FAQs

Being a regulated health professional is complex. We’re happy when MRITs ask us to help them understand topics like practice standards, quality assurance requirements, or the role and responsibilities of CMRITO in regulating MRITs. Here are some your most frequently asked questions.

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Why doesn’t CMRITO have a masking policy for MRITs working in hospitals and other health facilities? 

CMRITO regulates the profession of medical radiation and imaging technology in Ontario, not the facilities MRITs practise in. As a result, the College does not have the authority to set masking protocols for the facilities where MRITs practise. Neither the Regulated Health Professions Act, 1991 nor the Medical Radiation and Imaging Technology Act, 2017, the provincial acts that govern the College, allow CMRITO to do this.

Hospitals, integrated community health services centres, and other health care settings are responsible for establishing and enforcing their own masking policies. In an emergency, such as the COVID-19 pandemic, the Chief Medical Officer of Health for the province may institute masking mandates.

MRITs are reminded to follow the policies and procedures set at each of the locations where they practise, recognizing that different workplaces may have different policies and guidelines in place. As expressed in Standard #4 of the CMRITO Standards of Practice, “Members must have and maintain the knowledge, skills and judgement to practise safely by adhering to all relevant provincial and federal legislation and guidelines, departmental protocols and policies and manufacturers’ directions pertaining to health and safety.”

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What is the difference between orders, protocols, medical directives, and delegations? 

CMRITO Standards of Practice require registrants to ensure that they have an appropriate order prior to performing every procedure, treatment, or intervention. This applies to all procedures performed by registrants in all five specialties: radiography, radiation therapy, nuclear medicine, magnetic resonance and diagnostic medical sonography.

Orders
An order is an authorizing statement from a regulated health professional with prescribing authority, permitting registrants to perform a procedure, treatment or intervention that falls within the scope of practice of the profession. An order may also be called a requisition, protocol, medical directive or treatment plan.

An order may be one of two types:

1. Direct orders are orders for a specific procedure, treatment or intervention, to be performed on a specific patient, by an authorized health professional. Direct orders may be written, electronic or verbal.

  • For example: a patient arrives at the imaging department with a requisition, signed and dated by their family physician, for a chest x-ray to rule out pneumonia. 

2. Medical directives (also known as standing orders or protocols) are orders for a procedure, treatment, or intervention for a range of patients who meet specific conditions, authorized by a physician. Medical directives are always written or documented electronically. They cannot be verbal. 

  • For example: a patient arrives for an MRI of their brain to rule out brain metastases. The radiologist approved department protocol requires IV contrast for this procedure. The original requisition is for a Brain MRI (the direct order) and the department protocol provides the order to set up an IV and to give the contrast (the medical directives). 

Delegations 
Registrants of the CMRITO are not permitted to delegate the controlled acts they are authorized to perform and do not typically perform delegated acts. This is because most of the controlled acts CMRITO registrants perform in their practice fall under the five authorized acts they already have the authority to perform, provided they have a direct order or a medical directive to perform the authorized act. However, on occasion, some registrants will accept and perform the delegation of a controlled act which is not one of the five authorized acts.

  • For example: communicating to an individual or their personal representative a diagnosis is not one of the controlled acts authorized to registrants of CMRITO. However, registrants who perform procedures where pregnancy may be a contraindication may need to communicate pregnancy test results to their patient after performing a pregnancy test. This process would need to be set up as a delegation. 

The Health Profession Regulators of Ontario (HPRO) have developed a guide to address questions regarding the use of orders (direct orders and medical directives) and delegations across all professions and practice settings. You can find more information as well as templates for medical directives and delegations on the HRPO website.
For more information about orders and delegations, please read What you must know about … performing procedures.

This question was originally raised in the Winter 2023 issue of Insights.

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My department has hired an MRIT ‘assistant’ or ‘unregistered technologist’ to assist with patient preparation and other tasks. Is this legal? What can/can’t this individual do?

CMRITO protects the public by ensuring that only qualified MRITs are registered with CMRITO and able to practise the profession in Ontario. Medical imaging or radiation therapy departments who need additional support may employ ‘assistants’ in their departments to fill employment and service gaps or to help with patient throughput. The roles and responsibilities of these positions are hospital/ facility specific.

The legislative framework permits individuals to work in a supportive role, provided that the individuals do not perform any of the clinical activities restricted to CMRITO registrants.

Unless the individual is registered with CMRITO, they are not legally authorized to apply a form of energy or perform any of the controlled acts authorized to CMRITO registrants.

Therefore, an assistant or unregistered technologist cannot: 

  • apply ionizing radiation to human beings 
  • apply electromagnetism for magnetic resonance imaging procedures 
  • apply soundwaves for diagnostic medical sonography 
  • administer substances by injection or inhalation 
  • perform tracheal suctioning of a tracheostomy 
  • administer contrast media or put an instrument, hand or finger, 
    • beyond the opening of the urethra, 
    • beyond the labia majora, 
    • beyond the anal verge, or 
    • into an artificial opening of the body 
  • perform a procedure on tissue below the dermis, including starting an IV 

The ‘unregistered technologist’ or ‘assistant’ cannot perform any of the procedures listed above, even if the individual is working under the supervision of a CMRITO registrant

Sometimes students who have recently completed an approved educational program in medical radiation and imaging technology are hired as ‘unregistered technologists’ while their application for registration is being considered for approval by CMRITO. In this situation, the above restrictions still apply, and continue to apply until they are registered with CMRITO.

To learn more about this topic, please read CMRITO’s What you must know about … illegal practice publication and watch the What you must know about … illegal practice webinar. 

This question was originally raised in the Fall 2022 issue of Insights.

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What imaging exams are Nurse Practitioners authorized to order? 

Nurse Practitioners (NPs) are authorized to order x-ray, diagnostic ultrasound, computerized tomography (CT) and magnetic resonance imaging (MRI) scans.

The College of Nurses of Ontario (CNO) has established standards for NPs to support safe practice when ordering x-rays, ultrasounds, CTs and MRIs. Please visit the CNO website for more information.

MRITs who perform CT or MRI examinations on the order of an NP, or other authorized health care professional, will follow the protocols and medical directives established in their departments regarding other authorized acts to support the performance of the procedure.

To learn more about this topic, please read CMRITO’s What you must know about … performing procedures publication and watch the What you must know about ... performing procedures webinar.

This question was originally raised in the Summer 2022 issue of Insights.

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As a CMRITO registrant, can I perform procedures in another specialty of medical radiation and imaging technology, even if I’m not registered in that specialty? 

A registrant in one specialty can perform procedures in another specialty, provided that certain conditions set out in the legislation and the CMRITO Standards of Practice are met. The legislative framework governing the practice of CMRITO registrants enables MRITs to learn new skills and support the development of new procedures and processes, while also ensuring the effective, safe and ethical delivery of medical radiation and imaging technology services to patients.

All CMRITO registrants have a term, condition and limitation on their certificate of registration that they can only practise in the areas of medical radiation and imaging technology in which they are educated and experienced.

The CMRITO Standards of Practice require that MRITs are competent to perform any procedures they undertake, that they have the knowledge, skills and judgement to perform any procedure safely, effectively and ethically, and that they are able to manage any outcomes resulting from that procedure.

As a self-regulated health professional, you are in the best position to determine which procedures you are competent to perform, and you are ultimately responsible to ensure that you are competent to provide the medical radiation or imaging services required by patients within a particular practice setting. If you are not competent to perform a procedure, then you must not perform it and must take appropriate action to address the situation.

Registrants can attain the competencies necessary to perform a procedure in another specialty in several ways including on the job training, supervised clinical training from a colleague member who practices in that specialty, theoretical course work, or by completing a post-graduate certificate program offered by an educational institute or professional association.

Registrants are also responsible for meeting any training or qualifications required by their workplace to perform procedures in that practice setting. MRITs and facility administrators are encouraged to keep records of any additional education and training completed.

Some examples of CMRITO registrants performing procedures in another specialty include: 

  • an MRT(N) who practices in PET/CT and also applies ionizing radiation to patients for CT procedures in the diagnostic imaging department
  • an MRT(T) who applies electromagnetism for magnetic resonance imaging while administering radiation therapy using an MR-Linac machine
  • an MRT(R) who practices in a breast screening centre who performs mammography examinations and applies soundwaves for breast ultrasound examinations 

Although registrants can perform procedures in another specialty, the title and abbreviations you use must correspond to your specialty(ies) of registration. Only registrant of CMRITO registered in a particular specialty are legally authorized to use that specialty title in Ontario. 

If you have questions about this article or other professional practice matters, please contact practiceadvice@cmrito.org.

This question was originally raised in the Spring 2022 issue of Insights.

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As a manager, can I hire a new graduate before they are registered with CMRITO? 

Students who have completed an approved educational program in one of the specialties of radiography, radiation therapy, nuclear medicine, magnetic resonance and diagnostic medical sonography in Ontario are able to be hired while waiting for examination results. However, there are several restrictions on the activities that a new graduate can perform prior to their registration with CMRITO.

To practise the profession of medical radiation and imaging technology in Ontario, an individual must be registered with CMRITO.

There are exemptions in legislation that permit students in approved educational programs to perform authorized acts and to apply ionizing radiation, electromagnetism for MRI, and soundwaves for diagnostic medical sonography while they are actively enrolled in the approved educational program, provided they are supervised by a registrant of CMRITO. However, these exemptions do not apply after a person is no longer a student.

An individual who has completed an approved educational program, but is not yet registered with the College is:

  • not able to hold themselves out as a medical radiation and imaging technologist or a person qualified to practise in a specialty of medical radiation and imaging technology - MRT(R), MRT(T), MRT(N), MRT(MR) or DMS
  • not authorized to apply ionizing radiation, electromagnetism for MRI, or soundwaves for diagnostic medical sonography
  • not authorized to perform any of the controlled acts authorized to CMRITO registrants, including: 
    • administering substances by injection or inhalation
    • administering contrast media or putting an instrument, hand or finger beyond the opening of the urethra, labia majora, anal verge or into an artificial opening of the body
    • performing a procedure on tissue below the dermis

These same restrictions apply even if the new graduate is supervised by a registrant of CMRITO. More information is available in What you must know about ... performing procedures.

This question was originally raised in the Fall 2021 issue of Insights.

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Why doesn’t the CMRITO advocate on behalf of MRITs or promote the profession, such as informing MRITs of Sonography Week or MRT Week?

As the regulatory body for MRTs and DMSs in Ontario, CMRITO’s legislated mandate is to protect the public interest through the regulation of the profession. We do this by making sure that registered MRITs are qualified to practice (i.e. registration) and are practising professionally (i.e. meeting the CMRITO’s Standards of Practice).

It is a conflict of interest for the CMRITO to advocate for MRTs, DMSs or the profession of medical radiation and imaging technology. Advocacy is the role of the national professional associations – Sonography Canada and the Canadian Association of Medical Radiation Technologists (CAMRT) – and the provincial professional association – the Ontario Association for Medical Radiation Sciences (OAMRS). These organizations advocate for the profession, provide education and conferences, support individual registrants, and promote the profession through initiatives such as Sonography Week and MRT Week.

While it is outside the legislated role for CMRITO to promote the profession, we believe our registrants use their extensive expertise to provide an essential, valuable service to the public daily, and that service should be acknowledged and appreciated. This can be seen in our social media posts in support of Sonography Week and MRT Week.

To learn more about the role and regulatory responsibilities of the CMRITO, please watch the CMRITO self-regulated professionals video.

This question was originally raised in the Fall 2020 issue of Insights.

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If you have a practice question, we can help. Please contact by email at practiceadvice@cmrito.org or by phone at 416.975.4353 or 1.800.563.5847.