here. Below are the answers to Frequently Asked Questions regarding the new Rules.

Q: Our office only has licensed chiropractors taking patient x-rays. Do these new Rules affect us at all?

A: No. If licensed chiropractors are taking all radiological films in your clinic, you do not have to worry about these new requirements. However, if that changes, and a CA or other qualified, unlicensed person – or a licensed/registered provider whose scope does not include the taking of x-rays – takes such films, they will be required to obtain the certification.

Q: Do we need to have the letter of assurance for every staff member who does X-rays in our offices now?

A: Yes, these should already be in a file for every type of staff member described above.

Q: What should we write in the product and safety portion of the letter of assurance?

A: Below is a list of examples for this portion of the letter of assurance:

1. Equipment: list out the type of X-ray equipment you have by name and model
2. Procedures:
   1. Type of procedure: Example: Spinal and Extremity X-rays, etc.
   2. Safety Protocols: Examples: Adherence to X-ray principles to minimize patient and staff exposure, regular equipment maintenance, dosimetry badges, lead wall, etc.

• Patient Care: Example Informed consent, positioning aides (if any) communication and instructions for patient.

Q: Where do we get a dosimetry badge and what do they cost?

A: Dosimetry badges can be bought through many companies online. Costs range, but the average cost is approximately $200 per year.

Q: Does the MAC know of a company that offers dosimetry badges or that offers a discount?  

A: Currently, we do not. With the number of available options online, the competition has made it so that all the companies we have reached out to do not offer a discount program.

Q:  If a CA has been working for years as an X-ray technologist, does any of their years of training count toward the clinical portion of the training?

A: Yes, years of clinical practice can count toward the clinical portion of the training. This competency would need to be evaluated by a qualified person (Chiropractor) and a certificate provided to the student to indicate competency. The MAC will be providing our members with the metrics for the clinical portion of the training, as well as a sample certificate of competency, which is being created by the instructor who will be providing the didactic (online) portion of our program.

Q: When will the limited scope operator training program be available to start?

A: We will have a program available by October 1, 2024. The program will consist of the didactic portion of the requirement online, on our website, in an affordable and easy to use format. It will also include the clinical metrics and sample competency certificate for the clinical portion of the requirement that each doctor will need to provide in their office.

Q: If a Chiropractic Assistant has completed a certified X-ray course in another state (example ARRT, or college-based program) in the past, but did not keep up on the continuing education, as it was not previously required in Michigan, does their original educational certificate count towards the 40 hours for limited use?

A: Yes, the initial certificate will count toward the required 40 hours’ training. The continuing education requirement does not go into effect until the assistant has met the limited scope requirement, when their training is completed, but not before the rules become effective. The earliest date for this would be March 13, 2024. Thus, the earliest date that continuing education will be required for an already certified limited scope operator is March 13, 2026.

Q: When should my CA certify with the State?

A: That is a decision every office must make for themselves. However, keep in mind that once the CA certifies with the State, the two-year continuing education requirement begins immediately. For example, if the CA certifies on March 1, 2025, they will be required to have the needed continuing education to re-certify by March 1, 2027. If the CA waits until later in the process to certify, the deadline for the continuing education needed for re-certification is also delayed.

One option would be to complete the didactic (online classroom) portion of the training now, then complete the clinical portion at your convenience as we get closer to the March 17, 2027, date in which the certification must be completed.

Stay tuned for more information on when the didactic training through the MAC will be available, and when the clinical metrics and sample competency certificate for the clinical portion of the requirement (that each doctor will need to provide in their office) will be available.