California’s AB 460 bill, first introduced by the California Radiological Society (CRS) to establish alegal framework for virtual contrast supervision and align with CMS standards, was officially signed into law by Governor Newsom on Thursday, October 9th. This represents a meaningful step forward for medical imaging in California, though important amendments introduced at the Governor’s request have also added complexity for imaging facilities seeking to remain compliant.
At its core, AB 460 clarifies that virtual supervision of radiologic technologists is permissible in California. This is a positive and long-awaited acknowledgment, and proves that virtual care models have a legitimate role to play in medical imaging.However, the amended and signed version adds an important condition: a licensed practitioner,such as a registered nurse, nurse practitioner, clinical nurse specialist, physician assistant, or physician, must be physically present onsite when virtual supervision is provided by a remote physician.
This onsite requirement, while well-intentioned, introduces new operational and financial considerations. For many imaging centers, the cost and availability of onsite licensed practitioners will make it difficult to deploy virtual supervision.That said, there are creative and compliant ways forward. Facilities that integrate RNs or other qualified practitioners into broader clinical or operational roles, such as supporting patient flow, improving throughput, or assisting with care coordination, may find that virtual supervision remains both feasible and valuable. With thoughtful planning, this model can enhance patient experience while ensuring financial viability and compliance.
Supporters of the onsite requirement have emphasized patient safety, which remains a shared priority across the industry. However, it’s worth noting that other states have safely implemented virtual supervision under the CMS model, one that allows radiologic technologists to perform contrast injections under remote physician oversight. To date, no evidence suggests that requiring an onsite practitioner improves safety outcomes compared with CMS’s approach
Earlier drafts of AB 460 permitted virtual supervision without the additional onsite personnel clause, reflecting extensive discussion, safety review, and public input. While the final revision adds complexity, it also creates a foundation to build on. As imaging providers begin implementing virtual supervision in California, there is an opportunity to gather data,demonstrate safety outcomes, and inform future adjustments that bring California into closer alignment with national standards.
If California hopes to maintain its leadership in healthcare innovation and patient access, future legislative efforts could consider:- Refining AB 460 to allow adequately trained radiologic technologists to perform contrast injections under remote supervision, consistent with broader CMS standards.- Encouraging data-driven evaluation of patient outcomes and workflow efficiency in hybrid models that incorporate onsite RNs or other licensed practitioners.- Prioritizing sustainability and access for community imaging providers who play a vital role in delivering affordable, high-quality care.
AB 460 represents a meaningful acknowledgment of virtual supervision’s role in modern healthcare, but it also highlights the growing pains of translating innovation into policy. With continued collaboration between regulators, clinicians, and imaging leaders, California can refine this framework into one that both safeguards patients and empowers imaging companies to deliver the most efficient, equitable imaging care possible.Because ultimately, if there’s a will, and a shared commitment to patient-centered innovation,there’s a way forward.
54,000+
Contrast exams supervised monthly
44,000+
Hours of supervision monthly
2,200+
Technologists certified
0s
Of imaging partners nationwide
30+
Contrast reactions treated monthly
0%
Requested hours covered
