Can Arizona registered nurse practitioners order and interpret x-rays without a separate radiation license?

Plain-English summary

The Arizona Radiation Regulatory Agency (ARRA) regulates who can operate x-ray machines on people. Its statute says no one may "use ionizing radiation on a human being" without an ARRA-issued license. ARRA argued that the Nursing Board's 1987 rule, A.A.C. R4-19-508(B)(3), which allowed registered nurse practitioners (RNPs) to "order and interpret laboratory, radiographic, and other diagnostic tests," conflicted with that statute, because ordering and interpreting an x-ray was a form of "use." On that reading, every RNP would need a separate radiologic technologist (RT) certificate before sending a patient to imaging.

Joey Ridenour, the executive director of the Arizona State Board of Nursing, asked the AG whether the Nursing Board's rule was lawful. AG Mark Brnovich said yes, on two independent grounds.

First, "use" does not mean "order" or "interpret." The opinion read the statutory verb in its ordinary sense: "use" of an x-ray machine means physically operating it, applying ionizing radiation to a human being. That reading was confirmed by the absurdity of the alternative: ARRA does not even issue a certificate authorizing anyone to interpret x-rays. Reading "use" to include "interpret" would mean nobody could lawfully interpret an x-ray in Arizona. Reading "use" to include "order" would mean RT certificate holders could already order x-rays, but a different subsection requires them to act only "at the direction of a licensed practitioner." The structural reading therefore confined "use" to direct operation.

Second, RNPs are licensed practitioners. Section 30-672(D) exempts a list of medical professionals from needing an ARRA license to use a diagnostic x-ray machine: dentists, physician assistants, chiropodists, veterinarians, and those licensed to practice medicine, surgery, osteopathy, chiropractic, or naturopathic medicine. They are "governed by their own licensing acts." The opinion concluded that an RNP, while not on the literal list, was still governed by her own licensing act (the Nursing Practice Act and the Nursing Board's rules), and the Nursing Board had used its statutory authority under § 32-1606(B)(12) to authorize ordering and interpretation of radiographic tests. ARRA was not authorized to second-guess the Nursing Board's scope-of-practice judgment.

The opinion also distinguished an earlier 1982 AG opinion (I82-034) that had reached the opposite conclusion. That earlier opinion expressly conditioned its result on the Nursing Board not yet having promulgated authorizing rules. When the Nursing Board adopted R4-19-508(B)(3) in 1987, the predicate of the 1982 opinion fell away.

Currency note

This opinion was issued in 2017. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

How the AG worked through the statute

The opinion's central textual move was applying the dictionary meaning of "use" in A.R.S. § 32-2811(A). The Arizona Supreme Court has held in Premier Physicians Grp, PLLC v. Navarro, 240 Ariz. 193, 195 ¶ 9 (2016), that statutory interpretation begins with plain language, and in State v. Cox, 217 Ariz. 353, 356 ¶ 20 (2016), that words should carry their commonly accepted meanings unless context dictates otherwise. A.R.S. § 1-213 codifies the same canon.

The opinion identified two ordinary senses of "use": direct physical manipulation ("use a hammer") and a more abstract benefit ("use a surrogate"). It chose the direct-physical-manipulation sense, citing three contextual reasons:

1. Avoiding statutory conflict. A conflict between the Nursing Board rule and the radiation statute existed only if "use" stretched to include "order" and "interpret." Adopting the narrower reading harmonized both statutes, which the Navarro court emphasized was the goal: "courts seek to harmonize statutory provisions and avoid interpretations that result in contradictory provisions." 240 Ariz. at 195 ¶ 9. Section 32-2811(C) reinforced the harmony reading: "Nothing in this chapter relating to technologists shall be construed to limit, enlarge or affect in any respect the practice of their respective professions by duly licensed practitioners."

2. Avoiding absurdity on interpretation. ARRA does not issue any certificate authorizing the interpretation of x-ray images. Indeed, § 32-2819(E) specifically prohibits even "radiologist assistants" (a class of advanced RTs) from interpreting x-ray images. So if "use" in § 32-2811(A) included "interpret," then nobody (other than the listed exempt practitioners) could lawfully interpret an x-ray, even though no ARRA license exists for that activity. That cannot have been the legislative intent.

3. Avoiding internal contradiction on ordering. Section 32-2811(B) requires an RT to apply radiation only "at the direction of a licensed practitioner." That structurally implies someone other than the RT issues the order. If "use" in § 32-2811(A) already authorized RT certificate holders to "order" x-rays, the subsection (B) requirement would be self-contradictory.

Having confined "use" to direct physical operation, the opinion turned to the practitioner-exemption question. Section 30-672(D) exempts dentists, physician assistants, chiropodists, veterinarians, and those licensed in medicine, surgery, osteopathy, chiropractic, or naturopathic medicine from needing an ARRA license to use an x-ray machine. ARRA argued that because RNPs were not literally on this list, they were not exempt and could not order or interpret x-rays.

The opinion rejected that argument. It read the broader statutory scheme to distinguish ARRA's regulation of the technicians who operate radiation devices from the medical professionals who order and interpret diagnostic imaging. Section 32-2811(C) reflects the same point in different words: nothing in the technologist chapter limits the practice of "duly licensed practitioners." RNPs are licensed practitioners under their own licensing act. The Nursing Board, exercising statutory authority under § 32-1606(B)(12), had authorized RNPs to order and interpret radiographic tests. ARRA, the opinion concluded, had no statutory authority to override that scope-of-practice judgment by another regulatory body.

The 1982 AG opinion had concluded the opposite, but the AG read it carefully and found it self-limited: it explicitly said "inasmuch as the Board has not promulgated any rules that would otherwise permit professional nurse practitioners to order or interpret radiography examinations, they may not engage in these activities." When the Nursing Board promulgated R4-19-508(B)(3) in 1987, that condition was no longer satisfied, and the 1982 opinion's restriction lapsed.

Common questions

Q: Did this opinion say RNPs can physically operate x-ray machines?
A: No. The opinion held only that RNPs may order and interpret x-rays. The physical act of operating the x-ray machine, applying ionizing radiation to the patient, remained subject to ARRA's licensing scheme and the RT certification process. An RNP wanting to physically operate the machine would need to fall within an exemption or hold an appropriate certificate.

Q: Why was ARRA worried about this?
A: ARRA reads its statutory mandate to regulate "the use, storage and disposal of sources of radiation." The agency was concerned that allowing non-ARRA-certified professionals to direct x-ray imaging fell outside the regulatory framework that protects patients from unnecessary radiation exposure and ensures images are competently evaluated. The AG's response was that the regulatory framework for medical professionals (here, the Nursing Board's licensing of RNPs) provided the appropriate oversight, and ARRA's authority did not reach across that line.

Q: What about physician assistants?
A: Physician assistants are explicitly listed in A.R.S. § 30-672(D) as exempt from needing an ARRA license to use a diagnostic x-ray machine. The AG opinion did not address the PA scope of practice; it addressed only RNPs. PAs are governed by their own licensing acts.

Q: How did the AG reconcile the 1982 opinion?
A: The 1982 opinion (I82-034) had reasoned that an RNP's general authority to administer medications and treatment did not, by itself, authorize ordering or interpreting x-rays. But the 1982 opinion went on to say that the Nursing Board could change this by rule. The Nursing Board did so in 1987 by adopting A.A.C. R4-19-508(B)(3). The 2017 AG opinion concluded that the rule was within the Nursing Board's statutory authority and therefore valid.

Q: Can a hospital still require RT certification for everyone ordering x-rays?
A: This opinion addressed only the legal authority question, not what a hospital chooses to require for its credentialing process. Hospitals routinely impose credentialing standards beyond the statutory minimum, and a hospital could require additional training or certification as a condition of staff privileges.

Background and statutory framework

Arizona's regulation of radiation is split across multiple statutes and agencies. ARRA, established under A.R.S. § 30-654, regulates "the use, storage and disposal of sources of radiation." Its Medical Radiologic Technology Board of Examiners (MRTB) administers the RT certification process under § 32-2803(A). RT certificate holders may "apply ionizing radiation to individuals at the direction of a licensed practitioner for general diagnostic or therapeutic purposes." § 32-2801(18).

The "licensed practitioner" exemption in § 30-672(D) is broad: dentists, physician assistants, chiropodists, veterinarians, and those licensed in medicine, surgery, osteopathy, chiropractic, or naturopathic medicine do not need a separate ARRA license. They are "governed by their own licensing acts."

Registered nurse practitioners are an advanced category of registered nurse with an "expanded scope of practice within a specialty area that includes . . . diagnosing, performing diagnostic and therapeutic procedures, and prescribing, administering and dispensing therapeutic measures, including legend drugs, medical devices and controlled substances." A.R.S. § 32-1601(20)(d), (v). The Arizona State Board of Nursing has statutory authority under § 32-1606(B)(12) to "adopt rules establishing those acts that may be performed by a registered nurse practitioner in collaboration with a licensed physician."

The Nursing Board exercised that authority in 1987 with A.A.C. R4-19-508(B)(3), which authorized RNPs to "[o]rder and interpret laboratory, radiographic, and other diagnostic tests." This rule had been in place for 30 years before the question reached the AG.

Citations and references

Statutes and regulations:

• A.R.S. § 30-654 (ARRA's regulatory authority)
• A.R.S. § 30-672(D) (medical practitioner exemption from ARRA licensing)
• A.R.S. § 32-1601 (definitions, including RNP scope of practice)
• A.R.S. § 32-1606(B)(12) (Nursing Board rule-making authority for RNP acts)
• A.R.S. § 32-2811 (use of ionizing radiation; RT certification)
• A.R.S. § 32-2819(E) (radiologist assistants prohibited from interpreting images)
• A.A.C. R4-19-508(B)(3) (RNP authority to order and interpret tests)

Cases:

• Premier Physicians Grp, PLLC v. Navarro, 240 Ariz. 193 (2016) (statutory interpretation begins with plain language)
• State v. Cox, 217 Ariz. 353 (2016) (commonly accepted meanings of words)

Prior AG opinion:

• Op. Ariz. Att'y Gen. I82-034 (1982) (earlier conclusion limited by absence of authorizing Nursing Board rule)

Source

• Landing page: https://www.azag.gov/opinions/i17-002-r16-019
• Original PDF: https://www.azag.gov/sites/default/files/2025-06/I17-002.pdf

Original opinion text

To:

Joey Ridenour

Arizona State Board of Nursing

Questions Presented

Is Arizona Administrative Code (A.A.C.) Rule 4-19-508(B)(3), in which the Arizona State Board of Nursing authorized registered nurse practitioners to order and interpret radiographic tests (x-rays), consistent with Arizona law?

Summary Answer

Yes. A.A.C. R4-19-508(B)(3) is consistent with Arizona law because (1) the "use" of x‑rays does not include "ordering" or "interpreting" x-ray images and (2) the Nursing Board has licensed RNPs to order and interpret x-ray images.

Background

The Arizona Radiation Regulatory Agency (ARRA) "regulate[s] the use, storage and disposal of sources of radiation" in the State. A.R.S. § 30-654. Under this regulatory authority, the Medical Radiologic Technology Board of Examiners (MRTB), a division of ARRA, administers the radiologic technologist (RT) certification process. A.R.S. § 32‑2803(A). RT certificate holders are allowed "to apply ionizing radiation to individuals at the direction of a licensed practitioner for general diagnostic or therapeutic purposes." A.R.S. § 32-2801(18). In lay terms, this means that ARRA licenses the use of x-ray machines in the health care context. However, Arizona law also contains a broad exception to this licensing authority: dentists, physician assistants, chiropodists, veterinarians and those "licensed in this state to practice medicine, surgery, osteopathy, chiropractic or naturopathic medicine" do not need "to obtain any other license for the use of a diagnostic X-ray machine, but these persons are governed by their own licensing acts." A.R.S. § 30-672(D).

Responsible for regulating the practice of nursing in Arizona, the Arizona State Board of Nursing (Nursing Board) is authorized to "adopt rules establishing those acts that may be performed by a registered nurse practitioner in collaboration with a licensed physician." A.R.S. § 32‑1606(B)(12). Pursuant to this authority, a rule adopted in 1987 by the Nursing Board authorizes a registered nurse practitioner (RNP) to "[o]rder and interpret laboratory, radiographic, and other diagnostic tests." A.A.C. R4-19-508(B)(3). RNPs are registered nurses who have completed an advanced nurse practitioner education program and have "an expanded scope of practice within a specialty area that includes . . . diagnosing, performing diagnostic and therapeutic procedures, and prescribing, administering and dispensing therapeutic measures, including legend drugs, medical devices and controlled substances." A.R.S. § 32-1601(20)(d) and (v).

Arizona law provides that "[n]o person may use ionizing radiation on a human being unless the person is a licensed practitioner or the holder of a certificate as provided in this chapter." A.R.S. § 32-2811(A). ARRA believes that the administrative rule's authorization for RNPs to "[o]rder and interpret . . . radiographic . . . tests" without obtaining an RT certificate is contrary to Arizona law for two reasons. First, ARRA contends that persons prohibited to "use ionizing radiation" under Arizona law are necessarily prohibited from ordering and interpreting x-ray images. Second, ARRA contends that only those professions explicitly named in Section 30-672(D) qualify as exempt "licensed providers" and RNPs are not expressly listed.

Analysis

A. "Use," In A.R.S. § 32-2811(A), Does Not Include "Order" or "Interpret"

Courts interpret statutes by looking first to the plain language of the law as the best indicator of the legislature's intent. Premier Physicians Grp, PLLC v. Navarro, 240 Ariz. 193, 195 ¶ 9 (2016). Words and phrases should be given their commonly accepted meanings unless a special definition is given or the context requires otherwise. State v. Cox, 217 Ariz. 353, 356 ¶ 20 (2016); see also A.R.S. § 1-213 ("Words and phrases shall be construed according to the common and approved use of the language."). Courts "seek to harmonize statutory provisions and avoid interpretations that result in contradictory provisions". Navarro, 240 Ariz. at 195 ¶ 9.

The primary text at issue is the statutory limitation on who may "use" x-ray equipment. See A.R.S. § 32-2811(A) (no "person may use ionizing radiation on a human being."). In general, the word "use" primarily signifies a direct physical manipulation of an object ("use a hammer"), but it can also indicate a more nebulous benefit derived from an object ("use a surrogate"). The statutory context indicates that the text refers to a direct form of "use," specifically the physical act of applying ionizing radiation to a human being with an x-ray device.

Context affirms the adoption of the primary—direct-physical-manipulation—meaning of "use" for at least three reasons. First, a conflict between the administrative rule and the statute exists only if "use" includes "order" and "interpret." This serves the Legislature's intent to keep radiation regulations from inappropriately or unnecessarily interfering with the use of x-ray technology in the practice of medicine. See A.R.S. § 32-2811(C) ("Nothing in this chapter relating to technologists shall be construed to limit, enlarge or affect in any respect the practice of their respective professions by duly licensed practitioners.") The Legislature empowered both the Nursing Board and ARRA to effectively regulate their respective fields without either board encroaching on the other.

Second, it would be absurd to read the statute to say no person (other than a licensed practitioner) may "interpret" an x-ray image without ARRA approval given the fact that ARRA provides no certification entitling anyone to interpret an x-ray image. Indeed, radiologist assistants—advanced RTs who possess additional training beyond what is required to obtain an RT certificate—are specifically prohibited from interpreting x-ray images. A.R.S. § 32 2819(E).

Third, including "order" in the meaning of "use" would also be unworkable. Subsection B of § 32-2811 says that an RT can only apply radiation "while operating in each particular case at the direction of a licensed practitioner." In other words, an RT who may "use" x-ray equipment must be ordered to take an x-ray image before doing so. But if "use" includes "order" then the holder of a certificate under § 32-2811(A) would already be authorized to order an x-ray. It would be absurd to conclude that the legislature would authorize the holder of a certificate to "order" x-rays but to take x-rays only when ordered by someone else to do so.

B. RNPs are Licensed Practitioners Under A.R.S. § 32-2811(A)

Under Arizona law, a RNP is a licensed registered nurse who is certified, has completed an approved nurse practitioner education program, and has an expanded scope of practice. A.R.S. §§ 32-1601(19–20). RNPs' broad scope of practice is circumscribed by a Nursing Board empowered to "establish[] those acts that may be performed by a registered nurse practitioner in collaboration with a licensed physician." A.R.S. § 32-1606(B)(12).

ARRA's authority to regulate radiation does not reach so far as to interfere with the use of x-ray technology in the provision of health care. See A.R.S. § 32-2811(C) ("Nothing in this chapter relating to technologists shall be construed to limit, enlarge or affect in any respect the practice of their respective professions by duly licensed practitioners.") Dentists, physician assistants, chiropodists, veterinarians and those "licensed in this state to practice medicine, surgery, osteopathy, chiropractic or naturopathic medicine" do not need "to obtain any other license for the use of an X-ray machine, but these persons are governed by their own licensing acts." A.R.S. § 30-672(D). ARRA is neither competent nor authorized to dictate to a licensed medical professional when it may be necessary to order an x-ray examination or how to interpret an x-ray image. Instead, licensed medical professionals, including RNPs, are "governed by their own licensing acts." Id. Here, the Nursing Board's rule allowing licensed RNPs to order and interpret x-rays exempts RNPs from ARRA's regulatory purview.

ARRA points to a 1982 attorney general opinion that concluded that a RNP's authority to administer medications and treatment was not sufficient to authorize RNPs to order and interpret x-rays. Op. Ariz. Att'y Gen. I82-034 (1982). After analyzing the governing statutes for the nursing profession, Attorney General Corbin concluded that "the ability to administer medications and treatment" was not "sufficient authorization to order and interpret radiographs." Id. at 3. However, the next sentence turns the applicability of this conclusion on its head:

Further, inasmuch as the Board has not promulgated any rules that would otherwise permit professional nurse practitioners to order or interpret radiography examinations, they may not engage in these activities.

Id.In 1987 the Nursing Board promulgated A.A.C. R4-19-508(B)(3) and "otherwise permit[ed]" RNPs to order and interpret x-rays. RNPs, governed as they are by their own licensing acts, are now permitted to order and interpret radiographic tests. Nothing in the previous opinion of this office conflicts with this conclusion.

Conclusion

For the reasons stated above, the Nursing Board's regulation R4-19-508(B)(3), authorizing RNPs to order and interpret x-rays, is consistent with Arizona law.

Mark Brnovich

Attorney General