Tools of the trade: Untangling medical directives, delegations, and the medical radiation technology regulatory landscape in Ontario,✰✰★,

As self-regulated professions, it is incumbent on all disciplines of medical radiation and imaging technologists (MRITs) to maintain an understanding of how their practice is governed, including how its scope of practice and any governing legislation can be leveraged responsibly to optimize practice. With a focus on Ontario, Canada, this paper provides a primer on some of the key regulatory considerations for practice that may be of particular relevance as the profession seeks to optimize its ability to contribute to safe and timely care and to mitigate pressing staffing considerations. In certain Canadian provinces, including Ontario, MRIT disciplines are self-regulated, meaning that practice of the MRIT professions are overseen by a designated self-governing regulatory body in the public interest, pursuant to relevant healthcare legislation in that province. Multiple pieces of legislation govern the practice of MRITs in Ontario; the Regulated Health Professions (RHPA) Act is the legislation that governs all of Ontario's regulated health professions' colleges and identifies controlled acts. The Medical Radiation and Imaging Technology Act (MRIT Act) is the companion act that sets out the scope of practice for the profession and identifies controlled acts that are authorized to MRITs. A medical directive is a document that serves as an order for a procedure, treatment or intervention for a range of patients who meet specific conditions, authorized by a physician, and implemented by another individual. Some practical examples for MRITs include orders for establishing peripheral intravenous access for administration of contrast media (when a medical imaging or radiation therapy simulation scan has been ordered), or administering a pregnancy test (when nuclear medicine exam has been ordered). Delegation is the process by which a regulated health professional authorized to perform a controlled act, gives that authority to someone who is not authorized. Ontario examples include disclosure of results of pregnancy test prior to performing a nuclear medicine exam (RHPA Controlled Act 1) and the prescription of pharmaceuticals from a defined formulary in advanced practice radiation therapy roles (RHPA Controlled Act 8). Medical directives and delegations can be applied responsibly in various MRIT settings, including in standard practice, advanced practice, for MRIT students (and as-yet-uncertified graduates), and for limited practice or assistant MRIT roles.