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FAQs about X-rays & Ultrasounds


When did NPs gain the authority to order x-rays and ultrasounds?

On April 27, 2018, the College of Nurses of Ontario (CNO) announced to all NPs in the province that restrictions related to NPs ordering x-rays (except CT Scans) and ultrasounds were removed.


Did NPAO communicate about this change?

Yes, NPAO sent an email on April 27 to notify all of its members about this important scope of practice change. See NPAO’s Breaking News email.


What tests are included in the new ordering authority?

The ordering of all x-rays (except CT Scans) and all ultrasounds are included in this new authority. These tests can be ordered by NPs for both inpatients and outpatients without restriction.

NPs can order x-rays such as BMD, angiography, barium swallow, and of the spine, etc.). All x-rays are included except CT Scan. NPs can also order echocardiogram, soft tissue ultrasound, etc. All ultrasounds are included there are no exceptions.

For a list of diagnostic tests NPs can order, please refer to CNO website under Authority & Restrictions – Diagnostic Tests tab for the list of tests NPs can order


What legislation changed to provide NPs with this new scope?

The changes for ordering all x-rays (except CT Scans) were made under the Healing Arts and Radiation Protection Act, 1990 (HARPA). The changes for ordering ultrasounds were made under the Regulated Health Professions Act, 1991 (RHPA) (Regulation 107).


Has the College of Medical Radiation Technologists of Ontario (CMRTO) communicated the changes to its members?

Yes, CMRTO communicated widely about the new NP authority to order x-rays and ultrasound to their members via email and CMRTO website.


My hospital says NPs cannot order these tests, is this correct?

No, this is not correct. NPs are permitted to order all x-rays (except CT Scans) and ultrasounds for both inpatients and outpatients. In addition, physician payment issues have been addressed. NPAO has confirmed this information with the MOHLTC. The MOHLTC also advised that there were initial issues with implementation, but these issues have since been resolved.


What if I am still having issues related to ordering x-rays and ultrasounds?

If you are having an issue related to your order, send this communication to the parties involved to provide information and education.

If you or the hospital and/or the technologist still have questions contact Service Ontario for information about the changes at:


Toll free : 1-866-532-3161

In Toronto, (416) 314-5518

TTY : 1-800-387-5559


For questions related to payments to physicians by OHIP for services ordered by NPs, contact the Health Services Branch of the Ministry of Health and Long-Term Care by phone at 1-866-684-8620 or by email at


Where can I find a list of the tests I cannot order? When will changes be made so that NPs can order theses tests?

If a diagnostic test is not listed on CNO’s website (Authority & Restrictions – Diagnostic Tests tab ) then an NP is not able to order that test. For example, an ECG in emergency circumstances and holter monitors are not on the list. Many of these outstanding items are because the test is not covered under OHIP if ordered by an NP.

Other examples of tests that are not included within NP scope include:

  • Point-of-care testing which falls under the Laboratory and Specimen Collection Centre Licensing Act;
  • CT scans is a regulation change under Healing Arts Radiation Protection Act; and
  • defibrillation and MRI and other forms of energy fall which fall under Regulated Health Profession Act (Regulation 107).


NPAO has long advocated for the removal of these barriers and continues to work diligently with the MOHLTC in addressing the remaining ones. NPAO will provide updates to members as they become available.


Contact NPAO at if you have questions.

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