The short answer
What does ALARA stand for?
ALARA stands for "as low as reasonably achievable." It is the radiation protection principle that exposure should be kept as far below the legal dose limits as is practical, using time, distance and shielding. The Nuclear Regulatory Commission (NRC) wrote it into its rules, and in July 2026 proposed to remove it. The annual dose limits would stay.
- Status
- Proposed, not final
- Published July 15, 2026. Public comments closed August 31, 2026.
- Final rule
- Expected late November 2026
- Executive Order 14300 set a deadline of about November 23, 2026. None was published as of November 4, 2026.
- Dose limits
- Would stay
- The annual limits stay, including 150 millisieverts (mSv) a year for the lens of the eye.
- Fluoroscopy labs
- Reached through states
- The commission regulates radioactive materials, not X-ray machines. State rules are where a change could reach X-ray users.
The principle
What ALARA means in a fluoroscopy lab
A dose limit is the most a worker may receive in a year. ALARA asks for more: that a lab keep doses well below the limit wherever it reasonably can. The limit is the ceiling, and ALARA is the reason most monitored workers stay far below it. In a fluoroscopy lab it shows up as four daily habits.
Time
Shorter fluoroscopy time, and the lowest image settings that still answer the clinical question.
Distance
Scatter radiation falls off quickly with distance, so extra space between staff and the patient lowers dose wherever the case allows.
Shielding
Lead aprons, thyroid shields, leaded eyewear, ceiling-suspended and table shields, and newer engineered protection systems.
Monitoring
Dosimeters that are worn and reviewed, so a team can see its doses and act on them.
In the United States, ALARA is defined and required in the Nuclear Regulatory Commission's rule on standards for protection against radiation, Part 20 of Title 10 of the Code of Federal Regulations (CFR). Its own words:
ALARA (acronym for “as low as is reasonably achievable”) means making every reasonable effort to maintain exposures to radiation as far below the dose limits in this part as is practical consistent with the purpose for which the licensed activity is undertaken, taking into account the state of technology, the economics of improvements in relation to state of technology, the economics of improvements in relation to benefits to the public health and safety, and other societal and socioeconomic considerations, and in relation to utilization of nuclear energy and licensed materials in the public interest.
International guidance calls the same idea optimization of protection, and the United Kingdom says "as low as reasonably practicable" (ALARP). A related 2026 framework, ALARA+, adds the injuries caused by heavy lead protective garments. Read the ALARA+ explainer.
The dates
What is changing, in order
Every date below links to the document it comes from.
May 23, 2025
Executive Order 14300 tells the NRC to reconsider ALARA
The order, "Ordering the Reform of the Nuclear Regulatory Commission," told the Nuclear Regulatory Commission (NRC) to reconsider its reliance on the linear no-threshold (LNT) model, which assumes that any dose carries some risk in proportion to the dose, and on the "as low as reasonably achievable" standard, which the order says is predicated on LNT. It gave the NRC 18 months to finish revising its rules.
January 9, 2026
A Department of Energy memo approves removing ALARA
A memo dated January 9, 2026 and signed by Energy Secretary Chris Wright approved removing ALARA from all Department of Energy (DOE) directives and, once rulemaking is complete, from Part 835 of Title 10 of the Code of Federal Regulations (CFR), DOE's worker radiation protection rule. E&E News reported it on January 12. DOE later denied that it had abandoned its radiation safety standards, and Part 835 still contained ALARA on November 2, 2026. DOE oversees weapons sites, national laboratories and cleanup sites, not hospitals.
July 15, 2026
The NRC proposes to replace ALARA with a graded approach
The NRC published "Reforming and Modernizing the NRC's Radiation Protection Framework" (91 Federal Register 43456). It proposes to remove the definition of ALARA because the term would no longer be used, and to add a "graded approach to dose management," in which protection measures increase as expected or actual doses pass set dose levels, so that the dose limit is not exceeded. Public comments closed on August 31, 2026.
Late November 2026
A final rule is expected
Executive Order 14300 gave the NRC 18 months from May 23, 2025 to issue final rules, which is November 23, 2026. No final rule had been published as of November 4, 2026. This page will be updated when the NRC publishes one.
After a final rule
States decide how to match it
In its proposal the NRC says its Agreement States, the states that regulate radioactive materials in its place, would be required to revise their matching rule and remove the ALARA requirement. Each state decides how and when. ORSIF's State Rules Map shows where each state's ALARA requirement for X-ray users sits today.
The proposal
What the NRC proposal would change, and what it would not
Would change
- The word ALARA would leave the NRC's radiation protection rule, 10 CFR Part 20, with its definition and its requirement that licensees keep doses as low as reasonably achievable.
- A graded approach to dose management would take its place, with protection measures that increase as expected or actual doses pass set dose levels.
- A new planned extension of the annual limit would let a worker with unused dose from the previous five years receive up to twice the annual limit in one year. It would not apply to the lens of the eye.
- Agreement States would be required to revise their matching rule and remove the ALARA requirement.
Would not change
- The annual dose limits in 10 CFR Part 20: 50 mSv a year for the whole body and 150 mSv a year for the lens of the eye.
- The lens limit. The NRC noted that the National Council on Radiation Protection and Measurements (NCRP) recommends 50 mSv a year for the lens, called those findings preliminary, and did not propose a change.
- Who regulates X-ray machines. The NRC regulates radioactive materials, so fluoroscopes stay under state radiation control programs.
The NRC's lens limit, 150 mSv a year, is 7.5 times the 20 mSv a year that the International Commission on Radiological Protection (ICRP) recommends. The proposal leaves that gap in place, which makes everyday ALARA practice the main way a lab keeps lens dose low.
For your team
What it means for your lab
Your rules have not changed
A proposal is not a rule. Until the NRC publishes a final rule and your state acts on it, your state's current requirements and your facility's radiation safety program still apply.
The path to your lab runs through your state
ORSIF's State Rules Map found that in 20 of the 41 Agreement States the ALARA requirement for X-ray users sits only in a rule shared with radioactive materials. Look up your state to see where its requirement lives. The map is an ORSIF research summary that a regulatory expert has not yet reviewed, so confirm any requirement at the source.
Safe practice does not wait for a rule
Shorter fluoroscopy time, distance, shielding and monitored doses lower exposure whether or not a rule names ALARA. Ask your radiation safety officer (RSO) how your facility's program is written and whether it refers to ALARA. RSOs and medical physicists can also follow how their state radiation control program responds.
Frequently asked
Common questions about ALARA
What does ALARA stand for?
ALARA stands for "as low as reasonably achievable." In radiation protection it means making every reasonable effort to keep exposure as far below the legal dose limits as is practical. In a fluoroscopy lab that means shorter fluoroscopy time, more distance from the patient, good shielding and monitored doses.
Is the NRC eliminating ALARA?
Not yet. On July 15, 2026 the Nuclear Regulatory Commission (NRC) proposed to remove ALARA from its radiation protection rule and replace it with a graded approach to dose management. Public comments closed on August 31, 2026. As of November 4, 2026 no final rule has been published; one is expected around late November 2026.
Would the NRC proposal change dose limits?
The proposal keeps the annual dose limits in the Nuclear Regulatory Commission (NRC) rule, including 50 millisieverts (mSv) for the whole body and 150 mSv for the lens of the eye. It adds a new option, a planned extension of the annual limit for a worker with unused dose from the previous five years, which does not apply to the lens. The NRC lens limit is 7.5 times the 20 mSv a year that the International Commission on Radiological Protection (ICRP) recommends.
Does the NRC proposal apply to fluoroscopy and X-ray machines?
Not directly. The Nuclear Regulatory Commission (NRC) regulates radioactive materials, and X-ray machines such as fluoroscopes are regulated mainly by state radiation control programs. But the NRC proposes that its Agreement States, the states that regulate radioactive materials in its place, revise their matching rule to remove the ALARA requirement. In many states one rule covers both radioactive materials and X-ray use, so a change could reach X-ray users.
Which states could be affected?
ORSIF's State Rules Map found that in 20 of the 41 Agreement States the ALARA requirement for X-ray users sits only in a rule shared with radioactive materials, and that 6 of the 51 jurisdictions (50 states and the District of Columbia) have no ALARA requirement for X-ray users at all. The map is an ORSIF research summary that a regulatory expert has not yet reviewed, so confirm each state's rule at its source.
Did the Department of Energy end ALARA?
A Department of Energy (DOE) memo dated January 9, 2026 approved removing ALARA from all DOE directives and, once rulemaking is complete, from its worker radiation protection rule (Part 835 of Title 10 of the Code of Federal Regulations). DOE later denied that it had abandoned its radiation safety standards, and Part 835 still contained ALARA on November 2, 2026. The department oversees weapons sites and national laboratories, not hospitals.
When will the NRC publish a final rule?
Executive Order 14300 told the Nuclear Regulatory Commission (NRC) to issue final rules within 18 months of May 23, 2025, which is November 23, 2026. The NRC had not published a final rule as of November 4, 2026. ORSIF updates this page when it does.
Does ALARA still apply in my hospital?
Yes. A proposed rule is not a rule. Until a final rule is published and your state acts on it, your state's current requirements and your facility's radiation safety program still apply. ORSIF's State Rules Map, which a regulatory expert has not yet reviewed, found an ALARA requirement for X-ray users in 45 of 51 jurisdictions. Ask your radiation safety officer how your program is written.
What is the difference between ALARA and ALARA+?
ALARA covers radiation dose. ALARA+ ("As Low And as Light As Reasonably Achievable"), introduced in a 2026 summit paper endorsed by nine medical societies, extends it to the musculoskeletal injuries caused by heavy lead protective garments. It is a consensus framework, not a regulation.
More answers are in the radiation safety FAQs, and ORSIF's news posts explain the background: the NRC proposal and the Department of Energy memo.
Sources
Where each fact comes from
Reforming and Modernizing the NRC's Radiation Protection Framework (91 Federal Register 43456)
The Nuclear Regulatory Commission's proposed rule (docket NRC-2025-1140). It proposes removing the definition of ALARA, adds a graded approach to dose management, keeps the annual dose limits and set a comment deadline of August 31, 2026.
The proposed rule's public docket
The docket for the proposed rule, where comments were filed.
Executive Order 14300, Ordering the Reform of the Nuclear Regulatory Commission (90 Federal Register 22587)
Signed May 23, 2025. Section 5(b) tells the NRC to reconsider the linear no-threshold model and the ALARA standard, and Section 5 sets 18 months for final rules.
Definitions, including ALARA
The NRC's current definition of ALARA, read on November 2, 2026.
Radiation protection programs
Paragraph (b) requires NRC licensees to use procedures and engineering controls to achieve doses that are ALARA.
Occupational dose limits for adults
The annual limits the proposal keeps, including 150 mSv a year for the lens of the eye.
Radiation protection programs at DOE sites
DOE's worker rule. Paragraph (c) still calls for the ALARA process, read on November 2, 2026.
DOE kills decades-old radiation safety standard
The first report that the Energy Secretary had ended DOE's use of ALARA.
Fast-tracking nuclear facilities raises worker safety concerns
Reports the Energy Secretary's memo dated January 9, 2026 and the Idaho National Laboratory report it relies on.
DOE denies ditching ALARA; review sought in 2025 executive order
Reports DOE's denial that it had abandoned its radiation safety standards.
Related from ORSIF
- State Rules Map: what every state requires of fluoroscopy teams
- What is ALARA+? The 2026 reframing of radiation safety
- ORSIF news: NRC moves to eliminate ALARA
- ORSIF news: the Department of Energy and ALARA
- Radiation safety FAQs
Acronyms used on this page: as low as reasonably achievable (ALARA); Nuclear Regulatory Commission (NRC); Department of Energy (DOE); linear no-threshold (LNT); Code of Federal Regulations (CFR); International Commission on Radiological Protection (ICRP); National Council on Radiation Protection and Measurements (NCRP); millisievert (mSv); radiation safety officer (RSO).
This page is education, not legal advice. Rules change, so confirm any requirement at the source and with your facility's radiation safety officer. Last updated November 4, 2026.