Earlier this week, I wrote about publication by the American College of Radiology (ACR) of a new statement from its Drugs and Contrast Media Committee on the supervision of diagnostic tests that make use of contrast media. I wrote of my confusion about the statement and the absence of comprehensive guidance on “the who and the how” of providing remote direct supervision of contrast studies. 

Looking more closely at the statement, I can see that such a comprehensive guide was not the intent of the committee.  Instead, the committee focused only on one aspect - a critically important aspect - of the supervision of imaging studies that include the administration of contrast media. Namely, the qualification of the personnel who are on site when the contrast is administered and supervised remotely.  This is an admirable goal. 

But, some questions remain.

1. Will ACR comment on who can be the qualified persons on-site? Can they be be radiologic technologists, medical assistants or paramedics, so long as they are adequately trained and legally permitted to administer prescription medications?
2. The committee sees the facility or office looking to the general supervising radiologist to oversee the on-site qualified person who will interact with the direct supervising physician or practitioner. That makes sense. But what is meant by "This remote general supervision should be available whenever contrast material is administered and include the standard post administration monitoring…” The committee is not expecting, is it, for the general supervising physician to join the direct supervising physician/practitioner in being present virtually whenever Level 2 diagnostic tests are performed with the administration of contrast? At a time of extreme shortage of radiologists, such real-time availability of the general supervising physician would be challenging to say the least.
3. "When qualified to act under general supervision of a physician, be able to consult with the supervising physician within an appropriate timeframe." Which supervising physician/practitioner is the statement referencing, direct or general?  What is expected of the general supervising physician's availability for such a consult? What is an appropriate time frame?

One can expect that ACR's Accreditation Committee will consider whether to adopt this guidance as part of the essentials for accreditation of advanced diagnostic imaging modalities. If adopted, it is hoped that those accreditation requirements will be understood and achievable.