X-rays are high on the list of services patients expect urgent care centers to provide when needed. Currently, however, a dearth of qualified technicians can make guaranteeing that they can do so somewhat challenging.

The November issue of JUCM will start an in-depth discussion of how the industry can best approach meeting that challenge for the benefit of the patient and the individual operator. One essential part of that discussion will be answering the question of who, exactly, can perform x-rays in the urgent care center.

Qualifications aside, the answer is more complicated than you might think. So, we thought it would be beneficial to give you an overview of just how differently every state in the U.S. approaches the issue. As Alan Ayers, MBA, MAcc points out in Who Can Take X-Rays in an Urgent Care Center?, the first piece in our series, “Nearly all states require a licensed radiologic technologist (RT) to take x-rays and prohibit others from doing so.1,2 In fact, only a handful of states, do not impose any regulatory restrictions in this area.”3

The table that follows provides valuable insights.

(Note: Certification from the American Society of Radiologic Technologists requires an associate degree from an accredited school.)

StateRegulatory Authority (URL)Full RT LicenseLimited Scope LicenseLimited Scope Procedures
AlabamaAlabama Department of Health, Office of Radiation Control X-Ray Compliance Branch

https://www.alabamapublichealth.gov/radiation/xray-compliance.html  
No license requiredPass state-approved Industrial Radiology Exam

Complete 480 hours of on-the-job training
N/A
AlaskaState of Alaska Dept. of Health and Social Services, Section of State Laboratories, Radiologic Health Program

https://health.alaska.gov/dph/Labs/Pages/radiological/default.aspx  
No license required but must complete state prescribed training in radiology technology    N/AN/A
ArizonaArizona Department of Health Services Medical Radiologic Technology

https://www.azdhs.gov/licensing/special/index.php#mrt

https://www.azdhs.gov/documents/licensing/special/mrtbe/steps-to-cptr-certification.pdf?v=20220701

https://qa.azsos.gov/public_services/Title_12/12-02.htm  
ARRT Certification or Equivalent210 Training Hours

480 Clinical Hours

Pass ARRT Limited Scope of Practice in Radiography Exam

Must work under direction of licensed practitioner
X-ray, limited to chest and extremities
Arkansas  Arkansas Department of Health Radiologic Technology Licensure Program
  https://www.healthy.arkansas.gov/programs-services/topics/radiologic-technology-licensure-program

https://ssl-adh.ark.org/programs-services/topics/frequently-asked-questions-radiologic-tech
ARRT Certification or Equivalent180-Day Temporary License
Pass ARRT Limited Scope of Practice in Radiography Exam Must work under supervision of licensed practitioner
X-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam, including:

Chest
Extremities
Skull/sinus
Spine
Podiatry
CaliforniaCalifornia Department of Health, Radiologic Health Branch (RHB)

https://www.cdph.ca.gov/Programs/CEH/DRSEM/Pages/RHB.aspx

https://govt.westlaw.com/calregs/Document/IC369D8F05A2011EC8227000D3A7C4BC3?viewType=FullText&originationContext=documenttoc&transitionType=CategoryPageItem&contextData=(sc.Default)  
ARRT Certification or EquivalentLimited Permit X-Ray Technician School Diploma

Pass state-approved radiology safety and limited scope exams
Limited scope permit required for each area:

Chest
Dental
Extremities
Leg-podiatric Skull
Torso-skeletal
DEXA
ColoradoColorado Department of Public Health and Environment – X-Ray Certification Unit

https://cdphe.colorado.gov/xray

https://oitco.hylandcloud.com/CDPHERMPop/docpop/docpop.aspx  
No state license required; must pass ARRT ExamNo license required

80-hours didactic hours

480 hours clinical training

Perform 80 hands-on imaging procedures

Pass ARRT Limited Scope of Practice in Radiography Exam

24 continuing education hours every 2 years
N/A
ConnecticutConnecticut State Department of Public Health – Radiographer Licensure  

https://portal.ct.gov/DPH/Practitioner-Licensing–Investigations/Radiographer/Radiographer-Licensure-Requirements
ARRT Certification or EquivalentN/AN/A
DelawareDelaware Department of Public Health – Office of Radiation Control

https://dhss.delaware.gov/dph/hsp/orcradtechs.html

https://www.dhss.delaware.gov/dph/hsp/orcfaq.html  
ARRT Certification or EquivalentAttend approved study course

Pass ARRT Limited Scope of Practice in Radiography Exam
X-ray, must pass state-approved exam in each category:

Dental
Limited scope medical
Bone densitometry
District of Columbia N/AN/AN/A
FloridaFlorida Department of Health – Council on Radiation Protection

https://www.floridahealth.gov/licensing-and-regulation/radiologic-technology/index.html

http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0468/0468.html
ARRT Certification or EquivalentPass ARRT Limited Scope of Practice in Radiography Exam

Must work under supervision of licensed practitioner

12-hours continuing education every 2 years

Complete department-approved course of study
All licensed may perform “basic diagnostic radiography”

Separate license required for podiatry
GeorgiaGeorgia Department of Community Health

https://gsrt.wildapricot.org/licensure

https://rules.sos.ga.gov/gac/391-3-17  
No license required but must complete state prescribed training in radiology technology.  N/AN/A
HawaiiState Department of Health Indoor and Radiologic Health Branch

https://health.hawaii.gov/irhb/radforms/

https://health.hawaii.gov/irhb/files/2013/07/radtechguide.pdf  
ARRT CertificationN/AN/A
IdahoIdaho Department of Health and Welfare

https://publicdocuments.dhw.idaho.gov/WebLink/DocView.aspx?id=5513&dbid=0&repo=PUBLIC-DOCUMENTS&cr=1  
N/AN/AN/A
IllinoisIllinois Emergency Management Agency

https://public.iema.state.il.us/iema/radiation/radtech/radtechlogin.asp

https://www.ilga.gov/commission/jcar/admincode/032/03200401sections.html
ARRT Certification or EquivalentPass ARRT Limited Scope of Practice in Radiography Exam

Must work under direction of licensed practitioner
X-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam, including:

Chest
Extremities
Skull/sinus
Spine  
IndianaIndiana State Department of Health Division of Radiology and Weights & Measures

https://www.in.gov/health/cshcr/medical-radiology-services/

https://www.in.gov/health/files/A00052.PDF    
ARRT Certification or EquivalentComplete department-approved study course

Pass ARRT Limited Scope of Practice in Radiography Exam
Any radiographic procedure except:

Mammography
Contrast
Fluoroscopy
Portable surgery imaging
C-arm imaging
IowaDepartment of Public Health
https://idph.iowa.gov/permits-to-operate/general-radiologic-technologist

https://idph.iowa.gov/permits-to-operate/limited-radiologic-technologist
ARRT Certification or Equivalent24 hours continuing education every 2 yearsComplete state-approved online course

Pass ARRT Limited Scope of Practice in Radiography Exam

12 hours continuing education every 2 years
X-ray, must complete state-approved courses in each category:

Chest
Spine
Extremities  
KSKansas State Board of Healing Arts

http://www.ksbha.org/professions/LRT.shtml

http://www.ksbha.org/documents/publications/PracticeHandbook_LRT.pdf
ARRT Certification or Equivalent

12 hours continuing education in 12 months preceding renewal  
N/AN/A
KentuckyKentucky Board of Medical Imaging and Radiation Therapy

https://kbmirt.ky.gov/Pages/index.aspx  
ARRT Certification or Equivalent

24 hours continuing education in 2-year period  
Complete state-approved limited licensure course

Pass state limited scope exam.
General license allows X-ray of:

Thorax, lungs, ribs
Abdomen
Skull and sinuses
Extremities
Pectoral girdle, hips, pelvis
Spine  

Separate license required for Podiatry
DXMO
LouisianaLouisiana State Radiologic Technology Board of Examiners

https://lsrtbe.org/  

Louisiana Board of Medical Examiners
(Limited Scope in a Physician’s Office)

https://www.lsbme.la.gov/licensure/private-radiological-technologists

https://a.storyblok.com/f/150540/4ac605eeaf/radiologic-techicians.pdf  
ARRT CertificationComplete board-approved course

Must work under supervision of licensed physician in private practice setting
General x-ray in private practice setting under physician supervision
MaineRadiologic Technology Board of Examiners

https://www.maine.gov/pfr/professionallicensing/professions/radiologic-technology-board-examiners  
ARRT Certification or Equivalent

24 hours continuing education in 2-year period  
Complete state-approved limited licensure course

Pass ARRT Limited Scope of Practice in Radiography Exam

24 hours continuing education in 2-year period
X-ray, must complete supervised procedures during training for each category, then may perform for each category passed:

Skull, sinuses
Spine
Chest
Extremities
MarylandMaryland Board of Physicians – Allied Health Licensing

https://www.mbp.state.md.us/licensure_ahapp.aspx

https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gho&section=14-5B-01&enactments=False&archived=False
ARRT Certification or Equivalent

24 hours continuing education in 2-year period  
N/AN/A
MassachusettsCommonwealth of Massachusetts Radiation Control Program

https://www.mass.gov/radiation-control

https://malegislature.gov/Laws/GeneralLaws/PartI/TitleXVI/Chapter111/Section5L
ARRT Certification or Equivalent

20 hours in 2-year period  
N/AN/A
MichiganMichigan Occupational Safety and Health Administration

https://www.michigan.gov/leo/bureaus-agencies/miosha/divisions/technical-services-division/rad-safety/frequently-asked-questions
N/AN/AN/A
MinnesotaMinnesota Department of Health – X-Ray Program

https://www.health.state.mn.us/communities/environment/radiation/xray/index.html

https://www.revisor.mn.gov/statutes/cite/144.121
ARRT Certification or Equivalent

24 hours continuing education in 2-year period
Pass state-approved exam

Operators practicing before 2008 grandfathered
May only perform radiography on regions passed on state-approved exam
MississippiMississippi State Department of Health – Professional Licensure Division (RT)

http://www.msdh.state.ms.us/msdhsite/_static/30,0,82.html

http://www.msdh.state.ms.us/msdhsite/_static/resources/140.pdf  

Mississippi State Board of Medical Licensure (Limited XR)

https://www.msbml.ms.gov/Licensure/Limited_X-Ray_Machine_Operators

https://www.msbml.ms.gov/sites/default/files/Licensure/Limited%20X-Ray/radteclaw.pdf  
ARRT Certification or Equivalent

24 hours continuing education in 2-year period
12 hours state-approved education

12 hours continuing education in 2-year period
May perform radiography on:

Chest
Abdomen
Skeletal structures
MissouriMissouri Department of Health and Senior Services – Missouri Radiation Control Program

https://health.mo.gov/

https://health.mo.gov/safety/radprotection/pdf/xray-operator-requirements.pdf
N/AN/AN/A
MontanaMontana Department of Labor & Industry – Board of Radiologic Technologists

https://boards.bsd.dli.mt.gov/radiologic-technologists/license-information/radiologic-technologist

https://boards.bsd.dli.mt.gov/radiologic-technologists/license-information/limited-permit-xray
ARRT Certification or EquivalentComplete 104-hour board-approved course OR students who have completed half of ARRT-recognized RT program

Pass ARRT Limited Scope of Practice in Radiography Exam6 hours continuing education annually
X-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam, including:

Chest
Extremities
Skull/sinus
Spine
NebraskaNebraska Department of Health and Human Services

https://dhhs.ne.gov/licensure/pages/medical-radiography.aspx

https://dhhs.ne.gov/licensure/Documents/Medical%20Radiography%20Practice%20Act.pdf

https://www.nebraska.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-172/Chapter-093.pdf    
ARRT Certification or EquivalentPass ARRT Limited Scope of Practice in Radiography Exam

24 hours continuing education in 2-year period  
X-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam, including:

Chest
Extremities
Skull/sinus
Spine
Ankle and foot
Bone density
NevadaNevada Division of Public and Behavioral Health

https://dpbh.nv.gov/Reg/Radiation_Control_Programs/

https://www.leg.state.nv.us/nac/nac-459.html
N/AN/AN/A
New JerseyState of New Jersey Department of Environmental Protection – Radiation Protection Element
https://www.state.nj.us/dep/rpp/tec/index.htm

https://www.state.nj.us/dep/rpp/tec/LicInfo.htm
ARRT Certification or EquivalentLimited Chest – Complete 350-hour board-approved course

Limited Orthopedic – Complete 1,400-hour board-approved course

Pass board-approved exam or equivalent  
X-ray, must obtain license for each area of practice, including:
Chest
Orthopedic
Podiatric

Dental Licenses also available for:

Fusion Imaging CT
Urologic fluoroscopy
New HampshireState of New Hampshire Office of Professional Licensure and Certification Board of Medical Imaging and Radiation Therapy

https://www.oplc.nh.gov/board-medical-imaging-and-radiation-therapy

http://www.gencourt.state.nh.us/rsa/html/XXX/328-J/328-J-11.htm  
ARRT Certification or EquivalentComplete board-approved course of study in limited x-ray machine operation

Pass board-approved exam
X-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam or equivalent, including:

Chest
Extremities
Skull/sinus
Spine
Ankle and foot
Bone density
New MexicoNew Mexico Environment Department – Medical Imaging and Radiation Therapy Program

https://www.env.nm.gov/rcb/medical-imaging-radiation-therapy-program/

https://www.srca.nm.gov/parts/title20/20.003.0020.html  
ARRT Certification or Equivalent  Complete state-approved limited radiology program

Pass state-approved exam or equivalent

24 hours continuing education in 2-year period
X-ray, limited to:

Viscera of thorax
Extremities
Axial/appendicular skeleton
Foot, ankle, lower leg
Dental
New YorkNew York State Department of Health

https://www.health.ny.gov/professionals/doctors/radiological/

https://www.health.ny.gov/environmental/radiological/radon/docs/part_89.pdf
State-approved exam or ARRT Certification or Equivalent

12 hours continuing education annually  
N/AN/A
North CarolinaNorth Carolina Department of Health and Human Services – Radiology Compliance Branch

http://reports.oah.state.nc.us/ncac.asp?folderName=%5CTitle%2010A%20-%20Health%20and%20Human%20Services%5CChapter%2015%20-%20Radiation%20Protection

https://www.ncsrt.org/legislative  
N/AN/AN/A
North DakotaMedical Imaging and Radiation Therapy Board

https://www.ndmirtboard.com/

https://www.ndmirtboard.com/lic/LimitedX-RayMachineOperator.asp
ARRT Certification or EquivalentMust already be PA, RN/LPN, Tech, PT/PTA, or petition the board

Completed board-approved course of study

Complete 31 clinical competency exams

ARRT LXMO exam

12 hours continuing education per 2-year period
X-ray, limited to:

Chest/ribs
Abdomen
Extremities
Foot/ankle
Skull/sinuses
Spine

Other procedures may be performed during emergency with provider order and personal supervision
OhioOhio Department of Health – Radiologic Licensure

https://odh.ohio.gov/know-our-programs/radiologic-licensure/radiologic-licensure

https://odh.ohio.gov/know-our-programs/radiologic-licensure/general-info-fees/radiologic-licensure-radiographer-requirements

https://codes.ohio.gov/ohio-administrative-code/rule-3701-72-02
State-approved exam or ARRT Certification or Equivalent

24 hours continuing education in 2-year period
Complete state-approved education program or be enrolled in RT program

Complete state-approved clinical education program

Pass state-approved exam

12 continuing education hours in radiation safety
X-ray, complete competency-based clinical modules for each area, including:

Chest and abdomen
Extremities
Skull/sinus
Spine
Podiatric
Bone density
OklahomaOklahoma Medical Board

https://www.okmedicalboard.org/radiologist_assistants#laws-rules

https://www.okmedicalboard.org/radiologist_assistants/download/483/RALaw.pdf
N/AN/AN/A
OregonOregon Board of Medical Imaging

https://www.oregon.gov/obmi/resources/Pages/default.aspx

https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1418
ARRT Certification or EquivalentComplete board-approved course of study

Complete board-approved clinical study

Pass ARRT Limited Scope of Practice in Radiography Exam

Must work under supervision of licensed practitioner

18-24 hours continuing education per 2-year period (dependent on number of anatomical areas certified)
X-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam including:

Skull/sinus
Spine
Chest
Extremities
Podiatric
PennsylvaniaPennsylvania Department of State – State Board of Medicine

https://www.dos.pa.gov/ProfessionalLicensing/BoardsCommissions/Medicine/Pages/Radiology-Technician-Licensure-Requirements-Snapshot.aspx

http://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter18/subchapEtoc.html&d=reduce
ARRT Certification or Equivalent

24 hours continuing education per 2-year period  
Pass ARRT Limited Scope of Practice in Radiography ExamX-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam including:

Skull/sinus
Chest
Extremities
Rhode IslandState of Rhode Island Department of Health

https://rules.sos.ri.gov/regulations/part/216-40-05-34
ARRT Certification or EquivalentN/AN/A
South CarolinaSC Radiation Quality Standards Association

https://www.scrqsa.org/

https://cdn.ymaws.com/www.scrqsa.org/resource/resmgr/Governance/Final_Rules_and_Procedures_J.pdf
ARRT Certification or Equivalent

24 hours continuing education in 2-year period (excluding first renewal)
Complete board-approved course of study

Pass board-approved exam
May apply for limited license in the following areas:

General
Chest only
Chiropractic
Podiatric
Bone density
South DakotaSouth Dakota Department of Health

https://doh.sd.gov/providers/licensure/xray.aspx

https://sdlegislature.gov/Rules/Administrative/17498

https://sdlegislature.gov/Rules/Administrative/17500
No state license required.
ARRT Certification, another state license, or 40 hours training required to operate

5 hours continuing education per 3-year period
No state license required. ARRT Certification, another state license, or 40 hours training required to operate

5 hours continuing education per 3-year period
N/A
TennesseeTennessee Department of Health – Board of Medical Examiners

https://www.tn.gov/health/health-program-areas/health-professional-boards/me-board/me-board/xray-operators.html  

https://publications.tnsosfiles.com/rules/0880/0880-05.pdf
ARRT Certification or EquivalentComplete state-approved training course

Pass ARRT Limited Scope of Practice in Radiography Exam
X-ray, must be certified for each area:

Chest
Extremities
Spine
Skull/sinus
TexasTexas Medical Board

https://www.tmb.state.tx.us/page/licensing-full-medical-radiologic-technologist

https://www.tmb.state.tx.us/page/licensing-limited-medical-radiologic-technologist
ARRT Certification or EquivalentPass ARRT Limited Scope of Practice in Radiography Exam

Pass Texas Medical Jurisprudence Exam
X-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam including:

Skull/sinus
Spine
Chest
Extremities
Podiatric
UtahUtah Department of Commerce – Division of Occupational and Professional Licensing

https://dopl.utah.gov/rad/
ARRT Certification or Equivalent

24 hours continuing education per 2-year period           
Pass ARRT Limited Scope of Practice in Radiography Exam

10 hours continuing education per 2-year period
X-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam including:

Skull/sinus
Spine
Chest
Extremities
Podiatric
VTVermont Secretary of State – Office of Professional Regulation Radiologic Technology Licensing

https://legislature.vermont.gov/statutes/fullchapter/26/051

http://www.vtlmi.info/licocc.cfm?page=index#L
ARRT Certification24 hours continuing education per 2-year period  N/AN/A
VirginiaVirginia Department of Health Professions – Board of Medicine

https://www.dhp.virginia.gov/Boards/Medicine/AbouttheBoard/RegulatedProfessions/RadiologicTechnology/

http://www.dhp.virginia.gov/media/dhpweb/docs/med/leg/RadTech.pdf
ARRT Certification or EquivalentMinimum 50-hour board-approved education course

Pass ARRT Limited Scope of Practice in Radiography Exam
X-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam including:

Skull/sinus
Spine
Chest
Extremities
Podiatric  

To perform x-ray of abdomen/pelvis, must have 25 additional clinical hours  
WashingtonDepartment of Health

https://doh.wa.gov/licenses-permits-and-certificates/professions-new-renew-or-update/radiologic-technologist

https://app.leg.wa.gov/rcw/default.aspx?cite=18.84&full=true&pdf=true

https://doh.wa.gov/sites/default/files/legacy/Documents/Pubs/686046.pdf?uid=6312322ec87bb
Complete board-approved education course

Pass state-approved exam or ARRT exam
Complete registration formX-ray of:

Skull/sinus
Spine
Chest
Extremities
West VirginiaMedical Imaging and Radiologic Technologists Board of Examiners

https://www.wvrtboard.org/

http://www.wvlegislature.gov/wvcode/code.cfm?chap=30&art=23#01
Complete state-approved education course

Pass state-approved exam or ARRT exam
N/AN/A
WisconsinDepartment of Safety and Professional Services

https://dsps.wi.gov/Pages/Professions/RadiographerLicensed/Default.aspx

https://docs.legis.wisconsin.gov/statutes/statutes/462/03/1/b  
ARRT Certification or EquivalentComplete board-approved course of study

Pass board-approved exam
X-ray of:

Chest
Extremities (excluding pelvis/hips)
Foot and ankle
Spine
WyomingBoard of Radiologic Technologists Examiners

https://radiology.wyo.gov/ https://docs.google.com/document/d/1JVoRBb4Us3dNpjRu2z54nae-YDXvzNbGl_oaxKznFV4/edit

https://drive.google.com/file/d/1jVv-cFttz5cdYOimYv9eu4eZBUp2StaF/view  
ARRT Certification or EquivalentPass ARRT Limited Scope of Practice in Radiography ExamX-ray, all areas/modules passed on Limited Scope of Practice in Radiography Exam including:

Skull/sinus
Spine
Chest
Extremities
Podiatric  

References

  1. See Buchanan v Dept of Health. 322 So. 3d 238, 239 (Fla. DCA 2021).
  2. Commonwealth v Kattupalli, 221 A.3d 238 (Pa. Super. Ct. 2019).
  3. Individual State Licensure Information. American Society of Radiologic Technologists. Available at: https://www.asrt.org/main/standards-and-regulations/legislation-regulations-and-advocacy/individual-state-licensure.

For more on this timely and important topic, watch for the November and December issues of JUCM.

What Qualifies Someone to Take X-Rays in the Urgent Care Center? It All Depends on Where You’re Located
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