{ "title": "ORSIF State Rules Map", "description": "What each state's rules say about ALARA, dose limits, dosimeters, protective aprons and operator training for fluoroscopy teams.", "researchedOn": "2026-11-03", "recheckedOn": "2026-11-05", "agreementStateListSource": "https://www.nrc.gov/agreement-states (updated 2026-10-29); NRC fact sheet: 41 Agreement States as of October 2026", "method": "Compiled with AI-assisted research from each jurisdiction's own rules; 663 of 670 quotes were matched word for word to pages the research read. Not comprehensive and not always accurate: answers can be incomplete, out of date or wrong. Not legal advice. Rules change; double-check with the state radiation control program, the linked sources and your facility's radiation safety officer.", "notice": "ORSIF research summary. Please double-check this information: it is not comprehensive or always accurate.", "hub": "https://orsif.org/guidelines/us/states.html", "jurisdictions": [ { "code": "AL", "name": "Alabama", "pageUrl": "https://orsif.org/guidelines/us/states/alabama", "regulator": { "name": "Alabama Department of Public Health (ADPH), Office of Radiation Control (X-Ray Compliance Branch)", "url": "https://www.alabamapublichealth.gov/radiation/index.html" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Alabama's X-ray rule (420-3-26-.06) has no ALARA wording, but it makes registrants responsible for the shared Standards for Protection Against Radiation rule (.03), whose.03(5)(b) holds the ALARA duty for both materials licensees and X-ray registrants, so an NRC-driven change would reach fluoroscopy users. Dose limits follow the federal model: 50 mSv whole body, 150 mSv lens, 500 mSv skin/extremities, and 5 mSv embryo/fetus. Aprons of at least 0.25 mm lead equivalent are required for all in the room except the patient, unless measurements indicate otherwise; the rules do not address engineered shielding systems used in place of aprons, the state may grant waivers only for existing machines or installations that reach equivalent protection by other means, and the rules set no apron inspection schedule and say nothing about thyroid shields or eyewear. Alabama does not license radiologic technologists; operators need only be adequately instructed and competent.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The ALARA requirement and its definition are only in shared rule.03, which covers both materials licensees and X-ray registrants. Rule.06 has no ALARA wording and refers back to.03, so an NRC-driven change to.03(5)(b) would reach fluoroscopy registrants.", "citation": "r. 420-3-26-.03(3)(g), (5)(b); r. 420-3-26-.06(3)(f)1" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes, since October 1, 1966. The Agreement State program is run by the same Office of Radiation Control within ADPH.", "citation": "NRC list of Agreement States, updated October 29, 2026; NRC, Alabama Periodic Meeting Summary (May 2021), §3.1", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.nrc.gov/docs/ML2116/ML21162A113.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Ala. Admin. Code r. 420-3-26-.06 (X-ray/fluoroscopy rule, last amended effective June 24, 2010) and r. 420-3-26-.03 (Standards for Protection Against Radiation, last amended effective Nov 24, 2014, operative Dec 1, 2014). Machine registration is in r. 420-3-26-.05.", "citation": "r. 420-3-26-.06; r. 420-3-26-.03(1)-(2)", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.06", "https://admincode.legislature.state.al.us/api/rule/420-3-26-.03" ], "quote": "this Rule applies to persons licensed or registered by the Agency to receive, possess, use, transfer, or dispose of sources of radiation.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes, indirectly. The ALARA duty in.03(5)(b) applies to every licensee or registrant, and.06(3)(f)1 makes X-ray registrants responsible for meeting all of Rule.03.", "citation": "r. 420-3-26-.03(5)(b); r. 420-3-26-.06(3)(f)1", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.03" ], "quote": "The licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem) = 50 mSv per year TEDE.", "citation": "r. 420-3-26-.03(6)(a)1.(i)", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.03" ], "quote": "1. An annual limit, which is the more limiting of: (i) The total effective dose equivalent being equal to 0.05 Sv (5 rem); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) = 150 mSv per year. No lower limit has been adopted.", "citation": "r. 420-3-26-.03(6)(a)", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.03" ], "quote": "(i) A lens dose equivalent of 0.15 Sv (15 rem), and (ii) A shallow dose equivalent of 0.5 Sv (50 rem) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem) = 500 mSv per year shallow dose to the skin or any extremity.", "citation": "r. 420-3-26-.03(6)(a)", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.03" ], "quote": "(i) A lens dose equivalent of 0.15 Sv (15 rem), and (ii) A shallow dose equivalent of 0.5 Sv (50 rem) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant worker over the whole pregnancy.", "citation": "r. 420-3-26-.03(13)(a)", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.03" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Shared rule: adults likely to exceed 10% of the limits must be monitored, as must declared pregnant women likely to exceed 1 mSv over the pregnancy and minors above set thresholds. X-ray rule: every fluoroscopy operator must wear a dosimeter regardless of expected dose; so must anyone likely to receive more than 25 mR per week and mobile unit operators.", "citation": "r. 420-3-26-.03(18)(a); r. 420-3-26-.06(3)(e)", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.03" ], "quote": "Adults likely to receive, in one year from sources external to the body, a dose in excess of 10 percent of the limits in 420-3-26-.03(6)(a)", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "With a single badge, it is worn at the neck outside the apron. A second badge under the apron at the waist is required for a declared pregnant woman and is used for fetal dose. Eye dose is measured at the neck or closer to the eye. Effective dose = 0.3 × neck reading (single badge, if the reading exceeds 25% of the limit), or 1.5 × waist + 0.04 × neck (two badges).", "citation": "r. 420-3-26-.03(18)(c)1-3; r. 420-3-26-.03(6)(c)3", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.03" ], "quote": "When only one individual monitoring device is used to determine the effective dose equivalent for external radiation pursuant to 420-3-26-.03(6)(C)2., it shall be located at the neck outside the protective apron.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Aprons of at least 0.25 mm lead equivalent are required for all persons in the fluoroscopic room except the patient, unless measurements indicate otherwise. The fluoroscopist must wear 0.25 mm lead-equivalent gloves. The rules say nothing about thyroid shields or eyewear.", "citation": "r. 420-3-26-.06(4)(a)8-9", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.06" ], "quote": "Unless measurements indicate otherwise, protective aprons of at least a quarter millimeter lead equivalent shall be worn by all persons in the fluoroscopic room except the patient.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Alabama's rules do not require protective aprons or other protective apparel to be inspected on a schedule. The only inspection wording is about the state inspecting X-ray registrants, ideally every two years.", "citation": "r. 420-3-26-.06(1), (2)(q), (4)(a)8 to 9; r. 420-3-26-.03", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.06" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "no", "answer": "The rules do not address engineered shielding systems used in place of aprons. Everyone in the fluoroscopy room except the patient must wear an apron of at least 0.25 mm lead equivalent unless measurements show otherwise, and the state may grant waivers only for existing machines or installations that reach equivalent protection by other means.", "citation": "r. 420-3-26-.06(3)(a), (4)(a)8; r. 420-3-26-.03(5)(b)", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.06" ], "quote": "the registrant demonstrates, to the Agency's satisfaction, achievement through other means of radiation protection equivalent to that required by these rules.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "No license-type list. Operators must be adequately instructed and competent. Exposures require authorization by a licensed practitioner (or PA, CRNP, CNM subject to board rules) with a written order. No supervision rule found in ORC rules. Alabama does not license radiologic technologists.", "citation": "r. 420-3-26-.06(3)(b), (3)(f)2", "sourceUrls": [ "https://admincode.legislature.state.al.us/api/rule/420-3-26-.06" ], "quote": "The registrant shall assure that all x-ray equipment under his control is operated only by individuals adequately instructed in safe operating procedures and competent in safe use of the equipment.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "no", "answer": "No ARRT certification, state permit, training hours, CE or physician fluoroscopy training are required. The only syllabus (Appendix A to.05) is for servicers, not operators.", "citation": "r. 420-3-26-.06(3)(f)2; r. 420-3-26-.05(3) and Appendix A", "sourceUrls": [ "https://www.alabamapublichealth.gov/radiation/assets/part_05.pdf", "https://member.alsrt.org/licensure/" ], "quote": "Talk about why Alabama does not currently license our profession", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "Revisions to Radiation Control Chapter 420-3-26 (.02,.07,.15)", "kind": "adopted_rule", "status": "effective", "date": "11/14/21", "dateISO": "2021-11-14", "summary": "Most recent rule revisions listed by ADPH; they changed only.02,.07 and.15, not.03 or.06.", "sourceUrls": [ "https://www.alabamapublichealth.gov/radiation/whats-new.html" ] }, { "title": "ALSRT radiologic technologist licensure effort", "kind": "other", "status": "restarted with ASRT support; no bill introduced; seeking sponsor", "date": "September 2026", "dateISO": "2026-09", "summary": "The Alabama Society of Radiologic Technologists has restarted its effort to license the profession.", "sourceUrls": [ "https://member.alsrt.org/licensure/" ] } ], "notable": [ "Jefferson County (Birmingham) runs its own X-ray compliance program, so local rules or enforcement may differ.", "Rule.06 was last amended in 2010 and still uses film badges, milliroentgens, conventional fluoroscopic screens and NCRP Report 49.", "The.06 scope paragraph cites.03 where.06 seems intended.", "Table-top exposure rate is capped at 10 R/min (not during cine), and a manual-reset cumulative timer with a five-minute maximum is required.", "Every fluoroscopy operator must be badged regardless of expected dose.", "The rule's note recommends consulting a certified medical physicist to correct fetal dose estimates." ], "openQuestions": [ "Check ALISON and the Alabama Administrative Monthly for 2025-2026 radiation-control rule notices, technologist licensure bills or apron-alternative bills, and ask ORC (334-290-6244) whether it is drafting changes to.03 in response to the NRC Part 20 rule.", "Whether Jefferson County has its own X-ray regulations beyond the state rules (JCDH 205-930-1057).", "Whether exemptions under 420-3-26-.01(3)(a) could be used to approve engineered shielding systems instead of aprons.", "Board of Medical Examiners, PA and Board of Nursing rules on who may run fluoroscopy, supervision and physician fluoroscopy training.", "Any ADPH inspection guidance on apron integrity checks or eye/thyroid protection." ], "sources": [ { "title": "Ala. Admin. Code r. 420-3-26-.06 (official Legislature Administrative Code, PDF via API)", "url": "https://admincode.legislature.state.al.us/api/rule/420-3-26-.06" }, { "title": "Ala. Admin. Code r. 420-3-26-.03 (official Legislature Administrative Code, PDF via API)", "url": "https://admincode.legislature.state.al.us/api/rule/420-3-26-.03" }, { "title": "Ala. Admin. Code r. 420-3-26-.05, Registration of X-Ray Producing Machines (ADPH PDF)", "url": "https://www.alabamapublichealth.gov/radiation/assets/part_05.pdf" }, { "title": "ADPH Office of Radiation Control home page", "url": "https://www.alabamapublichealth.gov/radiation/index.html" }, { "title": "ADPH X-Ray Compliance Branch", "url": "https://www.alabamapublichealth.gov/radiation/xray-compliance.html" }, { "title": "ADPH Radiation Control \"What's New?\"", "url": "https://www.alabamapublichealth.gov/radiation/whats-new.html" }, { "title": "NRC, Alabama Periodic Meeting Summary (May 2021)", "url": "https://www.nrc.gov/docs/ML2116/ML21162A113.pdf" }, { "title": "Alabama Society of Radiologic Technologists, Licensure (Sept 2026 update; secondary source, professional society)", "url": "https://member.alsrt.org/licensure/" } ] }, { "code": "AK", "name": "Alaska", "pageUrl": "https://orsif.org/guidelines/us/states/alaska", "regulator": { "name": "Radiological Health Program, State Public Health Laboratories (Alaska Department of Health, Division of Public Health, Section of Laboratories)", "url": "https://health.alaska.gov/en/division-of-public-health/alaska-public-laboratories/radiological-health/" }, "nrcAgreementState": false, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "The research for this state ended before every question was fully answered, so some answers may be incomplete." }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Alaska's fluoroscopy rules are in 7 AAC 18, which covers all radiation sources and has a chapter-wide ALARA requirement (18.105(c)). Alaska is not an NRC Agreement State, so an NRC rule requiring Agreement States to remove ALARA would not bind it directly. Worker dose limits are 5 rem (50 mSv) whole body and 15 rem (150 mSv) for the lens of the eye; no lower eye limit was found. Anyone in the fluoroscopy room likely to get 5 mR per hour or more must wear an apron and gloves of at least 0.25 mm lead equivalent, and protective drapes and panels may not substitute for an apron. Alaska's rules do not name engineered shielding systems, though a waiver section lets the state accept equal protection by other means for an existing machine or room. No operator license or permit appeared in the rules read; the facility must ensure operators are trained and competent, and each fluoroscopy operator needs at least 10 hours of instruction. The rule text was read only on secondary sources (Cornell LII, Justia), and the research for Alaska ended before every question was fully checked.", "whereAlaraLives": { "category": "both", "explanation": "The main requirement, 7 AAC 18.105(c), is chapter-wide and applies to all radiation sources; the chapter uses 'registrant' for both X-ray and radioactive material. The X-ray operator training curriculum (18.420(b)(1)(B)) also requires teaching ALARA. Because Alaska is not an Agreement State, an NRC rule requiring Agreement States to drop ALARA would not legally reach this chapter.", "citation": "7 AAC 18.105(c); 7 AAC 18.150; 7 AAC 18.420(b)(1)(B)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "no", "answer": "No. Alaska is not an NRC Agreement State. This comes from the NRC list (updated 2026-10-29). The program page says it works with the NRC.", "citation": "NRC list of Agreement States, updated October 29, 2026; program webpage.", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://health.alaska.gov/en/division-of-public-health/alaska-public-laboratories/radiological-health/" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "7 AAC 18, Radiation Sources and Radiation Protection. Article 2 covers applicability and registration. Article 3 holds the general protection standards. Article 4 covers healing arts uses, including 7 AAC 18.440 on fluoroscopic installations. Article 6 holds definitions. 7 AAC 19 covers dental X-ray only. The research read the rule text only on secondary sources (Cornell LII, Justia).", "citation": "7 AAC 18.105(a); 7 AAC 18, Articles 3 and 4.", "sourceUrls": [ "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-2/section-7-aac-18-105" ], "quote": "the provisions of 7 AAC 18.110 - 7 AAC 18.990 apply to a person in this state who receives, possesses, uses, transfers, owns, or acquires a radiation source.", "quoteMatchedToSource": true, "confidence": "medium" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. 7 AAC 18.105(c) requires registrants and operators to apply the principles of ALARA, and 18.105(d) defines it. Operator training must also cover ALARA (18.420(b)(1)(B)).", "citation": "7 AAC 18.105(c)-(d); 7 AAC 18.420(b)(1)(B)", "sourceUrls": [ "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-2/section-7-aac-18-105" ], "quote": "registrants and operators shall apply the principles of ALARA to ensure that registrants, operators, and the general public are exposed only to the lowest amount of ionizing radiation necessary to accomplish an intended purpose.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) total effective dose equivalent per year, or 50 rem (500 mSv) to any single organ other than the lens, whichever is lower. Doses from multiple registrants are combined.", "citation": "7 AAC 18.210(a)-(c)", "sourceUrls": [ "https://health.alaska.gov/media/izdngk2u/inspection-checklists.pdf" ], "quote": "Standards For Protection Against Radiation Occupational Dose Limits for Adults (5 rem per year)", "quoteMatchedToSource": true, "confidence": "medium" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year. No lower lens limit has been adopted; a circa-2013 proposal to cut it to 5 rem appears not to have been adopted.", "citation": "7 AAC 18.210(a)", "sourceUrls": [ "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-3/section-7-aac-18-210" ], "quote": "(A) lens dose equivalent of 15 rems (0.15 Sv); and (B) shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Shallow-dose equivalent of 50 rem (500 mSv) per year to the skin of the whole body or any extremity.", "citation": "7 AAC 18.210(a)", "sourceUrls": [ "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-3/section-7-aac-18-210" ], "quote": "(A) lens dose equivalent of 15 rems (0.15 Sv); and (B) shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "Alaska's X-ray inspection checklist gives the occupational dose limit for the embryo or fetus of a declared pregnant worker as 0.5 rem (5 mSv) per pregnancy, and asks facilities for the part of their operating procedures that keeps that dose low.", "citation": "Alaska radiological health inspection checklists (Standards for Protection Against Radiation)", "sourceUrls": [ "https://health.alaska.gov/media/izdngk2u/inspection-checklists.pdf" ], "quote": "Standards For Protection Against Radiation Occupational Dose Equivalent to an Embryo/Fetus (0.5 rem per pregnancy)", "quoteMatchedToSource": true, "confidence": "medium" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "An individual dosimeter is required for anyone (other than a patient) in a controlled area who receives, or is likely to receive, more than 10% of an annual limit. The threshold is 5% for minors. Anyone entering a high or very high radiation area must also be monitored.", "citation": "7 AAC 18.280(a)(1) to (3)", "sourceUrls": [ "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-3/section-7-aac-18-280" ], "quote": "an individual, except a patient, who enters a controlled area under circumstances that the individual receives, or is likely to receive, a dose in any calendar year in excess of 10 percent of the applicable value specified in 7 AAC 18.210(a)", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "Alaska's rules do not say where to wear a badge with an apron, do not call for a two-badge method, and do not name a method for estimating dose under an apron. They do say the recorded deep dose must be for the part of the body that got the most exposure, and if the badge was not on that part, the dose may be worked out from surveys or other measurements. Badges must be used as the manufacturer instructs.", "citation": "7 AAC 18.210(b); 7 AAC 18.280(a)", "sourceUrls": [ "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-3/section-7-aac-18-210" ], "quote": "The deep dose equivalent, lens dose equivalent, and shallow dose equivalent may be assessed from surveys or other radiation measurements for the purpose of demonstrating compliance with the occupational dose limits, if the individual monitoring device was not in the region of highest potential exposure", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Yes. Anyone other than the patient likely to be exposed to 5 mR per hour or more must wear an apron and gloves of at least 0.25 mm lead equivalent in the fluoroscopy room. Drapes or panels of at least 0.25 mm lead equivalent are also required between patient and fluoroscopist. No thyroid shield or eyewear requirement was found.", "citation": "7 AAC 18.440(l), (i) (eff. 4/9/2009)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/alaska/7-AAC-18.440" ], "quote": "Each person, other than the patient, whose body is likely to be exposed to five milliroentgens per hour or more must wear a protective apron and gloves of at least 0.25 millimeters lead equivalent material in the fluoroscopy room.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "partial", "answer": "Alaska's X-ray inspection checklist asks facilities for documentation of annual evaluations of protective apparel and auxiliary shields, recording who inspected each item, which items and any repairs. The rule text itself was not found to state this.", "citation": "Alaska radiological health inspection checklists (medical X-ray radiation safety requirements)", "sourceUrls": [ "https://health.alaska.gov/media/izdngk2u/inspection-checklists.pdf" ], "quote": "Documentation of annual evaluations of protective apparel and auxiliary shields. Reference details such as who inspected the item, which item(s) were inspected, description of repairs, if needed.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Alaska's rules do not name engineered shielding systems. Anyone in the fluoroscopy room likely to get 5 milliroentgens per hour or more must wear an apron and gloves, and drapes or sliding panels may not replace the apron. A facility may ask the state to waive a fluoroscopy equipment rule for an existing machine or room if meeting it would mean replacing or substantially changing the machine or room, and it shows that other means give equal protection.", "citation": "7 AAC 18.405(b); 7 AAC 18.440(i), (l)", "sourceUrls": [ "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-4/section-7-aac-18-405" ], "quote": "the registrant can demonstrate, to the department's satisfaction, that protection has been achieved through other means equivalent to that required under", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "No profession, license or permit was found in the rules read. The registrant must ensure equipment is operated only by an adequately instructed, competent individual. No supervision requirement was found. A 2022 vendor blog says Alaska has no X-ray operator training legislation; the statutes were not verified.", "citation": "7 AAC 18.410(b) (eff. 4/9/2009)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/alaska/7-AAC-18.410" ], "quote": "A registrant of medical or veterinary x-ray equipment shall assure that all x-ray equipment under the registrant's control is operated only by an individual who is adequately instructed in safe operating procedures and competent in safe use of the equipment.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "The registrant must keep a training record for each operator. The minimum curriculum covers radiation safety and ALARA, personnel monitoring, equipment operation and dose control, quality control, and facility procedures. Fluoroscopy operators need at least 10 hours of instruction. No physician pathway, ARRT requirement, state permit or continuing education requirement was found.", "citation": "7 AAC 18.420(a)-(c) (eff. 4/9/2009)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/alaska/7-AAC-18.420" ], "quote": "An operator of medical fluoroscopic equipment must receive a minimum of 10 hours of instruction in the safe operation of the fluoroscope.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Proposed changes to 7 AAC 18 (lower dose limits)", "kind": "proposed_rule", "status": "Appears not adopted; current text still shows 5 rem and 15 rem", "date": "", "dateISO": null, "summary": "A DHSS draft from circa 2013 would have lowered the whole-body limit to 2 rem and the lens limit to 5 rem.", "sourceUrls": [ "https://aws.state.ak.us/OnlinePublicNotices/Notices/Attachment.aspx?id=93086" ] }, { "title": "New chapter 7 AAC 19 for dental radiological equipment; fee changes (Online Public Notice 212715)", "kind": "proposed_rule", "status": "Comments closed 2023-11-16; Cornell now lists Chapter 19, suggesting adoption", "date": "2023-11-16", "dateISO": "2023-11-16", "summary": "Following SB 173, the proposal adopts CRCPD Suggested State Regulations Part F (April 2015) by reference for dental equipment. It also changes the fee calculation for non-dental X-ray devices (7 AAC 80.030).", "sourceUrls": [ "https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=212715" ] } ], "notable": [ "Fluoroscope equipment rules (18.440) require a five-minute cumulative timer, a continuous audible alarm in high-level control mode, a dead-man exposure switch, a Bucky-slot cover of at least 0.25 mm lead equivalent, and a record of patient dose (or exposure factors) for each procedure.", "Doses from all employers count together (18.210(c)). Monitoring records must be kept for at least three years after a worker leaves (18.280(b)).", "Cornell still lists DEC chapter 18 AAC 85 (Radiation Protection). A Cornell note says the 7 AAC 18 rules took effect in 2009 along with repeal of DEC rules on the same subject. Whether 18 AAC 85 still applies to anything relevant is unclear.", "The program's dental inspection checklist asks facilities to describe how ALARA is practiced. That checklist relies on CRCPD Part F, which applies to dental, not medical, equipment.", "No 2025 or 2026 proposals, bills or newly adopted rules affecting medical fluoroscopy were found, but the search was not complete." ], "openQuestions": [ "Check every quote against the official Alaska Administrative Code at akleg.gov, and confirm nothing in 7 AAC 18 has changed since the 2025 Justia versions.", "Read 7 AAC 18.255 for the declared pregnant worker limit, and the full 7 AAC 18.240 for the fetal dose limit in uncontrolled areas.", "Read the unread sections: 7 AAC 18.270 (surveys), 18.300 (instruction of personnel) and 18.990 (definitions). These may affect the answers on dosimeters, apron inspection and apron alternatives.", "Confirm in the statutes (AS 08; AS 18.60.475-.525) that Alaska has no radiologic technologist license or fluoroscopy permit. Check what the AS 18.60.525 exception in 7 AAC 18.105(a) covers, and read the Legislative Research Services report on X-ray operator standards (30th Legislature).", "Determine the status of the circa-2013 proposal to lower the whole-body limit to 2 rem and the lens limit to 5 rem; the 2015 Register 214 amendments may show which parts were adopted.", "Check the Online Public Notices system and the program (doh.radiation.control@alaska.gov, 907-371-1000) for 2025-2026 rule work on medical X-ray, and check whether 18 AAC 85 (DEC) is still in effect." ], "sources": [ { "title": "Alaska Department of Health, Radiological Health program page", "url": "https://health.alaska.gov/en/division-of-public-health/alaska-public-laboratories/radiological-health/" }, { "title": "Alaska Online Public Notice 212715 (Radiological Health registration, inspection and fees; 7 AAC 19; 2023)", "url": "https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=212715" }, { "title": "Alaska Online Public Notice 170238 (DHSS/DEC Radiation Sources and Protection, earlier proposal)", "url": "https://aws.state.ak.us/OnlinePublicNotices/notices/view.aspx?id=170238" }, { "title": "DHSS proposed changes to 7 AAC 18 (circa 2013, search snippet only)", "url": "https://aws.state.ak.us/OnlinePublicNotices/Notices/Attachment.aspx?id=93086" }, { "title": "Radiological Health dental inspection checklist (search snippet only)", "url": "https://health.alaska.gov/media/izdngk2u/inspection-checklists.pdf" }, { "title": "Justia, 7 AAC 18.105", "url": "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-2/section-7-aac-18-105" }, { "title": "Justia, 7 AAC 18.210 (search snippet)", "url": "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-3/section-7-aac-18-210" }, { "title": "Justia, 7 AAC 18.220 (search snippet)", "url": "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-3/section-7-aac-18-220" }, { "title": "Justia, 7 AAC 18.280 (search snippet)", "url": "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-3/section-7-aac-18-280" }, { "title": "Justia, Article 3 index", "url": "https://regulations.justia.com/states/alaska/title-7/part-2/chapter-18/article-3" }, { "title": "Cornell LII, 7 AAC 18 Article 4 index", "url": "https://www.law.cornell.edu/regulations/alaska/title-7/part-2/chapter-18/article-4" }, { "title": "Cornell LII, 7 AAC 18.400", "url": "https://www.law.cornell.edu/regulations/alaska/7-AAC-18.400" }, { "title": "Cornell LII, 7 AAC 18.410", "url": "https://www.law.cornell.edu/regulations/alaska/7-AAC-18.410" }, { "title": "Cornell LII, 7 AAC 18.420", "url": "https://www.law.cornell.edu/regulations/alaska/7-AAC-18.420" }, { "title": "Cornell LII, 7 AAC 18.440", "url": "https://www.law.cornell.edu/regulations/alaska/7-AAC-18.440" }, { "title": "Cornell LII, 7 AAC 18.150 (search snippet)", "url": "https://www.law.cornell.edu/regulations/alaska/7-AAC-18.150" }, { "title": "Cornell LII, 7 AAC 18.240 (search snippet)", "url": "https://www.law.cornell.edu/regulations/alaska/7-AAC-18.240" }, { "title": "Cornell LII, Title 7 Part 2 index", "url": "https://www.law.cornell.edu/regulations/alaska/title-7/part-2" }, { "title": "Maven Imaging blog, Alaska portable X-ray regulations (secondary, about 2022)", "url": "https://www.mavenimaging.com/blog/alaska-portable-x-ray-regulations" } ] }, { "code": "AZ", "name": "Arizona", "pageUrl": "https://orsif.org/guidelines/us/states/arizona", "regulator": { "name": "Arizona Department of Health Services (ADHS), Public Health Licensing Services, Bureau of Radiation Control", "url": "https://www.azdhs.gov/xray" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "ADHS Bureau of Radiation Control regulates X-ray under 9 A.A.C. 7. ALARA applies to licensees and registrants through the shared Article 4. Dose limits are the standard US values: 50 mSv whole body, 150 mSv lens, 500 mSv skin and extremities, and 5 mSv embryo/fetus. Rules require 0.25 mm Pb aprons in the fluoroscopy room, annual apron checks, and dosimeters for fluoroscopy staff. SB 1121 (2026) bars hospitals from requiring aprons in cardiac cath rooms with radiation protection systems, but R9-7-606 has not been visibly amended. Article 4 and 6 text came from Cornell LII, and post-2022 amendments were not checked.", "whereAlaraLives": { "category": "both", "explanation": "The regulatory ALARA requirement is in the shared Article 4 (R9-7-402, -407(B)), which applies to licensees and registrants. No ALARA wording was found in the Article 6 sections read. A.R.S. § 36-420.06 separately uses the ALARA standard for hospital cardiac cath rooms.", "citation": "R9-7-402; R9-7-407(B); A.R.S. § 36-420.06(A)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Arizona is an NRC Agreement State; an ADHS rulemaking document also says so.", "citation": "NRC list of Agreement States, updated October 29, 2026; GRRC 2022 ADHS rule document", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://grrc.az.gov/sites/default/files/2022-08/Department%20of%20Health%20Services%20-%20A.A.C.%20Title%209,%20Chapter%207.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "9 A.A.C. 7, Article 6, \"Use of X-rays in the Healing Arts\" (R9-7-601 to -615), with fluoroscopy at R9-7-606. Standards for protection are in Article 4 (R9-7-401 to -455). The official chapter is Supp. 22-3. The Article 4 and 6 text was read on Cornell LII.", "citation": "9 A.A.C. 7, Arts. 4 and 6", "sourceUrls": [ "https://apps.azsos.gov/public_services/Title_09/9-07.pdf" ], "quote": "This Chapter contains rules that were filed to be codified in the Arizona Administrative Code between the dates of July 1, 2022 through September 30, 2022", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. R9-7-407(B) applies to licensees and registrants, so X-ray registrants are covered. Class B and C X-ray registrants are exempt only from the program record-keeping rules.", "citation": "A.A.C. R9-7-407(B); R9-7-102 (\"ALARA\")", "sourceUrls": [ "https://www.law.cornell.edu/regulations/arizona/Ariz-Admin-Code-SS-R9-7-407" ], "quote": "The licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem) = 50 mSv TEDE per year", "citation": "R9-7-408(A)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/arizona/Ariz-Admin-Code-SS-R9-7-408" ], "quote": "An annual limit, which is the more limiting of: a. The total effective dose equivalent being equal to 0.05 Sv (5 rem): or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) = 150 mSv per year. No lower lens limit or 20 mSv ICRP limit was found.", "citation": "R9-7-408(A)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/arizona/Ariz-Admin-Code-SS-R9-7-408" ], "quote": "a. A lens dose equivalent of 0.15 Sv (15 rem), and b. A shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem) = 500 mSv shallow dose equivalent to the skin or any extremity", "citation": "R9-7-408(A)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/arizona/Ariz-Admin-Code-SS-R9-7-408" ], "quote": "a. A lens dose equivalent of 0.15 Sv (15 rem), and b. A shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman for the pregnancy", "citation": "R9-7-415(A)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/arizona/Ariz-Admin-Code-SS-R9-7-415" ], "quote": "A licensee or registrant shall ensure that the dose equivalent to an embryo or fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "A dosimeter is required for adults likely to get more than 10% of a limit in a year. It is required regardless of dose for open-beam fluoroscopy operators and staff in the room, unless a registration condition relieves them. Declared pregnant women likely to exceed 1 mSv (0.1 rem) must also be monitored.", "citation": "R9-7-419(B)(3), (B)(5), (B)(10)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/arizona/Ariz-Admin-Code-SS-R9-7-419" ], "quote": "Individuals operating open beam fluoroscopic systems and ancillary personnel working in the room when the fluoroscopic system is in use, except when relieved of this requirement by registration condition", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "Single badge: neck outside the apron, with deep dose × 0.3 if the reading exceeds 25% of the limit. Two badges: waist under the apron × 1.5 plus neck outside × 0.04. Lens dose: badge at the neck or a closer unshielded spot. Declared pregnant women: second badge under the apron at the waist, with a qualified expert consulted if it reads more than 0.5 mSv in a month. Department-approved methods are allowed. NCRP 122 and Webster are not named.", "citation": "R9-7-408(C)(2)-(3); R9-7-419(D)(1)-(3)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/arizona/Ariz-Admin-Code-SS-R9-7-408" ], "quote": "If only one individual monitoring device is used and it is located at the neck outside the protective apron, and the reported dose exceeds 25% of the limit specified in subsection (A), the reported deep-dose equivalent value multiplied by 0.3 is the effective dose equivalent", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Aprons of at least 0.25 mm lead equivalent are required in the fluoroscopy room for each person except the patient likely exposed to 50 µSv/hr (5 mR/hr) or more. Drapes and panels are required for some systems and may not substitute for an apron. Thyroid shields and eyewear are not specifically required, but the Department may specify additional devices. SB 1121 changes the apron rule for hospital cardiac cath rooms.", "citation": "R9-7-606(E)(2)-(3); R9-7-604(A)(2)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/arizona/Ariz-Admin-Code-SS-R9-7-606" ], "quote": "Ensure that protective aprons of at least 0.25 millimeter lead equivalent are worn in the fluoroscopy room by each person, except the patient, whose body is likely to be exposed to 50 µSv/hr (5 mR/hr) or more.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes, annually. Aprons, gloves and shields must be checked for holes, tears and breaks. Defective items must be replaced or removed from service, and records kept for 3 years. No method is specified.", "citation": "R9-7-604(A)(5)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/arizona/Ariz-Admin-Code-SS-R9-7-604" ], "quote": "The registrant shall check radiation protective equipment for reliability and integrity defects on an annual basis, as follows: a. Aprons, gloves, and shields shall be checked for holes, tears, and breaks.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "yes", "answer": "Yes, by statute. A.R.S. § 36-420.06 (SB 1121) bars hospitals from requiring lead aprons in cardiac catheterization rooms when a radiation protection system (at least as protective as a 0.25 mm Pb apron) is in use. The RSO may still require aprons under ALARA. Staff who skip the apron must wear a real-time dosimeter. R9-7-606(E)(3) has not been visibly amended.", "citation": "A.R.S. § 36-420.06(B) (SB 1121, House engrossed)", "sourceUrls": [ "https://www.azleg.gov/legtext/57leg/2R/bills/SB1121H.pdf" ], "quote": "IF A HEALTH PROFESSIONAL CHOOSES TO NOT WEAR A LEAD APRON BECAUSE THE PROCEDURE ROOM IS EQUIPPED WITH A RADIATION PROTECTION SYSTEM, THE HOSPITAL SHALL REQUIRE THE HEALTH PROFESSIONAL TO WEAR A REAL-TIME DOSIMETER DEVICE TO MONITOR RADIATION EXPOSURE IN REAL TIME.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Licensed practitioners (MD, DO, dentists, podiatrists, chiropractors, naturopaths) and certificate holders working at their direction. PAs and NPs are listed in § 30-672(G); whether they may do fluoroscopy is unclear. Radiologist assistants may do fluoroscopy under radiologist supervision. Practical technologists may not use fluoroscopy. Residents and students are exempt under direction.", "citation": "A.R.S. §§ 32-2811(A)-(B), 32-2801(9), 30-672(G), 32-2819; R9-16-603(B)", "sourceUrls": [ "https://www.azleg.gov/ars/32/02811.htm" ], "quote": "Except as provided in subsection D of this section, a person may not 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.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "In Arizona, only a licensed practitioner or a person holding a state certificate may use X-rays on people. Exceptions include students and radiology residents working under a practitioner's direction. A radiologic technologist certificate needs at least 24 months of full-time approved study and a passed national exam, and renewal needs 24 hours of continuing education every 2 years (radiologist assistants 50 hours, practical technologists in radiology 6 hours). These statute sections do not create a separate fluoroscopy permit or a fluoroscopy training rule for physicians.", "citation": "A.R.S. § 32-2801(20); A.R.S. § 32-2811(A), (D); A.R.S. § 32-2815(D)", "sourceUrls": [ "https://codes.findlaw.com/az/title-32-professions-and-occupations/az-rev-st-sect-32-2801/" ], "quote": "“Radiologic technology certificate” means a certificate that is issued in radiologic technology to a person with at least twenty-four months of full-time study or its equivalent through an approved program and who has successfully completed an examination by a national certifying body.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "SB 1121 (Laws 2026, Ch. 142)", "kind": "bill", "status": "enacted", "date": "2026-06-19", "dateISO": "2026-06-19", "summary": "Adds A.R.S. § 36-420.06, which bars hospitals from requiring aprons in cardiac cath rooms that have a radiation protection system and requires real-time dosimeters for staff who skip the apron. Effective 2026-09-12, the legislature's general effective date for 2026 bills.", "sourceUrls": [ "https://legiscan.com/AZ/text/SB1121/id/3450824" ] }, { "title": "SB 1120", "kind": "bill", "status": "dead; failed on a tie vote in March 2026", "date": "2026-06-14", "dateISO": "2026-06-14", "summary": "Would have required hospitals to equip at least 50% of real-time X-ray procedure rooms with radiation protection systems, including real-time dosimetry, by 2027-07-01.", "sourceUrls": [ "https://www.billtrack50.com/billdetail/1925660" ] }, { "title": "HB 2050 (Laws 2026, Ch. 37)", "kind": "bill", "status": "enacted", "date": "2026-04-13", "dateISO": "2026-04-13", "summary": "Covers radiologic technologists and radiologist assistants, and the § 30-672(G) list including PAs and NPs.", "sourceUrls": [ "https://legiscan.com/AZ/text/HB2050/id/3411625" ] }, { "title": "9 A.A.C. 16, Article 6 amendments", "kind": "adopted_rule", "status": "effective", "date": "2025-02-04", "dateISO": "2025-02-04", "summary": "Technologist certification rules.", "sourceUrls": [ "https://www.azdhs.gov/documents/director/administrative-counsel-rules/rules/rulemaking/radiation-tech/nfer-as-filed.pdf" ] } ], "notable": [ "R9-7-606(E)(3) still requires 0.25 mm aprons and shows no amendment since 2018, while A.R.S. § 36-420.06 bars hospitals from requiring aprons in cardiac cath rooms with a qualifying system. No ADHS guidance reconciling the two was found.", "R9-7-606(E)(2) says drapes and panels may not substitute for an apron.", "For fluoroscopy, fetal dose is the under-apron waist badge reading corrected by a qualified expert (R9-7-419(D)(1)).", "Routinely holding film or a patient during exposure is banned (R9-7-604(A)(3)(d)).", "Exposing a monitoring device so it gives a misleading dose reading is banned (R9-7-604(A)(4))." ], "openQuestions": [ "Compare Articles 4 and 6 with the current official 9 A.A.C. 7 and check the Arizona Administrative Register for Chapter 7 rulemakings since 2022.", "Will ADHS amend R9-7-606(E)(3) or issue guidance or registration conditions in response to SB 1121? Ask the Bureau of Radiation Control (602-255-4840).", "Check the exact effective date of § 36-420.06 and whether hospital-licensing enforcement applies.", "Were PAs and NPs newly added to § 30-672(G)? May they operate fluoroscopy given § 32-2811? Watch for an Arizona Board of Nursing advisory opinion.", "The final enacted § 32-2819 supervision wording and the 9 A.A.C. 16 radiologist-assistant rules were not checked.", "No physician fluoroscopy training requirement was found. The third bill in Sen. Werner's package was not identified." ], "sources": [ { "title": "Arizona Administrative Code, 9 A.A.C. 7 (Supp. 22-3, official)", "url": "https://apps.azsos.gov/public_services/Title_09/9-07.pdf" }, { "title": "Cornell LII, 9 A.A.C. 7 chapter, Art. 4, Art. 6, and R9-7-402, -403, -407, -408, -415, -418, -419, -603, -604, -606", "url": "https://www.law.cornell.edu/regulations/arizona/title-9/chapter-7" }, { "title": "ADHS BRC-4 X-ray Registration Application", "url": "https://www.azdhs.gov/documents/licensing/radiation-regulatory/xray/registration/xray-brc-4.pdf" }, { "title": "GRRC, ADHS A.A.C. Title 9, Ch. 7 (2022)", "url": "https://grrc.az.gov/sites/default/files/2022-08/Department%20of%20Health%20Services%20-%20A.A.C.%20Title%209,%20Chapter%207.pdf" }, { "title": "SB 1121 (2026) chaptered text, LegiScan", "url": "https://legiscan.com/AZ/text/SB1121/id/3450824" }, { "title": "SB 1121 House Engrossed", "url": "https://www.azleg.gov/legtext/57leg/2R/bills/SB1121H.pdf" }, { "title": "SB 1121 House Health & Human Services committee amendment", "url": "https://www.azleg.gov/legtext/57leg/2R/adopted/H.1121HEALTH%20%20HUMAN%20SERVICES.PDF" }, { "title": "SB 1120, BillTrack50", "url": "https://www.billtrack50.com/billdetail/1925660" }, { "title": "SB 1120 Senate fact sheet", "url": "https://www.azleg.gov/legtext/57leg/2R/summary/S.1120HHS_ASPASSEDCOMMITTEE.DOCX.htm" }, { "title": "Tucson Sentinel on SB 1120 failing", "url": "https://www.tucsonsentinel.com/local/report/032426_az_radiation_protection/it-reeks-vendor-bill-arizona-radiation-protection-measure-fails-tie-vote/" }, { "title": "HB 2050 (2026), LegiScan", "url": "https://legiscan.com/AZ/text/HB2050/id/3411625" }, { "title": "HB 2050, Laws 2026 Ch. 37", "url": "https://www.azleg.gov/legtext/57Leg/2R/laws/0037.pdf" }, { "title": "HB 2050 floor amendment", "url": "https://www.azleg.gov/legtext/57leg/2R/adopted/H.2050FloorBLISS2_Merged.pdf" }, { "title": "A.R.S. § 32-2811", "url": "https://www.azleg.gov/ars/32/02811.htm" }, { "title": "A.R.S. § 32-2801 (FindLaw)", "url": "https://codes.findlaw.com/az/title-32-professions-and-occupations/az-rev-st-sect-32-2801/" }, { "title": "ADHS, unofficial 9 A.A.C. 16 Art. 6 (effective 2025-02-04)", "url": "https://www.azdhs.gov/documents/director/administrative-counsel-rules/rules/rulemaking/radiation-tech/nfer-as-filed.pdf" }, { "title": "Arizona State Library, MRTBE agency history", "url": "https://azlibrary.gov/agency-history/2099" } ] }, { "code": "AR", "name": "Arkansas", "pageUrl": "https://orsif.org/guidelines/us/states/arkansas", "regulator": { "name": "Radiation Control Section, Arkansas Department of Health", "url": "https://healthy.arkansas.gov/programs-services/licensing-military-member-licensure-permits-plan-reviews/radiation-control/" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Arkansas requires X-ray registrants to keep worker doses ALARA under RH-1004.b, in a section shared with radioactive-materials licensees, and Part G adds a duty to 'minimize patient and personnel exposure' without using the term ALARA. Dose limits follow the federal model: 50 mSv whole body, 150 mSv lens, 500 mSv skin and extremities, and all fluoroscopy workers must wear dosimeters. Staff must be protected by aprons or whole-body barriers of at least 0.25 mm lead equivalent, and fluoroscopy also calls for drapes or curtains or a distance of at least 120 cm from the center of the beam; aprons do not have to be inspected, and engineered shielding systems used instead of aprons are not mentioned. Fluoroscopy may be operated by licensed practitioners, radiologic technologists and two supervised cardiac specialist licenses, and a pending revision that would add training hours, annual apron checks and effective-dose formulas is still awaiting legislative approval and is not yet in force.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The explicit ALARA requirement is in RH-1004.b in Section 3, which covers radioactive-materials licensees and X-ray registrants together. Part G requires procedures to 'minimize patient and personnel exposure' (RH-1602.a.9) but does not use the term ALARA.", "citation": "RH-1004.b; RH-1602.a.9; RH-1602.a.10" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Arkansas is not on the list of non-Agreement jurisdictions, so it is an Agreement State.", "citation": "NRC list of Agreement States, updated October 29, 2026; Ark. Code Ann. § 20-21-207(a)(3), as quoted in the legislature's review packet", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.arkleg.state.ar.us/Home/FTPDocument?path=%2FAssembly%2FMeeting+Attachments%2F430%2F27893%2FExhibit+T-+Ionizing+Radiation.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Rules for Control of Sources of Ionizing Radiation, 20 CAR pt. 3 (revision effective September 14, 2024). Section 3 holds the general protection standards (RH-1000 onward), and Part G (RH-1600 to RH-1613) holds the X-ray rules, with fluoroscopy at RH-1603. A pending revision would move Part G into a new Section 10.", "citation": "20 CAR pt. 3; RH-1002, RH-1600", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330" ], "quote": "This Part establishes requirements, for which a registrant (or licensee) is responsible, for use of x-ray equipment by or under the supervision of an individual authorized by and licensed in accordance with state statutes to engage in the healing arts", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. RH-1004.b requires every licensee or registrant to achieve ALARA occupational doses, and the ALARA definition names x-ray equipment use explicitly.", "citation": "RH-1004.a-b; RH-1100 (definition of ALARA)", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330" ], "quote": "The licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rems (50 mSv) per year TEDE.", "citation": "RH-1200.a", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330" ], "quote": "The total effective dose equivalent being equal to 5 rems (0.05 Sv), or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rems (150 mSv) per year. No lower limit has been adopted, and the May 2026 draft keeps 15 rems.", "citation": "RH-1200.a", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330" ], "quote": "An lens dose equivalent of 15 rems (0.15 Sv), and … A shallow-dose equivalent of 50 rems (0.50 Sv) to the skin of the whole body or to skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rems (500 mSv) shallow-dose equivalent to the skin of the whole body or any extremity.", "citation": "RH-1200.a", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330" ], "quote": "An lens dose equivalent of 15 rems (0.15 Sv), and … A shallow-dose equivalent of 50 rems (0.50 Sv) to the skin of the whole body or to skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant woman over the whole pregnancy.", "citation": "RH-1207.a", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to the embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Monitoring is required for adults likely to exceed 10% of a limit and for declared pregnant women likely to exceed 0.1 rem (1 mSv). Everyone working with medical fluoroscopy equipment must be monitored, with no dose threshold.", "citation": "RH-1302.a.1, a.3, a.5", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330" ], "quote": "Adults likely to receive, in one (1) year from sources external to the body, a dose in excess of ten percent (10%) of the limits in RH-1200.a; … 5. Individuals working with medical fluoroscopic equipment.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "A single badge is worn at the collar outside the apron. A second badge, if used, is worn under the apron at the waist and is required for a declared pregnant woman. A lens badge is worn at the collar or closer to the eye. The current rule names no effective-dose method beyond a Department-approved method. Proposed RH-1200.d would add formulas: 0.3 × deep dose with one badge above 25% of the limit, and 1.5 × waist + 0.04 × collar with two badges.", "citation": "RH-1302.a.5.A-C; RH-1311; RH-1200.c; proposed RH-1200.d", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330", "https://www.arkleg.state.ar.us/Home/FTPDocument?path=%2FAssembly%2FMeeting+Attachments%2F430%2F27893%2FExhibit+T-+Ionizing+Radiation.pdf" ], "quote": "When only 1 individual monitoring device is used to determine the effective dose equivalent for external radiation, it shall be located at the neck (collar) outside the protective apron.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Staff must be protected by aprons or whole-body barriers of at least 0.25 mm lead equivalent, and aprons and gloves must be available in sufficient numbers. In fluoroscopy, drapes or curtains are required in addition to the apron, or staff must stand at least 120 cm from the beam. Thyroid shields and eyewear are not required.", "citation": "RH-1602.a.5.B; RH-1602.a.8.B.vi; RH-1603.f; RCG 2.2", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330", "https://healthy.arkansas.gov/wp-content/uploads/RCG_2.2_Guide_to_Medical_X-ray_Operating_and_Safety_Procedures_09082025.pdf" ], "quote": "Staff and ancillary personnel shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Arkansas's current X-ray rules do not require protective aprons or shields to be inspected; they only require facilities to have enough leaded aprons and gloves for all personnel involved in X-ray work. A proposed revision (RH-9200.g) would require yearly integrity checks and lead-equivalence labels, but it is still awaiting legislative approval and is not yet in force.", "citation": "RH-1602.a.5, RH-1602.a.8.B.vi and RH-1603.f, Rules for Control of Sources of Ionizing Radiation (revision effective September 14, 2024)", "sourceUrls": [ "https://healthy.arkansas.gov/wp-content/uploads/Rad-Control-2025-DRAFT-Complete-Rules-05152026r.pdf" ], "quote": "All protective apparel and auxiliary shields shall be evaluated annually for integrity and clearly labeled with their lead equivalence.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rules do not mention engineered shielding systems used instead of aprons, but they allow staff to be protected by either protective aprons or whole body protective barriers of at least 0.25 mm lead equivalent. For fluoroscopy scatter from above the table, staff can also be protected by keeping at least 120 centimeters from the center of the beam, or by shielding such as drapes or curtains.", "citation": "RH-1602.a.5.B; RH-1603.f.2", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330" ], "quote": "Staff and ancillary personnel shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Licensed practitioners (medicine, osteopathy, dentistry, podiatric medicine, chiropractic, optometry), licensed radiologic technologists, and Invasive Cardiovascular and Cardiac Electrophysiology Specialists under supervision may operate fluoroscopy. Limited licensees may not. Physician assistants and nurse practitioners are not listed.", "citation": "17 CAR §§ 49-102(24), (27); 49-103(a)-(b); 49-105(d)-(e); RH-1603.i.1", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/Rule?levelType=section&titleID=17&chapterID=93&subChapterID=118&partID=433&subPartID=4219§ionID=26369" ], "quote": "No person, other than a licensed practitioner, radiologic technologist, licensed technologist, or limited licensed technologist shall use radioactive materials or medical equipment emitting or detecting ionizing radiation on human beings for diagnostic or therapeutic purposes.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "The current radiation rule requires only that operators be 'adequately instructed' and competent, with no set hours. Technologists need a national registry, and specialists need a committee-approved exam. Pending RH-9305.l would require 4 hours of fluoroscopy training (8 for FGI, including 1 hour hands-on) and 2 hours every 2 years.", "citation": "RH-1602.a.2; 17 CAR § 49-102(48); proposed RH-9305.l", "sourceUrls": [ "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330", "https://www.arkleg.state.ar.us/Home/FTPDocument?path=%2FAssembly%2FMeeting+Attachments%2F430%2F27893%2FExhibit+T-+Ionizing+Radiation.pdf" ], "quote": "All persons operating, or supervising the operation of, fluoroscopy systems during fluoroscopically-guided interventional (FGI) procedures shall have completed a minimum of eight (8) hours of training approved by the Department.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "20 CAR pt. 3, Rules for Control of Sources of Ionizing Radiation (July 2025 package)", "kind": "proposed_rule", "status": "Approved by ALC Administrative Rules Subcommittee June 15, 2026; effective date not confirmed", "date": "2026-06-15", "dateISO": "2026-06-15", "summary": "Moves Part G to a new Section 10. Adds effective-dose formulas under aprons, annual apparel integrity checks, aprons for everyone in sterile-field cases, 4- and 8-hour fluoroscopy training, a written patient-dose policy, qualified-expert evaluations, an FGI Radiation Protocol Committee and skin-dose misadministration reporting. Removes gonadal shielding. Lens limit stays at 15 rems and ALARA stays in RH-1004.b.", "sourceUrls": [ "https://arkleg.state.ar.us/Home/FTPDocument?path=%2FAssembly%2FMeeting%20Attachments%2F000%2F27925%2FExhibit%20F.01%20-%20ALC%20Admin%20Rules%20Report%206.19.26.pdf" ] }, { "title": "17 CAR pt. 49 (technologist licensing)", "kind": "adopted_rule", "status": "Amended effective August 13, 2026 (Ark. R. 2026-92)", "date": "2026-08-13", "dateISO": "2026-08-13", "summary": "Updated 'two limited scope radiation modalities,' apparently the Invasive Cardiovascular and Cardiac Electrophysiology Specialist licenses (this research's inference).", "sourceUrls": [] } ], "notable": [ "Dosimeters are required for all fluoroscopy workers regardless of expected dose (RH-1302.a.5).", "Estimated patient doses must be logged for listed interventional, cardiac and electrophysiology procedures. Skin doses above 300 rad (adults) or 100 rad (children) must be reviewed by the radiation safety committee or explained to the Department within 30 days (RH-1603.h).", "A qualified expert must measure entrance exposure rates annually (RH-1603.j).", "The Department applies a 14-month window to 'annual' surveys.", "Guidance RCG 2.2 says workers should be told each year if their exposure exceeded 100 mrem." ], "openQuestions": [ "Effective date of the 20 CAR pt. 3 revision: check the Arkansas Register or call ADH Radiation Control, and compare the final text with Exhibit T.", "Whether physician assistants and nurse practitioners may operate fluoroscopy: read Ark. Code § 17-106-111 and the State Medical Board's PA rules.", "Hospital-rule limit on technologists performing fluoroscopy (Section 20 A.6): check the Rules for Hospitals and Related Institutions (20 CAR pt. 41).", "Approved effective-dose methods under RH-1200.c: no published approval (e.g., of NCRP 122) was found.", "Technologist continuing education: the 6-hour figure was found only in suspension and lapse provisions, so the renewal section of 17 CAR pt. 49 should be read directly.", "Two differing versions of § 49-105: confirm against the Ark. R. 2026-92 filing.", "Whether Arkansas would keep ALARA for X-ray users if NRC changes force edits to Section 3." ], "sources": [ { "title": "Code of Arkansas Rules, 20 CAR pt. 3, Rules for Control of Sources of Ionizing Radiation (official PDF, revision effective Sept. 14, 2024)", "url": "https://codeofarrules.arkansas.gov/Rules/PartDocument?partID=1330" }, { "title": "Arkansas Department of Health copy of the same rule", "url": "https://healthy.arkansas.gov/wp-content/uploads/Rad-Control-rule.pdf" }, { "title": "Arkansas Information Notice 26-01 (proposed revisions, Jan. 2026)", "url": "https://healthy.arkansas.gov/wp-content/uploads/IN-26-01-Proposed-Revisions-to-Rules-for-Control-of-Sources-of-Ionizing-Radiation-20-CAR-Pt.-3-January-2026.pdf" }, { "title": "Notice of public comment period", "url": "https://healthy.arkansas.gov/wp-content/uploads/Rad-Control-Notice-of-Public-Comment.pdf" }, { "title": "Public comment report", "url": "https://healthy.arkansas.gov/wp-content/uploads/Rad-Control-Public-Comment-Report.pdf" }, { "title": "Legislative Exhibit T, ionizing radiation rule packet (proposed text)", "url": "https://www.arkleg.state.ar.us/Home/FTPDocument?path=%2FAssembly%2FMeeting+Attachments%2F430%2F27893%2FExhibit+T-+Ionizing+Radiation.pdf" }, { "title": "Department draft of complete rules, May 15, 2026 (markup)", "url": "https://healthy.arkansas.gov/wp-content/uploads/Rad-Control-2025-DRAFT-Complete-Rules-05152026r.pdf" }, { "title": "ALC Administrative Rules Subcommittee agenda, June 15, 2026", "url": "https://www.arkleg.state.ar.us/Home/FTPDocument?path=%2FAssembly%2FMeeting+Attachments%2F040%2F27901%2FA.+Summary+Agenda_June+15+2026.pdf" }, { "title": "ALC Administrative Rules Subcommittee report, June 19, 2026", "url": "https://arkleg.state.ar.us/Home/FTPDocument?path=%2FAssembly%2FMeeting%20Attachments%2F000%2F27925%2FExhibit%20F.01%20-%20ALC%20Admin%20Rules%20Report%206.19.26.pdf" }, { "title": "17 CAR § 49-102 (Definitions)", "url": "https://codeofarrules.arkansas.gov/Rules/Rule?levelType=section&titleID=17&chapterID=93&subChapterID=118&partID=433&subPartID=4219§ionID=26368" }, { "title": "17 CAR § 49-103 (General requirements)", "url": "https://codeofarrules.arkansas.gov/Rules/Rule?levelType=section&titleID=17&chapterID=93&subChapterID=118&partID=433&subPartID=4219§ionID=26369" }, { "title": "17 CAR § 49-105 (Licenses required)", "url": "https://codeofarrules.arkansas.gov/Rules/Rule?levelType=section&titleID=17&chapterID=93&subChapterID=118&partID=433&subPartID=4219§ionID=26371" }, { "title": "ADH guidance RCG 2.2, Medical X-ray Operating and Safety Procedures (09/2025)", "url": "https://healthy.arkansas.gov/wp-content/uploads/RCG_2.2_Guide_to_Medical_X-ray_Operating_and_Safety_Procedures_09082025.pdf" }, { "title": "ADH guidance RCG 2.0, Developing a Radiation Safety Program (09/2025)", "url": "https://healthy.arkansas.gov/wp-content/uploads/RCG_2.0_Guidance_for_Developing_a_Radiation_Safety_Program_09082025.pdf" }, { "title": "ADH Radiation Control information notices page", "url": "https://healthy.arkansas.gov/programs-services/licensing-military-member-licensure-permits-plan-reviews/radiation-control/information-notices/" } ] }, { "code": "CA", "name": "California", "pageUrl": "https://orsif.org/guidelines/us/states/california", "regulator": { "name": "California Department of Public Health (CDPH), Radiologic Health Branch (RHB)", "url": "https://www.cdph.ca.gov/rhb" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "CDPH's Radiologic Health Branch regulates X-ray in California, and staff ALARA and dose limits come from 17 CCR § 30253, which adopts 10 CFR Part 20 as of January 1, 2021 and applies it to all users, including X-ray registrants, so an NRC change would not carry over automatically. The adopted yearly limits include 15 rem (150 mSv) for the lens of the eye and 50 rem (500 mSv) for the skin and extremities, plus 0.5 rem (5 mSv) to the embryo or fetus of a declared pregnant worker over the whole pregnancy, and badges are required for workers likely to receive more than 10 percent of a limit. Fluoroscopy staff likely to be exposed to 5 mR/hr or more must wear aprons of at least 0.25 mm lead equivalent, drapes and panels may not substitute for them, and the rules are silent on thyroid shields, eyewear, apron inspection and engineered shielding. Only permit holders may operate fluoroscopy, and each must pass an exam or training, with CE required for renewal.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The staff ALARA duty comes from the general § 30253 adoption of 10 CFR 20, which applies to \"Users\" (both radioactive-materials licensees and X-ray registrants). No X-ray-specific staff ALARA language was found. Because the adoption is fixed at January 1, 2021, an NRC change would not apply automatically; CDPH would have to amend § 30253.", "citation": "17 CCR §§ 30100(z), 30253(a)(5), 30305(a)(1)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Based on the NRC Agreement State list (updated 2026-10-29).", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "General radiation protection: 17 CCR § 30253 (Group 3, Subchapter 4; scope § 30252). Medical X-ray: Group 3, Article 4, starting at § 30305, plus § 30305.5 and § 30307. Operator rules: Subchapter 4.5, starting at § 30400. Text was read on Cornell LII (secondary); Cornell's heading for § 30305 appears mislabeled. § 30253 was last amended operative 7-1-2022.", "citation": "17 CCR §§ 30252, 30253, 30305, 30307", "sourceUrls": [ "https://www.law.cornell.edu/regulations/california/17-CCR-30253", "https://www.law.cornell.edu/regulations/california/17-CCR-30305" ], "quote": "( 10 CFR 20) sections 20.1001 through 20.2402 and Appendices A through G, (January 1, 2021) are hereby incorporated by reference with the following exceptions", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes, by adoption. § 30253 adopts 10 CFR 20.1001-20.2402; 20.1101 (ALARA) falls in that range and is not excepted. \"Licensee\" is replaced by \"User,\" which includes X-ray registrants. The text of 20.1101 itself was not read. The X-ray rules' \"as low as is practicable\" wording (§ 30307(a)(7)(A)) concerns the beam exposure rate at the patient, not staff doses.", "citation": "17 CCR § 30253(a)(1), (a)(6); § 30100(z)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/california/17-CCR-30253", "https://www.law.cornell.edu/regulations/california/17-CCR-30100" ], "quote": "The definition of the term \"Licensee\" as defined in 10 CFR 20, section 20.1003 is replaced by the definition of the term \"User\" as set forth in section 30100.", "quoteMatchedToSource": true, "confidence": "medium" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "Federal 10 CFR 20.1201 is adopted as of 2021 and applies to any source of ionizing radiation. The standard federal figure is 5 rem (50 mSv) per year TEDE, but this number was not verified by this research.", "citation": "17 CCR § 30253(a), (a)(5)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/california/17-CCR-30253" ], "quote": "With respect to dose limits and reporting requirements, the term \"Licensed material\" is to be construed broadly in context to include any source of ionizing radiation subject to the requirements of this subchapter.", "quoteMatchedToSource": true, "confidence": "medium" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "California adopts the federal occupational dose limits, which set the annual limit for the lens of the eye at 15 rem (150 mSv). No lower California lens limit, such as the ICRP's 20 mSv, appears in the adopted rules.", "citation": "10 CFR 20.1201(a)(2)(i), as adopted by 17 CCR § 30253", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" ], "quote": "A lens dose equivalent of 15 rems (0.15 Sv), and", "quoteMatchedToSource": true, "confidence": "medium" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "California adopts the federal occupational dose limits, which set the annual limit for the skin and the extremities (shallow-dose equivalent) at 50 rem (500 mSv).", "citation": "10 CFR 20.1201(a)(2)(ii), as adopted by 17 CCR § 30253", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" ], "quote": "A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "medium" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "Under the adopted federal rule, the dose to the embryo/fetus of a declared pregnant worker may not exceed 0.5 rem (5 mSv) over the entire pregnancy. Employers must also try to avoid large month-to-month variation in that worker's exposure.", "citation": "10 CFR 20.1208(a), as adopted by 17 CCR § 30253", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" ], "quote": "The licensee shall ensure that the dose equivalent to the embryo/fetus during the entire pregnancy, due to the occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "medium" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Under the adopted federal rule, an individual dosimeter is required for workers likely to receive more than 10 percent of an applicable annual dose limit in a year. California does not set a separate X-ray badging threshold.", "citation": "10 CFR 20.1502(a)(1), as adopted by 17 CCR § 30253", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-F" ], "quote": "Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of the limits in § 20.1201(a),", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "California adopts the federal rule that a badge reading must be counted as the dose to the part of the body that gets the highest exposure. A lower effective dose estimate (for example a two-badge method) may be used only if the method is approved by the state health department, which stands in for the federal regulator. The rules name no badge location, two-badge method or formula, and no state-approved method is published.", "citation": "10 CFR 20.1201(c), incorporated by 17 CCR § 30253(a) and (a)(2)", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" ], "quote": "the deep-dose equivalent must be used in place of the effective dose equivalent, unless the effective dose equivalent is determined by a dosimetry method approved by the NRC. The assigned deep-dose equivalent must be for the part of the body receiving the highest exposure.", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "partial", "answer": "Aprons of at least 0.25 mm lead equivalent are required for everyone in the fluoroscopy room except the patient who is likely to be exposed to 5 mR/hr or more (in place since 10-1-2020). Drapes and panels of at least 0.25 mm lead equivalent are required whenever practicable. Thyroid shields and eyewear are not addressed.", "citation": "17 CCR § 30307(b)(1)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/california/17-CCR-30307" ], "quote": "Protective aprons of at least 0.25 mm lead equivalent shall be worn in the fluoroscopy room by each person, except the patient, whose body is likely to be exposed to 5 mR/hr or more.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "California's fluoroscopy rules require protective aprons for people likely to be exposed to 5 mR per hour or more, but set no requirement to inspect aprons on any schedule.", "citation": "17 CCR § 30307", "sourceUrls": [ "https://www.law.cornell.edu/regulations/california/17-CCR-30307" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rules do not mention engineered shielding systems. Aprons of at least 0.25 mm lead equivalent must be worn by each person, except the patient, whose body is likely to be exposed to 5 mR/hr (0.05 mSv per hour) or more, so by the rule's own terms the apron duty depends on the exposure rate. Drapes and hinged or sliding panels on their own may not replace the apron.", "citation": "17 CCR § 30307(b)(1), (a)(11)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/california/17-CCR-30307" ], "quote": "(1) Protective aprons of at least 0.25 mm lead equivalent shall be worn in the fluoroscopy room by each person, except the patient, whose body is likely to be exposed to 5 mR/hr or more.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Only permit holders may operate. Physicians, osteopaths, podiatrists and chiropractors need a fluoroscopy S&O permit (§ 30463); radiologists may instead hold a radiology S&O certificate (§ 30466). Certified technologists need an RTF permit and work under a licentiate's supervision (§§ 30450, 30461). PAs need a PA fluoroscopy permit and work under an S&O-permitted physician (§ 30456.1). Unpermitted people may move the patient or equipment but may not energize the beam or select technique (§ 30305.5). No NP pathway was found.", "citation": "17 CCR § 30305.5(b)(2)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/california/17-CCR-30305.5" ], "quote": "The non-permitted individual does not actuate or energize the equipment to emit radiation or select the equipment's technique factors (e.g., kVp, mA)", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "Licentiates must pass a CDPH-approved fluoroscopy exam (ACBR-certified chiropractors exempt); a secondary source says renewal needs 10 CE credits every 2 years, at least 4 in fluoroscopy radiation safety (§ 30403(b), not read directly). A temporary permit has been available since December 15, 2022. Technologists must be certified, complete permit school or have ARRT credentials, and pass CDPH exams. PAs need at least 40 hours of coursework plus supervised clinical training, and 10 CE hours every 2 years.", "citation": "17 CCR §§ 30466(a)(2), 30451(a), 30456.4(b)(1), 30403(b)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/california/17-CCR-30466", "https://www.law.cornell.edu/regulations/california/17-CCR-30451", "https://fluorosafety.com/california-fluoroscopy-permit/" ], "quote": "For the fluoroscopy supervisor and operator permit, pass a Department approved examination in fluoroscopy radiation protection and safety, and use and supervision of use of fluoroscopy and ancillary equipment.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "AB 511 (radiologist assistants)", "kind": "bill", "status": "Held in committee 2025-05-23; one tracking site lists it as failed (last action 2026-02-02)", "date": "2025-05-23", "dateISO": "2025-05-23", "summary": "Bill on radiologist assistants.", "sourceUrls": [ "https://legiscan.com/CA/text/AB511/id/3111938" ] }, { "title": "AB 460", "kind": "bill", "status": "Status not confirmed", "date": "", "dateISO": null, "summary": "Changes \"direct supervision\" for technologists doing venipuncture.", "sourceUrls": [] }, { "title": "RTCC April 8, 2026 meeting items", "kind": "other", "status": "No outcome found", "date": "2026-04-08", "dateISO": "2026-04-08", "summary": "Agenda included a SCAI presentation on modern radiation shielding tools and a CDPH item on what counts as supervision by certified supervisors and operators.", "sourceUrls": [ "https://www.cdph.ca.gov/Programs/CEH/DRSEM/Pages/RHB-Certification/RTCCagenda/2026-04-08.aspx" ] } ], "notable": [ "§ 30253 adopts 10 CFR 20 as of January 1, 2021, so it is insulated from automatic federal change; it is shared between X-ray registrants and radioactive-materials licensees.", "Facilities must record cumulative air kerma (or fluoroscopy time) for each patient and keep it 3 years (§ 30307(c)).", "Users must ensure only adequately instructed operators run X-ray equipment (§ 30305(b)(1)).", "Each facility must display its operators' certificates or permits (§ 30305(e)).", "Room barrier design is tied to the federal dose limits (§ 30305(a)(5)).", "The newest fluoroscopy rule changes found were operative 10-1-2020." ], "openQuestions": [ "Check 10 CFR 20.1101, 20.1201, 20.1208 and 20.1502 at eCFR, using the version in force on January 1, 2021.", "Check the official California code on Westlaw for amendments after 2022, and confirm the correct heading for § 30305.", "Check CDPH's Radiation Safety and Protection Program Requirement Guidance (9/4/2024) and 17 CCR §§ 30254-30258 for dosimeter rules: https://www.cdph.ca.gov/Programs/CEH/DRSEM/CDPH%20Document%20Library/RHB/X-ray/RHB-Guide-RadProtectionProgram.pdf", "Check the April 2026 RTCC minutes (and any October 2026 meeting) and CDPH's rulemaking page for follow-up on the shielding and supervision items.", "Read technologist supervision rules (H&S Code § 106965 et seq.; 17 CCR §§ 30400-30403) and the § 30403(b) CE wording directly; confirm with RHB that there is no NP fluoroscopy pathway.", "Confirm AB 460's status and any 2026 bills on leginfo.legislature.ca.gov." ], "sources": [ { "title": "Cornell LII, 17 CCR § 30253", "url": "https://www.law.cornell.edu/regulations/california/17-CCR-30253" }, { "title": "Cornell LII, 17 CCR § 30252 (search excerpt only)", "url": "https://www.law.cornell.edu/regulations/california/17-CCR-30252" }, { "title": "Cornell LII, 17 CCR § 30100", "url": "https://www.law.cornell.edu/regulations/california/17-CCR-30100" }, { "title": "Cornell LII, 17 CCR § 30305 (mislabeled heading)", "url": "https://www.law.cornell.edu/regulations/california/17-CCR-30305" }, { "title": "Cornell LII, 17 CCR § 30305.5", "url": "https://www.law.cornell.edu/regulations/california/17-CCR-30305.5" }, { "title": "Cornell LII, 17 CCR § 30307", "url": "https://www.law.cornell.edu/regulations/california/17-CCR-30307" }, { "title": "Cornell LII, 17 CCR §§ 30450, 30451, 30466", "url": "https://www.law.cornell.edu/regulations/california/17-CCR-30450" }, { "title": "Cornell LII, 17 CCR §§ 30456, 30456.1, 30456.4, 30456.10 (search excerpts)", "url": "https://www.law.cornell.edu/regulations/california/17-CCR-30456.1" }, { "title": "Justia, 17 CCR § 30463 (search excerpt)", "url": "https://regulations.justia.com/states/california/title-17/division-1/chapter-5/subchapter-4-5/group-5/article-1/section-30463/" }, { "title": "vLex, 17 CCR § 30461 (search excerpt)", "url": "https://regulations.vlex.com/vid/cal-code-regs-tit-956744543" }, { "title": "CDPH, CE requirements for renewal", "url": "https://cdph.ca.gov/Programs/CEH/DRSEM/CDPH%20Document%20Library/RHB/Certification/RHB-CEC-Renewal.pdf" }, { "title": "CDPH, Temporary Fluoroscopy Permit notice", "url": "https://www.cdph.ca.gov/Programs/CEH/DRSEM/CDPH%20Document%20Library/RHB/Certification/IN-TempFluoroPermit.pdf" }, { "title": "CDPH, RTCC agenda 2026-04-08", "url": "https://www.cdph.ca.gov/Programs/CEH/DRSEM/Pages/RHB-Certification/RTCCagenda/2026-04-08.aspx" }, { "title": "SCAI news (March 25, 2026)", "url": "https://www.scai.org/media-center/news-and-articles/california-department-public-health-rtcc-meeting-include-radiation" }, { "title": "CA Veterinary Medical Board radiation guide", "url": "https://www.vmb.ca.gov/forms_pubs/radguide.pdf" }, { "title": "FluoroSafety, CA permit page (secondary)", "url": "https://fluorosafety.com/california-fluoroscopy-permit/" }, { "title": "LegiScan, AB 511", "url": "https://legiscan.com/CA/text/AB511/id/3111938" }, { "title": "GovBuddy, AB 511", "url": "https://www.govbuddy.com/california/bills/ab-511/" } ] }, { "code": "CO", "name": "Colorado", "pageUrl": "https://orsif.org/guidelines/us/states/colorado", "regulator": { "name": "Colorado Department of Public Health and Environment (CDPHE), Hazardous Materials and Waste Management Division, Radiation Control Program; rules adopted by the State Board of Health", "url": "https://cdphe.colorado.gov/hm/radiation-management" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Colorado's ALARA requirement is in its unified Part 4 (§4.5.2), which covers both radioactive-materials licensees and X-ray registrants; Part 6 points back to it. Colorado uses the standard federal dose limits (50 mSv whole body, 150 mSv lens, 500 mSv skin/extremity, 5 mSv embryo/fetus) and has not adopted a lower lens limit. Fluoroscopy staff must wear aprons or stand behind shields of at least 0.25 mm lead equivalent, and aprons must be checked visually and by touch every year. Barriers and shields are accepted as alternatives, but engineered protection systems are not named. Since 2021, fluoroscopy operators must be physicians, certain ARRT or radiologist-assistant credential holders, or registered fluoroscopy operators (PAs, APRNs and certified cardiovascular lab specialists with 40 hours of coursework and 40 hours of supervised clinical experience). The Part 6 findings are based on the 2020 text and need checking against the 2024 version.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The only operative ALARA sentence is in the unified Part 4 (§4.5.2), which applies to both licensees and registrants (§4.1.4.1). In the 2020 text, Part 6 cross-references Part 4 (§6.3.3.1) rather than creating its own ALARA duty, apart from one X-ray-specific line on auxiliary equipment designed to minimize exposure.", "citation": "§4.1.4.1; §4.5.2; §6.3.3.1 (2020 version)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Colorado is not on the NRC list of non-Agreement States, and its rules include a radioactive-materials licensing part.", "citation": "NRC list of Agreement States, updated October 29, 2026; 6 CCR 1007-1 Part 03", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.coloradosos.gov/CCR/NumericalCCRDocList.do?deptID=16&agencyID=141" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "6 CCR 1007-1: Part 4 (Standards for Protection Against Radiation, eff. 12/15/2023), Part 6 (X-Ray Imaging in the Healing Arts, eff. 04/14/2024), Part 2 (Registration of Radiation Machines, Facilities and Services, eff. 04/14/2024), and Part 1 (General Provisions, eff. 11/14/2017). The Part 4 text was read in a copy filed with the NRC, not the official SOS PDF.", "citation": "6 CCR 1007-1 Part 4, §4.1.3.1", "sourceUrls": [ "https://www.coloradosos.gov/CCR/DisplayRule.do?action=ruleinfo&ruleId=2933&deptID=16&agencyID=141&deptName=Department+of+Public+Health+and+Environment&agencyName=Hazardous+Materials+and+Waste+Management+Division&seriesNum=6+CCR+1007-1+Part+04" ], "quote": "This Part 4 establishes standards for protection against ionizing radiation resulting from activities conducted pursuant to licenses or registrations issued by the Department.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. §4.5.2 requires every licensee or registrant, including X-ray registrants, to use procedures and engineering controls that keep occupational doses ALARA.", "citation": "6 CCR 1007-1 §4.5.2 (eff. 12/15/2023 version)", "sourceUrls": [ "https://www.nrc.gov/docs/ML2400/ML24003A734.pdf" ], "quote": "The licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "50 mSv (5 rem) TEDE per year for adults.", "citation": "6 CCR 1007-1-4.6.1.1", "sourceUrls": [ "https://www.law.cornell.edu/regulations/colorado/6-CCR-1007-1-4.6" ], "quote": "The total effective dose equivalent being equal to 0.05 Sv (5 rem); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "150 mSv (15 rem) per year. Colorado has not adopted a lower lens limit.", "citation": "§4.6.1.2", "sourceUrls": [ "https://www.nrc.gov/docs/ML2400/ML24003A734.pdf" ], "quote": "(1) A lens dose equivalent of 0.15 Sv (15 rem), and (2) A shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "500 mSv (50 rem) per year shallow dose to the skin of the whole body or any extremity.", "citation": "§4.6.1.2", "sourceUrls": [ "https://www.nrc.gov/docs/ML2400/ML24003A734.pdf" ], "quote": "(1) A lens dose equivalent of 0.15 Sv (15 rem), and (2) A shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus over the whole pregnancy, with efforts to avoid substantial month-to-month variation in dose (§4.13.2).", "citation": "§4.13.1", "sourceUrls": [ "https://www.nrc.gov/docs/ML2400/ML24003A734.pdf" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to an embryo/fetus during the entire pregnancy, due to the occupational exposure of a declared pregnant woman, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Monitoring is required for adults likely to receive more than 10% of the §4.6.1 limits; minors likely to exceed 1 mSv deep dose, 1.5 mSv lens dose or 5 mSv skin/extremity dose; declared pregnant women likely to exceed 1 mSv deep dose over the pregnancy; and anyone entering high or very high radiation areas. In the 2020 text, §6.3.3.11 applies these duties to X-ray staff.", "citation": "§4.18.1.1-4.18.1.4", "sourceUrls": [ "https://www.nrc.gov/docs/ML2400/ML24003A734.pdf" ], "quote": "Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of the limits in 4.6.1;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "Under 145 kVp with lead garments, the registrant may calculate assigned dose using NRC RIS 2002-06 methods, Department-approved methods, or Colorado's equations: 0.06 × (collar - waist) + waist without a thyroid collar, and 0.02 × (collar - waist) + waist with one. Without an approved method, deep-dose equivalent replaces effective dose equivalent. NCRP 122 and Webster are not named. No explicit badge-location rule was found; assigned deep dose must be for the part of the body receiving the highest exposure.", "citation": "§4.6.3.1, 4.6.3.2, 4.6.3.5; §6.3.3.11 (2020)", "sourceUrls": [ "https://www.nrc.gov/docs/ML2400/ML24003A734.pdf" ], "quote": "In the case of occupational exposures to x-rays with accelerating voltages of less than 145 kVp and where the worker utilizes lead garment protection, the registrant may calculate the assigned dose equivalent using methods discussed in NRC Regulatory Information Summary (RIS) 2002-06", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Based on the 2020 text: ancillary shielding must be available and used for stationary fluoroscopes. Where sterile fields prevent normal barriers, everyone except the patient must wear aprons or stand behind a shield of at least 0.25 mm lead equivalent. Staff must be protected by at least 0.25 mm lead equivalent from scatter and 0.5 mm from the direct beam, with an RSO exception. No thyroid shield or eyewear requirement was found for human fluoroscopy staff.", "citation": "§6.5.11.1-6.5.11.2; §6.3.3.5 (2020 version)", "sourceUrls": [ "https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=9069&fileName=6+CCR+1007-1+Part+06" ], "quote": "All persons, except the patient, in the room where fluoroscopy is performed shall wear protective apparel (aprons) or shall be positioned behind a stationary or portable shield that provides a lead equivalent shielding of at least 0.25mm;", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes, annually under a written procedure, by visual inspection plus a tactile test; X-ray or fluoroscopic imaging of aprons is not required. Garments must be labeled with lead equivalence and hung, failed items must be removed from service, repaired or replaced, and records kept for 3 years (2020 text).", "citation": "§6.3.3.6(1)-(4) (2020 version)", "sourceUrls": [ "https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=9069&fileName=6+CCR+1007-1+Part+06" ], "quote": "All protective apparel and auxiliary shields shall be evaluated annually for integrity.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered radiation protection systems are not addressed by name. Whole body protective barriers and stationary or portable shields are accepted as alternatives to garments. It is unclear whether ceiling- or floor-mounted systems qualify, and no approval process was found.", "citation": "§6.3.3.5(2); §6.5.11.2(2) (2020 version)", "sourceUrls": [ "https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=9069&fileName=6+CCR+1007-1+Part+06" ], "quote": "All persons shall be protected from scatter radiation by protective garments, safety equipment or whole body protective barriers of at least 0.25 millimeter lead equivalent material", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Since January 1, 2021, fluoroscopy operators on living humans must be Colorado-licensed physicians, RRA/RPA meeting Appendix 2G, technologists with R.T.(R), (CV), (CI), (VI) or (T), or registered fluoroscopy operators. Registration is limited to licensed PAs, licensed APRNs and nationally certified cardiovascular lab specialists aged 18 or older. Limited-scope operators may not do fluoroscopy, and no category was found for non-APRN RNs. The 2020 text requires direct supervision; the current §6.3.1.6 adds a personal-supervision route for operators who meet Appendix 2O training.", "citation": "§2.4.5.5(1); Appendix 2O; §6.5.12.1 (2020); §6.3.1.6", "sourceUrls": [ "https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=11415&fileName=6+CCR+1007-1+Part+02" ], "quote": "On or after January 1, 2021, each individual operating a fluoroscopy imaging system on living humans shall be registered with the department as a fluoroscopy operator consistent with 2.4.5.5(2) or 2.4.5.5(3), except for:", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "Registration requires at least 40 hours of coursework, 40 hours of clinical experience under the personal supervision of a Colorado-licensed physician, and a credential: a passing ARRT fluoroscopy exam for PAs and APRNs, or CCI RCIS/RCES or another Department-approved credential for others. Registration lasts two years and is renewed by resubmitting a current license or certification; no CE hours were found. Physicians are deemed trained, but everyone who operates or supervises fluoroscopy needs documented training under §2.6.1.5, which since 2022 must cover patient and staff radiation protection, dose units and the outputs of each operating mode.", "citation": "Appendix 2O (2O.1-2O.2); §2.4.5.5(3)(e); §2.6.1.5", "sourceUrls": [ "https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=11415&fileName=6+CCR+1007-1+Part+02" ], "quote": "Has completed a course that includes at least forty (40) hours of education on topics that include, but are not limited to, radiation physics, radiation biology, radiation safety and radiation management applicable to fluoroscopy;", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [], "notable": [ "Since 2022, facilities performing fluoroscopically guided interventional (FGI) procedures must have an FGI Procedure Committee that includes a supervising physician, a registered medical physicist and, where applicable, a technologist, meets at least every 12 months, and focuses its dose management on patients (§6.5.15, 2020 version).", "Registrants must keep a list of fluoroscopy operators and supervisors, updated at least once a year, as part of the Part 4 radiation protection program (§2.6.1.1(2)).", "Part 6 answers are based on the superseded 10/15/2020 text; the current version took effect 04/14/2024.", "§4.6.3.1 refers to effective-dose methods approved by the NRC.", "Thyroid shield and eye protection appear only in the veterinary rules (§6.8.2.1(4))." ], "openQuestions": [ "Read the official 04/14/2024 Part 6 PDF to confirm the wording and numbering of §6.3.3.5, §6.3.3.6, §6.3.3.11, §6.5.11, §6.5.12.1 and §6.5.15, and check eDocket 2024-00016 and any 2021-2022 dockets.", "Confirm which operators need direct supervision (§6.5.12.1, 2020) versus personal supervision (§6.3.1.6(4), 2024), including Part 1's definition of personal supervision.", "Pending 2025-2026 rules or bills were not searched (SOS eDocket, Colorado Register, CDPHE rulemaking pages, leg.colorado.gov); also ask how CDPHE will handle any NRC compatibility change to 10 CFR 20.1101.", "Whether CDPHE treats ceiling- or table-mounted shielding systems as whole body protective barriers (see cdphe.colorado.gov/hm/xray-guidance-and-policy or ask the program).", "Which methods NRC RIS 2002-06 covers (e.g., Webster, NCRP 122), and whether CDPHE has approved others under §4.6.3.5.", "Confirm the agency website by opening cdphe.colorado.gov/hm/radiation-management." ], "sources": [ { "title": "Colorado SOS, 6 CCR 1007-1 Part 04 version page (current version eff. 12/15/2023)", "url": "https://www.coloradosos.gov/CCR/DisplayRule.do?action=ruleinfo&ruleId=2933&deptID=16&agencyID=141&deptName=Department+of+Public+Health+and+Environment&agencyName=Hazardous+Materials+and+Waste+Management+Division&seriesNum=6+CCR+1007-1+Part+04" }, { "title": "6 CCR 1007-1 Part 04 text, adopted 10/18/2023 and effective 12/15/2023; copy held in NRC ADAMS", "url": "https://www.nrc.gov/docs/ML2400/ML24003A734.pdf" }, { "title": "Colorado SOS, 6 CCR 1007-1 Part 02 PDF (history notes through eff. 04/14/2024)", "url": "https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=11415&fileName=6+CCR+1007-1+Part+02" }, { "title": "Colorado SOS, 6 CCR 1007-1 Part 06 PDF, eff. 10/15/2020 (superseded)", "url": "https://www.sos.state.co.us/CCR/GenerateRulePdf.do?ruleVersionId=9069&fileName=6+CCR+1007-1+Part+06" }, { "title": "Colorado SOS, Part 02 and Part 06 version pages (ruleId 2931 and 2935) and the division's document list", "url": "https://www.coloradosos.gov/CCR/NumericalCCRDocList.do?deptID=16&agencyID=141" }, { "title": "Colorado SOS, 6 CCR 1007-1 Part 06 version page (ruleId 2935)", "url": "https://www.coloradosos.gov/CCR/DisplayRule.do?action=ruleinfo&ruleId=2935&deptID=16&agencyID=141&deptName=Department%20of%20Public%20Health%20and%20Environment&agencyName=Hazardous%20Materials%20and%20Waste%20Management%20Division&seriesNum=6%20CCR%201007-1%20Part%2006" }, { "title": "Cornell LII (secondary), 6 CCR 1007-1-6.3 (reflects the 4/14/2024 amendment)", "url": "https://www.law.cornell.edu/regulations/colorado/6-CCR-1007-1-6.3" }, { "title": "Cornell LII (secondary), 6 CCR 1007-1-6.4", "url": "https://www.law.cornell.edu/regulations/colorado/6-CCR-1007-1-6.4" }, { "title": "CDPHE Radiation Control Program page (search result only, not opened)", "url": "https://cdphe.colorado.gov/hm/radiation-management" } ] }, { "code": "CT", "name": "Connecticut", "pageUrl": "https://orsif.org/guidelines/us/states/connecticut", "regulator": { "name": "Department of Energy and Environmental Protection (DEEP), Bureau of Air Management, Radiation Division", "url": "https://portal.ct.gov/deep/radiation/diagnostic-and-therapeutic-x-ray-devices" }, "nrcAgreementState": true, "agreementNote": "Agreement State since September 2025 (NRC news release 25-057).", "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "The research for this state ended before every question was fully answered, so some answers may be incomplete." }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Connecticut DEEP regulates medical X-ray and fluoroscopy under its 1982 regulations (RCSA §§ 19-24-1 to 19-24-14 and 19-25d-1 to 19-25d-11). These rules contain no ALARA requirement for workers' doses. The ALARA duty that does exist comes from 10 CFR 20, which the state copies, and applies only to radioactive-materials licensees. Worker dose limits are quarterly: 1¼ rem whole body (up to 3 rem under the age formula), with the lens of the eye counted as whole body; hands and feet are limited to 18¾ rem and skin to 7½ rem per quarter. There is no embryo/fetus limit. The rules do not address aprons for human fluoroscopy, apron inspection, badge placement or engineered alternatives to aprons. Operators generally need a DPH radiographer license; physician assistants using fluoroscopy have a statutory exemption with unconfirmed conditions. Connecticut became an Agreement State on Sept 25, 2025.", "whereAlaraLives": { "category": "none", "explanation": "X-ray registrants have no ALARA requirement, only advisory equipment wording. The ALARA duty for radioactive-materials licensees comes from 10 CFR 20, copied into state law 'as may be amended from time to time' by § 22a-153-1; Table 1.0 does not exclude § 20.1101 (not read directly). Since the Feb 11, 2026 amendment, § 19-24-1(c) keeps the X-ray rules separate from the licensee rules, so an NRC change would likely flow only into the licensee rules.", "citation": "RCSA § 19-24-1(c); § 22a-153-20(b); § 22a-153-1(b)(2)" }, "eyeLensLimitMsv": 50, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Connecticut became the NRC's 40th Agreement State on September 25, 2025 (NRC press release No. 25-057). Because the change is recent, the state's rules are still in transition.", "citation": "NRC list of Agreement States, updated October 29, 2026; DEEP news release, 2025", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://portal.ct.gov/deep/news-releases/news-releases---2025/governor-lamont-signs-agreement-giving-connecticut-oversight-of-radioactive-materials-in-research" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Yes. Three rule sets apply: RCSA §§ 19-24-1 to 19-24-14 (1982 general protection standards, eRegulations revised 2026-3-26); RCSA §§ 19-25d-1 to 19-25d-11 (X-ray device equipment and use rules; § 19-25d-4 covers fluoroscopy); and RCSA § 19-25a (registration). RCSA § 22a-153-20 (effective Oct 1, 2025) copies 10 CFR 20 into state law but applies only to radioactive-materials licensees. Cornell LII's 'repealed' label for 19-25d appears out of date; the repeal was reversed.", "citation": "RCSA § 19-24-1(a); § 19-25d-1; § 22a-153-20", "sourceUrls": [ "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BB0252B9D-0200-C82A-AAAB-23523ADE5B4E%7D" ], "quote": "Sections 19-24-2 to 19-24-14, inclusive, shall apply to all persons who receive, transfer, possess, manufacture, use, store, handle, transport or dispose of radioactive materials and to all persons who manufacture, use or operate other sources of ionizing radiation except as specifically exempted herein.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "no", "answer": "No. Connecticut's radiation protection rules that apply to X-ray users (RCSA §§ 19-24-1 to 19-24-14) and its fluoroscopy rule (§ 19-25d-4) do not require doses to workers to be kept as low as reasonably achievable. The only similar wording is advisory and concerns the fluoroscope's table-top exposure rate, which \"should\" be as low as practicable. The ALARA duty in federal rule 10 CFR 20, which Connecticut adopted in 2025, applies only to people licensed to handle radioactive materials.", "citation": "RCSA §§ 19-24-1 to 19-24-14; § 19-25d-4; § 22a-153-1(a)", "sourceUrls": [ "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BB3EA236C-E5D4-4707-A8C5-78D389050CC4%7D" ], "quote": "For routine fluoroscopy, the exposure rate measured at the panel or table top should be as low as practicable and shall not exceed ten roentgens per minute.", "quoteMatchedToSource": true, "confidence": "medium" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "1¼ rem (12.5 mSv) per calendar quarter, or up to 3 rem (30 mSv) per quarter if the lifetime dose stays within 5(N-18) rem and there is a written dose history. Workers under 18 are limited to 10% of these limits.", "citation": "RCSA § 19-24-5(a), (c)", "sourceUrls": [ "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BB0252B9D-0200-C82A-AAAB-23523ADE5B4E%7D" ], "quote": "“Dose to the whole body” shall be deemed to include any dose to the whole body, gonads, active blood-forming organs, head and trunk or lens of eye.", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "partial", "answer": "There is no separate lens limit and no adoption of the ICRP 20 mSv value. The lens counts as whole body, so the quarterly whole-body limits apply. That works out to 50 mSv a year at the base rate, and up to 120 mSv a year in principle under the 3-rem option.", "citation": "RCSA § 19-24-5(a), (c)", "sourceUrls": [ "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BB0252B9D-0200-C82A-AAAB-23523ADE5B4E%7D" ], "quote": "“Dose to the whole body” shall be deemed to include any dose to the whole body, gonads, active blood-forming organs, head and trunk or lens of eye.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Hands and forearms, and feet and ankles: 18¾ rem (187.5 mSv) per quarter. Skin of the whole body: 7½ rem (75 mSv) per quarter.", "citation": "RCSA § 19-24-5(a)", "sourceUrls": [ "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BB0252B9D-0200-C82A-AAAB-23523ADE5B4E%7D" ], "quote": "in such a manner as to cause any employee to receive in any period of one calendar quarter, from radioactive material and other sources of ionizing radiation, an occupational dose in excess of the limits specified in the following table.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "no", "answer": "Not addressed. There is no pregnancy or embryo/fetus provision anywhere in 19-24.", "citation": "RCSA § 19-24-5", "sourceUrls": [ "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BB0252B9D-0200-C82A-AAAB-23523ADE5B4E%7D" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Personal dosimeters must be supplied and required for anyone likely to receive more than 25% of the quarterly limit, workers under 18 likely to receive more than 5%, and anyone entering a high radiation area. Dose records must cover periods of no more than one quarter.", "citation": "RCSA § 19-24-6(a)(1)", "sourceUrls": [ "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BB0252B9D-0200-C82A-AAAB-23523ADE5B4E%7D" ], "quote": "Each employee and other individual who receives, or is likely to receive, a dose in any calendar quarter in excess of twenty-five per cent of the applicable value specified in subsection (a) of section 19-24-5;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "no", "answer": "Not addressed. The rules set no badge location, no two-badge method and no effective-dose formula. A 2015 proposal (REG2015-030) included such methods but was never adopted.", "citation": "RCSA § 19-24-6(a)(2)", "sourceUrls": [ "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BB0252B9D-0200-C82A-AAAB-23523ADE5B4E%7D" ], "quote": "“personnel monitoring equipment” means devices designed to be worn or carried by an individual for the purpose of measuring the dose received (e.g., film badges, pocket chambers, pocket dosimeters, film rings, etc.).", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "no", "answer": "There is no apron, thyroid shield or eyewear requirement for human fluoroscopy staff. Aprons are required only for operators of hand-held low-voltage therapy tubes (§ 19-25d-10, no lead value stated) and for veterinary radiography (§ 19-25d-11, 0.5 mm lead equivalent).", "citation": "RCSA § 19-25d-11 (veterinary only); § 19-25d-4 (fluoroscopy; no apparel provision)", "sourceUrls": [ "https://regulations.justia.com/states/connecticut/title-19/subtitle-25d/section-19-25d-11/" ], "quote": "clothing consisting of a protective apron having a lead equivalent of not less than one-half millimeter shall be worn by the operator and any other individuals in the room during exposures.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Not addressed. No requirement to inspect protective apparel was found in 19-24 or 19-25d.", "citation": "", "sourceUrls": [], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "no", "answer": "Not addressed. The rules are silent on engineered shielding systems used instead of aprons. DEEP has a general variance power, provided patient or operator exposure would not increase.", "citation": "RCSA § 19-25d-3(d)", "sourceUrls": [ "https://regulations.justia.com/states/connecticut/title-19/subtitle-25d/section-19-25d-3/" ], "quote": "The commissioner may grant a variance to requirements in Sections 19-25d-3 to 19-25d-11 inclusive, provided that it can be demonstrated that the use of the equipment under the variance will not result in an increase in radiation exposure to the patient or operator.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "A DPH radiographer license is required to operate a medical X-ray system. Radiographers work under the supervision and order of a licensed physician, chiropractor, naturopath, podiatrist, dentist or veterinarian. A physician assistant using fluoroscopy is exempt (§ 20-74ee(a)(6)), but the conditions are unconfirmed. The physician exemption is unconfirmed. Radiologist assistants work under direct radiologist supervision. Nurses and nurse practitioners: not found.", "citation": "CGS §§ 20-74bb, 20-74ee(a)(6), 20-74mm; RCSA § 19-25d-3(b)(2)", "sourceUrls": [ "https://www.lawserver.com/law/state/connecticut/ct-laws/connecticut_statutes_20-74bb" ], "quote": "No person shall operate a medical x-ray system unless such person has obtained a license as a radiographer from the department pursuant to this section.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "A radiographer license requires completing an accredited radiologic technology program (or an ARRT-deemed equivalent) and passing an exam. The DEEP rules require only that operators be adequately instructed and competent. No state fluoroscopy permit, physician or PA fluoroscopy training hours, or continuing-education requirement was found.", "citation": "CGS § 20-74bb(a); RCSA § 19-25d-3(b)(2)", "sourceUrls": [ "https://www.cga.ct.gov/2010/rpt/2010-R-0061.htm" ], "quote": "The owner shall assure that all x-ray equipment under his control is operated only by individuals adequately instructed in safe operating procedures and competent in safe use of the equipment.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "RCSA §§ 22a-153-1 to -150 (File No. 6419, PR2021-040)", "kind": "adopted_rule", "status": "Effective", "date": "2025-10-01", "dateISO": "2025-10-01", "summary": "Radioactive-materials rules copying 10 CFR 20. Section 4 repealed 19-24, 19-25a and 19-25d; that repeal was later reversed.", "sourceUrls": [ "https://eregulations.ct.gov/eRegsPortal/Search/getDocument?guid=%7B50484D92-0000-CE16-BFAD-716F874BC043%7D" ] }, { "title": "Emergency regulation ER2025-025", "kind": "adopted_rule", "status": "Effective; expiring Mar 24, 2026", "date": "2025-09-25", "dateISO": "2025-09-25", "summary": "Kept the old X-ray rules in force.", "sourceUrls": [ "https://www.cga.ct.gov/2025/rrdata/pr/2025REGE2025-001-CL.PDF" ] }, { "title": "Permanent regulation PR2025-026", "kind": "adopted_rule", "status": "Final approved regulation", "date": "2026-02-11", "dateISO": "2026-02-11", "summary": "Amended § 19-24-1 and repealed the repeal of the X-ray rules, in light of uncertainty in federal (NRC) rulemaking.", "sourceUrls": [ "https://portal.ct.gov/deep/public-notices/public-notices-proposed-actions---opportunity-for-comment/miscellaneous-proposed-actions/miscellaneous-proposed-actions-archive---2025/notice-of-radioactive-materials-and-sources-of-ionizing-radiation-permanent-regulation" ] }, { "title": "HB 5139 (2025)", "kind": "bill", "status": "Proposed; outcome not verified", "date": "2025", "dateISO": "2025", "summary": "Proposed repealing the X-ray registration fee.", "sourceUrls": [ "https://www.cga.ct.gov/2025/TOB/H/PDF/2025HB-05139-R00-HB.PDF" ] }, { "title": "NRC proposed Part 20 rewrite", "kind": "proposed_rule", "status": "Proposed; NRC final rule expected late Nov 2026", "date": "", "dateISO": null, "summary": "Because Connecticut copies 10 CFR 20 automatically, this would likely flow into the licensee rules but not the X-ray rules.", "sourceUrls": [] } ], "notable": [ "Fluoroscopy staff are protected by 1982-era rules: limits are counted by quarter, and there is no ALARA requirement, no pregnant-worker provision, and no rules on aprons, badges or apron inspection.", "DEEP had begun replacing the X-ray rules (2015 proposal); the 2025-26 actions deliberately postponed that while federal rules change.", "Employers must instruct staff on precautions and give them their exposure records annually on request, including to former employees (§ 19-24-10).", "The 2024 rule package added civil penalties for violations involving \"other sources of ionizing radiation.\"", "Cornell LII's 'repealed' label for §§ 19-25d appears outdated." ], "openQuestions": [ "Final text of PR2025-026: confirm whether any 19-25d wording changed (record: https://eregulations.ct.gov/eRegsPortal/Search/RMRView/PR2025-026).", "Full text of CGS § 20-74ee: conditions on the PA fluoroscopy exemption and on the physician exemption.", "Whether nurses or nurse practitioners may activate fluoroscopy, and whether any continuing-education or physician fluoroscopy training rule exists.", "Outcomes of HB 5139 (2025) and any 2026 bills on fluoroscopy, aprons or lens limits.", "Whether DEEP plans new X-ray rules after the NRC final rule (expected late Nov 2026).", "The research for Connecticut ended before these items were checked further." ], "sources": [ { "title": "RCSA §§ 19-24-1-Appendix A (official, Revised 2026-3-26)", "url": "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BB0252B9D-0200-C82A-AAAB-23523ADE5B4E%7D" }, { "title": "RCSA § 19-25d-4 (official)", "url": "https://eregulations.ct.gov/eRegsPortal/Browse/getDocument?guid=%7BB3EA236C-E5D4-4707-A8C5-78D389050CC4%7D" }, { "title": "Justia, RCSA §§ 19-25d-1 to 19-25d-11 (secondary)", "url": "https://regulations.justia.com/states/connecticut/title-19/subtitle-25d/" }, { "title": "Cornell LII § 19-25d-2 (secondary)", "url": "https://www.law.cornell.edu/regulations/connecticut/Regs-Conn-State-Agencies-SS-19-25d-2" }, { "title": "File No. 6419, RCSA §§ 22a-153-1 to -150", "url": "https://eregulations.ct.gov/eRegsPortal/Search/getDocument?guid=%7B50484D92-0000-CE16-BFAD-716F874BC043%7D" }, { "title": "DEEP Diagnostic and Therapeutic X-Ray Devices", "url": "https://portal.ct.gov/deep/radiation/diagnostic-and-therapeutic-x-ray-devices" }, { "title": "DEEP fact sheet", "url": "https://portal.ct.gov/DEEP/Permits-and-Licenses/Factsheets-Air/Diagnostic-and-Therapeutic-X-Ray-Source-Registrations-Fact-Sheet" }, { "title": "DEEP Agreement State news release", "url": "https://portal.ct.gov/deep/news-releases/news-releases---2025/governor-lamont-signs-agreement-giving-connecticut-oversight-of-radioactive-materials-in-research" }, { "title": "DEEP permanent-regulation notice", "url": "https://portal.ct.gov/deep/public-notices/public-notices-proposed-actions---opportunity-for-comment/miscellaneous-proposed-actions/miscellaneous-proposed-actions-archive---2025/notice-of-radioactive-materials-and-sources-of-ionizing-radiation-permanent-regulation" }, { "title": "DEEP regulation dashboard (PR2025-026)", "url": "https://portal.ct.gov/DEEP/About/Transparency-Predictability-and-Efficiency/Developing-Better-Transparency-Around-Regulation-and-Public-Participation-Initiative" }, { "title": "CEQ minutes, Oct 22, 2025", "url": "https://portal.ct.gov/ceq/meetings-and-agendas/minutes/2025-minutes/october-22-2025-meeting-minutes" }, { "title": "DEEP emergency-action letter ER2025-025 (search excerpt only)", "url": "https://www.cga.ct.gov/2025/rrdata/pr/2025REGE2025-001-CL.PDF" }, { "title": "CT Post article", "url": "https://www.ctpost.com/connecticut/article/ct-radioactive-materials-state-regulation-21061838.php" }, { "title": "CGS ch. 376c (excerpt)", "url": "https://www.cga.ct.gov/current/pub/chap_376c.htm" }, { "title": "LawServer, CGS § 20-74bb (secondary)", "url": "https://www.lawserver.com/law/state/connecticut/ct-laws/connecticut_statutes_20-74bb" }, { "title": "OLR Report 2010-R-0061", "url": "https://www.cga.ct.gov/2010/rpt/2010-R-0061.htm" }, { "title": "2015 proposed X-ray rules (not adopted)", "url": "https://cga.ct.gov/2015/rrdata/pr/2015REG2015-030-RC.PDF" }, { "title": "2025 Proposed HB 5139", "url": "https://www.cga.ct.gov/2025/TOB/H/PDF/2025HB-05139-R00-HB.PDF" } ] }, { "code": "DE", "name": "Delaware", "pageUrl": "https://orsif.org/guidelines/us/states/delaware", "regulator": { "name": "Delaware Department of Health and Social Services, Division of Public Health, Health Systems Protection, Office of Radiation Control (ORC)", "url": "https://dhss.delaware.gov/dph/homepage/about/sections/hsp/licenses-and-permits/radiation-control/" }, "nrcAgreementState": false, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Delaware's Division of Public Health, Office of Radiation Control, regulates fluoroscopy under 16 Del. Admin. Code 4465. Part D requires every licensee or registrant to keep worker doses ALARA. Delaware is not an NRC Agreement State, so an NRC compatibility change would not automatically reach its rule. Dose limits follow the federal model: 50 mSv whole body, 150 mSv lens of the eye, 500 mSv skin and extremities, and 5 mSv embryo/fetus. All fluoroscopy workers must wear a dosimeter. Where sterile fields or special procedures prevent normal barriers or drapes, everyone in the room except the patient must wear an apron of at least 0.25 mm lead equivalent, and aprons must be checked annually. The rules do not mention engineered shielding systems by name, though a general rule lets whole-body protective barriers of at least 0.25 mm lead equivalent stand in for garments against scatter radiation. Physicians, PAs and APRNs within their scope of practice and certified radiologic technologists may operate fluoroscopy; radiologist assistants, residents and students may do so under supervision. Every operator and supervisor must complete set training topics, but no number of hours is specified.", "whereAlaraLives": { "category": "both", "explanation": "The binding ALARA duty is in Part D §5.2, written for licensee or registrant (the format shared with materials licensees). In practice it applies mainly to X-ray registrants because Delaware is not an Agreement State. X-ray-specific language appears in Part B Appendix C (RSO duties), Part F §3.1.10 and Part F §3.1.1.2.", "citation": "4465 Part A §1.0; Part D §5.2; Part B §6.2.2 and Appendix C; Part F §§3.1.1.2, 3.1.10" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "no", "answer": "No. Delaware is not an NRC Agreement State; the NRC licenses radioactive materials and the state only registers those facilities.", "citation": "NRC list of Agreement States, updated October 29, 2026; 4465 Part C §1.0", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "16 Del. Admin. Code 4465 Part F (fluoroscopy at §5.0), with the general protection standard in Part D. Related parts are Part B (registration and RSO) and Part J (notices and instructions to workers). Technologist certification is in a separate rule, 4466.", "citation": "4465 Part F §1.0; Part D §2.0", "sourceUrls": [ "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "This Part establishes requirements, for which a registrant is responsible, for use of diagnostic and interventional X-ray equipment and imaging systems", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Part D §5.2 requires each licensee or registrant to keep occupational doses ALARA, with an annual program review (§5.3). Part F §3.1.10 adds an X-ray-specific duty to use dose reduction strategies.", "citation": "4465 Part D §5.2; Part F §§3.1.10, 3.1.21", "sourceUrls": [ "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "The licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "Total effective dose equivalent of 0.05 Sv (5 rem) = 50 mSv per year.", "citation": "4465 Part D §6.1.1.1", "sourceUrls": [ "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "The total effective dose equivalent being equal to 0.05 Sievert (5 rem, or 5000 millirem)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) = 150 mSv per year. No lower ICRP-style limit has been adopted.", "citation": "4465 Part D §6.1.2.1", "sourceUrls": [ "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "A lens dose equivalent of 0.15 Sievert (15 rem, or 15,000 millirem)", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Shallow dose equivalent of 0.5 Sv (50 rem) = 500 mSv per year to the skin or any extremity.", "citation": "Part D §6.1.2.2", "sourceUrls": [ "https://archive.regulations.delaware.gov/register/march2025/final/28%20DE%20Reg%20667%2003-01-25.htm" ], "quote": "6.1.2.2 A shallow dose equivalent of 0.5 Sievert (50 rem, or 50,000 millirem) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. Registrants must also try to avoid substantial month-to-month variation.", "citation": "4465 Part D §§12.1, 12.2", "sourceUrls": [ "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "does not exceed 5 millisievert (0.5 rem, or 500 millirem)", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Adults likely to exceed 10% of a limit must be monitored, and declared pregnant women must be monitored if likely to exceed 1 mSv. Everyone working with medical fluoroscopic equipment must be monitored, with no threshold.", "citation": "4465 Part D §§17.1.1.1, 17.1.1.3, 17.1.1.5", "sourceUrls": [ "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "shall supply and require the use of individual monitoring devices by: 17.1.1.1 Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10% of the limits in subsection 6.1; … 17.1.1.5 Individuals working with medical fluoroscopic equipment.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "The whole-body badge goes at the unshielded location with the highest exposure, typically the collar when an apron is worn. A second badge at the waist under the apron is optional but required for a declared pregnant woman. With one collar badge, the reported deep dose equivalent counts as the effective dose equivalent, multiplied by 0.30 if the reported dose is above 25% of the limit. With two badges, EDE = 1.5 × waist + 0.04 × collar. The rule does not name NCRP Report 122 or Webster, and parts of the wording are garbled.", "citation": "4465 Part D §§6.3.2.1-6.3.2.3, 17.1.1.5.1-17.1.1.5.2, 18.1.1-18.1.4", "sourceUrls": [ "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "the effective dose equivalent for external radiation shall be assigned the value of the sum of the deep dose equivalent reported for the individual monitoring device located at the waist under the protective apron multiplied by 1.5 and the deep dose equivalent reported for the individual monitoring device located at the neck outside the protective apron multiplied by 0.04.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Where sterile fields or special procedures prevent normal barriers or drapes, everyone in the room except the patient must wear an apron of at least 0.25 mm lead equivalent. Generally, scatter protection must be at least 0.25 mm (garments or whole-body barriers), and 0.5 mm is required where the direct beam could strike the body. Ancillary shielding is required on stationary fluoroscopy systems. Thyroid shields and eyewear are not required.", "citation": "4465 Part F §§3.1.6, 3.1.18.1-3.1.18.2, 5.12.1-5.12.3", "sourceUrls": [ "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "Where sterile fields or special procedures prohibit the use of normal protective barriers or drapes, all of the following conditions shall be met: … All persons, except the patient, in the room where fluoroscopy is performed shall wear protective aprons that provide a lead equivalent shielding of at least 0.25 millimeters.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. All protective apparel and auxiliary shields must be evaluated annually for integrity and labeled with their lead equivalence. No inspection method is specified.", "citation": "4465 Part F §§3.1.7, 5.15.1.7", "sourceUrls": [ "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "All protective apparel and auxiliary shields shall be evaluated annually for integrity and clearly labeled with their lead equivalence.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rules do not mention engineered shielding systems by name, but a general X-ray rule lets whole-body protective barriers of at least 0.25 mm lead equivalent stand in for protective garments against scatter radiation. For stationary fluoroscopy systems, drapes, curtains or viewing shields must be used as extra protection. Where sterile fields or special procedures prevent normal barriers or drapes, everyone in the room except the patient must still wear an apron.", "citation": "Part F §3.1.18.2", "sourceUrls": [ "https://archive.regulations.delaware.gov/register/march2025/final/28%20DE%20Reg%20667%2003-01-25.htm" ], "quote": "All persons shall be protected from the secondary radiation by protective garments or whole body protective barriers of not less than 0.25 millimeter lead equivalent material;", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Physicians, PAs and APRNs within scope of practice, and certified radiologic technologists. Radiologist assistants may operate under direct radiologist supervision; licensed PAs who passed the ARRT Fluoroscopy Exam under direct physician supervision; and residents and students under personal physician supervision. Registered nurses are not listed.", "citation": "4465 Part F §§2.0, 5.13.1.1-5.13.1.4, 5.14.1; Reg. 4466 §§4.0, 5.1-5.2", "sourceUrls": [ "https://regulations.delaware.gov/api/AdminCode/title16/4466/fa584fb5-7808-4bb0-b1d3-9769a6e95f77", "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "A licensed practitioner who is also a physician, or an advanced practitioner (PA or APRN) working within their professional scope of practice per Title 24 Delaware Code, or a certified radiologic technologist working within their scope of practice per these radiation control regulations.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "All operators and supervisors must complete training in listed topics, with additional topics for FGI procedures and documentation kept for 3 years. No hours, physician permit or physician exam are required. Technologists need a state certificate based on a national credential, valid for 3 years.", "citation": "4465 Part F §§5.13.2-5.13.3; Reg. 4466 §§6.2.3, 6.3.5, 7.1, 7.3, 8.1, 8.3", "sourceUrls": [ "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" ], "quote": "All persons operating, or supervising the operation of, fluoroscopy systems shall have completed training that includes but is not limited to the following:", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Amendments to 4465 and 4466 (28 DE Reg. 312 and 313)", "kind": "adopted_rule", "status": "adopted", "date": "10/01/24", "dateISO": "2024-10-01", "summary": "October 2024 amendments to 4465 and 4466. These inadvertently removed PA/APRN authority.", "sourceUrls": [] }, { "title": "28 DE Reg. 667 (4465) and 28 DE Reg. 668 (4466) final amendments", "kind": "adopted_rule", "status": "final; 4465 amendments effective March 11, 2025", "date": "03/01/25", "dateISO": "2025-03-01", "summary": "Restored the PA/APRN authority that the October 2024 amendments had accidentally removed.", "sourceUrls": [ "https://archive.regulations.delaware.gov/register/march2025/final/28%20DE%20Reg%20667%2003-01-25.htm" ] } ], "notable": [ "FGI facilities must have a Radiation Protocol Committee that meets at least every 12 months (Part F §5.16).", "Facilities need a written patient dose-management policy following ACR-AAPM, NCRP Report 168 or an equivalent (§5.14.7).", "Only those needed for the procedure, those in training, or a parent or guardian may be in the immediate area while the tube is energized (§3.1.18).", "No one may be used routinely to hold the patient or image receptor (§3.1.20.3).", "Workers likely to exceed 1 mSv a year must be instructed in radiation risks and the purpose of protective devices (Part J §3.1).", "ORC posts a sample declaration-of-pregnancy letter and the 'Form X' employee notice.", "All fluoroscopy workers must be monitored regardless of expected dose (Part D §17.1.1.5)." ], "openQuestions": [ "Is the text current? The archive PDF runs through the March 2025 amendments, and the current official viewer at regulations.delaware.gov/AdminCode/title16/4465 could not be loaded.", "2026 rulemaking: the May, June, September, October and November 2026 Register issues, and bills in the 153rd General Assembly, were not checked.", "Would ORC accept an engineered system instead of aprons, given §3.1.18.2 and §5.12.2.2, or would it require an exemption under Part A §3.0?", "Does 'certified radiologic technologist' cover CCI-credentialed cardiovascular technologists? How are the two PA provisions (§§5.13.1.1 and 5.13.1.3) applied? Can registered nurses ever activate fluoroscopy?", "How do the single-collar-badge provisions §6.3.2.1 and §6.3.2.2 fit together, and what does the wording of §17.1.1.5.2 mean?", "Apron inspection method is not specified in §3.1.7; ORC inspection guidance or the Users Guide to Machine Registration may address it.", "The text of 16 Del.C. Chapter 74 (Radiation Control Act) was not read directly." ], "sources": [ { "title": "16 Del. Admin. Code 4465, authenticated PDF (archive)", "url": "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.pdf" }, { "title": "4465 HTML on archive site", "url": "https://archive.regulations.delaware.gov/AdminCode/title16/Department%20of%20Health%20and%20Social%20Services/Division%20of%20Public%20Health/Health%20Systems%20Protection%20(HSP)/4465.shtml" }, { "title": "Delaware Regulations current viewer, Title 16, 4465", "url": "https://regulations.delaware.gov/AdminCode/title16/4465" }, { "title": "Cornell LII, 4465 table of contents", "url": "https://www.law.cornell.edu/regulations/delaware/title-16/department-of-health-and-social-services/division-of-public-health/health-systems-protection-hsp/4465" }, { "title": "16 Del. Admin. Code 4466, Radiation Technologists/Technicians (Certification)", "url": "https://regulations.delaware.gov/api/AdminCode/title16/4466/fa584fb5-7808-4bb0-b1d3-9769a6e95f77" }, { "title": "28 DE Reg. 667 (03/01/25), final order amending 4465", "url": "https://archive.regulations.delaware.gov/register/march2025/final/28%20DE%20Reg%20667%2003-01-25.htm" }, { "title": "Office of Radiation Control program page", "url": "https://dhss.delaware.gov/dph/homepage/about/sections/hsp/licenses-and-permits/radiation-control/" }, { "title": "Delaware Register of Regulations, Feb. 1, 2026", "url": "https://regulations.delaware.gov/api/register/February2026/8d147b07-7a27-4a47-b572-f96140d586ee" }, { "title": "Delaware Register of Regulations, Apr. 1, 2026", "url": "https://regulations.delaware.gov/api/register/April2026/ab292862-13f2-4f1b-8759-0604e8920763" }, { "title": "Delaware Register of Regulations, Aug. 1, 2026", "url": "https://regulations.delaware.gov/api/register/August2026/bf5d1b1f-1e4e-487b-bec3-b5c3fbe06640" }, { "title": "NRC Agreement State list", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "DC", "name": "District of Columbia", "pageUrl": "https://orsif.org/guidelines/us/states/district-of-columbia", "regulator": { "name": "DC Department of Health (DC Health), Health Regulation and Licensing Administration, Division of Radiation Control and Medical Devices (also called the Radiation Protection Division)", "url": "https://dchealth.dc.gov/service/radiation-control-medical-devices-division" }, "nrcAgreementState": false, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "DC Health posts CRCPD model 'Suggested State Regulations' (including Part F, December 2001) with unfilled placeholders, so it is unclear whether this is DC's legally adopted text; in that text, ALARA sits in the shared Part D covering both registrants and licensees, and DC is not an NRC Agreement State. Dose limits match federal ones, including a 150 mSv/yr lens limit. Fluoroscopy staff must be protected by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent, and the posted rules set no schedule for inspecting aprons for defects. D.C. Law 25-191 (2024) will license medical radiation technologists, including cardiovascular-interventional technologists, under physician or APRN supervision, with licenses required one year after implementing regulations take effect.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "ALARA wording appears only in the unified posted Part D, which applies to both licensees and registrants. Part F does not use the ALARA phrase but has an X-ray-specific rule (F.3a.ix) requiring procedures and equipment that minimize personnel exposure. DC is not an Agreement State, so NRC compatibility does not formally bind it, though Part D follows the CRCPD model based on 10 CFR Part 20.", "citation": "Posted Part D § D.1101(b); posted Part F § F.3a.ix." }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "no", "answer": "No. DC is not an NRC Agreement State; DC Health's radioactive material license application link goes to nrc.gov.", "citation": "NRC list of Agreement States, updated October 29, 2026; D.C. Law 25-277 § 2(6).", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "unclear", "answer": "Unclear which text is legally in force. DC Health says it enforces DCMR Title 20, Chapters 20-22, but posts CRCPD model Parts A-X (Part F, Diagnostic X-Rays, Dec. 2001 text) with unfilled placeholders. The official DCMR X-ray chapter was not found.", "citation": "20 DCMR Ch. 20-22 (per DC Health); posted model Parts D and F; 22 DCMR Ch. 68.", "sourceUrls": [ "https://dchealth.dc.gov/service/regulations-control-radiation", "https://dchealth.dc.gov/service/radiation-protection-services-and-forms" ], "quote": "The Radiation Protection Division enforces the Radiation Protection Standards (DCMR Title 20, Chapters 20-22)", "quoteMatchedToSource": true, "confidence": "low" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes, in posted Part D: each licensee or registrant must use procedures and engineering controls to keep occupational doses ALARA, with a program review at least every 12 months. Adoption status of the text is unclear.", "citation": "Posted Part D, §§ D.1101(b), D.1002.", "sourceUrls": [ "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Standards_Protection_Against_Rad.pdf" ], "quote": "occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA)", "quoteMatchedToSource": true, "confidence": "medium" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem) TEDE per year (50 mSv), per posted Part D.", "citation": "Sec. D.1201a.i.(1)", "sourceUrls": [ "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Standards_Protection_Against_Rad.pdf" ], "quote": "The total effective dose equivalent being equal to 0.05 Sievert (5 rem); or", "quoteMatchedToSource": true, "confidence": "medium" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) per year (150 mSv), per posted Part D; no lower limit adopted and nothing reflecting the ICRP 20 mSv was found.", "citation": "Posted Part D § D.1201.", "sourceUrls": [ "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Standards_Protection_Against_Rad.pdf" ], "quote": "A lens dose equivalent of 0.15 Sievert (15 rem)", "quoteMatchedToSource": true, "confidence": "medium" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Shallow dose to skin or any extremity: 0.5 Sv (50 rem) per year (500 mSv), per posted Part D.", "citation": "Sec. D.1201a.ii.(2)", "sourceUrls": [ "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Standards_Protection_Against_Rad.pdf" ], "quote": "A shallow dose equivalent of 0.5 Sievert (50 rem) to the skin or to any", "quoteMatchedToSource": true, "confidence": "medium" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy, per posted Part D.", "citation": "Sec. D.1208a.", "sourceUrls": [ "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Standards_Protection_Against_Rad.pdf" ], "quote": "exceed 5 millisievert (0.5 rem). See D.2106d. for recordkeeping requirements.", "quoteMatchedToSource": true, "confidence": "medium" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Dosimetry is required for adults likely to exceed 10% of the D.1201(a) limits, minors above lower thresholds, declared pregnant women likely to exceed 1 mSv (0.1 rem), entrants to high or very high radiation areas, and, listed separately, individuals working with medical fluoroscopic equipment (as written, without reference to the 10% threshold).", "citation": "Posted Part D § D.1502(a)(i)-(v).", "sourceUrls": [ "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Standards_Protection_Against_Rad.pdf" ], "quote": "Individuals working with medical fluoroscopic equipment", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "Single badge: at the neck (collar) outside the apron; the reported deep dose counts as effective dose, multiplied by 0.3 if above 25% of the limit. Two badges: waist under the apron and neck outside it; effective dose = 1.5 × waist + 0.04 × neck; the second badge is required for a declared pregnant woman. Lens badge: at the collar or an unshielded spot closer to the eye. Fetal badge: under the apron at the waist. NCRP 122 and Webster are not cited by name.", "citation": "Posted Part D §§ D.1201(c)(ii), D.1502(a)(v)(1)-(3).", "sourceUrls": [ "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Standards_Protection_Against_Rad.pdf" ], "quote": "it shall be located at the neck (collar) outside the protective apron", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Staff must be protected from scatter by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent. Anyone whose body could be in the useful beam needs at least 0.5 mm. Sufficient leaded aprons and gloves must be available. For fluoroscopy, under-table scatter must be attenuated by at least 0.25 mm; above the table, staff must be 120 cm from the beam center or behind an extra 0.25 mm (drapes, Bucky-slot cover, curtains), with exemptions for sterile fields. No thyroid shield or eyewear requirement was found.", "citation": "Posted Part F §§ F.3a.v, F.3a.viii(6), F.5h.", "sourceUrls": [ "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Diagnostic_Imaging_Systems_Healing_Art.pdf" ], "quote": "protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent material", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "The posted DC rules for diagnostic X-ray require staff in the room to wear protective aprons or use whole-body barriers of at least 0.25 millimeter lead equivalent, and require each facility to keep enough leaded aprons and gloves for all staff who are not otherwise shielded. They do not require protective aprons to be inspected or checked for defects on any schedule.", "citation": "Posted Part F, Sec. F.3a.v(2) and F.3a.viii(6)", "sourceUrls": [ "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Diagnostic_Imaging_Systems_Healing_Art.pdf" ], "quote": "Each facility shall have leaded aprons and gloves available in sufficient numbers", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered radiation protection systems are not addressed by name. Posted Part F accepts whole-body protective barriers (at least 0.25 mm lead equivalent) as an alternative to aprons for scatter protection; drapes and curtains count as additional shielding on top of the apron. Nothing comparable to Arizona SB 1121 or Illinois 32 Ill. Adm. Code 360 was found.", "citation": "Posted Part F §§ F.3a.v(2), F.5h.ii.", "sourceUrls": [ "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Diagnostic_Imaging_Systems_Healing_Art.pdf" ], "quote": "protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent material", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Posted Part F: equipment is used by, or under the supervision of, a licensed healing-arts practitioner, by adequately instructed and competent operators. D.C. Law 25-191 (effective July 19, 2024) creates medical radiation technologist licensure, including cardiovascular-interventional technologist, radiographer and radiologist assistant, practicing under supervision of a licensed physician or APRN. Licenses are not required until one year after implementing regulations take effect. No fluoroscopy-specific rule for PAs or NPs operating equipment themselves was found.", "citation": "D.C. Code §§ 3-1201.02(6E), 3-1208.91-.93; posted Part F §§ F.1, F.3a.ii.", "sourceUrls": [ "https://code.dccouncil.gov/us/dc/council/laws/25-191" ], "quote": "A person licensed under this title may only practice under the supervision of a licensed physician or a licensed advanced practice registered nurse.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Licensure requires graduation from an accredited program (e.g., JRCERT), passing a national certification exam recognized by the Board of Medicine, and other requirements set by rule; hours and continuing education are left to regulations, which were not found. Posted Part F requires instructed, competent operators, with Appendix A subject areas. No state fluoroscopy permit or required physician fluoroscopy training hours were found.", "citation": "D.C. Code § 3-1208.91; posted Part F § F.3a.ii and Appendix A.", "sourceUrls": [ "https://code.dccouncil.gov/us/dc/council/laws/25-191" ], "quote": "Passed a national certification examination from a body recognized by the Board", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "D.C. Law 25-277, Radiation Protection Act of 2024 (D.C. Code §§ 8-1551-8-1558)", "kind": "other", "status": "Effective Mar. 7, 2025 but every section marked [Not Funded]; not in force until its cost is included in an approved budget", "date": "2025-03-07", "dateISO": "2025-03-07", "summary": "If funded, would require a license, certification or registration to operate ionizing radiation machines (exempting licensed medical radiation technologists), authorize new rules on use standards, and repeal the 1990 Low-Level Radioactive Waste Act.", "sourceUrls": [ "https://code.dccouncil.gov/us/dc/council/code/sections/8-1551" ] }, { "title": "D.C. Law 25-191 technologist licensure implementing regulations", "kind": "other", "status": "Awaiting implementing regulations; could not determine whether proposed or adopted", "date": "", "dateISO": null, "summary": "Licensure of medical radiation technologists, including cardiovascular-interventional technologists, becomes mandatory one year after implementing regulations take effect.", "sourceUrls": [ "https://code.dccouncil.gov/us/dc/council/laws/25-191" ] }, { "title": "D.C. Law 26-105 and temporary act 26-219 amending § 3-1201.02", "kind": "other", "status": "Enacted; changes not reviewed", "date": "2026-03-24", "dateISO": "2026-03-24", "summary": "Both amended the health-occupation definitions in § 3-1201.02; the changes were not reviewed. The March 24, 2026 date is given for Law 26-105.", "sourceUrls": [ "https://code.dccouncil.gov/us/dc/council/code/sections/3-1201.02" ] }, { "title": "NRC Part 20 rewrite", "kind": "other", "status": "Not directly binding on DC", "date": "", "dateISO": null, "summary": "Not directly binding on DC since it is not an Agreement State.", "sourceUrls": [] } ], "notable": [ "The posted Parts are the CRCPD model with unfilled placeholders, posted in 2012 and called 'Suggested State Regulations', which conflicts with DC Health's citation to Title 20, Chapters 20-22 and with codified radiation chapters 67-69 of Title 22.", "Part F (2001) cross-references Part D sections D.201, D.205, D.207 and D.208, but the posted Part D (2003) uses D.1001-onward numbering, so the references do not line up.", "The ALARA language covering fluoroscopy workers sits in a rule shared with radioactive-materials licensees.", "Posted Part D lists individuals working with medical fluoroscopic equipment as requiring monitoring, without reference to the 10% threshold.", "Older secondary career sites saying DC does not license radiologic technologists are outdated because of Law 25-191." ], "openQuestions": [ "Which text is binding? Find the official DCMR X-ray and protection-standards chapters on dcregs.dc.gov (Title 22 Subtitle B radiation chapters and the Title 20, Chapters 20-22 DC Health cites), check whether DC adopted the CRCPD model by reference, and confirm with DC Health at (877) 672-2174 or radiation.protection@dc.gov.", "Apron inspection, thyroid shields and eyewear were not found in the posted model text; check the codified DCMR X-ray chapter and DC Health inspection guidance.", "Technologist licensure regulations under Law 25-191: are they proposed or final, when does the one-year transition end, and what scope does the cardiovascular-interventional category have? Check the D.C. Register and the Board of Medicine's Advisory Committee on Medical Radiation Technologists.", "What did Laws 26-105 and 26-219 change in § 3-1201.02? Check code.dccouncil.gov and LIMS.", "Has the CFO certified funding for Law 25-277? Check the FY2026-27 budget and the D.C. Register.", "Is there a fluoroscopy credentialing rule for physicians, PAs or NPs? Check Board of Medicine and Board of Nursing rules and hospital credentialing requirements." ], "sources": [ { "title": "DC Health, Radiation Control & Medical Devices Division", "url": "https://dchealth.dc.gov/service/radiation-control-medical-devices-division" }, { "title": "DC Health, Radiation Protection Services and Forms", "url": "https://dchealth.dc.gov/service/radiation-protection-services-and-forms" }, { "title": "DC Health, Regulations for the Control of Radiation (retrieved 2026-10-27)", "url": "https://dchealth.dc.gov/service/regulations-control-radiation" }, { "title": "DC Health, DC Health Regulations index", "url": "https://dchealth.dc.gov/page/dc-health-regulations" }, { "title": "Posted Part D, Standards for Protection Against Radiation (CRCPD model, Mar. 2003) (node page)", "url": "https://dchealth.dc.gov/node/210312" }, { "title": "Posted Part D, Standards for Protection Against Radiation (CRCPD model, Mar. 2003)", "url": "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Standards_Protection_Against_Rad.pdf" }, { "title": "Posted Part F, Diagnostic X-Rays and Imaging Systems (CRCPD model, Dec. 2001) (node page)", "url": "https://dchealth.dc.gov/node/210332" }, { "title": "Posted Part F, Diagnostic X-Rays and Imaging Systems (CRCPD model, Dec. 2001)", "url": "https://dchealth.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Diagnostic_Imaging_Systems_Healing_Art.pdf" }, { "title": "22 DCMR Chapter 68, Licensing Users of Radioactive Material (May 5, 2006)", "url": "https://doh.dc.gov/sites/default/files/dc/sites/doh/publication/attachments/Licensing-Users-of-Radioactive-Material.pdf" }, { "title": "D.C. Law 25-277, Radiation Protection Act of 2024", "url": "https://code.dccouncil.gov/us/dc/council/laws/25-277" }, { "title": "D.C. Code Chapter 15B", "url": "https://code.dccouncil.gov/us/dc/council/code/titles/8/chapters/15B" }, { "title": "D.C. Code § 8-1551", "url": "https://code.dccouncil.gov/us/dc/council/code/sections/8-1551" }, { "title": "D.C. Law 25-191, Health Occupations Revision General Amendment Act of 2024", "url": "https://code.dccouncil.gov/us/dc/council/laws/25-191" }, { "title": "D.C. Code § 3-1201.02", "url": "https://code.dccouncil.gov/us/dc/council/code/sections/3-1201.02" }, { "title": "D.C. Code § 3-1208.93", "url": "https://code.dccouncil.gov/us/dc/council/code/sections/3-1208.93" }, { "title": "NRC Agreement States list", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "FL", "name": "Florida", "pageUrl": "https://orsif.org/guidelines/us/states/florida", "regulator": { "name": "Florida Department of Health, Bureau of Radiation Control, Radiation Machine Program", "url": "https://www.floridahealth.gov/licensing-regulations/radiation-control/ionizing-radiation-machines-x-ray/" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Florida's ALARA requirement applies to X-ray registrants, including fluoroscopy users, through the general radiation protection rule (Part III of Chapter 64E-5), which also covers radioactive-materials licensees, while the X-ray part (Part V) has no ALARA wording of its own. Florida uses the standard US dose limits: 50 mSv a year whole body, 150 mSv lens of the eye (the lower ICRP 20 mSv limit has not been adopted), 500 mSv skin and extremities, and 5 mSv to the embryo/fetus. Staff must be protected by aprons \"or whole body protective barriers\" of at least 0.25 mm lead equivalent, and the fluoroscopy rule also accepts any material of at least that lead equivalence, though no rule names engineered systems used in place of aprons; a badge is worn at the collar outside the apron, and the rules do not require aprons to be inspected. Fluoroscopy may be performed by licensed practitioners, certified radiologist assistants, and, under conditions, certified general radiographers, although the statute's wider list of who may operate does not match the rule text exactly.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The ALARA duty is in Part III (64E-5.303(2)), which applies to \"licensee or registrant\" alike, and the definition is in Part I (64E-5.101(11)). Part V (X-ray) contains no \"reasonably achievable\" or \"ALARA\" wording; it only points back to Part III dose limits, and its \"minimize exposure\" language concerns patients. A separate ALARA program rule (64E-5.604) applies only to medical radioactive-materials licensees. An NRC-driven change to the Part III ALARA language would, as written, also reach X-ray registrants unless Florida writes separate X-ray wording.", "citation": "64E-5.101(11); 64E-5.303(2); 64E-5.604" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Florida is not among the non-Agreement jurisdictions on the NRC list (updated 2026-10-29), and a Florida rulemaking notice for 64E-5.101 refers to Florida's agreement with the NRC.", "citation": "NRC list of Agreement States, updated October 29, 2026; flrules.org rule history for 64E-5.101", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://flrules.org/gateway/ruleNo.asp?id=64E-5.101" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Chapter 64E-5, F.A.C., \"Control of Radiation Hazard Regulations.\" Part III (64E-5.301-.3xx) holds the general Standards for Protection Against Radiation and applies to both licensees and registrants. Part V (64E-5.501-.511) covers X-ray machines, including 64E-5.502 General Requirements (effective 3/21/2016) and 64E-5.504 Fluoroscopic X-Ray Systems (effective 5/8/2013). Operator certification is in Chapter 468, Part IV, F.S. and Chapter 64E-3, F.A.C. The text was read in the department's compiled version (Revision 15, March 21, 2016), which is not the official F.A.C. itself.", "citation": "64E-5.301(2), F.A.C.", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf", "https://flrules.org/gateway/ChapterHome.asp?Chapter=64E-5" ], "quote": "Except as specifically provided in other parts of these rules, this part applies to persons licensed or registered by the department to receive, possess, use, or transfer sources of radiation.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Registrants must use procedures and engineering controls to achieve occupational doses that are ALARA, and must have a written radiation protection program reviewed every 12 months. Dental and podiatry registrants are exempt from the program and review duties (64E-5.303(4)) but not from the ALARA sentence. Rule 64E-5.303 has been in effect since 10/8/2000.", "citation": "64E-5.303(2), F.A.C.", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf" ], "quote": "The licensee or registrant shall use to the extent practical procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as reasonably achievable.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) TEDE per year. Any organ or tissue except the lens: 50 rem (500 mSv) per year.", "citation": "64E-5.304(1)(a)", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf" ], "quote": "The total effective dose equivalent equal to 5 rem (0.05 sievert); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year. The lower ICRP 20 mSv limit has not been adopted.", "citation": "64E-5.304(1)(b)", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf" ], "quote": "An lens dose equivalent of 15 rem (0.15 sievert), and", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) per year to the skin of the whole body or any extremity.", "citation": "64E-5.304(1)(b)2.", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf" ], "quote": "A shallow dose equivalent of 50 rem (0.5 sievert) to the skin of the", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant worker over the whole pregnancy, with no more than 0.05 rem (0.5 mSv) recommended in any one month.", "citation": "64E-5.311(1)", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf" ], "quote": "does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Individual dosimeters must be supplied and required for: adults likely to receive more than 10% of the 64E-5.304(1) limits in a year (by this research's calculation, 5 mSv whole body, 15 mSv lens, or 50 mSv skin/extremity); declared pregnant women likely to receive more than 0.1 rem (1 mSv) deep dose over the pregnancy; minors above lower thresholds; and anyone entering high or very high radiation areas. Rule 64E-5.315 was last amended 12/26/2013.", "citation": "64E-5.315(1)(a)-(d)", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf" ], "quote": "Adults likely to receive in 1 year from sources external to the body a dose in excess of 10 percent of the limits in Rule 64E-5.304(1), F.A.C.;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "When an apron is worn, at least one dosimeter goes at the collar outside the apron; if more than one is used, each reading must be recorded with where it was worn. Deep dose is used in place of effective dose unless a department-approved dosimetry method is used. Information Notice 4 (rev. January 2022) requires a written request and approval before a correction factor is applied; the method must come from a published, peer-reviewed source and be accepted by a standards or consensus body (e.g., NCRP, AAPM, ACR, ICRP, IAEA). The notice does not name NCRP Report 122 or Webster. Declared pregnant workers wear a waist monitor under the apron plus one outside it.", "citation": "64E-5.502(1)(a)10.a; 64E-5.304(3); Information Notice 4", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf", "https://www.floridahealth.gov/wp-content/uploads/2025/08/IN_04.pdf" ], "quote": "When a protective apron is worn, the monitoring device shall be worn at the collar outside of the apron", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Only staff needed for the procedure may be in the room. Staff must be protected from direct scatter by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent, and any body part in the useful beam needs 0.5 mm lead equivalent. No thyroid shield or eyewear requirement was found, though the department may require additional protective devices where stray radiation could give one-fourth of the maximum permissible dose. Under the fluoroscopy rule, scatter reaching staff (except extremities) must pass through at least 0.25 mm lead equivalent unless the person is at least 120 cm from the center of the beam. The 64E-5.502(1)(a)4 requirement is worded \"during the radiographic exposure.\"", "citation": "64E-5.502(1)(a)4.a-d; 64E-5.504(9)", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf" ], "quote": "Staff and ancillary personnel shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Florida's rules do not require protective aprons or other protective apparel to be inspected or tested on a regular schedule. The rules set a minimum lead equivalence for aprons and say where the badge is worn, but they do not set any inspection requirement.", "citation": "Chapter 64E-5, Part III (64E-5.301 to 64E-5.3xx) and Part V (64E-5.501 to 64E-5.511), F.A.C.; Information Notice 5 (revised July 2003)", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Florida does not mention engineered shielding systems by name, but staff may be protected by protective aprons or by whole body protective barriers of at least 0.25 mm lead equivalent. The fluoroscopy rule also allows protection by distance (at least 120 centimeters from the center of the beam) or by any material of at least 0.25 mm lead equivalent.", "citation": "64E-5.502(1)(a)4.b.", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf" ], "quote": "Staff and ancillary personnel shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Under the rule (added 2007), fluoroscopy may be performed only by a licensed practitioner (medicine, osteopathic medicine, podiatric medicine/chiropody, naturopathy or chiropractic), a certified radiologist assistant, or a certified general radiographer trained and authorized in writing by the practitioner in charge, for imaging that does not rely on the radiographer for interpretation. Physician assistants and nurse practitioners are not listed. Certified technologists work under direct or general supervision of a licensed practitioner; radiologist assistants work under a radiologist, with fluoroscopy as a \"General\" supervision duty per 64E-3.0032. The statute is broader in two places that no source reconciles: 468.302(3)(a) lets basic X-ray machine operators perform \"general fluoroscopic procedures\" under direct supervision, and 468.302(6)(c) exempts cardiopulmonary technology staff under direct supervision from certification. The 2026 statute text is unchanged (amendment history ends in 2012).", "citation": "64E-5.502(1)(a)9.e; ss. 468.301, 468.302, F.S.; 64E-3.0032", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf", "https://www.flsenate.gov/Laws/Statutes/2026/0468.302", "https://www.flsenate.gov/Laws/Statutes/2025/0468.301" ], "quote": "A person shall not perform fluoroscopic imaging or otherwise expose a human to x-rays from a fluoroscopic system unless the person is a:", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "All operators must be instructed in and competent in safe use; medical operators must be certified or authorized under Chapter 468, Part IV. General radiographers obtain state certification by an ARRT-administered exam after a two-year accredited program. Basic X-ray machine operators take an ARRT-administered exam with no formal program required. Continuing education is 12 hours per two-year renewal cycle (64E-3.008-.010), and the statute caps CE at 24 hours. For fluoroscopy, general radiographers need written authorization from the practitioner in charge. No state fluoroscopy permit, set number of fluoroscopy training hours, or physician fluoroscopy training requirement was found.", "citation": "64E-3.008 to 64E-3.010, F.A.C.", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2025/08/GeneralGuidelinesandRequirementsforProviders030823.pdf" ], "quote": "persons possessing certification in Radiologic Technology must earn twelve (12) hours of continuing-education credits by the expiration date on their certificate (completed during their biennium) to renew.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "Proposed rule, 64E-5.101 (Definitions) and 64E-5.102 (Exemptions)", "kind": "proposed_rule", "status": "Published 9/1/2026 (FAR Vol. 52/170); comments closed 9/22/2026; Notice of Change followed on 10/27/2026 (Vol. 52/209)", "date": "2026-09-01", "dateISO": "2026-09-01", "summary": "Keeps pace with NRC requirements, adds phosphate-mining-land definitions (HB 167, ch. 2026-103), and adds common-carrier exemptions. The ALARA definition (subsection 11) is marked \"No change\" in the proposed text. The text of the 10/27/2026 Notice of Change could not be opened.", "sourceUrls": [ "https://flrules.org/Gateway/View_notice.asp?id=31319280" ] }, { "title": "Department of Health 2026-27 Annual Regulatory Plan", "kind": "other", "status": "Rulemaking expected by July 1, 2027", "date": "", "dateISO": null, "summary": "Lists rulemaking on several Part III and radioactive-materials rules, including 64E-5.314 (\"Improve coordination with other agencies\"). It does not list 64E-5.303,.304,.315,.502 or.504. Part III rules (.301-.319) are scheduled for periodic review in 2028-29 and Part V rules (.501,.503-.511) in 2027-28.", "sourceUrls": [ "https://www.floridahealth.gov/wp-content/uploads/2026/09/DOH-2026-2027-ARP.pdf" ] } ], "notable": [ "A declared pregnant worker must wear a waist monitor under protective clothing, plus one outside it (64E-5.311(5)).", "Information Notice 4 says doses from different facilities are added as recorded, whether or not each facility applies a correction factor. This matters for physicians working at several sites.", "The scatter-shielding requirement can be waived for special procedures where a sterile field prevents normal barriers, but not where prefitted sterile covers are practical (64E-5.504(9)(c)).", "The department inspects machines on a use-based schedule; owners have 90 days to fix non-urgent deficiencies.", "A 2025 PMC review lists Florida as requiring 0.50 mm aprons, but the rule text says 0.25 mm for staff, with 0.5 mm only for body parts in the useful beam.", "No 2025-2026 bill was found that changes fluoroscopy operator rules or addresses apron alternatives.", "The department reports more than 64,000 registered X-ray machines." ], "openQuestions": [ "The rule text comes from the department's compiled version (2016). Confirm it against the official VIEW_RULE text on flrules.org for 64E-5.303,.304,.315,.502 and.504.", "The Notice of Change (10/27/2026, FAR Vol. 52/209) could not be opened. Check whether it touches the ALARA definition or Part III.", "Who may operate: the rule does not line up with 468.302(3)(a) (basic X-ray machine operators may do \"general fluoroscopic procedures\") or 468.302(6)(c) (cardiopulmonary technology exemption). Ask the Bureau of Radiation Control, (850) 245-4888, how inspectors apply these in cath and EP labs, and whether physician assistants or nurse practitioners may activate fluoroscopy.", "Engineered systems: whether a ceiling-suspended or engineered system counts as a \"whole body protective barrier\" under 64E-5.502(1)(a)4.b. No written guidance was found; ask the Radiation Machine Program.", "Apron inspection: whether the Bureau's inspection checklists or unpublished guidance require it. Ask the department or check its inspection procedures.", "Whether Florida plans any response to the NRC's July 2026 proposed Part 20 \"graded approach\" rule. The 2026-27 regulatory plan does not mention it; watch the Florida Administrative Register for 64E-5.303 notices." ], "sources": [ { "title": "FL DOH, Control of Radiation Hazard Regulations, Ch. 64E-5 (compiled through Rev. 15, March 21, 2016)", "url": "https://www.floridahealth.gov/wp-content/uploads/2025/08/64e-5-r15-03-21-2016.pdf" }, { "title": "flrules.org, Chapter 64E-5 index (effective dates)", "url": "https://flrules.org/gateway/ChapterHome.asp?Chapter=64E-5" }, { "title": "flrules.org, Rule 64E-5.101 history", "url": "https://flrules.org/gateway/ruleNo.asp?id=64E-5.101" }, { "title": "FAR Notice of Proposed Rule 31319280 (9/1/2026) and its text", "url": "https://flrules.org/Gateway/View_notice.asp?id=31319280" }, { "title": "FL DOH, Ionizing Radiation Machines (X-Ray)", "url": "https://www.floridahealth.gov/licensing-regulations/radiation-control/ionizing-radiation-machines-x-ray/" }, { "title": "FL DOH Information Notice 4, Dose Weighting Factors (rev. Jan 2022)", "url": "https://www.floridahealth.gov/wp-content/uploads/2025/08/IN_04.pdf" }, { "title": "FL DOH Information Notice 5, Radiation Protection Program (rev. July 2003)", "url": "https://www.floridahealth.gov/wp-content/uploads/2025/08/in-05-revised.pdf" }, { "title": "FL DOH 2026-2027 Annual Regulatory Plan", "url": "https://www.floridahealth.gov/wp-content/uploads/2026/09/DOH-2026-2027-ARP.pdf" }, { "title": "Fla. Stat. 468.301 (2025)", "url": "https://www.flsenate.gov/Laws/Statutes/2025/0468.301" }, { "title": "Fla. Stat. 468.302 (2025)", "url": "https://www.flsenate.gov/Laws/Statutes/2025/468.302" }, { "title": "Fla. Stat. 468.302 (2026)", "url": "https://www.flsenate.gov/Laws/Statutes/2026/0468.302" }, { "title": "Fla. Stat. 468.309 (2025)", "url": "https://www.flsenate.gov/Laws/Statutes/2025/0468.309" }, { "title": "FL DOH, Radiologic Technologist Licensing", "url": "https://www.floridahealth.gov/licensing-regulations/radiation-control/radiologic-technologist/licensing/" }, { "title": "FL DOH, CE Provider Guidelines (03/08/23)", "url": "https://www.floridahealth.gov/wp-content/uploads/2025/08/GeneralGuidelinesandRequirementsforProviders030823.pdf" }, { "title": "FL DOH, 64E-3.0032 Radiologist Assistant Duties and Role Delineation", "url": "https://www.floridahealth.gov/wp-content/uploads/2026/07/radiologist-assistant-role-delineation.pdf" }, { "title": "NRC Agreement States", "url": "https://www.nrc.gov/agreement-states" }, { "title": "PMC, \"Variability in State-Level Regulations Regarding Occupational Radiation Exposure\" (secondary, used only to flag a discrepancy)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12230476/" } ] }, { "code": "GA", "name": "Georgia", "pageUrl": "https://orsif.org/guidelines/us/states/georgia", "regulator": { "name": "Georgia Department of Community Health (DCH), Healthcare Facility Regulation Division (HFRD) X-ray program; radioactive materials handled separately by Department of Natural Resources' Environmental Protection Division (EPD), Radioactive Materials Program", "url": "https://dch.georgia.gov/divisionsoffices/hfrd/facilities-provider-information/x-ray" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Georgia's X-ray rules are in Chapter 111-8-90, run by DCH, and they do not require ALARA for X-ray users; ALARA appears only in EPD's separate radioactive-materials rulebook (391-3-17). Dose limits are quarterly: the whole-body limit is 1¼ rem (12.5 mSv) per quarter, and the lens of the eye falls under that same limit (about 50 mSv a year, not the ICRP's 20 mSv). Staff who must stay in the room must be protected by aprons \"or whole body protective barriers\" of at least 0.25 mm lead equivalent, dosimeters are worn outside the apron at the collar, and the rules set no inspection schedule for aprons. Only licensed practitioners and authorized operators may apply radiation, and operators must get at least six hours of instruction, but there is no state technologist license and no fluoroscopy-specific permit.", "whereAlaraLives": { "category": "none", "explanation": "For X-ray users, ALARA appears nowhere. It appears only in EPD's radioactive-materials rule 391-3-17-.03(4)(b), which covers EPD licensees. The X-ray chapter (111-8-90) is a separate chapter run by a different agency (DCH) and has no ALARA to remove, so an NRC compatibility change would directly affect only the radioactive-materials rule.", "citation": "391-3-17-.03(1)(b) and (4)(b)" }, "eyeLensLimitMsv": 50, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Georgia is not on the list of non-Agreement States. Radioactive materials are licensed by EPD under Chapter 391-3-17.", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Ga. Comp. R. & Regs. Chapter 111-8-90, \"Rules and Regulations for X-Ray\":.01 General Provisions,.02 Registration,.03 Standards for Protection against Radiation (X-ray only),.04 X-Rays in the Healing Arts (fluoroscopy at.04(12)),.07 Records, Reports and Notifications. Cornell LII notes Rule.03 adopted F. Oct. 9, 2020, eff. Oct. 29, 2020, under O.C.G.A. § 31-13-5; text may be older content carried into the 2020 chapter (unconfirmed). Separate radioactive-materials rule 391-3-17-.03 applies to EPD licensees only.", "citation": "Ga. Comp. R. & Regs. 111-8-90-.01 to -.07; 391-3-17-.03", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90" ], "quote": "To set forth rules and regulations which implement the mandates of the Radiation Control Act, O.C.G.A. Chapter 31-13, as it relates to the registration and regulation of users of radiation machines.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "no", "answer": "Georgia's X-ray rules do not require registrants to keep workers' doses as low as reasonably achievable. The closest wording only lets registrants add information to warning signs to help people minimize exposure to radiation. The ALARA requirement appears only in Georgia's separate rules for radioactive materials.", "citation": "Ga. Comp. R. & Regs. 111-8-90-.01 to 111-8-90-.04 (closest wording at 111-8-90-.03(4))", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90", "https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-111-8-90-.03" ], "quote": "…similar precautionary information which may be appropriate in aiding individuals to minimize exposure to radiation.", "quoteMatchedToSource": true, "confidence": "medium" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "1¼ rem (12.5 mSv) per calendar quarter (about 50 mSv/year by this research's arithmetic). A registrant may allow up to 3 rem (30 mSv) per quarter if the lifetime total stays within 5(N-18) rem and prior dose is documented. No TEDE concept.", "citation": "111-8-90-.03(2)(a)1.", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90", "https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-111-8-90-.03" ], "quote": "Rems (Sv) Per Calendar Quarter Whole body; head and trunk; active blood-forming organs; lens of eyes; or gonads.. 1 1/4 rem (12.5 mSv)", "quoteMatchedToSource": true, "confidence": "medium" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "The lens of the eye is counted as part of the whole body: 1¼ rem (12.5 mSv) per quarter, about 50 mSv/year by this research's arithmetic. This comes from the old framework, not the ICRP 20 mSv.", "citation": "111-8-90-.03(1)(c)", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90", "https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-111-8-90-.03" ], "quote": "Dose to the whole body shall include any dose to the entire body or any major portion thereof, gonads, active blood-forming organs, head and trunk, or lens of the eye.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Hands, forearms, feet and ankles: 18¾ rem (187.5 mSv) per quarter (about 750 mSv/year). Skin of whole body: 7½ rem (75 mSv) per quarter (about 300 mSv/year).", "citation": "Ga. Comp. R. & Regs. R. 111-8-90-.03(2)(a)1.", "sourceUrls": [ "https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-111-8-90-.03" ], "quote": "no registrant shall possess, own, use, or receive, sources of radiation in such a manner as to cause an occupationally exposed individual to receive, from all sources of radiation in the possession of the registrant, a dose in excess of the limits in the following table:", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "Embryo/fetus: no more than 50 mrem (0.5 mSv) per month after the pregnancy is known, and 500 mrem (5 mSv) over the whole pregnancy. No declared pregnant worker procedure. Workers under 18 are limited to 10% of adult limits.", "citation": "111-8-90-.03(2)(b)3.", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90", "https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-111-8-90-.03" ], "quote": "The embryo/fetus shall not be exposed to doses in excess of 50 mrem in any one month after the pregnancy is known.", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "A dosimeter is required for anyone likely to get more than 25% of the quarterly limit (about 0.31 rem / 3.1 mSv per quarter for whole body), workers under 18 who may get more than 10% of the limit, and anyone entering a high radiation area. All operators of portable equipment must be monitored, but that rule sits in the non-fluoroscopic section, so whether it covers mobile C-arms is unclear.", "citation": "111-8-90-.03(3)(a)1.-3.;.04(13)(f)2.(v)", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90", "https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-111-8-90-.03" ], "quote": "…likely to receive, a radiation dose in any calendar quarter in excess of 25 percent of the applicable values specified in .03(2)(a)1. for occupational exposure;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "Badge worn outside the apron at collar level. Two-badge methods and approved effective-dose calculation methods were not found.", "citation": "111-8-90-.03(3)(d)", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90", "https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-111-8-90-.03" ], "quote": "When using protective aprons, personnel monitoring shall be worn outside the apron at collar level.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "partial", "answer": "Staff who must stay in the room must be protected by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent. A person who could be struck by the useful beam (the direct X-ray beam) must be protected by at least 0.5 mm lead equivalent. People holding patients must be given protective clothing. The paragraph refers to \"the radiographic exposure,\" so whether it expressly covers fluoroscopy is uncertain. Thyroid shields and eyewear are not addressed.", "citation": "111-8-90-.04(2)(b)1.-2.,.04(2)(f)3.;.01(9)(d)4.", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90" ], "quote": "Staff and ancillary personnel who must remain in areas because of their required presence during an x-ray procedure, shall be protected from direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent;", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Georgia's X-ray rules do not require lead aprons or other protective apparel to be inspected on a schedule. The only related wording, in the veterinary section, says the effectiveness of gloves and aprons must not be impaired, with no inspection method or schedule.", "citation": "Ga. Comp. R. & Regs. 111-8-90-.03 and 111-8-90-.04 (including.04(15)(a)10., veterinary only)", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90" ], "quote": "The effectiveness of protective equipment (i.e., gloves, aprons, etc.), shall not be impaired.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered radiation protection systems are not mentioned by name, but the staff-protection rule lists \"whole body protective barriers\" of at least 0.25 mm lead equivalent as an either/or alternative to protective aprons. No performance standards, approval process or definition for such barriers was found.", "citation": "111-8-90-.04(2)(b)2.", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90" ], "quote": "…protected from direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent;", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Only licensed practitioners and \"authorized operators\" (anyone the registrant authorizes) may apply radiation to people. No specific professions are named. The healing-arts part covers use \"by or under the supervision of\" someone authorized by state law to practice the healing arts, with no supervision level specified. Radiologist assistants are now licensed under 2026 HB 571.", "citation": "111-8-90-.04(1)", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90" ], "quote": "This part establishes requirements, for which a registrant is responsible, for use of x-ray equipment by or under the supervision of an individual authorized in accordance with State statutes to engage in the healing arts.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "The registrant must give operators at least 6 hours of instruction (including protective clothing, time/distance/shielding and radiation protection standards), starting within 30 days of hire and finishing within 90 days, with records kept. Not found: fluoroscopy-specific training, ARRT certification, a state permit, continuing education, or physician fluoroscopy training. A secondary source says Georgia has no individual radiologic technologist license.", "citation": "111-8-90-.04(2)(a)1.-4.", "sourceUrls": [ "https://rules.sos.ga.gov/gac/111-8-90" ], "quote": "The registrant shall require persons operating his radiation machine and associated equipment to receive, at a minimum, six hours of instruction.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "HB 571, Radiologist Assistant Act", "kind": "bill", "status": "Enacted as Act 404; signed and effective May 5, 2026", "date": "May 5, 2026", "dateISO": "2026-05-05", "summary": "Creates licensing for radiologist assistants under the Georgia Composite Medical Board (O.C.G.A. §§ 43-34-330 to -338). Final text not obtained; whether it mentions fluoroscopy is unchecked.", "sourceUrls": [ "https://www.legis.ga.gov/api/document/docs/default-source/legislative-counsel-document-library/sumdoc2026-edit.pdf?sfvrsn=6257533e_2" ] }, { "title": "EPD Proposed Amendments to 391-3-17", "kind": "proposed_rule", "status": "Status unknown", "date": "August 29, 2025", "dateISO": "2025-08-29", "summary": "Proposed amendments to the radioactive-materials rules; they do not cover X-ray machines.", "sourceUrls": [ "https://epd.georgia.gov/document/document/proposed-rules-rad/download" ] }, { "title": "DCH annual registration fee suspension pending rule revisions", "kind": "other", "status": "Unconfirmed; reported only by a secondary source", "date": "", "dateISO": null, "summary": "No proposed changes to 111-8-90 were found. A secondary source says DCH has suspended the annual registration fee \"pending rule revisions.\"", "sourceUrls": [] } ], "notable": [ "Each fluoroscope must have its entrance exposure rate measured, including the rate at staff positions around the table, at least annually and after maintenance, with results posted where fluoroscopists can see them (111-8-90-.04(12)(f)).", "The fluoroscopy timer may not exceed 5 minutes without resetting.", "Hand-held fluoroscopic screens are banned, except for law-enforcement or forensic use approved by the Department.", "Only staff needed for the procedure may be in the room.", "The pregnancy limit is triggered \"after the pregnancy is known,\" not by a formal written declaration.", "Dose limits use an older quarterly system with no TEDE concept." ], "openQuestions": [ "Was the official text complete? The SOS page fetched cut off at the start of Rule.07, and per-rule pages were blocked, so records and reporting duties are unchecked. Read https://rules.sos.ga.gov/gac/111-8-90-.07 and the SOS PDF download.", "How old is the text? It reads like older content, but Cornell shows a 2020 adoption. Ask DCH HFRD (hfrd.diagnostic@dch.ga.gov) about the rule's history and any planned rewrite. The fee-suspension claim comes only from a secondary source.", "Do the apron and staff-protection rules (.04(2)(b), \"the radiographic exposure\") cover fluoroscopy, and does DCH treat engineered shielding systems as \"whole body protective barriers\"?", "Does the portable-equipment monitoring rule (.04(13)(f)2.(v)) cover C-arms?", "What does HB 571 say about fluoroscopy scope or supervision for radiologist assistants? Check legis.ga.gov and any Composite Medical Board rules adopted under it.", "Do other boards (Composite Medical Board Chapter 360-5, Board of Nursing) limit who may run fluoroscopy?", "Where do the proposed EPD 391-3-17 amendments (Aug. 2025) stand? Check EPD's Radioactive Materials Program and the Georgia Register." ], "sources": [ { "title": "Georgia Secretary of State, Rules and Regulations of the State of Georgia, Subject 111-8-90 Rules and Regulations for X-Ray (official)", "url": "https://rules.sos.ga.gov/gac/111-8-90" }, { "title": "Cornell LII, Ga. Comp. R. & Regs. R. 111-8-90-.03 (history notes)", "url": "https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-111-8-90-.03" }, { "title": "Cornell LII, Ga. Comp. R. & Regs. R. 391-3-17-.03 Standards for Protection Against Radiation (radioactive materials)", "url": "https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-391-3-17-.03" }, { "title": "Cornell LII, Subject 391-3-17 index", "url": "https://www.law.cornell.edu/regulations/georgia/department-391/chapter-391-3/subject-391-3-17" }, { "title": "Georgia DCH HFRD, X-ray page", "url": "https://dch.georgia.gov/divisionsoffices/hfrd/facilities-provider-information/x-ray" }, { "title": "Georgia DCH HFRD, Laws & Regulations page", "url": "https://dch.georgia.gov/divisionsoffices/hfrd/hfrd-laws-regulations" }, { "title": "Georgia EPD, Proposed Amendments to 391-3-17 (Aug. 29, 2025)", "url": "https://epd.georgia.gov/document/document/proposed-rules-rad/download" }, { "title": "Georgia Legislative Counsel, Summary of General Statutes Enacted, 2026 session", "url": "https://www.legis.ga.gov/api/document/docs/default-source/legislative-counsel-document-library/sumdoc2026-edit.pdf?sfvrsn=6257533e_2" }, { "title": "BillTrack50, GA HB571 (secondary)", "url": "https://www.billtrack50.com/billdetail/1842393" }, { "title": "SRPE, \"Another RA Win!\" (May 13, 2026; secondary)", "url": "https://www.srpeweb.org/2026/05/13/another-ra-win/" }, { "title": "Allied License Guide, Georgia Radiologic Technologist (May 2026; secondary)", "url": "https://alliedlicenseguide.com/radiologic-technologist/georgia/" }, { "title": "NRC Agreement States list", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "HI", "name": "Hawaii", "pageUrl": "https://orsif.org/guidelines/us/states/hawaii", "regulator": { "name": "Hawaii Department of Health, Indoor and Radiological Health Branch (IRHB), Radiation Section", "url": "https://health.hawaii.gov/irhb/radiation/" }, "nrcAgreementState": false, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Hawaii requires X-ray and fluoroscopy facilities to keep worker doses ALARA under the general standards subchapter (HAR 11-45, subchapter 4), which the X-ray subchapter applies to X-ray workers while adding its own minimization requirement; Hawaii is not an NRC Agreement State, and the rule appears unamended since 11/12/1999. Its dose limits are 50 mSv whole body, 150 mSv lens of the eye, 500 mSv skin and extremities, and 5 mSv to the embryo/fetus of a declared pregnant woman. Staff must be protected by aprons or whole-body barriers of at least 0.25 mm lead equivalent unless a qualified medical physicist authorizes otherwise, and the rules are silent on thyroid shields, eyewear, apron inspection and badge placement. Anyone performing radiography on people, including interventional work, needs an ARRT-based state radiographer license; exemptions include licensed medical practitioners in radiology and physician assistants, but the law does not define the radiology term, so it is unclear whether other physicians are exempt, and nurses and nurse practitioners are not on the exemption list.", "whereAlaraLives": { "category": "both", "explanation": "The explicit ALARA wording is in §11-45-39, in the unified subchapter 4, which applies to all state licensees. The X-ray subchapter links into it through §11-45-116(a)(11) and has its own minimization requirement in §11-45-116(a)(10). Subchapter 7 has a separate ALARA program requirement for radionuclide licensees only (§11-45-129). Because Hawaii is not an Agreement State and §11-45-37 exempts NRC-licensed sources, subchapter 4 mainly governs machine users in practice.", "citation": "HAR §§11-45-39(b), 11-45-116(a)(10)-(11), 11-45-129, 11-45-37" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "no", "answer": "No. Hawaii is not an NRC Agreement State, so the NRC licenses radioactive materials there directly. Hawaii's rule exempts NRC-licensed sources from its standards subchapter.", "citation": "NRC list of Agreement States, updated October 29, 2026; HAR §11-45-37", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "HAR Title 11, Chapter 45, \"Radiation Control,\" effective 11/12/1999, replaced chapter 11-40. Subchapter 6, \"X-Rays in the Healing Arts\" (§§11-45-115 to 11-45-125), contains the X-ray rules. Fluoroscopy is in §11-45-118 and general requirements are in §11-45-116. The general standards are in subchapter 4 (§§11-45-36 to 11-45-97). The text appears unamended since 1999 and incorporates the 1995 CRCPD Suggested State Regulations.", "citation": "HAR ch. 11-45; subchapters 4 and 6", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "Chapter 40 of Title 11, Hawaii Administrative Rules, Entitled \"Radiation Protection\" is repealed. 2. Chapter 45 of Title 11, Hawaii Administrative Rules, Entitled \"Radiation Control,\" is adopted.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Licensees, which include X-ray facilities, must use procedures and engineering controls to keep occupational doses ALARA. §11-45-116(a)(11) makes everyone associated with operating an X-ray system subject to subchapter 4. A documented radiation protection program must be reviewed at least once a year.", "citation": "HAR §11-45-39(b); §11-45-2 (\"Licensee\" and \"As low as is reasonably achievable\" definitions); §11-45-116(a)(11)", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "The licensee shall use, to the extent practicable, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rems (0.05 Sv), or 50 mSv, per year TEDE for adults.", "citation": "HAR §11-45-40(a)(1)(A)", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "The total effective dose equivalent being equal to five rems (0.05 sievert); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rems (0.15 Sv), or 150 mSv, per year. No lower ICRP-style limit (such as 20 mSv) has been adopted.", "citation": "HAR §11-45-40(a)", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "An eye dose equivalent of fifteen rems (0.15 sievert), and (B) A shallow dose equivalent of fifty rems (0.50 sievert) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rems (0.50 Sv), or 500 mSv, per year shallow dose to the skin or any extremity.", "citation": "HAR §11-45-40(a)", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "An eye dose equivalent of fifteen rems (0.15 sievert), and (B) A shallow dose equivalent of fifty rems (0.50 sievert) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. The licensee must also avoid substantial variation above a uniform monthly exposure rate.", "citation": "HAR §11-45-47(a)-(b)", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "does not exceed 0.5 rem (five millisieverts).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "The licensee must supply, and require the use of, individual monitoring devices for: adults likely to receive more than 10% of the §11-45-40(a) limits in a year from external sources; minors and declared pregnant women likely to exceed 10% of their applicable limits; and anyone entering a high or very high radiation area.", "citation": "HAR §11-45-54(a)", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "Adults likely to receive, in one year from sources external to the body, a dose in excess of ten percent of the limits in section 11-45-40(a)", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "no", "answer": "Hawaii's rules do not say where to wear a dosimeter when wearing a protective apron, such as at the collar outside the apron. They also set no two-badge method and approve no method for estimating effective dose. They only require monitoring badges for workers likely to exceed 10 percent of the dose limits, and require the recorded dose to be for the part of the body getting the highest exposure, which may be estimated from surveys if the badge was not worn in that region.", "citation": "HAR §11-45-40(c); HAR §11-45-54; HAR §11-45-116", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "The assigned deep dose equivalent and shallow dose equivalent shall be for the portion of the body receiving the highest exposure", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Yes, with alternatives. Body parts in the useful beam need at least 0.5 mm lead equivalent. For scatter, staff must be protected by aprons or whole-body barriers of at least 0.25 mm lead equivalent, unless a qualified medical physicist authorizes otherwise. Facilities must keep enough leaded aprons and gloves for all unshielded personnel. Fluoroscopy requires scatter shielding below and above the table. Thyroid shields and eyewear are not addressed.", "citation": "HAR §11-45-116(a)(6)(A)-(B), (a)(9)(F); §11-45-118(i)", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent material, unless otherwise authorized by a qualified medical physicist.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Hawaii's rules do not require protective aprons or other protective apparel to be inspected periodically. They require aprons or whole-body barriers of at least 0.25 mm lead equivalent for staff, and require each facility to keep enough leaded aprons and gloves for all staff who are not otherwise shielded.", "citation": "HAR §11-45-116(a)(6) and (a)(9)(F); HAR 11-45 subchapter 6 (X-ray)", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "Film cassettes and intensifying screens shall be inspected periodically", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered radiation protection systems are not addressed as such. However, the rule accepts whole-body protective barriers of at least 0.25 mm lead equivalent as an alternative to aprons, and a qualified medical physicist may authorize something else. Above-table drapes and curtains count in addition to the apron. No law or rule like Arizona SB 1121 or Illinois' proposed 32 Ill. Adm. Code 360 was found.", "citation": "HAR §11-45-116(a)(9)(F)", "sourceUrls": [ "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" ], "quote": "Each facility shall have leaded aprons and gloves available in sufficient numbers to provide protection for all personnel who are involved with x-ray operations and who are otherwise not shielded.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Anyone performing radiography on people, including interventional and cardiac interventional work, must hold a state radiographer license, and all X-ray operators must be trained and competent in safe use of the equipment. The law exempts licensed medical practitioners in radiology, practitioners of nuclear medicine, physician assistants, dentists, dental technicians, dental hygienists, and students working under the direct supervision of a licensed radiographer. The law does not define 'medical practitioner in radiology', so it does not say whether other physicians are exempt, and nurses and nurse practitioners are not on the exemption list.", "citation": "HRS §466J-6(a); HAR §11-44-3(b); HAR §11-45-116(a)(2) to (3)", "sourceUrls": [ "https://law.justia.com/codes/hawaii/title-25/chapter-466j/section-466j-6/", "https://data.capitol.hawaii.gov/sessions/session2017/HRS-Chapter-PDF%27s/HRS_0466J.pdf" ], "quote": "Any provision in this chapter to the contrary notwithstanding, a license shall not be required for: (1) A licensed medical practitioner in radiology; (2) A licensed practitioner of nuclear medicine; (3) A licensed physician assistant;", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Radiographers must be registered in good standing with the ARRT. Licenses renew every two years and require 24 continuing-education credits, or meeting ARRT CE requirements or good standing with the ARRT. No fluoroscopy permit or physician fluoroscopy training requirement was found. At the facility level, operators must be adequately instructed and competent.", "citation": "HRS §§466J-5(a), 466J-5.5; HAR §§11-44-5(a), 11-44-7 (effective 3/29/2010); HAR §11-45-116(a)(2)", "sourceUrls": [ "https://data.capitol.hawaii.gov/sessions/session2017/HRS-Chapter-PDF%27s/HRS_0466J.pdf" ], "quote": "An applicant for a license to practice as a radiographer or as a radiation therapist shall submit to the board written evidence, verified by oath or affirmation, that the applicant is registered in good standing with the American Registry of Radiologic Technologists.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [], "notable": [ "Fluoroscopy requires continuous pressure on the control by the fluoroscopist (dead-man switch) (§11-45-118(c)).", "A cumulative 5-minute timer with an audible alarm is required (§11-45-118(h)).", "Exposure rate limits are 10 R/min with automatic exposure rate control, and 20 R/min with high-level control for equipment made after May 19, 1995 (§11-45-118(d)).", "A qualified medical physicist must measure entrance exposure rate at least once a year and evaluate newly installed systems before use on patients (§11-45-118(d)(6), (l)).", "Scatter shielding is required below the table, and above the table unless staff stand at least 120 cm from the beam (§11-45-118(i)).", "Shielding evaluations and area radiation surveys are required under subchapter 3.", "Hawaii calls X-ray users \"licensees\" holding a Radiation Facility License, not \"registrants.\"", "The rules are 1990s-era and appear unamended since 11/12/1999. Chapter 11-44 was last amended effective 3/29/2010.", "The IRHB proposed-rules page lists only a 2022 chapter 11-41 (lead-based paint) amendment, with nothing for 11-45 or 11-44." ], "openQuestions": [ "Is the 1999 text of chapter 11-45 current, or has it been amended or a revision drafted? Confirm with IRHB at (808) 586-4700 or the Lieutenant Governor's office.", "Are cardiologists, surgeons and other non-radiologist physicians covered by \"licensed medical practitioner in radiology\" (HRS §466J-6)? May nurses or nurse practitioners activate fluoroscopy?", "The official current text of HRS §466J-5 and §466J-6 could not be reached; it should be checked at https://www.capitol.hawaii.gov.", "Does IRHB have guidance or license conditions on badge placement, effective-dose methods, apron inspection, or physicist authorizations under §11-45-116(a)(6)?", "The search of 2025-2026 legislative sessions for bills on radiologic technology, fluoroscopy or engineered shielding was incomplete.", "If the NRC adopts a Part 20 \"graded approach,\" NRC-licensed materials users in Hawaii would come under different language than X-ray users under §11-45-39, unless Hawaii revises its rule." ], "sources": [ { "title": "Hawaii DOH, Repeal of Chapter 11-40 and Adoption of Chapter 11-45, HAR \"Radiation Control\" [11/12/99]", "url": "https://health.hawaii.gov/opppd/files/2015/06/11-45.pdf" }, { "title": "Hawaii DOH IRHB, Radiation Section", "url": "https://health.hawaii.gov/irhb/radiation/" }, { "title": "Hawaii DOH IRHB, Radiation, Forms and Links", "url": "https://health.hawaii.gov/irhb/radforms/" }, { "title": "Hawaii DOH IRHB, Proposed Rule Changes and Public Hearing Notice", "url": "https://health.hawaii.gov/irhb/proposed-rule-changes-and-public-hearing-notice/" }, { "title": "Hawaii DOH IRHB, Radiation License Information Sheet", "url": "https://health.hawaii.gov/irhb/files/2013/07/radlicenseinfo.pdf" }, { "title": "HAR chapter 11-44, Radiologic Technology Rules (effective 3/29/10)", "url": "https://health.hawaii.gov/irhb/files/2020/06/HAR-11-44-RTB-03-29-2010.pdf" }, { "title": "HRS §466J-1 (official current HRS)", "url": "https://data.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0466J/HRS_0466J-0001.htm" }, { "title": "HRS chapter 466J, 2017 compilation PDF", "url": "https://data.capitol.hawaii.gov/sessions/session2017/HRS-Chapter-PDF%27s/HRS_0466J.pdf" }, { "title": "Justia, HRS §466J-6 (2025) Persons exempted", "url": "https://law.justia.com/codes/hawaii/title-25/chapter-466j/section-466j-6/" }, { "title": "Cornell LII, Haw. Code R. §11-45-120", "url": "https://www.law.cornell.edu/regulations/hawaii/Haw-Code-R-SS-11-45-120" }, { "title": "NRC Agreement States list", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "ID", "name": "Idaho", "pageUrl": "https://orsif.org/guidelines/us/states/idaho", "regulator": { "name": "Idaho Department of Health and Welfare (DHW), Idaho Radiation Control Program, Bureau of Laboratories, Division of Public Health", "url": "https://healthandwelfare.idaho.gov/providers/idaho-laboratories-and-testing/x-ray-licensure" }, "nrcAgreementState": false, "agreementNote": "Its 1968 agreement ended in 1991.", "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Idaho's rewritten X-ray rule, IDAPA 16.02.27 (effective 1 July 2026), removed all incorporation by reference, including the CRCPD model dose limits and fluoroscopy rules, and Idaho is not an NRC Agreement State. The rule requires exposure \"as low as is practical\" but has no numeric dose limits, no dosimetry threshold, and no rules on aprons, apron inspection, or apron alternatives. For private-sector workers, federal OSHA 29 CFR 1910.1096 limits whole-body dose, including the lens of the eye, to 1.25 rem (12.5 mSv) per quarter, sets higher limits for the hands, feet and skin, and requires dosimeters above 25 percent of a limit, but it does not cover state and local government workers and sets no limit for a declared pregnant worker. Anyone trained in 11 radiation-safety topics may operate X-ray equipment, including fluoroscopy, and Idaho does not license technologists.", "whereAlaraLives": { "category": "xray_specific", "explanation": "ALARA-type language appears only in the X-ray-only rule IDAPA 16.02.27. Idaho has no state radioactive-materials program or shared rule, is not an Agreement State, and removed all incorporation by reference, so an NRC change would not reach it directly.", "citation": "IDAPA 16.02.27.009.01.b; Senate Health & Welfare Committee minutes, 19 January 2026." }, "eyeLensLimitMsv": 50, "answers": { "agreement_state": { "question": "Agreement State", "status": "no", "answer": "No. Idaho's 1968 agreement ended in 1991; the NRC (Region IV) licenses radioactive materials in Idaho.", "citation": "NRC list of Agreement States, updated October 29, 2026; DHW X-ray Licensure page.", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://healthandwelfare.idaho.gov/providers/idaho-laboratories-and-testing/x-ray-licensure" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "IDAPA 16.02.27, \"Idaho Radiation Control Rules,\" sections 000-010, effective 7-1-26, is an X-ray-only rule. The 2026 rewrite (Docket 16-0227-2501) removed the adopted CRCPD model Parts D and F. The official PDF's cover page still refers to incorporation under Section 004, but the rule body governs. Statute: Idaho Code §§ 56-1041 to 56-1053.", "citation": "IDAPA 16.02.27.001 (Scope).", "sourceUrls": [ "https://adminrules.idaho.gov/rules/current/16/160227.pdf" ], "quote": "To define licensure, education, quality assurance, and safety requirements for X-ray machines.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes, in different words. Licensed facilities must keep radiation exposure \"as low as is practical.\" The phrase is undefined, and the rule does not say whether it covers worker dose, patient dose, or both.", "citation": "IDAPA 16.02.27.009.01.b.", "sourceUrls": [ "https://adminrules.idaho.gov/rules/current/16/160227.pdf" ], "quote": "Licensed facilities must: … b. Keep radiation exposure as low as is practical;", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "partial", "answer": "Idaho's X-ray rule sets no numeric dose limit and only requires facilities to keep exposure as low as is practical. For private-sector employers, federal OSHA limits whole-body dose to 1.25 rem (12.5 mSv) per calendar quarter, or up to 3 rem (30 mSv) per quarter if lifetime dose stays within 5 rem (50 mSv) times the worker's age minus 18 and records are kept. State and local government workers are not covered by federal OSHA.", "citation": "29 CFR 1910.1096(b)(1) Table G-18 and (b)(2)(i)", "sourceUrls": [ "https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1096" ], "quote": "During any calendar quarter the dose to the whole body shall not exceed 3 rems; and", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "partial", "answer": "Idaho's rule sets no lens of the eye limit. For private-sector employers, federal OSHA counts the lens of the eye as part of the whole body, so the same limit applies: 1.25 rem (12.5 mSv) per calendar quarter, or up to 3 rem (30 mSv) per quarter under lifetime-dose conditions. Neither Idaho nor OSHA has adopted the ICRP's 20 mSv figure.", "citation": "29 CFR 1910.1096(b)(1) Table G-18 and (b)(2)(iii)", "sourceUrls": [ "https://www.law.cornell.edu/cfr/text/29/1910.1096" ], "quote": "As used in this subparagraph Dose to the whole body shall be deemed to include any dose to the whole body, gonad, active bloodforming organs, head and trunk, or lens of the eye.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "partial", "answer": "Idaho's rule sets no skin or extremity limit. For private-sector employers, federal OSHA limits dose to the hands, forearms, feet and ankles to 18.75 rem (187.5 mSv) per calendar quarter, and dose to the skin of the whole body to 7.5 rem (75 mSv) per quarter.", "citation": "29 CFR 1910.1096(b)(1), Table G-18", "sourceUrls": [ "https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1096" ], "quote": "shall possess, use, or transfer sources of ionizing radiation in such a manner as to cause any individual in a restricted area to receive in any period of one calendar quarter from sources in the employer's possession or control a dose in excess of the limits specified in Table G-18", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "no", "answer": "Neither Idaho's X-ray rule nor the federal OSHA radiation standard sets a dose limit for the embryo or fetus of a declared pregnant worker. Idaho's rule only requires facilities to keep radiation exposure as low as is practical.", "citation": "IDAPA 16.02.27.000 to.010 (7-1-26); 29 CFR 1910.1096", "sourceUrls": [ "https://adminrules.idaho.gov/rules/current/16/160227.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "partial", "answer": "Idaho's rule sets no numeric threshold and only requires facilities to ensure personnel wear monitoring devices \"if applicable.\" For private-sector workers covered by federal OSHA, employers must supply and require dosimeters for anyone likely to receive more than 25 percent of the applicable dose limit in a calendar quarter (5 percent for workers under 18).", "citation": "29 CFR 1910.1096(d)(2)(i)", "sourceUrls": [ "https://www.law.cornell.edu/cfr/text/29/1910.1096" ], "quote": "Each employee who enters a restricted area under such circumstances that he receives, or is likely to receive, a dose in any calendar quarter in excess of 25 percent of the applicable value specified in paragraph (b)(1) of this section", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "no", "answer": "Idaho's rule only says facilities must make sure staff wear monitoring devices if applicable, and that operator training covers the use of personnel monitoring equipment. It says nothing about where to wear a badge with an apron, two-badge methods or how to estimate effective dose.", "citation": "IDAPA 16.02.27.009.01.g and 009.02.i (7-1-26)", "sourceUrls": [ "https://adminrules.idaho.gov/rules/current/16/160227.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "no", "answer": "Idaho's rule does not require protective aprons, thyroid shields or protective eyewear, and sets no lead equivalence. Operator training must cover controlling dose through time, distance and shielding, but there is no requirement to wear protective garments.", "citation": "IDAPA 16.02.27.000 to.010, including 009.02.f (7-1-26)", "sourceUrls": [ "https://adminrules.idaho.gov/rules/current/16/160227.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Idaho's rule has no requirement to inspect protective aprons or garments. Its quality control section covers only following the X-ray machine manufacturer's quality control procedures and keeping a written quality assurance plan.", "citation": "IDAPA 16.02.27.007 (7-1-26)", "sourceUrls": [ "https://adminrules.idaho.gov/rules/current/16/160227.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "no", "answer": "Idaho's rule does not address engineered shielding systems used in place of personal protective garments. It requires a qualified expert to prepare a shielding plan for the room, and requires training on time, distance and shielding, but it says nothing about replacing aprons.", "citation": "IDAPA 16.02.27.005 and 009.02.f (7-1-26)", "sourceUrls": [ "https://adminrules.idaho.gov/rules/current/16/160227.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Any individual may operate X-ray equipment, including fluoroscopy, after completing facility training and proving competency in radiation safety. There is no profession or supervision restriction, and Idaho does not license radiologic technologists. One commercial source conflicts on licensure, but no supporting statute was found.", "citation": "IDAPA 16.02.27.009.02.", "sourceUrls": [ "https://adminrules.idaho.gov/rules/current/16/160227.pdf" ], "quote": "No individual will be permitted to operate an X-ray machine until they have completed training and proven competency in radiation safety topics.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "Facility-provided training in 11 listed radiation-safety topics, with records kept for at least two license renewal cycles. There is no ARRT requirement, fluoroscopy permit, minimum hours, or continuing education. DHW posts a free training course.", "citation": "IDAPA 16.02.27.009.02.a-k.", "sourceUrls": [ "https://adminrules.idaho.gov/rules/current/16/160227.pdf" ], "quote": "X-ray operator training must include the following topics:", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Zero-Based Regulation rewrite of IDAPA 16.02.27, Docket 16-0227-2501", "kind": "adopted_rule", "status": "In effect 1 July 2026; approved by SCR 128", "date": "2026-07-01", "dateISO": "2026-07-01", "summary": "Negotiated rulemaking notice 2 April 2025; proposed rule 4 June 2025; pending rule 6 August 2025, adopted with no changes; approved by the Senate Health & Welfare Committee 19 January 2026 and by SCR 128. Removed all incorporation by reference, including CRCPD Parts D and F.", "sourceUrls": [ "https://adminrules.idaho.gov/bulletin/2025/08.pdf" ] } ], "notable": [ "Idaho is not an OSHA State Plan; federal OSHA (29 CFR 1910.1096) may cover most private-sector workers, but public-sector workers may not be covered.", "Section 009.01.a still requires posting \"notice standards for protection against radiation\" although Idaho no longer has its own standards to post.", "Federal facilities are exempt from Idaho X-ray licensing (16.02.27.003.01).", "A shielding plan by a qualified expert must be submitted 30 days before patient imaging (005).", "DHW may revoke a license if a device is used in a way that \"endangers patients, facility staff, or the public\" (010).", "The official rule PDF's cover page is stale and still refers to incorporation under Section 004." ], "openQuestions": [ "How does DHW decide when monitoring is \"applicable,\" what are its dosimetry waiver criteria, and do inspectors use the old model limits as guidance?", "Does federal OSHA enforce 29 CFR 1910.1096 against X-ray and fluoroscopy users in Idaho, and what covers public-sector workers?", "What exactly did the removed model Part D and Part F text say?", "Do Board of Medicine or Board of Nursing rules address fluoroscopy by physicians, PAs or NPs?", "Will there be any 2027 bill or DHW docket on technologist licensure, apron alternatives, or restoring dose standards?" ], "sources": [ { "title": "IDAPA 16.02.27, Idaho Radiation Control Rules (current, 7-1-26)", "url": "https://adminrules.idaho.gov/rules/current/16/160227.pdf" }, { "title": "DHW, X-ray Licensure (Idaho Radiation Control Program)", "url": "https://healthandwelfare.idaho.gov/providers/idaho-laboratories-and-testing/x-ray-licensure" }, { "title": "Idaho Code Title 56, Chapter 10 (§§ 56-1041 to 56-1053)", "url": "https://legislature.idaho.gov/wp-content/uploads/statutesrules/idstat/Title56/T56CH10.pdf" }, { "title": "Legislative Services Office packet with the proposed rule redline, Docket 16-0227-2501 (Bulletin 25-6, 4 June 2025)", "url": "https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2025/interim/adminrules/1602272501G9.pdf" }, { "title": "Idaho Administrative Bulletin, 6 August 2025 (Vol. 25-8), pending rule notice", "url": "https://adminrules.idaho.gov/bulletin/2025/08.pdf" }, { "title": "Idaho Administrative Bulletin, 1 July 2026 (Vol. 26-7), 2026 legislative rules review summary (SCR 128)", "url": "https://proddfmmainsa.blob.core.windows.net/dfm-admin-website/bulletin/2026/07.pdf" }, { "title": "Senate Health & Welfare Committee minutes, 19 January 2026", "url": "https://legislature.idaho.gov/wp-content/uploads/sessioninfo/2026/standingcommittees/260119_sh&w_0300PM-Minutes.pdf" }, { "title": "2026 Idaho Legislation index", "url": "https://legislature.idaho.gov/sessioninfo/2026/legislation/" }, { "title": "29 CFR 1910.1096, Ionizing radiation (Cornell LII, secondary copy)", "url": "https://www.law.cornell.edu/cfr/text/29/1910.1096" }, { "title": "OSHA State Plans (seen in search results only)", "url": "https://www.osha.gov/stateplans" }, { "title": "College of Southern Idaho, Radiologic Technology licensure page (secondary)", "url": "https://www.csi.edu/programs/radiologic-technology/licensure-certification.aspx" } ] }, { "code": "IL", "name": "Illinois", "pageUrl": "https://orsif.org/guidelines/us/states/illinois", "regulator": { "name": "Illinois Emergency Management Agency and Office of Homeland Security (IEMA-OHS), Nuclear & Radiation Safety program", "url": "https://iemaohs.illinois.gov/nrs.html" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Illinois's ALARA requirement is in its general radiation protection rule, 32 Ill. Adm. Code 340.110(b), which applies to both licensees and X-ray registrants, while the X-ray rule (Part 360) asks for procedures to minimize patient and occupational doses without ALARA wording. Occupational limits are 50 mSv per year whole body and 150 mSv per year to the lens of the eye, with no lower eye limit, and the dose to the embryo or fetus of a declared pregnant worker must be kept at or below 5 mSv over the whole pregnancy. Fluoroscopy staff must be protected by aprons of at least 0.25 mm lead equivalent, by barriers or by distance, and everyone except the patient in a stationary cardiac cath room must wear an apron; a proposed rule published March 13, 2026 that would allow Enhanced Radiation Protection Systems as an alternative to lead aprons was paused on October 22, 2026. Only licensed physicians, dentists and podiatrists may run fluoroscopy on their own, with limited supervised exceptions for accredited radiographers, radiation therapists and radiologist assistants.", "whereAlaraLives": { "category": "both", "explanation": "The explicit ALARA requirement is only in the shared rule, Part 340, which covers both licensees and registrants. The X-ray rule, Part 360 (Section 360.30), requires \"procedures to minimize patient and occupational doses\" but does not use ALARA wording. An NRC-driven change to Part 340 would apply to X-ray registrants unless Illinois limits it to licensees.", "citation": "32 Ill. Adm. Code 340.110(b); 360.30" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Illinois is on the NRC's list of Agreement States, updated October 29, 2026.", "citation": "NRC list of Agreement States, updated October 29, 2026; 32 Ill. Adm. Code 340.520(b) (incorporates 10 CFR 20 Appendix B)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.issrt.org/news/", "https://www.nrc.gov/docs/ML2301/ML23018A038.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "The X-ray and fluoroscopy rule is 32 Ill. Adm. Code 360, \"Use of X-Rays in the Healing Arts Including Medical, Dental, Podiatry, and Veterinary Medicine.\" Fluoroscopy is in Section 360.50. Part 360 was last amended effective May 29, 2014 (38 Ill. Reg. 12031), and Section 360.50 effective February 29, 2008 (32 Ill. Reg. 3693). Part 360 applies in addition to Parts 310, 320, 340, 400 and 410. General standards are in Part 340, and operator accreditation is in Part 401.", "citation": "32 Ill. Adm. Code 360.10(a); 340.10(a)", "sourceUrls": [ "https://www.ilga.gov/Commission/jcar/admincode/JCARTitlePart.asp?Title=032&Part=0360", "https://www.ilga.gov/ftp/JCAR/AdminCode/032/032003600000500R.html", "https://www.ilga.gov/agencies/JCAR/EntirePart?titlepart=03200340" ], "quote": "The provisions of this Part are in addition to, and not in substitution for, other applicable provisions of 32 Ill. Adm. Code 310, 320, 340, 400 and 410.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. 340.110(b) applies to each licensee or registrant, and X-ray machine users are registrants. The annual program review in 340.110(c) applies only to licensees; registrants must review their program at least once per inspection cycle (340.110(e)).", "citation": "32 Ill. Adm. Code 340.110(b), (e)", "sourceUrls": [ "https://www.ilga.gov/agencies/JCAR/EntirePart?titlepart=03200340", "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-340.110", "https://regulations.justia.com/states/illinois/title-32/part-340/subpart-b/section-340-110" ], "quote": "The licensee or registrant shall use, to the extent practicable, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem), or 50 mSv per year, TEDE.", "citation": "32 Ill. Adm. Code 340.210(a)(1)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-340.210" ], "quote": "1) An annual limit, which is the more limiting of: A) The total effective dose equivalent being equal to 0.05 Sv (5 rem); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem), or 150 mSv per year. No lower lens limit has been adopted.", "citation": "32 Ill. Adm. Code 340.210(a)(1)-(2)", "sourceUrls": [ "https://www.ilga.gov/ftp/JCAR/AdminCode/032/032003400C02100R.html", "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-340.210" ], "quote": "A) A lens dose equivalent of 0.15 Sv (15 rem); and B) A shallow dose equivalent of 0.5 Sv", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem), or 500 mSv per year, for the skin or any extremity.", "citation": "32 Ill. Adm. Code 340.210(a)(1)-(2)", "sourceUrls": [ "https://www.ilga.gov/ftp/JCAR/AdminCode/032/032003400C02100R.html", "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-340.210" ], "quote": "A) A lens dose equivalent of 0.15 Sv (15 rem); and B) A shallow dose equivalent of 0.5 Sv", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "The employer must keep the dose to the embryo/fetus of a declared pregnant worker at or below 5 mSv (0.5 rem) over the whole pregnancy. If the worker has not given the estimated date of conception, the dose must not exceed 0.5 mSv (0.05 rem) per month for the rest of the pregnancy.", "citation": "32 Ill. Adm. Code 340.280(a)", "sourceUrls": [ "https://ilga.gov/commission/jcar/admincode/032/032003400C02800R.html" ], "quote": "the licensee or registrant shall ensure that the dose equivalent to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Individual dosimeters must be provided and used for adults likely to receive more than 10% of the 340.210(a) limits in a year, minors likely to receive more than 10% of their limits, declared pregnant women likely to receive a deep dose above 1 mSv (0.1 rem) during the pregnancy, and anyone entering a high or very high radiation area. Section 360.30 applies these monitoring rules to everyone associated with X-ray operation.", "citation": "32 Ill. Adm. Code 340.520(a)", "sourceUrls": [ "https://regulations.justia.com/states/illinois/title-32/part-340/subpart-f/section-340-520/" ], "quote": "Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of the limits in Section 340.210(a);", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "Section 340.530 sets where badges go: the whole-body badge at the unshielded part of the body likely to get the highest exposure, typically the neck (collar) when an apron is worn; a badge for eye dose at the collar outside any apron, or at an unshielded spot closer to the eye; and a badge for a declared pregnant worker's embryo or fetus at the waist under any apron. Under 340.210(c), the deep dose from a worn badge is used in place of effective dose unless effective dose is worked out with a dosimetry method the state agency has approved. Neither section names a two-badge method or a specific method such as NCRP Report 122.", "citation": "32 Ill. Adm. Code 340.530 and 340.210(c)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-340.530" ], "quote": "When a protective apron is worn, the location of the individual monitoring device is typically at the neck (collar).", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "In general fluoroscopy, the operator, assistants and observers must be protected by aprons of at least 0.25 mm lead equivalent, by whole-body barriers, or by sufficient distance. A shield of at least 0.25 mm lead equivalent must be provided and used but does not replace the apron. In stationary cardiac cath rooms, aprons are mandatory for everyone except the patient, and any viewing panel must be at least 0.5 mm lead equivalent. No thyroid shield or eyewear requirement was found.", "citation": "32 Ill. Adm. Code 360.50(i), (j), (k)", "sourceUrls": [ "https://www.ilga.gov/ftp/JCAR/AdminCode/032/032003600000500R.html", "https://www.ilsos.gov/content/dam/departments/index/register/volume50/register_volume50_11.pdf" ], "quote": "Protective aprons of not less than 0.25 millimeter of lead equivalent shall be worn in the fluoroscopy room by all individuals (except the patient).", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Illinois's X-ray rules require written procedures on the use of personnel protective devices and require aprons for fluoroscopy staff, but set no requirement to inspect aprons on any schedule.", "citation": "32 Ill. Adm. Code 360.30 and 360.50", "sourceUrls": [ "https://regulations.justia.com/states/illinois/title-32/part-360/section-360-30/", "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-360.30" ], "quote": "Use of personnel and patient protective devices;", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Current rules allow whole-body barriers or distance instead of aprons in general fluoroscopy, but shields do not replace aprons and aprons are required for everyone in stationary cardiac cath rooms. A proposed rule (50 Ill. Reg. 3961, published March 13, 2026) would authorize Enhanced Radiation Protection Systems as an alternative to lead aprons. It was paused on October 22, 2026.", "citation": "32 Ill. Adm. Code 360.50(j)(2); proposed amendments, 50 Ill. Reg. 3961", "sourceUrls": [ "https://www.ilga.gov/ftp/JCAR/AdminCode/032/032003600000500R.html", "https://iemaohs.illinois.gov/laws/regs-proposed.html", "https://www.ilsos.gov/content/dam/departments/index/register/volume50/register_volume50_11.pdf" ], "quote": "This shielding shall not be a substitute for the wearing of a protective apron (0.25 millimeter lead equivalent) for protection against scattered radiation.", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Only those licensed under the Medical Practice Act, Dental Practice Act or Podiatric Medical Practice Act may operate fluoroscopy on people, with four exceptions: accredited medical radiographers for static functions needing no diagnostic interpretation, under supervision; accredited radiographers under the direct supervision of a licensed practitioner who is physically present and participating; accredited radiographers or radiation therapists for therapy simulation, under supervision; and accredited radiologist assistants under the supervision of an ABR- or AOBR-certified practitioner. Physician assistants and nurse practitioners are not listed.", "citation": "32 Ill. Adm. Code 360.50(n); 77 Ill. Adm. Code 250.630(d)", "sourceUrls": [ "https://www.ilga.gov/ftp/JCAR/AdminCode/032/032003600000500R.html", "https://www.ilsos.gov/content/dam/departments/index/register/volume50/register_volume50_11.pdf", "https://ilga.gov/commission/jcar/admincode/077/077002500F06300R.html" ], "quote": "No person shall intentionally administer radiation to a human being with a fluoroscopic radiation machine unless such person is licensed to practice a treatment of human ailments under the Medical Practice Act of 1987", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Non-physician operators must hold IEMA-OHS accreditation under Part 401 as a medical radiographer, radiation therapist or radiologist assistant, which includes examination and renewal requirements. The hospital rule requires accredited staff to take continuing education. All operators must be instructed in, and show competence with, the registrant's operating and safety procedures. No fluoroscopy-specific training requirement for physicians was found.", "citation": "32 Ill. Adm. Code 360.30; 401.20; 401.70; 77 Ill. Adm. Code 250.630(e)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-360.30", "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-401.20" ], "quote": "Individuals who operate radiation machines shall be instructed in and able to demonstrate competence with the registrant's operating and safety procedures.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "ERPS amendments to Part 360 (360.20 and 360.50)", "kind": "proposed_rule", "status": "Paused on October 22, 2026, at second notice, to incorporate forthcoming CRCPD guidance", "date": "2026-03-13", "dateISO": "2026-03-13", "summary": "Would authorize Enhanced Radiation Protection Systems during fluoroscopically guided procedures as an alternative to lead aprons (IEMA's page describes the scope as cardiac catheterization). Published at 50 Ill. Reg. 3961. The American Society of Echocardiography filed supporting comments on April 8, 2026.", "sourceUrls": [ "https://iemaohs.illinois.gov/laws/regs-proposed.html" ] }, { "title": "HR0565 (104th General Assembly)", "kind": "bill", "status": "Status not determined", "date": "", "dateISO": null, "summary": "House resolution urging IEMA-OHS to amend Part 360 to create a pathway for ERPS.", "sourceUrls": [ "https://ilga.gov/Legislation/BillStatus/FullText?LegDocId=205966&DocName=10400HR0565&DocNum=565&DocTypeID=HR&LegID=164618&GAID=18&SessionID=114&SpecSess=&Session=&Print=1" ] }, { "title": "Radiation Protection Act sunset", "kind": "other", "status": "Act expires January 1, 2027; whether an extension passed is not confirmed", "date": "2027-01-01", "dateISO": "2027-01-01", "summary": "The GOMB study (May 8, 2026) reports that IEMA-OHS made no recommendations to change the Act and that rulemakings for Part 360 (fluoroscopy) and Part 370 (mammography) are under way.", "sourceUrls": [ "https://budget.illinois.gov/content/dam/soi/en/web/budget/documents/budgeting-for-results/sunset-reports/2026-studies/Study%20-%20Radiation%20Protection%20Act%20of%201990.pdf" ] }, { "title": "HB3744", "kind": "bill", "status": "Signed August 15, 2025; effective January 1, 2026", "date": "2025-08-15", "dateISO": "2025-08-15", "summary": "Deals with nuclear fuel shipments and stray radiation sources, not fluoroscopy.", "sourceUrls": [] } ], "notable": [ "360.50(i) accepts barriers or distance instead of aprons in general fluoroscopy, while 360.50(k)(2) requires aprons in stationary cardiac cath rooms. An agency note in (k) recommends that staff step back behind barriers during exposures.", "360.50(i) and 360.40 measure \"sufficient distance\" against the limits in 340.310, which the codification index titles \"Dose Limits for Individual Members of the Public,\" not the occupational limits.", "Registrants must give monitored workers an annual dose report if their dose exceeds 1 mSv (100 mrem).", "Workers or their representatives may ask IEMA for an inspection if they believe there is a violation or unnecessary exposure (Part 400).", "Fluoroscopes need a 5-minute cumulative timer and an audible signal when high-level control is used." ], "openQuestions": [ "Agreement State status: not confirmed directly. Check the NRC's Agreement State program list and IEMA-OHS's \"About\" page.", "Badge placement and effective-dose methods: check 340.1160 and the rest of Subpart F, plus IEMA X-ray guidance (https://iemaohs.illinois.gov/nrs/forms.html).", "Full text of 360.30 and 360.40, to confirm whether there are apron inspection, thyroid shield or eyewear provisions.", "The proposed ERPS rule text (50 Ill. Reg. 3961): which procedures it covers, its performance criteria (HR0565 mentions 0.5 mm lead equivalent), its monitoring conditions, and whether the one-year first-notice window leaves time to file a second notice after the pause.", "Radiation Protection Act sunset: whether an extension bill passed in 2026 before the January 1, 2027 expiry.", "Status of HR0565.", "Effective date of the 2023 Part 340 amendments (47 Ill. Reg. 9163), and whether Illinois has begun any rulemaking on the NRC's proposed ALARA change.", "The 340.310 cross-reference: confirm what limit 360.50(i) and 360.40 actually point to.", "Physician training: whether IDFPR medical licensing rules or hospital credentialing impose fluoroscopy training, and whether ARRT certification satisfies 401.70." ], "sources": [ { "title": "IEMA-OHS, Proposed/Pending Regulations", "url": "https://iemaohs.illinois.gov/laws/regs-proposed.html" }, { "title": "32 Ill. Adm. Code 360.50 (ILGA official)", "url": "https://www.ilga.gov/ftp/JCAR/AdminCode/032/032003600000500R.html" }, { "title": "32 Ill. Adm. Code Part 360 (ILGA, Parts 360.10-360.20 and source history)", "url": "https://www.ilga.gov/Commission/jcar/admincode/JCARTitlePart.asp?Title=032&Part=0360" }, { "title": "32 Ill. Adm. Code 360.40 (ILGA excerpt)", "url": "https://ilga.gov/commission/jcar/admincode/032/032003600000400R.html" }, { "title": "32 Ill. Adm. Code 360.30 (Cornell LII)", "url": "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-360.30" }, { "title": "32 Ill. Adm. Code 360.30 (Justia)", "url": "https://regulations.justia.com/states/illinois/title-32/part-360/section-360-30/" }, { "title": "32 Ill. Adm. Code Part 340 (ILGA excerpt)", "url": "https://www.ilga.gov/agencies/JCAR/EntirePart?titlepart=03200340" }, { "title": "32 Ill. Adm. Code 340.110 (Cornell)", "url": "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-340.110" }, { "title": "32 Ill. Adm. Code 340.110 (Justia)", "url": "https://regulations.justia.com/states/illinois/title-32/part-340/subpart-b/section-340-110" }, { "title": "32 Ill. Adm. Code 340.210 (ILGA)", "url": "https://www.ilga.gov/ftp/JCAR/AdminCode/032/032003400C02100R.html" }, { "title": "32 Ill. Adm. Code 340.210 (Cornell)", "url": "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-340.210" }, { "title": "32 Ill. Adm. Code 340.520 (Justia)", "url": "https://regulations.justia.com/states/illinois/title-32/part-340/subpart-f/section-340-520/" }, { "title": "32 Ill. Adm. Code Part 400", "url": "https://www.ilga.gov/Commission/jcar/admincode/JCARTitlePart.asp?Title=032&Part=0400" }, { "title": "32 Ill. Adm. Code 400.130 (Cornell)", "url": "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-400.130" }, { "title": "32 Ill. Adm. Code 401.20 (Cornell)", "url": "https://www.law.cornell.edu/regulations/illinois/Ill-Admin-Code-tit-32-SS-401.20" }, { "title": "Part 401 section list (ILGA)", "url": "https://my.ilga.gov/agencies/JCAR/Sections?PartID=03200401&TitleDescription=TITLE+32%3A++ENERGY" }, { "title": "77 Ill. Adm. Code 250.630 (hospital licensing)", "url": "https://ilga.gov/commission/jcar/admincode/077/077002500F06300R.html" }, { "title": "Illinois Register Vol. 50, Issue 11 (search excerpt only)", "url": "https://www.ilsos.gov/content/dam/departments/index/register/volume50/register_volume50_11.pdf" }, { "title": "Illinois Register Vol. 47, Issue 27 (2023 Part 340 amendments; excerpt)", "url": "https://www.ilsos.gov/content/dam/departments/index/register/volume47/register_volume47_27.pdf" }, { "title": "Title 32 codification index", "url": "https://www.ilsos.gov/departments/index/codification_indexes/title32.pdf" }, { "title": "NRC ADAMS, Illinois Part 340 draft", "url": "https://www.nrc.gov/docs/ML2301/ML23018A038.pdf" }, { "title": "GOMB Regulatory Sunset Act Study (May 8, 2026)", "url": "https://budget.illinois.gov/content/dam/soi/en/web/budget/documents/budgeting-for-results/sunset-reports/2026-studies/Study%20-%20Radiation%20Protection%20Act%20of%201990.pdf" }, { "title": "HR0565 full text", "url": "https://ilga.gov/Legislation/BillStatus/FullText?LegDocId=205966&DocName=10400HR0565&DocNum=565&DocTypeID=HR&LegID=164618&GAID=18&SessionID=114&SpecSess=&Session=&Print=1" }, { "title": "ASE comments on ERPS amendment", "url": "https://www.asecho.org/resource/ase-submits-comments-on-illinois-amendment-on-the-use-of-enhanced-radiation-protection-systems/" }, { "title": "ISSRT news (Act sunset)", "url": "https://www.issrt.org/news/" } ] }, { "code": "IN", "name": "Indiana", "pageUrl": "https://orsif.org/guidelines/us/states/indiana", "regulator": { "name": "Indiana Department of Health (IDOH), Consumer Services and Healthcare Regulation, Division of Radiology, Weights, and Measures", "url": "https://www.in.gov/health/cshcr/radiology-weights-and-measures/" }, "nrcAgreementState": true, "agreementNote": "Agreement State since 2026-09-30 (91 FR 62635).", "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Indiana's X-ray rules (IDOH, 410 IAC 5) use very old wording: the only general ALARA language is advisory ('should'), and while the X-ray rule mandates procedures and equipment that minimize patient and personnel exposure, it does not cross-reference the ALARA section. Worker dose limits are pre-1994 quarterly limits, with the lens of the eye falling under the whole-body limit of 1¼ rem (12.5 mSv) per quarter, and the rules set no separate embryo/fetus limit and no pregnancy declaration process for pregnant workers. Staff in the room must be protected by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent, but the rules say nothing specific about engineered radiation protection systems and do not require aprons to be inspected. Only state-licensed staff may operate X-ray machines (physicians, dentists, chiropractors and podiatrists are exempt), a limited general radiography license does not allow fluoroscopy, and radioactive materials are regulated separately by IDHS under its own rules (290 IAC 3).", "whereAlaraLives": { "category": "both", "explanation": "The advisory ALARA sentence is in the shared general standards rule, 410 IAC 5-4-1(b), but the X-ray rule (5-6.1-118(a)) cross-references only 5-4-2, 5-4-3 and 5-4-10, not 5-4-1. A separate X-ray-specific minimization duty is in 5-6.1-118(x). Materials licensees now fall under IDHS's 290 IAC 3, which incorporates 10 CFR Part 20. It is unconfirmed whether that incorporation is as of a fixed date.", "citation": "410 IAC 5-4-1(b); 410 IAC 5-6.1-118(a), (x); 290 IAC 3-2-2" }, "eyeLensLimitMsv": 50, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Indiana became an Agreement State on 2026-09-30 (the IDHS page says the agreement was signed on Sept. 24). The IDHS Radioactive Materials Control Program runs the materials program, so materials rules may still be in transition.", "citation": "NRC list of Agreement States, updated October 29, 2026; IC 10-19-12-5", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.in.gov/dhs/fire-and-building-safety/fire-investigations/hazmat-and-radiation/radioactive-materials-control-program" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "410 IAC 5, Radiological Health (IDOH). General standards are in 410 IAC 5-4, Protection and Exposure Standards, which applies to all licensees or registrants. Medical X-ray and fluoroscopy rules are in 410 IAC 5-6.1, X-rays in the Healing Arts, especially 5-6.1-118 (general operating requirements) and 5-6.1-120 (fluoroscopic systems). Operator licensing is in 410 IAC 5.2. The text was read from IDOH's posted PDF, with history notes through a readoption filed Nov 13, 2019. A 2025 notice and memo say 410 IAC 5 was readopted without changes. The official site could not be loaded. IDHS's 290 IAC 3 covers radioactive-materials licensees.", "citation": "410 IAC 5-4-1(a); 410 IAC 5-6.1-118, -120", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "Except as otherwise specifically provided, 410 IAC 5-4 applies to all licensees or registrants.", "quoteMatchedToSource": true, "confidence": "medium" }, "alara_required": { "question": "ALARA for X-ray users", "status": "partial", "answer": "Only partly. 410 IAC 5-4-1(b) says every reasonable effort 'should' be made to keep exposures ALARA, which is advisory. 410 IAC 5-6.1-118(x) mandates procedures and auxiliary equipment that minimize patient and personnel exposure, which is similar to ALARA but does not use the term.", "citation": "410 IAC 5-4-1(b); 410 IAC 5-6.1-118(x)", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "In addition to complying with the rules set forth in 410 IAC 5-4, every reasonable effort should be made to maintain radiation exposures, and releases of radioactive materials in effluents to unrestricted areas, as low as is reasonably achievable.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "Pre-1994 quarterly limit of 1¼ rem (12.5 mSv) per calendar quarter, which works out to 5 rem (50 mSv) a year. Up to 3 rem (30 mSv) per quarter is allowed if the dose history is recorded on Form Y and lifetime dose stays within 5(N-18) rem. There is no TEDE concept and no annual limit. Minors are limited to 10% of these limits.", "citation": "410 IAC 5-4-2(a)-(b); 5-4-5(a)", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "During any calendar quarter, the total occupational dose to the whole body from sources of radiation in the licensee's or registrant's possession shall not exceed 3 rems;", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "partial", "answer": "The lens of the eye falls under the whole-body limit of 1¼ rem (12.5 mSv) per quarter, or up to 3 rem (30 mSv) per quarter under the exception. There is no separate annual lens limit. This is a leftover of the old framework, not an adoption of the ICRP's 20 mSv.", "citation": "410 IAC 5-4-2(a)-(b)", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "Whole body; head and trunk; active blood-forming organs; lens of eyes; or gonads", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Hands, forearms, feet and ankles: 18¾ rem (187.5 mSv) per quarter. Skin of the whole body: 7½ rem (75 mSv) per quarter.", "citation": "410 IAC 5-4-2(a)", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "no licensee or registrant shall possess, use, receive, or transfer sources of radiation in such a manner as to cause any individual in a restricted area to receive in any period of one calendar quarter from all sources of radiation", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "no", "answer": "No. Indiana's X-ray and worker protection rules set no separate dose limit for the embryo or fetus of a pregnant worker and have no process for declaring a pregnancy. A pregnant worker is covered only by the general worker limits.", "citation": "410 IAC 5-4 (sections 5-4-1 to 5-4-28, including 5-4-2 and 5-4-5); 410 IAC 5-6.1", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "A personal dosimeter is required for anyone in a restricted area who receives, or is likely to receive, more than 25% of a quarterly limit. For the whole body that is 0.3125 rem (3.125 mSv) per quarter. The threshold is 5% for workers under 18. Anyone entering a high radiation area must also be monitored. The dosimetry processor must be NVLAP-accredited. X-ray users are bound by 5-4-10 through 5-6.1-118(a).", "citation": "410 IAC 5-4-10", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "Each individual who enters a restricted area under such circumstances that he receives, or is likely to receive, a dose in any calendar quarter in excess of 25 percent of the applicable value specified in 410 IAC 5-4-2(a);", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "no", "answer": "No. The rules require badges for workers likely to receive more than 25 percent of a quarterly limit, but they say nothing about where to wear a badge with an apron, two-badge methods, or formulas for estimating effective dose. A footnote lets X-ray dose be taken as the exposure measured at or near the body surface where the dose rate is highest, and deliberately exposing a badge to give a false reading is prohibited.", "citation": "410 IAC 5-4-10; 410 IAC 5-4-2, footnote 1; 410 IAC 5-6.1-118(y)", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "a dose from x or gamma rays up to 10 MeV may be assumed to be equivalent to the exposure measured by a properly calibrated appropriate instrument in air at or near the body surface in the region of the highest dose rate.", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Only staff needed for the procedure or for training may be in the room. They must be protected from scatter by aprons or whole-body barriers of at least 0.25 mm lead equivalent. Any body part in the useful beam needs 0.5 mm lead equivalent. In fluoroscopy, there must be at least 0.25 mm lead equivalent below the table, and an additional 0.25 mm above the table beyond the apron unless the person is at least 120 cm from the beam center. No rule text was found on thyroid shields or protective eyewear.", "citation": "410 IAC 5-6.1-118(t); 5-6.1-120(r)", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "Staff and ancillary personnel shall be protected from direct scattered radiation by protective aprons or whole body protective barriers of not less than twenty-five hundredths (0.25) mm lead equivalent.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "No. Indiana's X-ray rules set minimum lead equivalence for aprons and shielding (0.25 mm lead equivalent) but do not require protective aprons or other protective apparel to be inspected periodically.", "citation": "410 IAC 5-6.1-81; 410 IAC 5-6.1-118(t); 410 IAC 5-6.1-120(r)", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered radiation protection systems are not named. 5-6.1-118(t)(2) accepts 'whole body protective barriers' of at least 0.25 mm lead equivalent as an alternative to aprons. 5-6.1-120(r)(2) lists drapes, Bucky-slot covers and self-supporting curtains for attenuating scatter above the table. The commissioner may exempt a facility where a sterile field prevents normal barriers, but not where prefitted sterilized covers are practical. Whether IDOH reads 'whole body protective barriers' to cover modern systems is unknown.", "citation": "410 IAC 5-6.1-120", "sourceUrls": [ "https://www.in.gov/health/files/A00050.PDF" ], "quote": "The commissioner may grant an exemption to subdivision (2) where a sterile field will not permit the use of the normal protective barriers. Where the use of prefitted sterilized covers for protective barriers is practical, the commissioner shall not permit such exemption.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Only holders of an IDOH license, certificate or permit may operate a radiation machine. Physicians, dentists, chiropractors, podiatrists and dental hygienists are exempt, and IDOH may grant other exemptions. Radiologic technologists must be licensed to perform radiographic and fluoroscopic procedures. A limited cardiac catheterization radiography license exists, but its scope was not read. Physician assistants and nurse practitioners are not on the exemption list, and no provision authorizing them was found. A practitioner of the healing arts must authorize exposure to the useful beam.", "citation": "410 IAC 5.2-3-1; 5.2-2-1; 5.2-6-1; 5.2-1-8", "sourceUrls": [ "https://www.law.cornell.edu/regulations/indiana/410-IAC-5.2-3-1" ], "quote": "A person who does not have a current license, certificate, or permit issued by the department shall not operate a radiation machine or use radiopharmaceutical agents.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "A radiologic technologist license requires current ARRT certification and registration and lasts 24 months. A limited general radiography license excludes fluoroscopy, C-arm, contrast, mammography and portable surgery procedures. No physician fluoroscopy training rule and no state continuing education hours were found.", "citation": "410 IAC 5.2-6-1(c); 5.2-11-2; IC 16-41-35-29", "sourceUrls": [ "https://www.law.cornell.edu/regulations/indiana/410-IAC-5.2-6-1" ], "quote": "", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "410 IAC 5 readopted without changes", "kind": "adopted_rule", "status": "Readopted without changes", "date": "2025-11-07", "dateISO": "2025-11-07", "summary": "A Register notice of September 10, 2025 and an IDOH memo of November 7, 2025 say 410 IAC 5 was readopted without changes, so the rules will not expire on January 1, 2026.", "sourceUrls": [ "https://secure.in.gov/health/files/IDOH-Readoption-Memo-2025.pdf" ] }, { "title": "410 IAC 5.2 readopted", "kind": "adopted_rule", "status": "Readopted", "date": "2024-11-14", "dateISO": "2024-11-14", "summary": "Readoption of the operator licensing rules was filed 11/14/2024.", "sourceUrls": [] }, { "title": "IDHS 290 IAC 3 Standards for Protection Against Radiation", "kind": "adopted_rule", "status": "Final rule published", "date": "2025-11-26", "dateISO": "2025-11-26", "summary": "IDHS adopted 290 IAC 3 for radioactive-materials licensees; it incorporates 10 CFR Part 20. The final rule was published Nov. 26, 2025, according to WFYI.", "sourceUrls": [ "https://www.wfyi.org/statewide/2026-09-29/indiana-nrc-agreement-state-radioative-materials-regulation" ] } ], "notable": [ "Fluoroscopic systems must be evaluated every 12 months by an IDOH-approved physicist or inspector (5-6.1-120(a)).", "Fluoroscopy is limited to 10 R/min, or 5 R/min without high-level control, and a 5-minute cumulative timer is required.", "Before someone enters a restricted area where they are likely to exceed 25% of a quarterly limit, the employer must get a signed statement of their prior dose that quarter (5-4-3).", "The two-agency split (IDOH for X-ray, IDHS for materials) puts X-ray and materials standards in separate rule sets.", "Much of the 410 IAC 5-4 text still refers to 'the board' and repealed statutes.", "Dose limits are pre-1994 quarterly limits in rems, with no TEDE concept or annual limit." ], "openQuestions": [ "Confirm against the Indiana Register (iar.iga.in.gov) that 410 IAC 5-4 and 5-6.1 were readopted unchanged in late 2025.", "Ask IDOH whether 410 IAC 5-4 still applies to radioactive-materials licensees now that IDHS regulates them.", "Check whether 290 IAC 3 adopts 10 CFR Part 20 as of a fixed date (290 IAC 3-2-2, 3-18-2), which decides whether NRC changes flow through automatically.", "Read 410 IAC 5.2-15-2 for the limited cardiac catheterization license scope, including whether fluoroscopy is allowed.", "Read 410 IAC 5.2-6-2 (technologist scope and supervision) and 5.2-4-2 (renewal and continuing education).", "Check IC 25-27.5 (PAs), IC 25-23 (NPs) and IDOH for any authority for PAs or NPs to operate fluoroscopy.", "Search the Indiana General Assembly (iga.in.gov) for 2026 bills on radiation protection systems, aprons or fluoroscopy operators.", "Check IDOH guidance on dosimeter placement, apron inspection, or how IDOH reads 'whole body protective barriers'." ], "sources": [ { "title": "IDOH, 410 IAC 5 Radiological Health (posted PDF)", "url": "https://www.in.gov/health/files/A00050.PDF" }, { "title": "Indiana Register, 410 IAC 5 (official; would not load, JavaScript)", "url": "https://iar.iga.in.gov/latestArticle/410/5" }, { "title": "IDOH, Radiology, Weights, and Measures", "url": "https://www.in.gov/health/cshcr/radiology-weights-and-measures/" }, { "title": "IDOH Readoption Memo, Nov. 7, 2025", "url": "https://secure.in.gov/health/files/IDOH-Readoption-Memo-2025.pdf" }, { "title": "IDOH Office of Legal Affairs rules page", "url": "https://secure.in.gov/health/directory/office-of-the-commissioner/rules/" }, { "title": "Cornell LII, 410 IAC 5.2-3-1 (secondary)", "url": "https://www.law.cornell.edu/regulations/indiana/410-IAC-5.2-3-1" }, { "title": "Cornell LII, 410 IAC 5.2-6-1 (secondary)", "url": "https://www.law.cornell.edu/regulations/indiana/410-IAC-5.2-6-1" }, { "title": "Indiana Register, 410 IAC 5.2 (search excerpt only)", "url": "https://iar.iga.in.gov/latestArticle/410/5.2" }, { "title": "Justia, IC 16-41-35-29 (2025, secondary)", "url": "https://law.justia.com/codes/indiana/title-16/article-41/chapter-35/section-16-41-35-29/" }, { "title": "IDHS Radioactive Materials Control Program", "url": "https://www.in.gov/dhs/fire-and-building-safety/fire-investigations/hazmat-and-radiation/radioactive-materials-control-program" }, { "title": "Indiana Register, 290 IAC 3 proposed rule (search excerpt only)", "url": "https://iar.iga.in.gov/register/20250820-IR-290250385RAA?highlight=25-385" }, { "title": "WFYI, \"Indiana will oversee some radioactive materials…\" (2026-09-29)", "url": "https://www.wfyi.org/statewide/2026-09-29/indiana-nrc-agreement-state-radioative-materials-regulation" } ] }, { "code": "IA", "name": "Iowa", "pageUrl": "https://orsif.org/guidelines/us/states/iowa", "regulator": { "name": "Bureau of Radiological Health, Iowa Department of Health and Human Services (Iowa HHS)", "url": "https://hhs.iowa.gov/health-prevention/providers-professionals/radiological-health" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Iowa's X-ray and fluoroscopy rules are in Chapter 40, effective 7/1/26, and the binding ALARA duty for X-ray registrants is in shared Chapter 37.11, effective 7/29/26, which is consistent with 10 CFR Part 20. Dose limits follow the federal model, including a 150 mSv lens limit, and all fluoroscopy workers must be badged. Aprons of at least 0.25 mm lead equivalent are required in interventional rooms and must be inspected annually, and a general X-ray rule lets whole body protective barriers of at least 0.25 mm lead equivalent serve in place of aprons. Technologists need an ARRT-based permit and direct supervision for fluoroscopy; ARNPs may supervise after a course but may not operate fluoroscopy unless they hold an Iowa permit.", "whereAlaraLives": { "category": "both", "explanation": "The binding occupational ALARA duty is in shared Chapter 37 (37.11(2)\"b\"), which applies to registrants and licensees and is consistent with 10 CFR Parts 19/20. Materials licensees also follow Part 20 by reference as amended to August 1, 2025. Chapter 40 mentions ALARA only for patient shielding (40.4(9)\"b\") and for staff not wearing aprons (40.6(14)\"d\").", "citation": "641-37.11 (introduction); 641-39.5(1); 641-40.6(14)\"d\"" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Iowa has been an NRC Agreement State since January 1, 1986.", "citation": "NRC list of Agreement States, updated October 29, 2026; 641-39.3 (Iowa Admin. Code, Ch. 39, effective 7/1/26)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.legis.iowa.gov/docs/ACO/chapter/641.39.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "641-Chapter 40 (ARC 0180D, effective 7/1/26) covers X-ray and fluoroscopy, with fluoroscopy in rule 40.6. General protection standards are in 641-37.11 (ARC 0387D, effective 7/29/26). Related chapters are 38 (operator permits), 39 (radioactive materials) and 42 (therapy and analytical machines). Pre-July 2026 numbering (Chapters 40/41) is out of date.", "citation": "641-40.3(2)\"d\"; 641-37.11", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/chapter/641.40.pdf" ], "quote": "In addition to the rules of this chapter, registrants shall also comply with the requirements of the rules in 641-Chapter 37, including but not limited to:\" … \"Standards for protection against radiation in rule 641-37.11(136C);", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes, binding on registrants under 37.11(2)\"b\". 37.1(7) uses weaker 'should be made' wording, and ALARA is defined in 37.2.", "citation": "641-37.11(2)\"b\"; 641-37.1(7)", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/rule/06-24-2026.641.37.11.pdf" ], "quote": "The licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are ALARA.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "TEDE of 5 rem (50 mSv) per year. Deep dose plus committed dose to any single organ other than the lens is limited to 50 rem (500 mSv). Minors are limited to 10% of adult limits.", "citation": "641-37.11(3)\"a\"", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/rule/06-24-2026.641.37.11.pdf" ], "quote": "The total effective dose equivalent being equal to 5 rem (0.05 Sv)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year. Iowa has not adopted a lower lens limit.", "citation": "641-37.11(3)\"a\"", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/rule/06-24-2026.641.37.11.pdf" ], "quote": "A lens dose equivalent of 15 rem (0.15 Sv), and", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Shallow dose equivalent of 50 rem (500 mSv) per year to the skin or any extremity.", "citation": "641-37.11(3)\"a\"", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/rule/06-24-2026.641.37.11.pdf" ], "quote": "A shallow dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant worker over the whole pregnancy.", "citation": "641-37.11(10)", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/rule/06-24-2026.641.37.11.pdf" ], "quote": "does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Adults likely to exceed 10% of a limit in a year must be monitored. All individuals working with medical fluoroscopic equipment must be monitored regardless of expected dose. Declared pregnant workers likely to exceed 0.1 rem (1 mSv) must be monitored. Dosimeters must be processed by an NVLAP-accredited processor.", "citation": "641-37.11(14)\"a\"(1), (4), (5)", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/rule/06-24-2026.641.37.11.pdf" ], "quote": "(1) Adults likely to receive, in one year from sources external to the body, a dose in excess of 10 percent of the limits in subrule 37.11(3);\" … \"(4) Individuals working with medical fluoroscopic equipment; and", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "Eye-dose badge goes at the collar outside the apron, or at an unshielded spot closer to the eye. Fetal badge goes at the waist under the apron. Extremity badge goes on the highest-dose extremity. Badges under protective clothing follow NCRP Report No. 57, Chapter 4. Deep dose must be used for EDE unless a department-approved method is used, but no named approved method was found.", "citation": "641-37.11(14)\"c\"(1)-(3); 641-37.11(3)\"c\"; 641-40.4(13)\"a\"", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/rule/06-24-2026.641.37.11.pdf" ], "quote": "An individual monitoring device used for monitoring the eye dose equivalent, to demonstrate compliance with subrule 37.11(3) shall be located at the neck (collar), outside any protective apron being worn by the monitored individual or at an unshielded location closer to the eye;", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Aprons of at least 0.25 mm lead equivalent must be worn by all except the patient in interventional/special-procedure rooms (brief occupants may skip them if badge reports confirm low exposure) and in sterile-field cases. Barriers with viewing panels of at least 0.5 mm must be available. Ancillary shielding must be used on stationary systems, and sufficient apparel must be kept on hand. No rule requires wearing thyroid shields or eyewear.", "citation": "641-40.6(12), 40.6(14), 40.4(9)", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/chapter/641.40.pdf" ], "quote": "Protective aprons of not less than 0.25 mm of lead equivalent shall be worn in the fluoroscopy room by all individuals (except the patient).", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. All protective apparel and auxiliary shields must be evaluated annually for integrity and labeled with their lead equivalent. The method is not specified.", "citation": "641-40.4(9)\"a\"", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/chapter/641.40.pdf" ], "quote": "All protective apparel and auxiliary shields shall be evaluated annually for integrity and clearly labeled with lead equivalent.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Iowa's rules do not mention engineered shielding systems by name. A general X-ray rule lets people in the room, including operators, be protected from scatter by either protective aprons or whole body protective barriers of at least 0.25 millimeter lead equivalent, so a whole body barrier can serve in place of an apron.", "citation": "641-40.4(8)\"b\"(3)", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/chapter/641.40.pdf" ], "quote": "shall be protected from scattered primary radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Fluoroscopy may be operated only by people with an Iowa permit or those exempt from needing one (licensed physicians, physician assistants, chiropractors, dentists, dental hygienists, podiatrists, certified dental radiographers and students), and they must also have extra fluoroscopy training from a qualified expert. Radiologic technologists and students must use fluoroscopy under direct supervision, meaning the supervisor is physically present and watching, by a licensed practitioner, a radiologist assistant or a nurse practitioner (ARNP) who has completed a radiation safety course. ARNPs are not on the list of people who don't need a permit, so they may supervise fluoroscopy but may not operate it unless they hold an Iowa permit.", "citation": "641-40.6(13)\"c\"", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/chapter/641.40.pdf" ], "quote": "The operation of a fluoroscopy X-ray system for clinical purposes is limited to those individuals permitted to operate radiation machines as specified in 641-Chapter 38 and persons who have received additional training provided by a qualified expert", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "Technologist permit requires passing the ARRT radiography exam and 24 CE hours every two years. Radiologist assistants need formal education, one year as a technologist, the ARRT RA exam and 50 CE hours. All fluoroscopy operators need qualified-expert training in eight topics and competence in dose-saving features. Supervising ARNPs need a course. There is no separate fluoroscopy permit, set hour count or physician-specific requirement.", "citation": "641-38.4, 38.6, 40.6(13)\"c\"; 481-621.4(5)", "sourceUrls": [ "https://www.legis.iowa.gov/docs/iac/chapter/641.38.pdf" ], "quote": "Submit proof of a passing score on the ARRT general radiography examination, the NMTCB nuclear medicine examination, or the ARRT radiation therapist examination.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Chapter 37 General Provisions for Radiation and Radiation Protection Standards (ARC 0387D)", "kind": "adopted_rule", "status": "Adopted; effective July 29, 2026", "date": "7/29/26", "dateISO": "2026-07-29", "summary": "Proposed as ARC 9772C (11/26/25), amended as ARC 0223D (4/29/26), adopted in IAB 6/24/26 with no comments and no changes.", "sourceUrls": [ "https://www.legis.iowa.gov/docs/aco/bulletin/06-24-2026.pdf" ] }, { "title": "Chapters 38-42 rewrite under Executive Order 10 (ARC 0288D, 0179D, 0180D, 0181D, 0182D)", "kind": "adopted_rule", "status": "Adopted; effective July 1, 2026", "date": "7/1/26", "dateISO": "2026-07-01", "summary": "Full Red Tape Review replacement of Chapters 38-42; the new chapters carry a rescission date of 7/1/31.", "sourceUrls": [] } ], "notable": [ "Every fluoroscopy worker must wear a dosimeter, not only those above 10% of a limit.", "A dose-area-product monitor is required on interventional and special-procedure units (40.6(16)).", "Facilities need a written patient-dose policy following ACR-AAPM guidance or NCRP Report 168, and field size must be kept minimal under sterile-field conditions.", "A qualified expert must test fluoroscopy equipment at least every 12 months (40.6(6)).", "Outdated cross-references: 37.11(2)\"d\" points to 40.4(9)\"b\", now a patient-shielding provision; 481-621.4(5) points to 641-38.2, now the exemptions rule.", "There was a gap of about four weeks between the Chapter 40 effective date (7/1/26) and the Chapter 37 effective date (7/29/26).", "Iowa has not adopted a lower lens limit; it remains 150 mSv per year." ], "openQuestions": [ "Pending changes after June 2026 (bulletins July-November 2026 and 2026 bills) could not be checked.", "Whether Iowa HHS commented on the NRC ALARA proposal or plans to change 37.11 or update the Chapter 39 reference date.", "Which dosimetry method is department-approved under 37.11(3)\"c\".", "Whether ARNPs or other unlisted clinicians may operate fluoroscopy, and how to read \"and\" in 40.6(13)\"c\".", "Why the general technologist definition omits fluoroscopy although 40.6(15) assumes technologists perform it.", "How the bureau treated occupational standards for X-ray registrants during the July 1-28, 2026 gap." ], "sources": [ { "title": "Iowa Admin. Code 641-37.1", "url": "https://www.legis.iowa.gov/docs/iac/rule/06-24-2026.641.37.1.pdf" }, { "title": "Iowa Admin. Code 641-37.2", "url": "https://www.legis.iowa.gov/docs/iac/rule/06-24-2026.641.37.2.pdf" }, { "title": "Iowa Admin. Code 641-37.11", "url": "https://www.legis.iowa.gov/docs/iac/rule/06-24-2026.641.37.11.pdf" }, { "title": "Iowa Legislature, Rule Listings, 641 Chapter 37", "url": "https://www.legis.iowa.gov/law/administrativeRules/rules?agency=641&chapter=37" }, { "title": "641-Chapter 38, Permits to Operate", "url": "https://www.legis.iowa.gov/docs/iac/chapter/641.38.pdf" }, { "title": "641-Chapter 39, Radioactive Materials", "url": "https://www.legis.iowa.gov/docs/ACO/chapter/641.39.pdf" }, { "title": "641-Chapter 40, Radiation Emitting Machines in the Healing Arts", "url": "https://www.legis.iowa.gov/docs/iac/chapter/641.40.pdf" }, { "title": "641-Chapter 42, Therapeutic machines", "url": "https://www.legis.iowa.gov/docs/iac/chapter/641.42.pdf" }, { "title": "481-Chapter 621, Advanced Registered Nurse Practitioners", "url": "https://www.legis.iowa.gov/docs/iac/chapter/481.621.pdf" }, { "title": "Iowa Administrative Bulletin 6/24/26 (ARC 0387D)", "url": "https://www.legis.iowa.gov/docs/aco/bulletin/06-24-2026.pdf" }, { "title": "ARC 0223D Amended Notice (Chapter 37)", "url": "https://rules.iowa.gov/Notice/Details/0223D" }, { "title": "Iowa HHS Radiological Health", "url": "https://hhs.iowa.gov/health-prevention/providers-professionals/radiological-health" }, { "title": "Iowa HHS X-Ray Machines", "url": "https://hhs.iowa.gov/health-prevention/providers-professionals/radiological-health/x-ray-machines" } ] }, { "code": "KS", "name": "Kansas", "pageUrl": "https://orsif.org/guidelines/us/states/kansas", "regulator": { "name": "Kansas Department of Health and Environment (KDHE) Radiation Control Program, Bureau of Community Health Systems (Division of Public Health); Kansas State Board of Healing Arts (KSBHA) separately licenses radiologic technologists", "url": "https://www.kdhe.ks.gov/1009/Radiation" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Kansas's X-ray rules require fluoroscopy users to follow the Part 4 general radiation protection standards, which apply to radioactive-materials licensees and X-ray registrants alike and contain the ALARA requirement. Dose limits follow the federal model: 50 mSv whole body, 150 mSv lens of the eye, 500 mSv skin or extremities, and 5 mSv to the embryo/fetus. Aprons or whole-body protective barriers of at least 0.25 mm lead equivalent are required, but the rules do not require aprons to be inspected on a schedule, and no rule specifically addresses engineered shielding systems used in place of aprons, although the state may waive specific X-ray requirements for an existing machine or installation if the registrant offers an alternative giving equal radiation protection. KSBHA licenses radiologic technologists, with exemptions for practitioners and for supervised, trained staff; no state fluoroscopy permit and no physician fluoroscopy training rule were found, and most rule text came from Cornell LII, a secondary source.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The general ALARA duty is in K.A.R. 28-35-211d, the single Part 4 standard for both radioactive-materials licensees and X-ray registrants. The X-ray rules link to Part 4 through 28-35-242a(a)(9) rather than stating their own ALARA duty. ALARA is also mentioned in fluoroscopy weighting-factor approvals under 28-35-212a(c)(2), which is itself in Part 4.", "citation": "K.A.R. 28-35-211d; 28-35-242a(a)(9) (effective Dec. 30, 2005); 28-35-212a(c)(2)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Kansas is not on the NRC list of non-Agreement States, so it is an Agreement State. KDHE describes its 2025 rule changes as keeping Kansas compatible with NRC rules.", "citation": "NRC list of Agreement States, updated October 29, 2026; Kansas Register Vol. 44, No. 11 (2025-03-13)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.kssos.org/publications/Register/Volume-44/Issues/Issue-11/03-13-25-52922.html" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Diagnostic X-ray rules are in Part 5, K.A.R. 28-35-241 to 28-35-256, including 28-35-243a for fluoroscopic systems and 28-35-256 for operator training. The Standards for Protection Against Radiation are in Part 4, K.A.R. 28-35-211a to 28-35-234a, written by Kansas itself. Rule text was taken from Cornell LII, a secondary source.", "citation": "K.A.R. 28-35-241 (effective Jan. 1, 1970; amended Dec. 30, 2005)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-241" ], "quote": "The provisions of this part shall be in addition to, and not in substitution for, the other applicable provisions of these regulations.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. The Part 4 radiation protection program rule applies to each licensee or registrant. It requires procedures and engineering controls to keep doses ALARA and a program review at least every 12 months. The X-ray rules pull X-ray workers into Part 4.", "citation": "K.A.R. 28-35-211d(b) (effective Oct. 17, 1994; amended Dec. 30, 2005); K.A.R. 28-35-242a(a)(9)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-211d" ], "quote": "Each licensee or registrant shall use, to the extent practicable, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem), which is 50 mSv per year TEDE. There is also a separate 500 mSv limit to any organ other than the lens.", "citation": "K.A.R. 28-35-212a(a)(1)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-212a" ], "quote": "The annual limit shall be the more limiting of either of the following: (A) The total effective dose equivalent being equal to 0.05 Sv (5 rem); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem), which is 150 mSv per year. Kansas has not adopted the ICRP's 20 mSv.", "citation": "K.A.R. 28-35-212a(a) (last amended March 18, 2011)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-212a" ], "quote": "(A) An eye dose equivalent of 0.15 Sv (15 rem); and (B) a shallow dose equivalent of 0.50 Sv (50 rem) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.50 Sv (50 rem), which is 500 mSv per year shallow dose to the skin or any extremity.", "citation": "K.A.R. 28-35-212a(a) (last amended March 18, 2011)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-212a" ], "quote": "(A) An eye dose equivalent of 0.15 Sv (15 rem); and (B) a shallow dose equivalent of 0.50 Sv (50 rem) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy.", "citation": "K.A.R. 28-35-213b(a)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-213b" ], "quote": "Each licensee or registrant shall ensure that the dose to an embryo or fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Dosimeters are required for adults likely to exceed 10% of an adult limit in a year from external sources (5 mSv whole body, 15 mSv lens, 50 mSv skin or extremity). They are also required for minors and declared pregnant women likely to exceed 10% of the limit that applies to them, and for anyone entering a high or very high radiation area. Badges that need processing must be read by an NVLAP-accredited processor.", "citation": "K.A.R. 28-35-217a(a)-(b) (amended Dec. 30, 2005, per LII; see Q14)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-217a" ], "quote": "Any adult likely to receive, in one year from sources external to the body, a dose in excess of 10 percent of the limits", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "When an apron is worn, the badge goes at the collar outside the apron. A single badge reading is recorded as the whole-body dose. With written approval from the Secretary (the request must include ALARA procedures), apron-wearing fluoroscopists may use weighting factors. One neck badge: the deep dose is the effective dose. One neck badge reading above 25% of the limit: deep dose x 0.3. Two badges: 1.5 x waist reading + 0.04 x neck reading. The rule does not name NCRP 122 or Webster.", "citation": "K.A.R. 28-35-212a(c)(2), (c)(3)(A), (c)(5)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-212a" ], "quote": "When an apron is worn, the monitoring device shall be worn at the collar outside of the apron", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Everyone in the room other than the patient must be protected by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent. Any body part in the useful beam needs at least 0.5 mm. Facilities must keep enough leaded aprons and gloves for X-ray personnel. Fluoroscopy rooms have under-table and over-table scatter shielding requirements. Thyroid shields and eyewear were not found in rule text; a KDHE dental guide mentions a thyroid shield, but that is not rule text.", "citation": "K.A.R. 28-35-242a(a)(5), (a)(7)(F); 28-35-243a(h) (effective Dec. 30, 2005)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-242a" ], "quote": "shall be protected from the direct scattered radiation by protective aprons or whole-body protective barriers of not less than 0.25 millimeter of lead-equivalent material.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Kansas's general X-ray rules require protective aprons or whole-body barriers of at least 0.25 millimeter lead equivalent and enough leaded aprons and gloves for staff, but they do not require protective apparel to be inspected on a schedule. The only periodic inspection the rule mentions is for film cassettes and intensifying screens.", "citation": "K.A.R. 28-35-242a(a)(5), (a)(7)(F) and (d)(2)(E)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-242a" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "No rule specifically addresses engineered shielding systems used in place of aprons. The state may waive specific X-ray requirements for an existing machine or installation if the registrant offers an alternative that gives radiation protection equal to the Part 4 standards.", "citation": "K.A.R. 28-35-242(a)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-242" ], "quote": "Compliance with the specific requirements of these regulations relative to an existing machine or installation may be waived by the secretary if the registrant provides an alternative to the requirement that provides radiation protection equal to that prescribed in part 4 of these regulations.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Exposures must be authorized by a licensed practitioner, a physician-supervised PA or APRN, a dentist or a podiatrist. The fluoroscopy tube needs continuous manual activation by 'the fluoroscopist' (term not defined). Operators must be instructed and competent. KSBHA licenses radiologic technologists. Exempt from licensing are licensed practitioners, students, people helping in emergencies, and PAs, nurses and unlicensed persons who are supervised and trained on the equipment.", "citation": "K.A.R. 28-35-242(c); 28-35-243a(b); K.S.A. 65-7302(d); K.S.A. 65-7304", "sourceUrls": [ "https://law.justia.com/codes/kansas/chapter-65/article-73/section-65-7304/" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Licensed technologists: the Board may accept an ARRT (or equivalent) certificate, and 12 CE credits per year are required. Exempt operators need 12 CE credits per year including equipment training, per KSBHA. KDHE rule 28-35-256 lists general training topics without set hours. No state fluoroscopy permit, fluoroscopy-specific hours requirement or physician fluoroscopy training requirement was found.", "citation": "K.A.R. 28-35-256 (effective Dec. 30, 2005); K.S.A. 65-7305(c); K.A.R. 100-73-7", "sourceUrls": [ "https://www.ksbha.ks.gov/departments/general-counsel/general-counsel-faqs/radiologic-technology" ], "quote": "a license is not required for a person to perform radiologic technology procedures if they have obtained 12 credits of continuing education per year", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "KDHE radiation regulations package (NRC compatibility)", "kind": "adopted_rule", "status": "Proposed 2025-03-13 (hearing 2025-05-21); final rules published 2025-12-11, effective 2025-12-26", "date": "2025-12-26", "dateISO": "2025-12-26", "summary": "Amendments to stay compatible with the NRC, including K.A.R. 28-35-189a, 221b, 264, 284 and 354, and allowing instant-reading dosimeters. From the excerpts seen, they deal with radioactive-materials and industrial uses and do not change the X-ray rules, ALARA or dose limits. The full list of sections changed was not confirmed.", "sourceUrls": [ "https://sos.ks.gov/publications/Register/Volume-44/Issues/Issue-50/12-11-25-53714.html" ] } ], "notable": [ "A qualified expert must measure fluoroscope entrance exposure rates (typical and maximum) annually and after maintenance that could affect them, with results posted where the fluoroscopist can see them.", "Fluoroscopes need a cumulative timer, reset at 5 minutes or less, with an audible signal.", "Registrants must have a written radiation protection program and review it at least every 12 months (28-35-211d(d)).", "Deliberately exposing a dosimeter to give a false reading is prohibited (28-35-212a(c)(4)).", "A person holding a patient must be instructed and protected, and no one may be used routinely for this.", "KDHE Information Notice KS IN 2025-01 (2025-07-24) reminds registrants that human X-ray exposure needs authorization by a practitioner.", "No Kansas bill on fluoroscopy radiation protection systems or aprons was found in 2025-2026, and no KDHE response to the NRC ALARA proposal was found." ], "openQuestions": [ "Most rule text came from Cornell LII; compare it against the official K.A.R. volumes and the Kansas Register index (https://sos.ks.gov/publications/pubs_kar.aspx).", "Which sections were amended effective 2025-12-26? Check whether 28-35-211d, 212a, 217a or 217b changed.", "K.A.R. 28-35-242b was not read; check it for any apron or shielding inspection requirement.", "Does KDHE check apron inspections during facility inspections? Ask the X-ray Compliance program (785-296-1560).", "Has KDHE approved any facility's request to use weighting factors under 28-35-212a(c)(2), or published guidance on it?", "Does KDHE consider engineered radiation protection systems to be 'whole-body protective barriers' under 28-35-242a(a)(5)(B)?", "What does K.A.R. 100-73-9 say, and does it set anything specific to fluoroscopy?", "Has KDHE commented on, or planned for, the NRC's proposed Part 20 graded approach rule (docket NRC-2025-1140)?" ], "sources": [ { "title": "KDHE, Regulations & Statutes (Radiation)", "url": "https://www.kdhe.ks.gov/1124/Regulations-Statutes" }, { "title": "KDHE, Kansas Radiation Control Program Regulations and Statutes (unofficial compilation, Feb. 2021; could not open)", "url": "https://www.kdhe.ks.gov/DocumentCenter/View/9862" }, { "title": "Cornell LII, Kansas regulations, Article 35 index", "url": "https://www.law.cornell.edu/regulations/kansas/agency-28/article-35" }, { "title": "Cornell LII, K.A.R. 28-35-211a", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-211a" }, { "title": "Cornell LII, K.A.R. 28-35-211d", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-211d" }, { "title": "Cornell LII, K.A.R. 28-35-212a", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-212a" }, { "title": "Cornell LII, K.A.R. 28-35-213b", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-213b" }, { "title": "Cornell LII, K.A.R. 28-35-217a", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-217a" }, { "title": "Cornell LII, K.A.R. 28-35-217b", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-217b" }, { "title": "Cornell LII, K.A.R. 28-35-241", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-241" }, { "title": "Cornell LII, K.A.R. 28-35-242", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-242" }, { "title": "Cornell LII, K.A.R. 28-35-242a", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-242a" }, { "title": "Cornell LII, K.A.R. 28-35-243a", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-243a" }, { "title": "Cornell LII, K.A.R. 28-35-256", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-28-35-256" }, { "title": "KDHE, Dental Regulations and Explanations", "url": "https://www.kdhe.ks.gov/DocumentCenter/View/10065/Dental-Regulations-and-Explanations-PDF" }, { "title": "KDHE, Information Notice KS IN 2025-01", "url": "https://www.kdhe.ks.gov/DocumentCenter/View/52177/KS-IN-2025-01-PDF" }, { "title": "Kansas Register Vol. 44, Issue 11 (2025-03-13), KDHE hearing notice", "url": "https://www.kssos.org/publications/Register/Volume-44/Issues/Issue-11/03-13-25-52922.html" }, { "title": "Kansas Register Vol. 44, Issue 50 (2025-12-11), KDHE permanent regulations (search excerpts only)", "url": "https://sos.ks.gov/publications/Register/Volume-44/Issues/Issue-50/12-11-25-53714.html" }, { "title": "K.S.A. 65-7302 (Kansas Revisor)", "url": "https://ksrevisor.gov/statutes/chapters/ch65/065_073_0002.html" }, { "title": "KSBHA, Radiologic Technologists Practice Act", "url": "https://www.ksbha.ks.gov/statutes-regulations/statutes-and-regulations/radiologic-technologists-practice-act" }, { "title": "KSBHA, General Counsel FAQ, Radiologic Technology", "url": "https://www.ksbha.ks.gov/departments/general-counsel/general-counsel-faqs/radiologic-technology" }, { "title": "Justia, K.S.A. 65-7304 (2024)", "url": "https://law.justia.com/codes/kansas/chapter-65/article-73/section-65-7304/" }, { "title": "Kansas Legislature, K.S.A. 65-7305 (2016 version)", "url": "https://www.kslegislature.gov/li_2016/b2015_16/statute/065_000_0000_chapter/065_073_0000_article/065_073_0005_section/065_073_0005_k/" }, { "title": "Cornell LII, K.A.R. 100-73-7 (search excerpt)", "url": "https://www.law.cornell.edu/regulations/kansas/K-A-R-100-73-7" }, { "title": "FusionMedStaff, Kansas radiology license guide (secondary, for K.A.R. 100-73-9 only)", "url": "https://www.fusionmedstaff.com/licenses/radiology/kansas/" } ] }, { "code": "KY", "name": "Kentucky", "pageUrl": "https://orsif.org/guidelines/us/states/kentucky", "regulator": { "name": "Radiation Producing Machines Program, Radiation Health Branch, Division of Protection and Safety, Department for Public Health, Cabinet for Health and Family Services", "url": "https://www.chfs.ky.gov/agencies/dph/dphps/rhb/Pages/rpmp.aspx" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Kentucky requires ALARA for X-ray users in the shared general rule 902 KAR 100:015 §2 and in the registrant-only standards rule 902 KAR 100:019 (since December 2023); licensees follow 902 KAR 100:185 adopting 10 CFR Part 20. Dose limits are standard US limits, with a lens limit of 150 mSv per year. Everyone in the fluoroscopy room except the patient must wear an apron of at least 0.25 mm lead equivalent; leaded drapes may be used only in addition to aprons, not instead of them, and periodic apron inspections are not required. Licensed practitioners need no imaging license; technologists need a KBMIRT license, and limited X-ray machine operators may not perform fluoroscopy.", "whereAlaraLives": { "category": "both", "explanation": "ALARA appears in the shared general rule 902 KAR 100:015 §2 (licensees and registrants) and in the registrant-only 902 KAR 100:019 §2(2); licensees follow 100:185 adopting 10 CFR Part 20 by reference. The shared ALARA definition in 100:010 is written in licensee terms.", "citation": "902 KAR 100:015 §§1-2; 100:019 §1(2), §2(2) and its impact analysis; 100:185 §2" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Kentucky is not on the NRC's list of non-Agreement States, so it is an Agreement State; 902 KAR 100:185 makes radioactive-materials licensees follow 10 CFR Part 20.", "citation": "NRC list of Agreement States, updated October 29, 2026; 902 KAR 100:185 §2", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://apps.legislature.ky.gov/law/kar/titles/902/100/185/" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "902 KAR Chapter 100: 100:105 (X-rays; general), 100:110 (registration), 100:115 (diagnostic), 100:125 (fluoroscopic); 100:019 standards for protection for X-ray registrants (eff. 12-13-2023); 100:185 for radioactive materials; shared rules 100:015 and 100:010.", "citation": "902 KAR 100:019; 100:105; 100:115; 100:125; 100:185; 100:015", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/", "https://apps.legislature.ky.gov/law/kar/titles/902/100/125/" ], "quote": "This regulation shall apply to fluoroscopic x-ray systems and to persons, equipment and materials used in connection with the possession and use or operation of these such systems.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Registrants must use procedures and engineering controls to keep occupational doses ALARA, referencing the general rule in 902 KAR 100:015 §2.", "citation": "902 KAR 100:019 §2(2); 902 KAR 100:015 §2", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/019/" ], "quote": "Use procedures and engineering controls based upon sound radiation protection principles, to the extent practical, to achieve occupational doses and doses to members of the public that shall be as low as reasonably achievable (ALARA) pursuant to 902 KAR 100:015, Section 2.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) TEDE per year for adults.", "citation": "902 KAR 100:019 Section 3(1)(a)", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/019/" ], "quote": "Total effective dose equivalent being equal to five (5) rems (0.05 SV); and", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year; no lower lens limit adopted.", "citation": "902 KAR 100:019 §3(1)", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/019/" ], "quote": "A lens dose equivalent of fifteen (15) rems (0.15 Sv); and", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) shallow-dose equivalent per year to skin or extremities.", "citation": "902 KAR 100:019 Section 3(1)(b)", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/019/" ], "quote": "A shallow-dose equivalent of fifty (50) rems (five-tenths (0.50) Sv) to the skin of the whole body or to the skin of an extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant woman for the whole pregnancy.", "citation": "902 KAR 100:019 §7(1)", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/019/" ], "quote": "does not exceed five-tenths (0.5) rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Monitoring required for adults likely to exceed 10% of limits (0.5 rem TEDE, 1.5 rem lens, 5 rem skin/extremity); minors likely to exceed 0.1 rem deep, 0.15 rem lens, or 0.5 rem skin/extremity; declared pregnant women likely to exceed 0.1 rem; anyone entering high or very high radiation areas. NVLAP-accredited processor required.", "citation": "902 KAR 100:019 §11(2)", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/019/" ], "quote": "Adults likely to receive, in one (1) year from radiation sources external to the body, a dose in excess of ten (10) percent of the limits in Section 3(1) of this administrative regulation;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "If an apron is worn, at least one badge must be worn at the neck outside the apron; with multiple badges each dose must be labeled with body location. No approved effective-dose method (NCRP 122, Webster) found.", "citation": "902 KAR 100:105 §2(2)(f); 902 KAR 100:019 §3(3)", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/105/" ], "quote": "If an apron is worn, the monitoring device shall be worn at the neck area outside of the apron; and", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Aprons of at least 0.25 mm lead equivalent required for fluoroscopist and everyone in the room except the patient; 0.25 mm Pb gloves must be readily available; scatter shielding requirements for table and above-table. Thyroid shields and eyewear not addressed.", "citation": "902 KAR 100:125 §§12, 13(3), 13(7); 902 KAR 100:115 §14", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/125/" ], "quote": "Protective aprons of at least 0.25 mm lead equivalence shall be worn by the fluoroscopist and by persons in the fluoroscopic room except the patient during each examination;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Kentucky's rules do not require protective aprons or other protective apparel to be inspected periodically. The fluoroscopy rule only requires aprons of at least 0.25 mm lead equivalent to be worn by the fluoroscopist and everyone else in the room except the patient during each exam.", "citation": "902 KAR 100:125 (Sections 1 to 14, including Section 13 Operating Procedures and Auxiliary Equipment); also 902 KAR 100:115, 100:105, 100:120 and 100:019", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/125/" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "unclear", "answer": "Not addressed for fluoroscopy; 100:125 requires aprons with no alternative and drapes are in addition to aprons. 100:115 §14(2) allows aprons or whole body protective barriers for radiographic exposure, but applicability to fluoroscopy is unclear. Exemptions may be granted on request.", "citation": "902 KAR 100:125 §12(2)(b), §13(7); 902 KAR 100:115 §14(2); 902 KAR 100:015 §7", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/115/" ], "quote": "Staff and ancillary personnel shall be protected from direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 mm lead equivalent;", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Licensed practitioners of the healing arts (physicians, dentists, chiropractors, podiatrists, veterinarians) are exempt from imaging licensure; others need a KBMIRT license. Limited X-ray machine operators may not perform fluoroscopy. Technologist fluoroscopy requires supervision; PA/APRN status unsettled.", "citation": "KRS 311B.090; KRS 311B.020(8)-(9); 902 KAR 100:125 §13(1)-(2); 201 KAR 46:035 §§1-2", "sourceUrls": [ "https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=40203" ], "quote": "This chapter shall not apply to any individual licensed in the Commonwealth of Kentucky as a licensed practitioner of the healing arts, any student enrolled in an approved educational program in medical imaging technology or radiation therapy,", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Technologists need a KBMIRT license (credentialing by recognized national organization such as ARRT; continuing education required). No physician fluoroscopy training requirement found; operators must be adequately instructed and competent. Specific hours not confirmed.", "citation": "KRS 311B.100, 311B.110, 311B.020; 902 KAR 100:105 §2(2)(b)", "sourceUrls": [ "https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=45530" ], "quote": "The following individuals are required to apply for and receive a license from the Commonwealth of Kentucky before performance of any procedures utilizing radiation for either medical imaging or radiation therapy:", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "2025 HB 72 (2025 Ky. Acts ch. 132)", "kind": "bill", "status": "Signed March 31, 2025; effective June 27, 2025", "date": "2025-06-27", "dateISO": "2025-06-27", "summary": "States limited X-ray machine operators may not perform fluoroscopy; allows them to work at fluoroscopy facilities only for limited diagnostic radiography.", "sourceUrls": [ "https://apps.legislature.ky.gov/law/acts/25RS/documents/0132.pdf" ] }, { "title": "2026 HB 89 (medical imaging licensure overhaul)", "kind": "bill", "status": "01/14/26: to Licensing, Occupations, & Administrative Regulations (H); not confirmed whether it died", "date": "2026-01-14", "dateISO": "2026-01-14", "summary": "Would add MRI and sonography licensure and criminal background checks, among other changes.", "sourceUrls": [ "https://apps.legislature.ky.gov/record/26RS/HB89.html" ] }, { "title": "201 KAR 46:035 amendment", "kind": "adopted_rule", "status": "Effective 2-5-2025", "date": "2025-02-05", "dateISO": "2025-02-05", "summary": "Updated incorporated practice standards, including ACR-AAPM fluoroscopy standard revised 2023.", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/201/046/035/" ] }, { "title": "902 KAR 100:015, 105, 115, 125 certification", "kind": "other", "status": "Certification notation \"Crt eff. 4-21-2026\"; no text changes found", "date": "2026-04-21", "dateISO": "2026-04-21", "summary": "Certification notation of uncertain meaning; no text changes found.", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/" ] }, { "title": "902 KAR 100:190 (licensing of source material)", "kind": "proposed_rule", "status": "Proposed", "date": "", "dateISO": null, "summary": "Radioactive materials only; the only proposed rule shown in the 902 KAR 100 index.", "sourceUrls": [ "https://apps.legislature.ky.gov/law/kar/titles/902/100/" ] } ], "notable": [ "The shared ALARA definition in 902 KAR 100:010 (last amended 2015) is tied to 100:019 limits and the \"licensed activity,\" though 100:019 applies only to registrants since 2023.", "The fluoroscopy rule (100:125) dates from 1992, still names the \"Cabinet for Human Resources,\" and covers non-image-intensified systems.", "100:125 requires a five-minute cumulative timer with audible alarm, entrance exposure rate limits of 10 R/min (5 R/min without high-level control) measured at least annually, and bans hand-held fluoroscopic screens.", "Registrants must review their radiation protection program annually (100:019 §2(3)) and post KR441 \"Notices to Employees.\"", "No Kentucky response to the NRC's proposed ALARA rewrite was found." ], "openQuestions": [ "Technologist qualifications in 201 KAR 46:040 and continuing education hours in 46:060 were not read.", "Whether PAs and APRNs may operate or activate fluoroscopy is unresolved.", "Confirm whether 2026 HB 89 died when the session ended.", "Whether 902 KAR 100:185 adopts 10 CFR Part 20 as of a fixed date or automatically picks up later federal changes.", "Meaning of the \"Crt eff. 4-21-2026\" notation and whether any 2026 rule review proposes changes.", "Whether the Radiation Health Branch has guidance on effective-dose calculation, apron inspection, eyewear, or engineered shielding systems.", "Whether 100:115 §14 (aprons or whole body protective barriers) applies in fluoroscopy rooms.", "Whether the cabinet still enforces 100:125 §13(1) radiologist-direction requirement alongside KBMIRT's broader supervision standard." ], "sources": [ { "title": "KY LRC, 902 KAR Chapter 100 index", "url": "https://apps.legislature.ky.gov/law/kar/titles/902/100/" }, { "title": "902 KAR 100:019, Standards for protection against radiation (eff. 12-13-2023)", "url": "https://apps.legislature.ky.gov/law/kar/titles/902/100/019/" }, { "title": "902 KAR 100:185, Standards for protection against radiation from radioactive materials", "url": "https://apps.legislature.ky.gov/law/kar/titles/902/100/185/" }, { "title": "902 KAR 100:015, General requirements", "url": "https://apps.legislature.ky.gov/law/kar/titles/902/100/015/" }, { "title": "902 KAR 100:010, Definitions", "url": "https://apps.legislature.ky.gov/law/kar/titles/902/100/010/" }, { "title": "902 KAR 100:105, X-rays; general", "url": "https://apps.legislature.ky.gov/law/kar/titles/902/100/105/" }, { "title": "902 KAR 100:115, Diagnostic x-ray", "url": "https://apps.legislature.ky.gov/law/kar/titles/902/100/115/" }, { "title": "902 KAR 100:125, Fluoroscopic x-ray", "url": "https://apps.legislature.ky.gov/law/kar/titles/902/100/125/" }, { "title": "CHFS Radiation Producing Machines Program", "url": "https://www.chfs.ky.gov/agencies/dph/dphps/rhb/Pages/rpmp.aspx" }, { "title": "KBMIRT Laws and Regulations", "url": "https://kbmirt.ky.gov/Pages/Statutes-Admin-Regulations.aspx" }, { "title": "201 KAR 46:035, Practice standards", "url": "https://apps.legislature.ky.gov/law/kar/titles/201/046/035/" }, { "title": "KRS 311B.020", "url": "https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=56479" }, { "title": "KRS 311B.090", "url": "https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=40203" }, { "title": "KRS 311B.100", "url": "https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=45530" }, { "title": "KRS 311B.110", "url": "https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=40205" }, { "title": "2025 Ky. Acts ch. 132 (HB 72)", "url": "https://apps.legislature.ky.gov/law/acts/25RS/documents/0132.pdf" }, { "title": "26RS HB 89 bill record", "url": "https://apps.legislature.ky.gov/record/26RS/HB89.html" }, { "title": "KBMIRT November 2015 board minutes (APRN supervision)", "url": "https://kbmirt.ky.gov/Documents/November.pdf" }, { "title": "NRC Agreement States list", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "LA", "name": "Louisiana", "pageUrl": "https://orsif.org/guidelines/us/states/louisiana", "regulator": { "name": "Louisiana Department of Environmental Quality (LDEQ), Radiation Section", "url": "https://www.deq.louisiana.gov/radiation" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "LDEQ regulates X-ray and fluoroscopy machines under LAC 33:XV, and the ALARA requirement for X-ray registrants appears only in the shared Chapter 4 (§406), since the X-ray chapter (Chapter 6) has no ALARA wording of its own. Dose limits follow the federal model: 50 mSv per year whole body, 150 mSv per year to the lens of the eye (the lower 20 mSv lens limit has not been adopted), 500 mSv per year to skin and extremities, and 5 mSv to the embryo/fetus over a declared pregnancy. Staff must wear aprons of at least 0.25 mm lead equivalent or be protected by whole-body protective barriers of the same rating, stationary fluoroscopy units must have drapes, curtains or viewing shields, and aprons must be checked every 12 to 14 months, while thyroid shields, protective eyewear and engineered radiation protection systems are not mentioned by name. Fluoroscopy may be run by licensed practitioners (including NPs and PAs under the DEQ rule, though the statute's definition does not list PAs), medical residents, or ARRT fluoroscopy-certified operators under general supervision, and everyone who operates or supervises fluoroscopy needs at least 2 hours of training.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The ALARA duty for X-ray users appears only in Chapter 4 (§406), which applies to both materials licensees and machine registrants. Chapter 6 has no ALARA wording, only related dose-minimization duties (§603.A.14, §603.A.18). Chapter 7's ALARA program (§705) does not apply to X-ray registrants.", "citation": "LAC 33:XV.402.A, 406.B, 603.A.14, 603.A.18" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Louisiana is not on the NRC's list of non-Agreement States. LDEQ sent the NRC its final compatibility rule RP071, published in the Louisiana Register on December 20, 2024.", "citation": "NRC list of Agreement States, updated October 29, 2026; NRC ADAMS ML25022A242", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.nrc.gov/docs/ML2502/ML25022A242.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "LAC Title 33, Part XV (Radiation Protection). Chapter 6, \"X-Rays in the Healing Arts\" (§§601-699), covers X-ray and fluoroscopy, with fluoroscopy at §605. Chapter 4, \"Standards for Protection Against Radiation\", is the general rule. Chapter 6 adds to the rest of Part XV rather than replacing it. The text used is LDEQ's April 2026 compilation, not the official OSR LAC. The older 2017 PDF is out of date.", "citation": "LAC 33:XV.601.A", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx", "https://www.deq.louisiana.gov/assets/docs/Radiation/RadiationRegulations.pdf" ], "quote": "The provisions of this Chapter are in addition to, and not in substitution for, other applicable provisions of LAC 33:XV.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. §406.B requires each licensee or registrant to use procedures and engineering controls to keep occupational and public doses ALARA. §406.C requires the radiation protection program to be reviewed at least every 12 months.", "citation": "LAC 33:XV.406.B (and.406.A,.406.C)", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx", "https://www.deq.louisiana.gov/assets/docs/Radiation/RadiationRegulations.pdf" ], "quote": "The licensee or registrant shall use, to the extent practicable, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem), or 50 mSv, TEDE per year. The limit applies to X-ray workers via §603.A.21.", "citation": "LAC 33:XV.410.A; 417.A; 603.A.21", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx", "https://www.deq.louisiana.gov/assets/docs/Radiation/RadiationRegulations.pdf" ], "quote": "the total effective dose equivalent being equal to 0.05 Sv (5 rem)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem), or 150 mSv, per year. Louisiana has not adopted the ICRP 20 mSv lens limit. The limit was last amended at LR 40:1341 (July 2014).", "citation": "LAC 33:XV.410.A", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx", "https://www.deq.louisiana.gov/assets/docs/Radiation/RadiationRegulations.pdf" ], "quote": "a lens dose equivalent of 0.15 Sv (15 rem); and", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem), or 500 mSv, per year shallow dose to the skin of the whole body or to any extremity.", "citation": "LAC 33:XV.410.A", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx", "https://www.deq.louisiana.gov/assets/docs/Radiation/RadiationRegulations.pdf" ], "quote": "a shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. Employers should avoid substantial variation above a uniform monthly exposure rate; a footnote cites NCRP 91's recommendation of no more than 0.5 mSv per month.", "citation": "LAC 33:XV.417.A", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Radiation/RadiationRegulations.pdf" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to the embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Adults likely to receive more than 10% of a §410 limit in a year from external sources must wear a dosimeter, and the same 10% test applies to minors and declared pregnant women against their own limits. Separately, individuals working with medical fluoroscopic equipment are listed as a group that must be given and use dosimeters, apparently without the 10% test. LDEQ's interpretation of that category is unconfirmed.", "citation": "LAC 33:XV.431.A.1, A.2, A.4", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx", "https://www.deq.louisiana.gov/assets/docs/Radiation/RadiationRegulations.pdf" ], "quote": "adults likely to receive, in one year from sources external to the body, a dose in excess of 10 percent of the limits specified in LAC 33:XV.410.A; … individuals working with medical fluoroscopic equipment, who will locate monitoring devices as follows:", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "When an apron is worn, at least one badge goes at the collar outside the apron. A second badge, if used, goes at the waist under the apron, and it is required for declared pregnant women. Effective dose is calculated as follows: with one neck badge, the deep dose counts in full; with one neck badge and a reported dose above 25% of the limit, the deep dose is multiplied by 0.3; with two badges, effective dose is 1.5 × waist + 0.04 × neck. Other department-approved methods are allowed. NCRP 122 and Webster are not named.", "citation": "LAC 33:XV.603.A.21; 431.A.4; 432.A; 410.C-D", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx" ], "quote": "when a protective apron is worn, at least one such monitoring device shall be worn at the collar outside of the protective apron;", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Everyone in the fluoroscopy room except the patient must wear aprons of at least 0.25 mm lead equivalent where sterile fields or special procedures prevent using barriers or drapes. Stationary systems must have drapes, curtains or viewing shields. Staff may instead be protected by whole-body protective barriers of at least 0.25 mm lead equivalent (§603.A.7.b). Facilities must have enough aprons and gloves for all X-ray personnel not otherwise shielded. Thyroid shields and protective eyewear are not mentioned.", "citation": "LAC 33:XV.605.A.11.a-b; 603.A.7.b; 603.A.10", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx" ], "quote": "All persons, except the patient, in the room where fluoroscopy is performed shall wear protective aprons that provide a lead equivalent shielding of at least 0.25 mm.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. All protective apparel and auxiliary shields must be evaluated for integrity every 12-14 months and labeled with their lead equivalence. The inspection method is not specified.", "citation": "LAC 33:XV.603.A.11; 605.D.1.h", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx" ], "quote": "All protective apparel and auxiliary shields shall be evaluated at intervals of no less than 12 months, and no more than 14 months, for integrity and clearly labeled with their lead equivalence.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rules do not mention engineered shielding systems by name. They allow staff to be protected by whole body protective barriers of at least 0.25 mm lead equivalent as an alternative to protective aprons, and for stationary fluoroscopy units they require extra shielding such as drapes, self-supporting curtains or viewing shields. When sterile fields or special procedures prevent the use of normal barriers or drapes, everyone in the room except the patient must wear aprons of at least 0.25 mm lead equivalent.", "citation": "LAC 33:XV.603.A.7.b", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx", "https://www.deq.louisiana.gov/assets/docs/Radiation/RadiationRegulations.pdf" ], "quote": "the X-ray operator, other professional staff, and ancillary personnel shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent material;", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Under the DEQ rule: licensed practitioners (including NPs and PAs) or medical residents within their scope of practice; ARRT fluoroscopy-certified individuals under general supervision; and other RTs or RT students only under personal supervision. The statute's definition of licensed practitioner (2018 compilation) does not list PAs, so PA status is unresolved.", "citation": "LAC 33:XV.605.B.1; 602 (definitions); R.S. 37:3213(B) as amended by Act 929 (2026); R.S. 37:3200(5); LSRTBE Position Statements", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx", "https://www.legis.la.gov/Legis/ViewDocument.aspx?d=1481836", "https://wwwcfprd.doa.louisiana.gov/boardsandcommissions/StatutoryCitations/35_LRS%2037%203200-3221%20(2018).pdf", "https://lsrtbe.org/about-us/position-statements/" ], "quote": "Licensed Practitioner - a person licensed or otherwise authorized by law to practice medicine, dentistry, chiropractic, osteopathy or podiatry, or a licensed nurse practitioner, or physician assistant.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "Everyone who operates or supervises fluoroscopy needs at least 2 hours of training on 10 listed topics, with records kept 3 years. Operators who are not practitioners or residents need ARRT fluoroscopy certification. There is no state fluoroscopy permit or fluoroscopy-specific continuing education, and the LXMO limited permit excludes fluoroscopy.", "citation": "LAC 33:XV.605.B.1-3; 603.F.1.a; LAC 46:LXVI-1131", "sourceUrls": [ "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx", "https://www.law.cornell.edu/regulations/louisiana/La-Admin-Code-tit-46-SS-LXVI-1131" ], "quote": "All persons operating, or supervising the operation of, fluoroscopy systems shall have completed a minimum of two hours of training that includes but is not limited to the following:", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Act 929 of 2026 (HB 949)", "kind": "bill", "status": "Became law without Governor's signature 06/23/2026; effective 08/01/2026; LSRTBE implementing rules not checked", "date": "2026-08-01", "dateISO": "2026-08-01", "summary": "Amends the Radiologic Technology practice act (R.S. 37:3200-3221). It creates limited purpose permits and the radiologist assistant license, and amends §3213 on who must hold a license or permit.", "sourceUrls": [ "https://www.legis.la.gov/legis/BillInfo.aspx?s=26rs&b=HB949&sbi=y" ] }, { "title": "RP072 Miscellaneous Corrections", "kind": "adopted_rule", "status": "Final", "date": "2025-12-20", "dateISO": "2025-12-20", "summary": "Amends LAC 33:XV.328, 709 and 778. Radioactive materials only.", "sourceUrls": [ "https://www.deq.louisiana.gov/page/monthly-regulation-changes-2025%20" ] }, { "title": "MM024 Late Fee Update", "kind": "adopted_rule", "status": "Final", "date": "2026-04-20", "dateISO": "2026-04-20", "summary": "Includes the Part XV late-payment fee section §2510 (LR 52, April 2026).", "sourceUrls": [ "https://www.deq.louisiana.gov/about-ldeq/monthly-regulation-changes-2026" ] }, { "title": "RP071 NRC compatibility", "kind": "adopted_rule", "status": "Final", "date": "2024-12-20", "dateISO": "2024-12-20", "summary": "NRC compatibility rule published in the Louisiana Register.", "sourceUrls": [ "https://www.nrc.gov/docs/ML2502/ML25022A242.pdf" ] } ], "notable": [ "The 0.3 multiplier for a single neck badge applies only when the reported dose exceeds 25% of the limit (§410.D.2); below that, the neck badge reading counts in full.", "Facilities doing fluoroscopically guided interventional procedures must keep written protocols naming who may use fluoroscopy, review them every 12-14 months, and report annually to the radiation safety committee or responsible person (§605.E).", "A qualified expert must evaluate fluoroscopy equipment every 12-14 months, and within 30 days of installation or of maintenance that may affect exposure rates (§605.D).", "Badges must be processed by an NVLAP-accredited lab, and exposures may not be subtracted from official records without the department's written approval (§430.C).", "New or modified diagnostic or therapy X-ray installations need shielding plan review before construction (§603.E).", "Equipment and facility rules come from LDEQ, while operator licensing comes from the LSRTBE (and the Board of Medical Examiners for private-office operators); their definitions of \"licensed practitioner\" differ.", "LDEQ's monthly regulation-change lists through October 2026 show no proposed changes to Chapter 4 or Chapter 6.", "No Louisiana proposal responding to the NRC ALARA proposal was found, but the search was incomplete." ], "openQuestions": [ "Verify §§406, 410, 431, 603 and 605 against the Office of the State Register's official LAC Title 33 Part XV (https://www.doa.la.gov/doa/osr/louisiana-administrative-code/).", "Does LDEQ read §431.A.4 as requiring a dosimeter for every fluoroscopy worker regardless of the 10% test?", "Physician assistants: the DEQ rule counts PAs as licensed practitioners, but the RT statute's definition (2018 compilation) does not. Check the current R.S. 37:3200, the Board of Medical Examiners' PA rules and advisory opinions, and R.S. 37:1292.", "Act 929 implementing rules: has the LSRTBE issued limited-purpose-permit or radiologist-assistant rules, and do any touch fluoroscopy? The effective date of the LXMO rule (LAC 46:LXVI-1131) is also unconfirmed.", "Are there 2026 Louisiana bills on lead aprons or engineered shielding, or any LDEQ comment on or plan for the NRC's proposed Part 20 graded approach?", "How does LDEQ apply \"whole body protective barriers\" in §603.A.7.b, and could it cover engineered shielding systems?" ], "sources": [ { "title": "LDEQ, LAC 33:XV Radiation Protection, compiled Word file (April 2026)", "url": "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/ERC/33v15Rad.docx" }, { "title": "LDEQ, Regulations, LAC Title 33", "url": "https://www.deq.louisiana.gov/about-ldeq/regulations-lac-title-33" }, { "title": "LDEQ, Radiation Registrations page", "url": "https://www.deq.louisiana.gov/radiation" }, { "title": "LDEQ, Rules & Regulations", "url": "https://www.deq.louisiana.gov/about-ldeq/rules-regulations" }, { "title": "LDEQ, Monthly Regulation Changes 2026", "url": "https://www.deq.louisiana.gov/about-ldeq/monthly-regulation-changes-2026" }, { "title": "LDEQ, Monthly Regulation Changes 2025", "url": "https://www.deq.louisiana.gov/page/monthly-regulation-changes-2025%20" }, { "title": "LDEQ, Legislative report on RP068 (Chapter 6 update)", "url": "https://www.deq.louisiana.gov/assets/docs/Legal_Affairs/Legislative_Reports/DEQACTIONS.pdf" }, { "title": "LDEQ, older Part XV PDF (out of date, through 2017)", "url": "https://www.deq.louisiana.gov/assets/docs/Radiation/RadiationRegulations.pdf" }, { "title": "NRC ADAMS ML25022A242, LDEQ letter on RP071", "url": "https://www.nrc.gov/docs/ML2502/ML25022A242.pdf" }, { "title": "Louisiana Legislature, HB 949 (2026) bill history", "url": "https://www.legis.la.gov/legis/BillInfo.aspx?s=26rs&b=HB949&sbi=y" }, { "title": "Louisiana Legislature, Act 929 (HB 949 enrolled)", "url": "https://www.legis.la.gov/Legis/ViewDocument.aspx?d=1481836" }, { "title": "R.S. 37:3200-3221, 2018 compilation", "url": "https://wwwcfprd.doa.louisiana.gov/boardsandcommissions/StatutoryCitations/35_LRS%2037%203200-3221%20(2018).pdf" }, { "title": "LSRTBE Position Statements", "url": "https://lsrtbe.org/about-us/position-statements/" }, { "title": "Cornell LII, LAC 46:LXVI-1131 (Limited X-ray Machine Operator Permit)", "url": "https://www.law.cornell.edu/regulations/louisiana/La-Admin-Code-tit-46-SS-LXVI-1131" } ] }, { "code": "ME", "name": "Maine", "pageUrl": "https://orsif.org/guidelines/us/states/maine", "regulator": { "name": "Maine CDC Radiation Control Program, Department of Health and Human Services (DHHS)", "url": "https://www.maine.gov/dhhs/mecdc/services/business-services/radiation-control-nuclear-safety" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Maine (an Agreement State) regulates X-ray through the Maine CDC Radiation Control Program under 10-144 CMR ch. 220, and the occupational ALARA duty is in the shared Part D, not the X-ray-specific Part F, which mentions ALARA only in its QA appendix. Dose limits follow the NRC model: 50 mSv whole body, 150 mSv lens (the ICRP's lower limit has not been adopted), 500 mSv skin and extremities, and 5 mSv to the embryo/fetus. Fluoroscopy staff must be protected by aprons or, as an alternative to aprons, by whole-body protective barriers of at least 0.25 mm Pb, and aprons are tested semi-annually; the rules do not mention engineered shielding systems that replace aprons and are silent on thyroid shields and eyewear. Physicians and supervised licensed radiographers may perform fluoroscopy, and credentialed CV technologists may do limited tasks; limited radiographers may not.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The binding occupational ALARA duty is in Part D §1101.B, the Standards for Protection Against Radiation part shared by radioactive-materials licensees and X-ray registrants. Part F mentions ALARA only in Appendix G, as the stated basis for the QA program, and has a general duty to minimize personnel exposure (§F.3.A(1)(i)); neither is a separate occupational-dose ALARA requirement. This research's own reading, not stated in the rules, is that an NRC-driven change to Part D would affect the X-ray ALARA duty unless the State carves it out.", "citation": "Part D §1101.B; Part F §F.3.A(1)(i) and Appendix G §I.C; 22 M.R.S. §674(4)(B)-(C)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Maine is not among the non-Agreement States on the NRC list, and the NRC's July 10, 2025 periodic meeting summary on the Maine Agreement State Program is consistent with this.", "citation": "NRC list of Agreement States, updated October 29, 2026; NRC Region I periodic meeting summary", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.nrc.gov/docs/ML2526/ML25262A080.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "All rules are in 10-144 CMR ch. 220 (Radiation Protection Rule). Part D (Standards for Protection Against Radiation, October 23, 2022) covers licensees and registrants. Part F (X-Rays in the Healing Arts, October 23, 2022) covers medical X-ray, with §F.6 specific to fluoroscopy. Part A holds the definitions. The chapter was last amended October 23, 2022 (filing 2022-210).", "citation": "10-144 CMR ch. 220, Part D §1001; Part F (Scope)", "sourceUrls": [ "https://www.maine.gov/sos/rulemaking/agency-rules/radiation-protection-regulations", "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220d.docx" ], "quote": "Part D establishes standards for protection against ionizing radiation resulting from activities conducted pursuant to licenses or registrations issued by the Agency.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Part D requires every licensee or registrant (which includes X-ray machine users) to use procedures and engineering controls to keep occupational doses ALARA. Part F §F.3.A(1)(j) also makes X-ray personnel subject to D.1201, D.2104 and D.1502.", "citation": "10-144 CMR ch. 220, Part D §1101.B; Part A (definition of ALARA)", "sourceUrls": [ "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220d.docx" ], "quote": "The licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "TEDE of 0.05 Sv (5 rem) = 50 mSv/yr, or 0.5 Sv to any organ other than the lens, whichever is more limiting. Minors are limited to 10% of the adult limits.", "citation": "10-144 C.M.R. ch. 220, § D-C-1201", "sourceUrls": [ "https://www.law.cornell.edu/regulations/maine/10-144-C-M-R-ch-220-SS-D-C-1201" ], "quote": "The total effective dose equivalent (TEDE) being equal to 0.05 Sv (5 rem); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) = 150 mSv/yr. Maine has not adopted a lower lens limit such as the ICRP's 20 mSv.", "citation": "Part D §§1201.A, 1207, 1208", "sourceUrls": [ "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220d.docx" ], "quote": "(a) A lens dose equivalent of 0.15 Sv (15 rem), and (b) A shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem) = 500 mSv/yr shallow dose equivalent to the skin or any extremity.", "citation": "Part D §§1201.A, 1207, 1208", "sourceUrls": [ "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220d.docx" ], "quote": "(a) A lens dose equivalent of 0.15 Sv (15 rem), and (b) A shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. D.1208.D states the allowance remaining after declaration as \"5mSv (0.05 rem)\"; the units do not match, which looks like a typo in the Maine text.", "citation": "10-144 C.M.R. ch. 220, § D-C-1208", "sourceUrls": [ "https://www.law.cornell.edu/regulations/maine/10-144-C-M-R-ch-220-SS-D-C-1208" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Individual dosimeters must be supplied and used for: adults likely to exceed 10% of the D.1201.A limits in a year; minors likely to exceed 1 mSv deep dose, 1.5 mSv lens dose, or 5 mSv skin/extremity dose; declared pregnant women likely to exceed 1 mSv (0.1 rem) during the pregnancy; and anyone entering a high or very high radiation area. Part F §F.3.A(1)(j) applies this to X-ray personnel.", "citation": "Part D §1502.A(1)-(4); Part F §F.3.A(1)(j)", "sourceUrls": [ "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220d.docx" ], "quote": "Adults likely to receive, in one year from sources external to the body, a dose in excess of 10 percent of the limits in D.1201.A", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "When an apron is worn, at least one dosimeter must be worn at the collar, outside the apron. If more than one device is used, each dose must be identified with where it was worn, and the whole-body dose is based on the maximum dose attributed to the most critical organ. No formal two-badge method and no named effective-dose method (NCRP 122, Webster) is specified. Part D §1201.C allows effective dose equivalent only by a dosimetry method approved by the NRC.", "citation": "Part F §F.3.A(1)(j)(i)-(iii); Part D §1201.C", "sourceUrls": [ "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220f.docx" ], "quote": "When an apron is worn, the monitoring device shall be worn at the collar outside of the apron.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "partial", "answer": "Staff must be protected from scatter by protective aprons or whole-body protective barriers of at least 0.25 mm lead equivalent, and anyone who could be struck by the useful beam needs at least 0.5 mm. Facilities must keep enough leaded aprons and gloves. For fluoroscopy, under-table scatter must be attenuated by at least 0.25 mm Pb. For above-table scatter, staff must stand at least 120 cm from the beam center, or the scatter must pass through at least 0.25 mm Pb (drapes, Bucky-slot cover, curtains) in addition to the apron. Thyroid shields and protective eyewear are not addressed.", "citation": "Part F §F.3.A(1)(e)(i)-(ii), §F.3.A(1)(h)(vi), §F.6.I(1)-(2)", "sourceUrls": [ "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220f.docx" ], "quote": "The x-ray operator, other staff, ancillary personnel and other persons required for the medical procedure shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes, semi-annually. Under the Appendix G QA program, aprons, gloves and drapes are tested semi-annually. The method is not specified, and facilities may change tests or frequencies if they show image quality will still be assured.", "citation": "Part F §F.5.I(1); Appendix G §IV.A", "sourceUrls": [ "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220f.docx" ], "quote": "Each facility shall conduct the following tests, at the frequency specified, and maintain records of the data.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rules do not mention engineered shielding systems that replace aprons, but they do let fluoroscopy staff be protected either by protective aprons or by whole-body protective barriers of at least 0.25 mm lead equivalent. The Agency may also grant exceptions where a sterile field prevents normal barriers, and may grant exemptions from Part F when a qualified expert submits written justification.", "citation": "10-144 C.M.R. ch. 220, § F-3", "sourceUrls": [ "https://www.law.cornell.edu/regulations/maine/10-144-C-M-R-ch-220-SS-F-3" ], "quote": "The x-ray operator, other staff, ancillary personnel and other persons required for the medical procedure shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent.", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Physicians and other licensed practitioners may operate fluoroscopy, as may licensed radiographers under a licensed practitioner's supervision. Credentialed cardiovascular technologists may do certain table-side fluoroscopy tasks under a physician's direct supervision in cath and EP labs. Residents and students are exempt while supervised. Limited radiographers and limited-license trainees may not perform fluoroscopy. Whether PAs and NPs may operate is unclear.", "citation": "32 M.R.S. §§9852(5), (10); 9854(2), (3)(C), (3)(E); Board rules 02-465 CMR ch. 8 §§2, 5 and ch. 6; 10-144 CMR ch. 220 §F.3.A(1)(b), §F.6.B", "sourceUrls": [ "https://legislature.maine.gov/statutes/32/title32ch103.pdf", "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/465c-all.doc" ], "quote": "Limited radiographers may not perform cardiovascular-interventional radiography, cardiac-interventional radiography, vascular interventional radiography, mammography, computed tomography, bone densitometry, fluoroscopy or administration of radiographic contrast.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "There is no separate fluoroscopy permit and no fluoroscopy-specific training hours were found. Radiographers need a board-approved course and exam, or ARRT certification and current registration, plus continuing education at each two-year renewal (current ARRT registration in CE compliance or 24 CE hours, among other options). Cardiovascular technologists must hold the credentials named in the statute. For physicians, Part F requires only that operators be adequately instructed and competent.", "citation": "32 M.R.S. §9855(1)(C); 02-465 CMR ch. 9 §3(4); 10-144 CMR ch. 220 §F.3.A(1)(b)", "sourceUrls": [ "https://legislature.maine.gov/statutes/32/title32ch103.pdf" ], "quote": "Either have successfully completed a course of study in radiologic technology and an examination that is approved by the board or possess valid certification and current registration from the American Registry of Radiologic Technologists", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "NRC compatibility packages (RATS IDs 2022-1, 2022-2, 2023-1, and others)", "kind": "proposed_rule", "status": "Draft; scheduled to be adopted in early 2026; adoption not confirmed", "date": "", "dateISO": null, "summary": "Overdue or NRC-commented compatibility packages are in draft form and in the State's process. The Secretary of State still lists Parts D and F at October 23, 2022.", "sourceUrls": [ "https://www.nrc.gov/docs/ML2526/ML25262A080.pdf" ] }, { "title": "PL 2025 c. 314 (LD 649)", "kind": "bill", "status": "Enacted", "date": "2025", "dateISO": "2025", "summary": "Created a chiropractic radiographer exemption and amended the cardiovascular technologist exemption in 32 M.R.S. §9854(3).", "sourceUrls": [ "https://legislature.maine.gov/statutes/32/title32ch103.pdf" ] }, { "title": "PL 2025 c. 83", "kind": "bill", "status": "Enacted", "date": "2025", "dateISO": "2025", "summary": "Amended the dental exemption.", "sourceUrls": [ "https://legislature.maine.gov/statutes/32/title32ch103.pdf" ] }, { "title": "PL 2025 c. 738", "kind": "bill", "status": "Enacted; effective January 1, 2027", "date": "2027-01-01", "dateISO": "2027-01-01", "summary": "Updates \"physician associates\" wording in 32 M.R.S. §9855(4).", "sourceUrls": [ "https://legislature.maine.gov/statutes/32/title32ch103.pdf" ] } ], "notable": [ "Part D's ALARA duty and dose limits apply to X-ray registrants through a materials-compatible rule, while the statute holds machine programs to \"consistency\" with federal programs rather than \"compatibility\" (22 M.R.S. §674(4)(C)).", "Part D §1201.C ties approval of effective-dose methods to the NRC, not to the state.", "Fluoroscopy entrance exposure rate is capped at 10 R/min (20 R/min high-level control for equipment made on or after May 1995), with an audible signal; the rate is measured annually and posted.", "Fluoroscopy requires a 5-minute cumulative timer, recorded on-time, and minimum source-to-skin distances.", "Hospital X-ray machines must be inspected yearly by a qualified expert.", "NRC reported the program has a manager and two technical staff (about 2.5 FTE).", "D.1208.D's \"5mSv (0.05 rem)\" appears to be a unit typo." ], "openQuestions": [ "Were Chapter 220 compatibility packages proposed or adopted in 2026, and will Maine follow the NRC's ALARA/\"graded approach\" change in Part D?", "Does the Program accept NCRP 122, Webster or two-badge effective dose methods, given §1201.C's reference to methods \"approved by the NRC\"?", "May PAs (physician associates) or NPs operate fluoroscopy without a radiographer license?", "What is the current amendment status of Board rules ch. 8 and ch. 9? The combined file shows 2009 filings.", "Are there physician fluoroscopy training requirements in hospital credentialing or Board of Licensure in Medicine rules?", "Would a \"whole body protective barrier\" under §F.3.A(1)(e)(ii) or a §F.3.D(4) exemption cover an engineered apron-replacement system?" ], "sources": [ { "title": "Maine Secretary of State, Radiation Protection Regulations (10-144 CMR ch. 220)", "url": "https://www.maine.gov/sos/rulemaking/agency-rules/radiation-protection-regulations" }, { "title": "Part D", "url": "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220d.docx" }, { "title": "Part F", "url": "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220f.docx" }, { "title": "Cover and history", "url": "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144220cv.docx" }, { "title": "Part A", "url": "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/144c220a.docx" }, { "title": "Justia, 10 ME Code Rules §144-220-F-3", "url": "https://regulations.justia.com/states/maine/10/144/chapter-220/part-f/section-144-220-f-3/" }, { "title": "Maine CDC Radiation Control & Nuclear Safety", "url": "https://www.maine.gov/dhhs/mecdc/services/business-services/radiation-control-nuclear-safety" }, { "title": "Maine CDC X-Ray Licensing", "url": "https://www11.maine.gov/dhhs/mecdc/services/radiation-control-nuclear-safety/x-ray-licensing" }, { "title": "Maine CDC Rules (rulemaking updates)", "url": "https://www11.maine.gov/dhhs/mecdc/rules/maine-cdc-rules.shtml" }, { "title": "22 M.R.S. ch. 160, Radiation Protection Act", "url": "https://www.mainelegislature.org/legis/statutes/22/title22ch160.pdf" }, { "title": "32 M.R.S. ch. 103, Medical Radiation Health and Safety Act", "url": "https://legislature.maine.gov/statutes/32/title32ch103.pdf" }, { "title": "Radiologic Technology Board of Examiners, Licensing & Forms", "url": "https://www.maine.gov/pfr/professionallicensing/professions/radiologic-technology-board-examiners/licensing-and-forms" }, { "title": "Board rules, 02-465 CMR (combined file)", "url": "https://www.maine.gov/sos/sites/maine.gov.sos/files/content/assets/465c-all.doc" }, { "title": "NRC Region I, Maine Periodic Meeting Summary (meeting July 10, 2025)", "url": "https://www.nrc.gov/docs/ML2526/ML25262A080.pdf" } ] }, { "code": "MD", "name": "Maryland", "pageUrl": "https://orsif.org/guidelines/us/states/maryland", "regulator": { "name": "Radiological Health Program (RHP), Air and Radiation Administration, Maryland Department of the Environment (MDE)", "url": "https://mde.maryland.gov/programs/air/radiologicalhealth/pages/index.aspx" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Maryland's X-ray rules share a document with its radioactive-materials rules (Regulations for the Control of Ionizing Radiation (1994), adopted by COMAR 26.12.01.01); ALARA is in shared Part D, so an NRC change could affect X-ray users, while Part F has its own duty to minimize exposure. Dose limits follow the NRC model: 50 mSv whole body, 150 mSv lens, 500 mSv skin/extremity and 5 mSv embryo/fetus, and a D.209 formula estimates fluoroscopy effective dose from one or two badges. Supplement 35 (effective 15 September 2025) deleted the general 0.25 mm apron rule, leaving a fluoroscopy standard of 0.25 mm lead-equivalent shielding or 120 cm distance; aprons need no scheduled inspection, and alternatives to aprons are not addressed by name. Only licensed practitioners or radiological technologists may energize fluoroscopy, with 4 hours of initial training and 1 hour every 2 years.", "whereAlaraLives": { "category": "both", "explanation": "The ALARA requirement (D.101(a)) is in shared Part D, which covers both licensees and registrants. D.101(e) and D.209 refer to an \"ALARA program.\" Part F has a separate X-ray-specific duty to minimize exposure (F.3(a)(1)(x)) without using the term ALARA, and this duty would survive an NRC-driven change to Part D.", "citation": "§D.101(a)-(b), (e); §F.3(a)(1)(x)-(xi) (Supp. 35 numbering)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Maryland is not on the NRC list of non-Agreement States, and the NRC reviewed Supplement 35 for compatibility on 8 August 2025.", "citation": "NRC list of Agreement States, updated October 29, 2026; NRC letter, \"Maryland Final Regulations to RATS ID 2023-1\" (ML25198A160)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.nrc.gov/docs/ML2519/ML25198A160.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "COMAR 26.12.01.01 adopts by reference the \"Regulations for the Control of Ionizing Radiation (1994),\" as amended through Supplement 35 (effective 15 September 2025). The relevant parts are Part D (Standards for Protection Against Radiation, applying to licensees and registrants) and Part F (X Rays in the Healing Arts: F.3 general, F.5 fluoroscopy). COMAR 26.12.02 covers machine inspection and certification. There is no free official online text, so the research relied on unofficial MDE copies.", "citation": "COMAR 26.12.01.01; Parts D and F", "sourceUrls": [ "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Pages/RegulationsforControlofIonizingRadiation.aspx" ], "quote": "COMAR 26.12.01.01 includes the \"Regulations for the Control of Ionizing Radiation (1994)\", which is incorporated by reference.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. D.101(a) requires each licensee or registrant to keep occupational doses ALARA, and Part D's scope (D.2) covers registrants. D.101(e) lets registrants build the D.209 fluoroscopy method into their ALARA program.", "citation": "Regs. for Control of Ionizing Radiation §D.101(a), (e); §D.2 (page D4, Supp. 22)", "sourceUrls": [ "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "a licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to the members of the general public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "Total effective dose equivalent of 0.05 Sv (5 rem), which is 50 mSv per year.", "citation": "D.201(a)(i)", "sourceUrls": [ "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "The total effective dose equivalent being equal to 0.05 Sv (5 rem); or (2) The sum of the deep dose equivalent and the committed dose equivalent to any individual organ or tissue other than the lens of the eye being equal to 0.5 Sv (50 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem), which is 150 mSv per year. No lower ICRP-style limit has been adopted.", "citation": "§D.201(a)(i)-(ii), §D.207, §D.208 (pages D4-D5, D12)", "sourceUrls": [ "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "(1) A lens dose equivalent of 0.15 Sv (15 rem), and (2) A shallow-dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem), which is 500 mSv shallow-dose equivalent to the skin of the whole body or any extremity.", "citation": "§D.201(a)(i)-(ii), §D.207, §D.208 (pages D4-D5, D12)", "sourceUrls": [ "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "(1) A lens dose equivalent of 0.15 Sv (15 rem), and (2) A shallow-dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. A footnote cites the NCRP Report 91 recommendation of no more than 0.5 mSv in any one month.", "citation": "Sec. D.208 Dose to an Embryo/Fetus", "sourceUrls": [ "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Badges are required for adults likely to exceed 10% of a D.201 limit in a year (5 mSv whole body, 15 mSv lens, 50 mSv skin or extremity), minors above 1 mSv deep dose, declared pregnant women likely to exceed 1 mSv, and anyone entering a high or very high radiation area.", "citation": "§D.502(a)(i)-(iv) (page D16, Supp. 30)", "sourceUrls": [ "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "Adults who potentially may receive, in 1 year, from sources external to the body, a dose in excess of 10 percent of the limits in D.201a;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "When an apron is worn, at least one badge must be worn at the collar outside the apron. Under D.209, for C-arm interventional fluoroscopy, effective dose can be estimated as the collar reading, as collar × 0.3 once the collar reading exceeds 25% of the limit, or as 1.5 × waist (under apron) + 0.04 × collar with two badges. The registrant must notify MDE when a worker reaches 80% (40 mSv).", "citation": "§F.3(a)(1)(xi)(a)(1) (Supp. 35, page F12); §D.209(a)-(c) (pages D13-D13-1, Supp. 22)", "sourceUrls": [ "https://www.nrc.gov/docs/ML2519/ML25198A129.pdf", "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "the sum of the deep dose equivalent reported for the individual monitoring device located at the waist under the protective apron multiplied by 1.5 and the deep dose equivalent reported for the individual monitoring device located at the neck outside the protective apron multiplied by 0.04.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "partial", "answer": "Supplement 35 deleted the general rule requiring aprons or whole-body barriers of at least 0.25 mm lead equivalent. For fluoroscopy, F.5(i) still requires 0.25 mm lead-equivalent shielding against under-table scatter. For above-table scatter, staff must be at least 120 cm from the beam centre or behind at least 0.25 mm lead-equivalent material. Thyroid shields and eyewear for staff are not addressed.", "citation": "§F.5(i)(1)-(3) (Supp. 35, page F22-5); deleted §F.3(a)(1)(viii)-(x)", "sourceUrls": [ "https://www.nrc.gov/docs/ML2519/ML25198A129.pdf", "https://mgaleg.maryland.gov/pubs/committee/aelr/2025-AELR-synopses-regulations-received-4-29-2025-through-5-8-2025.pdf" ], "quote": "remove Sections F.3(a)(1)(viii), F.3(a)(1)(ix), and F.3(a)(1)(x), on page F11;", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Maryland's X-ray rules do not require protective aprons or gloves to be inspected on a schedule. They define protective aprons and gloves and say where a dose badge goes when an apron is worn, but they set no inspection duty.", "citation": "COMAR 26.12.01.01 Part F, Sections F.3 and F.5 (including Supp. 35 pages F11 to F12)", "sourceUrls": [ "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "\"Protective apron\" means an apron made of radiation absorbing materials used to reduce radiation exposure.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Not addressed by name. Instead of naming aprons, Maryland's fluoroscopy rule sets a shielding standard: no part of a staff member's body except the extremities may be exposed to unattenuated scattered radiation from above the tabletop unless the person is at least 120 centimeters from the center of the beam, or the radiation has passed through at least 0.25 mm lead-equivalent material \"including, but not limited to\" drapes, bucky-slot cover panels or self-supporting curtains.", "citation": "COMAR 26.12.01.01, Section F.5(i)(2) (Supplement 35)", "sourceUrls": [ "https://www.nrc.gov/docs/ML2519/ML25198A129.pdf", "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "Is at least 120 centimeters from the center of the useful beam, or (ii) Is in a location such that the radiation has passed through not less than 0.25 millimeter lead equivalent material including, but not limited to, drapes, bucky-slot cover panel, or self-supporting curtains.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Only a licensed practitioner of the healing arts or a radiological technologist may energize fluoroscopy equipment; \"radiological technologist\" is undefined. Under Board of Physicians rules, radiographers and radiologist assistants may perform fluoroscopy under supervision. RCIS may assist but may not perform fluoroscopy. PAs are limited to nonfluoroscopic mini C-arm work from 1 October 2026. Limited X-ray operators are barred, and no provision for NPs was found.", "citation": "§F.5(n)(1); definition \"Licensed practitioner of the healing arts\" (Part A); COMAR 10.32.10.07A,.09A(8),.10; COMAR 10.32.12.06; Health Occupations §§14-306.1, 14-306.3, 15-302.1(c) (Ch. 214 of 2026)", "sourceUrls": [ "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "The registrant shall ensure that only a licensed practitioner of the healing arts or a radiological technologist be allowed to energize fluoroscopic x-ray systems.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "At least 4 hours of training before clinical use, plus at least 1 hour of in-service or CME every 24 months. Records are kept for 3 years. Certified radiologists and therapy-simulation-only users are exempt. There is no separate state fluoroscopy permit. RCIS need 40 hours of didactic training plus supervised clinical training.", "citation": "§F.5(n)(1)-(6) (pages F22-7-F22-8); COMAR 10.32.10.04B, 10.32.10.13; COMAR 10.32.12.06B(2)", "sourceUrls": [ "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" ], "quote": "all persons energizing these systems shall have completed at least four hours of training as specified in Section F.5(n)(2) prior to clinical use of a fluoroscopic system", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Supplement 35 to COMAR 26.12.01.01", "kind": "adopted_rule", "status": "Adopted; effective; NRC found compatible 8 August 2025", "date": "2025-09-15", "dateISO": "2025-09-15", "summary": "Deleted the general apron/barrier rule and patient gonad and thyroid shielding (F.3(a)(1)(viii)-(x)). Removed the apron reference in F.5(i)(2)(ii). Annual dose reports to workers are now required only above 1 mSv (J.13(b)).", "sourceUrls": [ "https://mgaleg.maryland.gov/pubs/committee/aelr/2025-AELR-synopses-regulations-received-4-29-2025-through-5-8-2025.pdf" ] }, { "title": "Ch. 214 of 2026 (SB 915; companion HB 1047)", "kind": "bill", "status": "Approved 28 April 2026; effective 1 October 2026", "date": "2026-10-01", "dateISO": "2026-10-01", "summary": "Creates Board of Physicians registration for limited X-ray machine operators, who are excluded from fluoroscopy. Moves the RCIS fluoroscopy-assist rule to a new §14-306.1. Limits PAs to nonfluoroscopic mini C-arm work on the extremities.", "sourceUrls": [ "https://mgaleg.maryland.gov/2026RS/chapters_noln/Ch_214_sb0915E.pdf" ] }, { "title": "COMAR 26.12.03 fee update", "kind": "other", "status": "Listed in MDE regulations in development", "date": "", "dateISO": null, "summary": "Fee update for the Radiological Health Program; it is the only item on the list, and nothing is pending for COMAR 26.12.01.", "sourceUrls": [ "https://mde.maryland.gov/programs/regulations/air/Pages/RegsInDev.aspx" ] } ], "notable": [ "§F.5(o)(2) requires registrants to evaluate at least 3 months of electrophysiology and interventional fluoroscopy times every 2 years, by procedure and by practitioner.", "Fluoroscopy units must display air-kerma values (units made from June 2006 on) and sound an alarm every 5 minutes of fluoroscopy time.", "With a single collar badge below the 25% trigger, the full collar reading counts as effective dose, which is conservative.", "After Supplement 35, leftover cross-references to F.3(a)(1)(v), such as in F.3(a)(1)(ix)(c), may cause confusion.", "Part J worker notices and reports, including the new 1 mSv threshold for annual dose reports, apply to both licensees and registrants.", "Supplement 35 deleted the general apron rule, while the badge rule still assumes aprons may be worn." ], "openQuestions": [ "The final Maryland Register notice for Supplement 35 should be checked to confirm the adopted wording of F.3 and F.5(i); the research used a \"Clean Draft\" posted by the NRC.", "MDE's reasons for removing the apron rule, and any guidance for registrants, were not found.", "\"Radiological technologist\" is undefined, and whether PAs or NPs count as qualified fluoroscopy users under F.5(n)(1) is unsettled.", "No apron inspection rule was found; MDE guidance documents and inspector checklists were not reviewed.", "Board of Physicians regulations implementing Ch. 214 of 2026 were not located.", "No MDE statement was found on how it would handle the July 2026 NRC ALARA proposal for D.101(a), D.101(e) and D.209." ], "sources": [ { "title": "MDE Radiological Health Program home page", "url": "https://mde.maryland.gov/programs/air/radiologicalhealth/pages/index.aspx" }, { "title": "MDE, Regulations for Control of Ionizing Radiation page", "url": "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Pages/RegulationsforControlofIonizingRadiation.aspx" }, { "title": "MDE, COMAR 26.12.01.01 status and supplement list (\"effective through Supplement 35\")", "url": "https://mde.maryland.gov/programs/air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/HERE%2025%20Final%200916025_web.pdf" }, { "title": "MDE, unofficial consolidated compilation of COMAR 26.12.01.01 (through Supplement 30)", "url": "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/RH_comar/regs_final_new.pdf" }, { "title": "MDE, Supplement 31 redline draft", "url": "https://mde.maryland.gov/programs/Air/RadiologicalHealth/Documents/Supplement%2031%20Redline%20version.pdf" }, { "title": "Supplement 32 draft (NRC ADAMS ML22097A076)", "url": "https://www.nrc.gov/docs/ML2209/ML22097A076.pdf" }, { "title": "MDE, Supplement 33 clean copy", "url": "https://mde.maryland.gov/programs/air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/Clean%20Copy%20of%20Supplement%2033.pdf" }, { "title": "MDE, Supplement 34", "url": "https://mde.maryland.gov/programs/air/RadiologicalHealth/Documents/www.mde.state.md.us/assets/document/air/COMAR%2026.12.01.01%20Supplement%2034.pdf" }, { "title": "Supplement 35 pages, \"Clean Draft Supp. 35\" (NRC ADAMS ML25198A129)", "url": "https://www.nrc.gov/docs/ML2519/ML25198A129.pdf" }, { "title": "NRC letter to MDE, 8 August 2025, on final Supplement 35 (ML25198A160)", "url": "https://www.nrc.gov/docs/ML2519/ML25198A160.pdf" }, { "title": "Maryland General Assembly AELR Committee, synopses of regulations received 29 April, 8 May 2025", "url": "https://mgaleg.maryland.gov/pubs/committee/aelr/2025-AELR-synopses-regulations-received-4-29-2025-through-5-8-2025.pdf" }, { "title": "2026 Laws of Maryland Ch. 214 (SB 915)", "url": "https://mgaleg.maryland.gov/2026RS/chapters_noln/Ch_214_sb0915E.pdf" }, { "title": "HB 1047 (2026), third reader", "url": "https://mgaleg.maryland.gov/2026RS/bills/hb/hb1047t.pdf" }, { "title": "COMAR 10.32.10, licensure of radiation therapists, radiographers, nuclear medicine technologists and radiologist assistants", "url": "https://regs.maryland.gov/us/md/exec/comar/10.32.10/index.full.html" }, { "title": "COMAR 10.32.12, delegation of acts by a licensed physician (RCIS and fluoroscopy)", "url": "https://regs.maryland.gov/us/md/exec/comar/10.32.12/index.full.html" }, { "title": "MDE, Air and Radiation Regulations in Development", "url": "https://mde.maryland.gov/programs/regulations/air/Pages/RegsInDev.aspx" }, { "title": "MDE, Public Hearings, Meetings and Request for Comments", "url": "https://mde.maryland.gov/programs/regulations/air/Pages/reqcomments.aspx" } ] }, { "code": "MA", "name": "Massachusetts", "pageUrl": "https://orsif.org/guidelines/us/states/massachusetts", "regulator": { "name": "Division of Radiation Control (DRC), Radiation Control Program, Bureau of Climate and Environmental Health, Massachusetts Department of Public Health (DPH)", "url": "https://www.mass.gov/orgs/division-of-radiation-control" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Massachusetts requires X-ray registrants, including fluoroscopy users, to keep worker doses ALARA under 105 CMR 120.210(B), a rule in Part 120.200 that is shared with radioactive-materials licensees, and the X-ray part (120.403) separately calls for minimizing personnel exposure. Dose limits match the federal numbers: 50 mSv whole body, 150 mSv lens (no lower limit adopted), 500 mSv skin/extremities, and 5 mSv embryo/fetus; all fluoroscopy workers must wear dosimeters, and the rules specify badge placement and one- or two-badge effective-dose calculations. Staff need aprons or whole-body protective barriers of at least 0.25 mm lead equivalent, plus lead glasses for interventional procedures, and protective equipment must be X-rayed annually; engineered radiation protection systems are not expressly addressed, but because barriers are allowed in place of aprons, a barrier-type alternative to the apron is accepted. Only radiologists, trained physicians, licensed radiologic technologists trained in fluoroscopy, and qualifying physician assistants may operate fluoroscopy.", "whereAlaraLives": { "category": "both", "explanation": "The ALARA requirement is in 120.210(B), in Part 120.200, which applies to radioactive-materials licensees and X-ray registrants alike, so an NRC Part 20 compatibility change could affect it. Section 120.403(A)(1)(i) separately requires procedures and equipment that minimize personnel exposure, without using the word 'ALARA'. Section 120.403(A)(1)(j) cross-references the dose-limit sections but does not list 120.210.", "citation": "105 CMR 120.210(B); 120.403(A)(1)(i); 120.403(A)(1)(j)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Massachusetts is on the NRC's list of Agreement States, updated October 29, 2026.", "citation": "NRC list of Agreement States, updated October 29, 2026; NRC letter to MA DPH, May 22, 2025 (Tracking Ticket 25-29).", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "105 CMR 120.000 (Massachusetts Regulations for the Control of Radiation) is one combined rule. The relevant parts are 120.400 X-rays in the Healing Arts (120.403 general requirements; 120.405 fluoroscopic systems) and 120.200 Standards for Protection Against Radiation, which applies to both licensees and registrants. Radiologic technologist licensing is in 105 CMR 125.000. The posted 105 CMR 120 PDF is Mass. Register #1480, dated 10/14/22; the 105 CMR 125 PDF is Mass. Register #1567, dated 02/13/2026. Mass.gov says the official version is the purchased print edition.", "citation": "105 CMR 120.202; 120.401", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "Except as otherwise specifically provided in other Parts of 105 CMR 120.000, 105 CMR 120.200 applies to persons licensed or registered by the Department to receive, possess, use, transfer, or dispose of sources of radiation.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Every licensee or registrant must use procedures and engineering controls to keep occupational doses ALARA. A radiation protection program is required (120.210(A)) and must be reviewed at least every 12 months (120.210(C)).", "citation": "105 CMR 120.210(B)", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "The licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem) = 50 mSv TEDE per year; applies to registrants as well as licensees.", "citation": "105 CMR 120.019: Appendix A (C)(1)(a)", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "A radiation exposure during any year of a worker in excess of 5 rems total effective dose equivalent, 15 rems to the lens of the eye, or 50 rems to the skin of the whole body", "quoteMatchedToSource": true, "confidence": "medium" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) = 150 mSv per year. Massachusetts has not adopted a lower limit such as the ICRP's 20 mSv.", "citation": "105 CMR 120.211(A)", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "(a) a lens dose equivalent of 0.15 sievert (15 rems); and (b) a shallow dose equivalent of 0.5 sievert (50 rems) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem) = 500 mSv shallow dose per year to the skin and extremities.", "citation": "105 CMR 120.211(A)", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "(a) a lens dose equivalent of 0.15 sievert (15 rems); and (b) a shallow dose equivalent of 0.5 sievert (50 rems) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. Employers must also avoid large variations above a uniform monthly exposure rate.", "citation": "105 CMR 120.218(A)", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed five millisieverts (0.5 rems).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Adults likely to receive more than 10% of a 120.211(A) limit in a year from external sources must be badged. For declared pregnant women, the trigger is a likely deep dose above 1 mSv (0.1 rem) over the pregnancy. All individuals working medical fluoroscopic equipment must be badged, with no 10% test. The 1998 DRC guidance notice (AIN 98-01) describes only the 10% test and is out of date for fluoroscopy.", "citation": "105 CMR 120.226(A)(4) to (5)", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "(4) individuals entering a high or very high radiation area; (5) individuals working medical fluoroscopic equipment.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "Badge locations: one badge at the collar outside the apron; a second badge under the apron at the waist, which is required for a declared pregnant woman. Lens dose is measured at the collar outside the apron or at an unshielded spot closer to the eye. Extremity badges go on the extremity likely to get the highest dose. Effective dose (120.211(C)(2)): (a) with one collar badge, the deep dose counts as the effective dose; (b) with one collar badge reading above 25% of the limit, effective dose = 0.3 × deep dose; (c) with two badges, effective dose = 1.5 × waist + 0.04 × neck. The rule does not name NCRP Report 122, and the research did not verify the coefficients against it. Other Agency-approved methods are allowed (120.211(C)(1)).", "citation": "105 CMR 120.226(A)(5)(a)-(c); 120.226(C); 120.211(C)(2)", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "When a second individual monitoring device is used, for the same purpose, it shall be located under the protective apron at the waist. The second individual monitoring device is required for a declared pregnant woman.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Staff must be protected from scatter by protective aprons or whole-body protective barriers of at least 0.25 mm lead equivalent. Anyone whose body could be hit by the useful beam needs 0.5 mm lead equivalent. Lead glasses are required for interventional procedures, with no lead equivalence specified. Facilities must have enough lead aprons and gloves for all unshielded personnel. Thyroid shields are not addressed.", "citation": "105 CMR 120.403(A)(1)(e)1-2; 120.403(A)(1)(h)6", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "The x-ray operator, other staff, ancillary personnel, and other persons required for the medical procedure shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent. For interventional procedures, lead glasses shall be used.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. Aprons, gloves and shields must be X-rayed every year for defects, with a record kept. Defective items must be removed from service until repaired or replaced.", "citation": "105 CMR 120.403(A)(1)(i)3", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "Protective equipment including aprons, gloves, and shields shall be x-rayed annually for defects, such as holes, cracks, and tears to assure reliability and integrity. A record of this test shall be maintained for inspection by the Radiation Control Program.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rules do not expressly address engineered radiation protection systems. However, staff may be protected from scatter radiation by either protective aprons or whole body protective barriers of at least 0.25 mm lead equivalent, so a barrier-type alternative to the apron is accepted.", "citation": "105 CMR 120.403(A)(1)(e)2", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "The x-ray operator, other staff, ancillary personnel, and other persons required for the medical procedure shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Only four groups may operate fluoroscopy: (a) licensed physicians board-certified in radiology; (b) other licensed physicians trained in seven listed subjects; (c) radiologic technologists licensed under 105 CMR 125.000 and trained in safe fluoroscopy use; (d) licensed physician assistants who meet 120.405(K)(2), with delegation by a supervising physician, a written practice agreement and a competency statement. Nurse practitioners are not listed as operators but may act as first assistants in cardiac catheterization with a qualified physician as primary operator. Students may operate only under direct supervision. Limited-scope technologists may not do fluoroscopy. Facilities must have privileging policies (120.405(K)(5)).", "citation": "105 CMR 120.405(K)(1), (2), (5), (9); 120.405(M)(1); 120.401; 105 CMR 125.005(B)", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "The Registrant of a facility shall ensure that only the following health care providers shall be allowed to operate fluoroscopic x-ray systems:", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "Physicians not board-certified in radiology: initial training in seven subjects (no hour count), then 2 hours of radiation safety training a year for those who perform fluoroscopy and 4 hours a year for those who supervise it. Physician assistants: didactic training in seven topics, 40 supervised clinical hours, and an ARRT or Agency-approved equivalent exam. Radiologic technologists: a state license requiring ARRT or approved board certification, plus training in safe fluoroscopy use; continuing education is 24 CEUs every two years, including 2 in radiation safety. Facilities must keep CE records for five years. No state fluoroscopy permit was found.", "citation": "105 CMR 120.405(K)(1)-(7); 105 CMR 125.005; 125.009", "sourceUrls": [ "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" ], "quote": "The Registrant of the facility shall ensure that all physicians who are not board certified in radiology and who perform fluoroscopic procedures complete two hours of training in Radiation Safety/Radiation Protection on an annual basis", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "105 CMR 125.000 amendment: Limited Scope of Practice in Radiography license", "kind": "adopted_rule", "status": "Public hearing held March 26, 2025; Public Health Council approval on December 10, 2025 reported by MSRT; posted as the Mass. Register #1567 version", "date": "02/13/2026", "dateISO": "2026-02-13", "summary": "Adds a limited-scope radiography license. Limited-scope licensees are excluded from fluoroscopy.", "sourceUrls": [ "https://member.msrt-ma.org/wp-content/uploads/2025/02/Hearing-Notice.pdf" ] }, { "title": "Proposed 105 CMR 120 revisions (NRC SRS Tracking Ticket 25-29)", "kind": "proposed_rule", "status": "NRC reviewed with no comments; adoption not confirmed", "date": "May 22, 2025", "dateISO": "2025-05-22", "summary": "Covers radioactive-materials sections (e.g., 120.059, 120.128, 120.281, 120.282, 120.290, 120.5xx, 120.933). Does not include the occupational-dose sections (120.210-120.226) or the X-ray part (120.400).", "sourceUrls": [ "https://www.nrc.gov/docs/ML2513/ML25134A203.pdf" ] }, { "title": "S.1637 (194th General Court)", "kind": "bill", "status": "Sent to study order", "date": "12/18/2025", "dateISO": "2025-12-18", "summary": "Concerns non-ionizing radiation. No 2025-2026 bill on fluoroscopy staff protection or engineered shielding was found.", "sourceUrls": [ "https://malegislature.gov/Bills/194/S1637" ] } ], "notable": [ "DRC may grant exemptions from the above-table shielding requirement (120.405(H)(2)) where a sterile field prevents normal barriers. Appendix D (120.423) lists procedures where exemptions are automatically granted, including angiograms, biopsies, myelograms and nephrostomies. No exemption is allowed where prefitted sterile covers are practical.", "Mini C-arms are expressly covered by 120.405.", "Facilities must keep written safety procedures reviewed annually (120.403(A)(1)(d)), and their QA program must cover radiation protection for fluoroscopy (120.403(A)(6)).", "Facilities doing interventional procedures must evaluate patient dose. Any skin dose of 2 Gy or more must go to the Radiation Safety Committee (120.405(L)).", "Section 120.403(A)(1)(j) cites 120.215, which does not appear in the Part 120.200 table of contents (possible stale cross-reference).", "No response by Massachusetts to the NRC's July 2026 ALARA proposal was found." ], "openQuestions": [ "Is 105 CMR 120 current? The posted PDF is dated 10/14/22, and the 2025 radioactive-materials amendments may have since been adopted. Check the Massachusetts Register and the DPH proposed-regulations page.", "Does DPH/DRC plan to change 120.210(B) in response to the NRC ALARA proposal, and how would it treat registrants? Check NRC's State Communication Portal and contact DRC.", "Would DRC accept an engineered system as a 'whole body protective barrier' under 120.403(A)(1)(e)2? No guidance was found; ask DRC directly.", "Do the 1.5/0.04 coefficients in 120.211(C)(2)(c) come from NCRP Report 122, and has DRC approved other methods under 120.211(C)(1)?", "What is the meaning or status of the 120.215 cross-reference in 120.403(A)(1)(j)? Confirm with DRC.", "Does 105 CMR 130.900 (hospital cardiac catheterization standards) contain additional staff radiation-safety provisions? It was not reviewed.", "Is there any ionizing-radiation worker-protection bill in the 194th General Court? A full-text search on malegislature.gov would confirm." ], "sources": [ { "title": "Mass.gov, 105 CMR 120.00: The control of radiation (regulation page)", "url": "https://www.mass.gov/regulations/105-CMR-12000-the-control-of-radiation" }, { "title": "105 CMR 120.000 PDF (Mass. Register #1480, 10/14/22)", "url": "https://www.mass.gov/doc/105-cmr-120-the-control-of-radiation-0/download" }, { "title": "Mass.gov, 105 CMR 125.00: Licensing of radiologic technologists", "url": "https://www.mass.gov/regulations/105-CMR-12500-licensing-of-radiologic-technologists" }, { "title": "105 CMR 125.000 PDF (Mass. Register #1567, 02/13/2026)", "url": "https://www.mass.gov/doc/105-cmr-125-licensing-of-radiologic-technologists/download" }, { "title": "Division of Radiation Control (DRC)", "url": "https://www.mass.gov/orgs/division-of-radiation-control" }, { "title": "DRC application forms page", "url": "https://www.mass.gov/lists/radiation-control-program-application-forms" }, { "title": "NRC letter to MA DPH on proposed 105 CMR 120 revisions, May 22, 2025", "url": "https://www.nrc.gov/docs/ML2513/ML25134A203.pdf" }, { "title": "NRC Agreement State list", "url": "https://www.nrc.gov/agreement-states" }, { "title": "DPH Notice of Public Hearing, 105 CMR 125.000 (hosted by MSRT)", "url": "https://member.msrt-ma.org/wp-content/uploads/2025/02/Hearing-Notice.pdf" }, { "title": "MSRT Advocacy page (secondary)", "url": "https://member.msrt-ma.org/advocacy/" }, { "title": "Cornell LII, 105 CMR 120.211, 120.403 and 120.405 (secondary; matched the official PDF)", "url": "https://www.law.cornell.edu/regulations/massachusetts/105-CMR-120-403" }, { "title": "MA DPH Agency Information Notice 98-01 (1998; out of date)", "url": "https://www.mass.gov/doc/agency-information-notice-1998-01-demonstration-of-the-need-to-provide-monitoring-to/download" }, { "title": "Bill S.1637 (194th General Court)", "url": "https://malegislature.gov/Bills/194/S1637" } ] }, { "code": "MI", "name": "Michigan", "pageUrl": "https://orsif.org/guidelines/us/states/michigan", "regulator": { "name": "Radiation Safety Section, Technical Services Division, MIOSHA (Michigan Occupational Safety and Health Administration), Department of Labor and Economic Opportunity (LEO)", "url": "https://www.michigan.gov/leo/bureaus-agencies/miosha/divisions/technical-services-division/rad-safety" }, "nrcAgreementState": false, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Michigan's X-ray rules define ALARA but impose no operative ALARA requirement. Those rules cover only radiation machines, and Michigan is not an NRC Agreement State. Occupational dose limits match the NRC's, including a 150 mSv lens limit. Everyone in a fluoroscopy room except the patient must wear an apron of at least 0.5 mm lead equivalence. The rules are silent on engineered shielding, though secondary sources report a state certification of one engineered shielding system. Since March 13, 2024, non-physician operators must hold a recognized credential. There is no state license, and conditional status ends March 13, 2027.", "whereAlaraLives": { "category": "none", "explanation": "The ALARA definition appears only in the radiation-machine rules (R 333), which since 2016 apply only to machines, and no rule imposes it. The NRC regulates radioactive materials in Michigan directly. The status of the older R 325.5001 et seq. rules is unconfirmed.", "citation": "R 333.5002(5); LEO notice \"New Radiation Machine Rules Now Effective\" (5/25/2016)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "no", "answer": "No. Michigan is not an NRC Agreement State, so the NRC regulates radioactive materials there directly.", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Michigan Administrative Code R 333.5001-R 333.5721, \"Ionizing Radiation Rules Governing the Use of Radiation Machines.\" Most rules took effect 5/25/2016. R 333.5065 was amended in 2023 and Part 5 was added effective 3/13/2024. Part 3 contains the general protection standards, Part 7 covers medical X-ray (fluoroscopy at R 333.5337,.5347 and.5348) and Part 5 covers operator qualifications. The governing statute is MCL 333.13501 et seq.", "citation": "R 333.5051(1); R 333.5052", "sourceUrls": [ "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "This part applies to radiation machine registrants of the department.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "no", "answer": "ALARA is defined in R 333.5002(5), but no operative requirement to keep doses ALARA was found. The closest provisions are R 333.5093(1)(a) (instruction in precautions to minimize exposure) and R 333.5348(2) (only necessary people in the fluoroscopy room).", "citation": "R 333.5002(5)", "sourceUrls": [ "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "\"As low as reasonably achievable\" (ALARA) means making every reasonable effort to maintain exposures to radiation as far below the dose limits in these rules as is practical", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem), or 50 mSv per year, effective dose equivalent. Minors are limited to 10% of adult limits.", "citation": "R 333.5057(1)", "sourceUrls": [ "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "Rule 57. (1) A registrant shall control the occupational dose to individual adults, to the following dose limits : (a) An annual limit, which is the more limiting of the following: (i) The effective dose equivalent of 0.05 sievert (5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem), or 150 mSv per year. No lower limit has been adopted.", "citation": "R 333.5057(1)", "sourceUrls": [ "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "(i) A lens dose equivalent of 0.15 sieverts (15 rem). (ii) A shallow dose equivalent of 0.5 sievert (50 rem)", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem), or 500 mSv per year, shallow dose equivalent to the skin of the whole body or the extremities.", "citation": "R 333.5057(1)", "sourceUrls": [ "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "(i) A lens dose equivalent of 0.15 sieverts (15 rem). (ii) A shallow dose equivalent of 0.5 sievert (50 rem)", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (500 mrem) to the embryo/fetus of a declared pregnant woman over the entire pregnancy.", "citation": "R 333.5059(1)", "sourceUrls": [ "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "The registrant shall ensure that the dose equivalent to the embryo or fetus during the entire pregnancy, due to the occupational exposure of a declared pregnant woman, does not exceed 5 millisieverts (500 mrem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "The general rule requires a dosimeter for adults likely to exceed 10% of a limit, minors above set lower levels, declared pregnant women likely to exceed 1 mSv, and anyone entering a high radiation area. For diagnostic X-ray, every occupationally exposed person must be monitored. Under policy MIOSHA-RSS-118, only the operator of a mini C-arm needs a dosimeter.", "citation": "R 333.5064(a); R 333.5348(3); MIOSHA-RSS-118", "sourceUrls": [ "https://www.michigan.gov/leo/-/media/Project/Websites/leo/Documents/MIOSHA/RSS/RSS--100s/RSS-118_Dosimetry_for_Extremity_Fluoroscopy_Mini_CArms.pdf", "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "Personnel monitoring shall be performed in controlled areas for each individual occupationally exposed to ionizing radiation from diagnostic x-ray equipment.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "With an apron, the whole-body badge goes at the unshielded location of highest exposure, typically the neck. The lens badge goes at the neck or nearer the eye, and the fetal badge at the waist under the apron. With one collar badge, the deep dose counts as the effective dose, or the deep dose may be multiplied by 0.3 if it exceeds 25% of the limit. With two badges, effective dose is 1.5 × waist + 0.04 × neck. The department may approve other methods. R 333.5348(5) conflicts by saying badges are normally worn on the chest or abdomen.", "citation": "R 333.5057(3)(b); R 333.5065; R 333.5348(5)", "sourceUrls": [ "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "multiplied by 1.5 and the deep dose equivalent reported for the individual monitoring device located at the neck outside the protective apron multiplied by 0.04", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Everyone in a fluoroscopy room except the patient must wear an apron of at least 0.5 mm lead equivalence. Fixed fluoroscopes need drapes or panels of at least 0.25 mm lead equivalence. Mobile-unit operators need a 0.5 mm apron unless 1.6 mm portable shielding is provided. No thyroid shield or eyewear requirement was found.", "citation": "R 333.5348(1); R 333.5337(6); R 333.5353(2)", "sourceUrls": [ "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "An individual present in a fluoroscopic room, except the patient, shall wear a protective apron of at least 0.5 millimeter lead equivalence.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Michigan's rules require everyone in a fluoroscopy room except the patient to wear an apron of at least 0.5 mm lead equivalence. They do not require aprons or other protective clothing to be inspected or tested on any schedule. The general safety equipment rule only says protective clothing is presumed to be used properly, and that deliberately not using required safety equipment is a willful violation.", "citation": "R 333.5348 (fluoroscopy conditions of operation); R 333.5333 and R 333.5353 (radiographic and mobile conditions of operation); R 333.5075 (use of safety equipment)", "sourceUrls": [ "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "Unauthorized override of safety interlocks or other intentional misuse or non-use of required safety equipment shall be considered willful violation", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "unclear", "answer": "The rules do not address engineered shielding systems, and R 333.5348(1) requires aprons for everyone present. R 333.5015 allows exemptions where there is no undue hazard. Secondary sources report that Michigan certified one engineered shielding system for use without aprons, but no primary state record was found. Separately, the statute exempts operators of handheld dental X-ray systems from aprons under certain conditions (MCL 333.13527).", "citation": "R 333.5348(1); R 333.5015; MCL 333.13527", "sourceUrls": [ "https://scholarlyworks.corewellhealth.org/cardiology_confabstract/67/" ], "quote": "", "quoteMatchedToSource": true, "confidence": "low" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Facilities may not employ non-exempt people to perform medical radiologic technology unless they meet Part 5 or have the department's written approval. Article 15 licensed practitioners acting within their scope of practice, including physicians, are exempt. Whether PAs, NPs and RNs are covered is unclear. Technologists work under general supervision and students need direct supervision. Violations are cited against the facility.", "citation": "R 333.5201(2); R 333.5209(1); R 333.5206(1)", "sourceUrls": [ "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" ], "quote": "a registrant shall not employ an individual to perform medical radiologic technology who does not meet the requirements of this part", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "There is no state license or fluoroscopy permit, and none is planned. Operators need a recognized credential, such as ARRT (R) or CAMRT, or for cardiac and interventional work ARRT CV, CI or VI or CCI RCIS. Temporary status lasts up to 3 years after an approved program. Conditional status based on a signed statement of assurance ends March 13, 2027. Limited radiographers need 40 hours of training plus 12 CE credits every 24 months, and their categories exclude fluoroscopy. No fluoroscopy-specific training requirement for physicians was found.", "citation": "R 333.5210; R 333.5211(e); R 333.5212; R 333.5213", "sourceUrls": [ "https://www.michigan.gov/leo/-/media/Project/Websites/leo/Documents/MIOSHA/LESS/FAQs.pdf" ], "quote": "No, a license is not required, and a licensing program is not anticipated.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Draft rule set 2026-25 LE", "kind": "proposed_rule", "status": "Filed with JCAR in 2026 as a Draft Proposed Rule; hearing and adoption dates unconfirmed", "date": "", "dateISO": null, "summary": "Would amend Part 5 (R 333.5203,.5205,.5207,.5209,.5210,.5211): add an explicit licensed-practitioner exemption, add nurse-practitioner wording to a definition, say bone densitometry includes non-osseous tissue, and fix March 13, 2027 as the end of conditional status. Known from search excerpts only.", "sourceUrls": [ "https://council.legislature.mi.gov/JCAR/File?path=%2FJCARFiles%2F2026+Documents+Received%2FDraft+Proposed+Rules%2F2026-25+LE+Ionizing+Radiation+Rules_DraftRuleVersion_5.doc.htm" ] }, { "title": "Public Act 63 of 2025 (SB 136)", "kind": "bill", "status": "Enacted; effective March 24, 2026", "date": "2026-03-24", "dateISO": "2026-03-24", "summary": "Moves mammography standards into LEO rules, resets fees with CPI adjustment from October 1, 2026, and repeals the Radiation Advisory Board (MCL 333.13531).", "sourceUrls": [ "https://www.legislature.mi.gov/documents/2025-2026/billanalysis/House/pdf/2025-HLA-0136-MRYXBQ50.pdf" ] }, { "title": "Part 5 operator qualifications (R 333.5201-R 333.5213)", "kind": "adopted_rule", "status": "Adopted; effective 3/13/2024", "date": "2024-03-13", "dateISO": "2024-03-13", "summary": "Adds credential requirements for non-exempt operators.", "sourceUrls": [] }, { "title": "Amendment to R 333.5065", "kind": "adopted_rule", "status": "Adopted 2023", "date": "2023", "dateISO": "2023", "summary": "Amended dosimeter placement rule.", "sourceUrls": [] } ], "notable": [ "The radiation program sits inside MIOSHA, Michigan's workplace-safety agency.", "Part 4 (R 333.5091-.5101) covers instructions to workers, worker requests for inspection (R 333.5098) and employee protection (R 333.5101); only the section titles were seen.", "Registrants may not require routine radiation staff to hold patients (R 333.5333(3)).", "Only necessary people may be in the fluoroscopy room (R 333.5348(2)).", "The mini C-arm dosimetry policy (RSS-118) relaxes badge requirements for assisting staff.", "PA 63 of 2025 abolished the Radiation Advisory Board." ], "openQuestions": [ "Do R 325.5001-R 325.5721 still apply to any radioactive material in Michigan, and do they contain an ALARA requirement?", "Is ALARA imposed indirectly, for example through registration conditions, shielding-plan review or inspection guidance?", "What form did that certification take, and who does it cover?", "Do PAs, NPs and RNs fall under the R 333.5209(1) licensed-practitioner exemption, and what would draft 2026-25 LE change?", "How does the department enforce the conflict between R 333.5348(5) (chest or abdomen badge) and R 333.5065(a) (collar badge)?", "Are there 2025-26 bills on technologist licensure, aprons or shielding? A full legislative search was not run.", "The 2016 notice, MCL 333.13527 and the 2026-25 LE draft were read only through search excerpts; their text needs verification." ], "sources": [ { "title": "Michigan Administrative Rules System, R 333.5001-R 333.5721 (current, read 2026-11-03)", "url": "https://ars.apps.lara.state.mi.us/AdminCode/DownloadAdminCodeFile?FileName=R+333.5001+to+R+333.5721.pdf&ReturnHTML=True" }, { "title": "Office of Regulatory Reinvention, 2016 compiled rules (superseded in part)", "url": "https://dtmb.state.mi.us/ORRDocs/AdminCode/1305_2013-107LR_AdminCode.pdf" }, { "title": "LEO, About Radiation Safety Section", "url": "https://www.michigan.gov/leo/bureaus-agencies/miosha/divisions/technical-services-division/rad-safety/inside" }, { "title": "LEO, Radiation Safety Rules page (part effective dates)", "url": "https://www.michigan.gov/leo/bureaus-agencies/miosha/divisions/technical-services-division/rad-safety/radiation-safety-rules2" }, { "title": "LEO, Part 5 operator qualification FAQ", "url": "https://www.michigan.gov/leo/-/media/Project/Websites/leo/Documents/MIOSHA/LESS/FAQs.pdf" }, { "title": "MIOSHA-RSS-118, Dosimetry in Extremity Fluoroscopy", "url": "https://www.michigan.gov/leo/-/media/Project/Websites/leo/Documents/MIOSHA/RSS/RSS--100s/RSS-118_Dosimetry_for_Extremity_Fluoroscopy_Mini_CArms.pdf" }, { "title": "JCAR, draft rule set 2026-25 LE (search excerpts only)", "url": "https://council.legislature.mi.gov/JCAR/File?path=%2FJCARFiles%2F2026+Documents+Received%2FDraft+Proposed+Rules%2F2026-25+LE+Ionizing+Radiation+Rules_DraftRuleVersion_5.doc.htm" }, { "title": "Enrolled SB 136 (2025)", "url": "https://www.legislature.mi.gov/documents/2025-2026/billenrolled/Senate/pdf/2025-SNB-0136.pdf" }, { "title": "Senate Fiscal Agency analysis, SB 136", "url": "https://www.legislature.mi.gov/documents/2025-2026/billanalysis/Senate/pdf/2025-SFA-0136-G.pdf" }, { "title": "House Fiscal Agency analysis, PA 63 of 2025", "url": "https://www.legislature.mi.gov/documents/2025-2026/billanalysis/House/pdf/2025-HLA-0136-MRYXBQ50.pdf" }, { "title": "MCL 333.13527 (search excerpt only)", "url": "https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-333-13527" }, { "title": "Corewell Health conference abstract on an engineered shielding system (secondary)", "url": "https://scholarlyworks.corewellhealth.org/cardiology_confabstract/67/" }, { "title": "PMC review on cath lab radiation protection (secondary)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12060925/" }, { "title": "Health Physics Society, Webster formula (secondary)", "url": "https://hps.org/publicinformation/ate/q10019/" } ] }, { "code": "MN", "name": "Minnesota", "pageUrl": "https://orsif.org/guidelines/us/states/minnesota", "regulator": { "name": "Minnesota Department of Health, Radiation Control, X-ray Unit (Environmental Health)", "url": "https://www.health.state.mn.us/communities/environment/radiation/xray/index.html" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Minnesota regulates X-ray and fluoroscopy under Minnesota Rules chapter 4732, separate from radioactive materials (chapter 4731), with its own ALARA requirement (4732.0530), so an NRC-driven change to 4731 would not automatically change it. Occupational limits are 50 mSv whole body, 150 mSv lens, and 500 mSv skin/extremity per year. Anyone in the room during fluoroscopy must wear a garment of at least 0.5 mm lead equivalent, garments must be checked at least every 24 months, and engineered shielding may not replace garments unless the Minnesota Department of Health grants a variance after the facility shows equal protection. Fluoroscopy may be run by licensed practitioners, physician assistants, radiologist assistants, and exam passers (ARRT radiography), while limited-scope operators are barred and cardiovascular technologists may not activate the beam.", "whereAlaraLives": { "category": "xray_specific", "explanation": "The X-ray ALARA duty is in chapter 4732 (part 4732.0530), which excludes radioactive materials. Licensees have a separate radiation protection program requirement in 4731.2010. No shared part applies to both, so an NRC-driven change to chapter 4731 would not automatically change 4732.0530. The 4731 ALARA definition refers to \"licensed or registered\" activity, but chapter 4731 is limited to radioactive materials.", "citation": "Minn. R. 4732.0530 (X-ray); Minn. R. 4731.2010 (radioactive materials)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Minnesota is an NRC Agreement State.", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Minnesota Rules chapter 4732, \"Ionizing Radiation,\" covers radiation-producing equipment; radioactive materials are excluded and covered by chapter 4731. X-ray dose standards are in parts 4732.0400-4732.0440, safety parts in 4732.0500-4732.0590, and fluoroscopy rules in 4732.0825 and 4732.0830. Statutory authority is Minn. Stat. § 144.121. Most parts date from 2007 (32 SR 777); 4732.0110 shows October 13, 2021.", "citation": "Minn. R. 4732.0100, subp. 2", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0100/" ], "quote": "The scope of this chapter does not include those sources of ionizing radiation known as radioactive materials, which are covered under chapter 4731.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Registrants must use procedures and engineering controls to keep occupational and public doses ALARA. ALARA is defined in 4732.0110, subp. 11, and 4732.0550, subp. 1(C) applies ALARA to patient exposure.", "citation": "Minn. R. 4732.0530 (ALARA Program)", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0530/" ], "quote": "The registrant must use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and dose to the public that are as low as is reasonably achievable and do not exceed the dose limits in parts 4732.0410 to 4732.0430.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) total effective dose equivalent per year.", "citation": "Minn. R. 4732.0410, subp. 2", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0410/" ], "quote": "the total effective dose equivalent being equal to five rem (0.05 Sv)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) lens dose equivalent per year; no lower ICRP 20 mSv limit has been adopted.", "citation": "Minn. R. 4732.0410, subp. 2", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0410/" ], "quote": "a lens dose equivalent of 15 rem (0.15 Sv); and", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) shallow dose equivalent to the skin or any extremity per year.", "citation": "Minn. R. 4732.0410, subp. 2", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0410/" ], "quote": "a shallow dose equivalent of 50 rem (0.5 Sv) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant woman over the whole pregnancy, with a reasonable effort to stay at or below 0.05 rem (0.5 mSv) per month.", "citation": "Minn. R. 4732.0415", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0415/" ], "quote": "does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Dosimeters must be supplied and worn by: adults likely to exceed 10% of the 4732.0410 limits in a year; declared pregnant women likely to exceed 0.1 rem (1.0 mSv) over the pregnancy; anyone entering a high or very high radiation area; and minors likely to exceed 0.1 rem (1.0 mSv) in a year. Badges may not be shared, and workers get an annual written dose report.", "citation": "Minn. R. 4732.0440, subps. 1, 2, 14", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0440/" ], "quote": "adults likely to receive in one year, a dose in excess of ten percent of the limits in part 4732.0410;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "With an apron, the badge is worn at the collar outside the apron. If more than one badge is worn, records must show each badge's location and whether it was over or under the apron. A declared pregnant worker wears an abdomen badge under the lead. Whole-body dose methods are: (1) single collar badge deep dose taken as whole-body dose; (2) single collar badge deep dose × 0.3; (3) two badges: 1.5 × waist badge under the apron + 0.04 × collar badge outside the apron. Other methods need commissioner approval. Items (1) and (2) conflict, which appears to be a drafting error. The rule does not name NCRP Report 122 or Webster.", "citation": "Minn. R. 4732.0440, subp. 3; 4732.0410, subp. 4(C)-(D)", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0440/" ], "quote": "when a protective apron is worn, the individual monitoring device must be worn at the collar outside of the protective apron;", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Required. Anyone in the room during fluoroscopy must wear a garment of at least 0.5 mm lead equivalence; this is repeated for over-table units and portable C-arms (4732.0825, subp. 8(C)-(D)). No body part may be in the useful beam unless covered by 0.5 mm lead equivalent. Thyroid and eye protection is required only if the worker's potential exposure would exceed the 4732.0410 limits. Personal protective garments include aprons, gloves and thyroid collars.", "citation": "Minn. R. 4732.0825, subp. 3(C); 4732.0510, subp. 3(C)", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0825/" ], "quote": "any individual who is in the room during a fluoroscopic procedure must wear a protective garment of not less than 0.5 millimeter lead equivalence; and", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. Protective garments must be checked for integrity when first put into use and at least every 24 months, with records kept. The rule sets no method or pass/fail standard. MDH guidance says checks may be done with fluoroscopy and that MDH has no rule defining failure.", "citation": "Minn. R. 4732.0550, subp. 1(F)-(G); MDH Chiropractic and Veterinary Regulatory Guides (guidance, not rule)", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0550/" ], "quote": "Personal protective garments must be monitored for integrity initially and at intervals not to exceed 24 months.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "no", "answer": "Minnesota's rules do not allow an engineered shielding system to replace protective garments. Everyone in the room during fluoroscopy must wear a garment of at least 0.5 mm lead equivalent, and shields, drapes and barriers are required in addition to it, not instead of it. A facility that wants to use other protective measures can only do so by asking the Minnesota Department of Health for a variance (an exception to the rule), and it must show the alternative protects people just as well.", "citation": "Minn. R. 4732.0825, subp. 3, item C; see also subp. 8, items B and C, and part 4732.0308 (variance)", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0825/" ], "quote": "any individual who is in the room during a fluoroscopic procedure must wear a protective garment of not less than 0.5 millimeter lead equivalence; and", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "These may operate: licensed practitioners of the healing arts, physician assistants, registered radiologist assistants or radiology practitioner assistants, and people who passed an exam under § 144.121, subd. 5 (e.g., ARRT radiography). Limited-scope operators may not use fluoroscopy. Cardiovascular technologists may assist under personal supervision but may not activate the beam. No general physician-supervision rule for technologists was found, and nurse practitioner status is unresolved.", "citation": "Minn. R. 4732.0500, subp. 3; 4732.0580; Minn. Stat. § 144.121, subds. 5, 5a, 5c (2025 Statutes)", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0500/" ], "quote": "Only those individuals who are licensed practitioners of the healing arts, physician assistants, registered radiologic assistants or radiology practitioner assistants, or individuals who have successfully passed an examination under Minnesota Statutes, section 144.121, subdivision 5, may apply radiation to an individual.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "Non-practitioners must pass a national or state exam (effectively ARRT radiography for fluoroscopy). Anyone who activates a fluoroscope, except licensed practitioners, must be trained and documented in ten topics (items A-J). All operators get facility- and system-specific instruction at the start and when the QA program or radiation output changes. No state fluoroscopy permit, minimum hours, continuing education, or physician fluoroscopy training was found.", "citation": "Minn. R. 4732.0825, subp. 2; 4732.0510, subp. 1; 4732.0570; Minn. Stat. § 144.121, subd. 5", "sourceUrls": [ "https://www.revisor.mn.gov/rules/4732.0825/" ], "quote": "Except licensed practitioners of the healing arts, any individual activating the fluoroscopic system must be trained in the aspects of fluoroscopic equipment use listed in items A to J.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Chapter 4732 rewrite (Request for Comments)", "kind": "other", "status": "Request for Comments published; no draft available; comments accepted until further notice", "date": "July 27, 2026", "dateISO": "2026-07-27", "summary": "MDH restarted a full rewrite of chapter 4732 (begun 2016, paused 2020) with a Request for Comments in the State Register Vol. 51, No. 4. Topics: equipment technology, operator scope of practice, service providers, inspections. Page last updated 08/27/2026.", "sourceUrls": [ "https://www.health.state.mn.us/communities/environment/radiation/xray/rules/xrayrulerev.html" ] }, { "title": "2025 First Special Session ch. 3, art. 1 amending § 144.121", "kind": "bill", "status": "enacted", "date": "July 1, 2025", "dateISO": "2025-07-01", "summary": "Amended § 144.121; MDH lists statutory fee increases effective July 1, 2025.", "sourceUrls": [] }, { "title": "Laws 2026 ch. 95, art. 2 amending § 144.121", "kind": "bill", "status": "enacted", "date": "", "dateISO": null, "summary": "Amended § 144.121 subd. 1a (fees) and subd. 9 (security-screening exemption). Appears unrelated to fluoroscopy staff; session-law text not read.", "sourceUrls": [ "https://www.revisor.mn.gov/laws/2026/0/95/laws.7.12.0" ] } ], "notable": [ "Anyone likely to exceed 100 mrem (1.0 mSv) a year must be told about radiation use, instructed in protection, and told to report violations (4732.0510, subp. 2(B)).", "Fluoroscopes require a bucky-slot cover and drapes or self-supporting shields, plus high-level-control limits and minimum source-to-skin distances (4732.0825).", "Dose records are kept for the worker's lifetime or 30 years after the job ends, whichever is less.", "A worker with an off-scale badge may not return to work until the dose is assessed.", "Registrants must subtract dose a worker received at other employers (4732.0410, subps. 5-6).", "Service technicians may not do performance evaluations on fluoroscopy equipment (§ 144.121, subd. 10).", "Single-collar-badge methods in 4732.0410, subp. 4(C)(1) and (2) conflict; this appears to be a drafting error.", "Parts 4732.0320 (employee protection) and 4732.0830 (dose-area-product monitor) were seen only as titles." ], "openQuestions": [ "Which single-collar-badge method in 4732.0410, subp. 4(C)(1) vs (2) MDH inspectors apply; compare against the official chapter 4732 PDF.", "Content of the 2014 MDH notice \"Protective Barrier Use in Fluoroscopic Examinations\" (infnotfluoro.pdf) on whether barriers can replace aprons.", "Whether variance part 4732.0308 or Minn. R. 4717.7000-.7050 has been used to approve apron-free work with engineered shielding.", "Whether physician presence or supervision is required when technologists run fluoroscopy (MDH notice \"Operation of Fluoroscopic X-ray Equipment\"), and whether APRNs are \"qualified practitioners\" under § 144.121, subd. 5(b)(12).", "Exact text and effective dates of Laws 2026 ch. 95, art. 2, §§ 2-3.", "Watch for a draft rule or Notice of Intent to Adopt for chapter 4732.", "Current primary text of 4731.2010, subp. 2, and the chapter 4731 dose limits." ], "sources": [ { "title": "MN Revisor, Minnesota Rules ch. 4732 (full; page cut off partway)", "url": "https://www.revisor.mn.gov/rules/4732/full" }, { "title": "MN Revisor, Minn. R. 4732 individual parts (e.g., 4732.0530)", "url": "https://www.revisor.mn.gov/rules/4732.0530/" }, { "title": "MN Revisor, Minn. Stat. § 144.121 (2025 Statutes)", "url": "https://www.revisor.mn.gov/statutes/cite/144.121" }, { "title": "MN Revisor, Minn. R. 4731.2010 (search snippet)", "url": "https://www.revisor.mn.gov/rules/4731.2010/" }, { "title": "Cornell LII, Minn. R. 4731.2010 (secondary)", "url": "https://www.law.cornell.edu/regulations/minnesota/Minn-R-4731-2010" }, { "title": "MDH X-ray Program", "url": "https://www.health.state.mn.us/communities/environment/radiation/xray/index.html" }, { "title": "MDH X-ray Rulemaking, Chapter Revision", "url": "https://www.health.state.mn.us/communities/environment/radiation/xray/rules/xrayrulerev.html" }, { "title": "MDH X-ray Rules Request for Comments", "url": "https://www.health.state.mn.us/communities/environment/radiation/xray/rules/xrayrulerequest.html" }, { "title": "MDH Chiropractic X-ray Regulatory Guide (July 1, 2025; search snippets)", "url": "https://www.health.state.mn.us/communities/environment/radiation/docs/xray/guidance/chiroregguide.pdf" }, { "title": "MDH Veterinary X-ray Regulatory Guide (search snippets)", "url": "https://www.health.state.mn.us/communities/environment/radiation/docs/xray/guidance/vetregguide.pdf" }, { "title": "MN Revisor, Laws 2026 ch. 95 (search snippet only)", "url": "https://www.revisor.mn.gov/laws/2026/0/95/laws.7.12.0" } ] }, { "code": "MS", "name": "Mississippi", "pageUrl": "https://orsif.org/guidelines/us/states/mississippi", "regulator": { "name": "Mississippi State Department of Health (MSDH), Division of Radiological Health, X-ray Branch", "url": "https://msdh.ms.gov/programs-services/environmental-permits-and-regulations/radiological-health" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Mississippi adopts 'the current revision' of 10 CFR Part 20, including ALARA, by reference and applies it to X-ray registrants as well as materials licensees, so an NRC removal of ALARA could carry over; whether that happens automatically or needs state rulemaking is unsettled. Fluoroscopy workers have the federal dose limits, including the 150 mSv/year lens limit. Staff must be protected by aprons 'or whole body protective barriers' of at least 0.25 mm lead equivalent, and the rules do not require apron inspection or address thyroid shields, eyewear or engineered systems. Medical radiation technologists must register with MSDH, while licensed practitioners and permitted Limited X-Ray Machine Operators working under a practitioner's direction are exempt, and the rules do not set out a fluoroscopy-specific operator permit or physician training rule.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The explicit ALARA requirement comes only through Subchapter 4, which adopts 10 CFR 20.1101 for licensees and registrants alike; the definition is in general Rule 1.1.2. Subchapter 6 does not use the term ALARA but requires procedures and equipment that minimize patient and personnel exposure (Rule 1.6.3(1)(i)). Because Rule 1.4.1 adopts 'the current revision' of Part 20, an NRC change could carry over to X-ray registrants; whether that happens automatically is unsettled.", "citation": "Rule 1.4.1; Rule 1.1.2(14); Rule 1.6.3(1)(i)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes, Mississippi is an NRC Agreement State; the rules also refer to the state-NRC agreement.", "citation": "NRC list of Agreement States, updated October 29, 2026; 15 Miss. Admin. Code Pt. 21, Subpt. 78, Ch. 1, Rule 1.1.1, footnote 1", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.sos.ms.gov/adminsearch/ACCode/00000213c.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Title 15, Part 21, Subpart 78, Chapter 1, 'Regulations for Control of Radiation in Mississippi'. X-ray/fluoroscopy rules are in Subchapter 6 (Rules 1.6.1-1.6.10; Rule 1.6.3 general requirements, Rule 1.6.5 fluoroscopic systems). Standards for protection against radiation are in Subchapter 4, Rule 1.4.1, which adopts most of 10 CFR Part 20 by reference. The Secretary of State PDF has file metadata dated 7 Oct 2024, but the text shows no overall effective date.", "citation": "15 Miss. Admin. Code 21-78-1.4.1; 21-78-1.6.1 to 1.6.10", "sourceUrls": [ "https://www.sos.ms.gov/adminsearch/ACCode/00000213c.pdf" ], "quote": "This Regulation adopts by reference the current revision of the following sections in Title 10 Code of Federal Regulations Part 20", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Rule 1.4.1 adopts 10 CFR 20.1101(b), which requires ALARA. Rule 1.4.1(2) applies all of Subchapter 4 to registrants, and 'licensee' in Part 20 includes 'registrant'. Rule 1.1.2(14) also defines ALARA.", "citation": "Rule 1.4.1 and 1.4.1(2); 10 CFR 20.1101(b) as adopted; Rule 1.1.2(14)", "sourceUrls": [ "https://www.sos.ms.gov/adminsearch/ACCode/00000213c.pdf" ], "quote": "All of the requirements in Subchapter 4 apply to both licensees and registrants.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "TEDE of 5 rem (50 mSv) per year, or 50 rem (500 mSv) to any organ other than the lens, whichever is more limiting (10 CFR 20.1201, adopted by Rule 1.4.1).", "citation": "10 CFR 20.1201(a)(1), adopted by Rule 1.4.1", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" ], "quote": "An annual limit, which is the more limiting of - ( i ) The total effective dose equivalent being equal to 5 rems (0.05 Sv); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year. No lower limit (such as 20 mSv) has been adopted.", "citation": "Rule 1.4.1 adopting 10 CFR 20.1201", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" ], "quote": "(i) A lens dose equivalent of 15 rems (0.15 Sv), and (ii) A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) per year shallow-dose equivalent to the skin or any extremity.", "citation": "Rule 1.4.1 adopting 10 CFR 20.1201", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" ], "quote": "(i) A lens dose equivalent of 15 rems (0.15 Sv), and (ii) A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant worker over the whole pregnancy.", "citation": "10 CFR 20.1208(a), adopted by Rule 1.4.1", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" ], "quote": "The licensee shall ensure that the dose equivalent to the embryo/fetus during the entire pregnancy, due to the occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Dosimeters are required for adults likely to receive more than 10% of the 20.1201(a) limits in a year, minors above set thresholds, and declared pregnant workers likely to receive more than 0.1 rem (1 mSv) deep dose over the pregnancy. Rule 1.6.3(1)(j) also makes everyone associated with operating an X-ray system subject to the monitoring rules.", "citation": "Rule 1.4.1 adopting 10 CFR 20.1502; Rule 1.6.3(1)(j)", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-F/section-20.1502" ], "quote": "Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of the limits in § 20.1201(a)", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "When an apron is worn, at least one badge must be worn at the collar outside the apron. The whole-body dose, based on the maximum dose to the most critical organ, must be recorded. If more than one badge is used, each dose must be identified with where it was worn; no two-badge formula is set. EDE requires a method approved by MSDH (substituted for NRC), but no named method was found. Rule 1.6.3(1)(j) cites rules 1.4.5-1.4.7, which no longer exist in Subchapter 4.", "citation": "Rule 1.6.3(1)(j)(i); Rule 1.4.1(3); 10 CFR 20.1201(c)", "sourceUrls": [ "https://www.sos.ms.gov/adminsearch/ACCode/00000213c.pdf" ], "quote": "When an apron is worn, the monitoring device shall be worn at the collar outside of the apron.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Staff in the room must be protected from direct scatter by aprons or whole-body barriers of at least 0.25 mm lead equivalent; body parts struck by the useful beam need at least 0.5 mm. Facilities must supply enough leaded aprons and gloves. For fluoroscopy, 0.25 mm lead equivalent is required against under-table scatter, and an additional 0.25 mm against above-table scatter on top of the apron unless the person is at least 120 cm from the beam center. Thyroid shields and eyewear are not mentioned in Subchapter 6.", "citation": "Rule 1.6.3(1)(e)(i)-(ii), (h)(vii); Rule 1.6.5(8)", "sourceUrls": [ "https://www.sos.ms.gov/adminsearch/ACCode/00000213c.pdf" ], "quote": "shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent material.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Mississippi's X-ray rules require staff in the room to wear protective aprons or use whole body barriers of at least 0.25 mm lead equivalent, and require facilities to keep enough leaded aprons and gloves for all unshielded personnel. The rules do not require protective aprons or other apparel to be inspected on a schedule, by fluoroscopy, by eye or in any other way.", "citation": "15 Miss. Code R. 21-78-1.6.3 (General and Administrative Requirements), Subchapter 6, X-Rays in the Healing Arts", "sourceUrls": [ "https://www.law.cornell.edu/regulations/mississippi/15-Miss-Code-R-SS-21-78-1-6-3" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Not addressed by name; there is no engineered-system or apron-free provision. The rule allows 'protective aprons or whole body protective barriers', and 'whole body protective barrier' is not defined beyond the general 'protective barrier' definition. Drapes, Bucky-slot covers and curtains are listed for above-table scatter in addition to the apron.", "citation": "Rule 1.6.3(1)(e)(ii); Rule 1.6.2(66); Rule 1.6.5(8)(b)(ii)", "sourceUrls": [ "https://www.sos.ms.gov/adminsearch/ACCode/00000213c.pdf" ], "quote": "the radiation has passed through not less than 0.25 millimeter lead equivalent material including, but not limited to, drapes, Bucky-slot cover panel, or self-supporting curtains, in addition to any lead equivalency provided by the protective apron", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "X-ray use is by or under the supervision of a licensed healing-arts practitioner, and fluoroscopy is run by a switch held by 'the fluoroscopist'. Medical radiation technologists must be registered with MSDH. Exempt are licensed practitioners acting within their scope, supervised students, and Board of Medical Licensure 'Limited X-Ray Machine Operator' permit holders working under a licensed practitioner's specific direction. PA/NP fluoroscopy rules and whether limited operators may do fluoroscopy were not found.", "citation": "Rule 1.6.1; Rule 1.6.5(2); 15 Miss. Admin. Code 19-60-7.6.1 (authority Miss. Code Ann. §41-58-3)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/mississippi/15-Miss-Code-R-SS-19-60-7-6-1" ], "quote": "No person shall practice medical radiation technology unless he is registered by the Department, except as otherwise provided in this section.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Operators must be adequately instructed and competent; Appendix A lists the subjects, including personnel protection and dosimetry, and MSDH may check by interview, observation or testing. No fluoroscopy permit, training-hours rule or physician fluoroscopy training rule was found. A secondary source says technologist registration rests on ARRT credentials with 24 hours of CE every 2 years; this is unconfirmed.", "citation": "Rule 1.6.3(1)(b); Subchapter 6 Appendix A", "sourceUrls": [ "https://www.sos.ms.gov/adminsearch/ACCode/00000213c.pdf" ], "quote": "Individuals who will be operating the x-ray systems shall be adequately instructed in the safe operating procedures and be competent in the safe use of the equipment.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "MSDH final revisions to radiation subchapters (NRC review, Tracking Ticket 25-25)", "kind": "other", "status": "Sent to NRC 1 Apr 2025; NRC replied 21 Jan 2026 with three comments", "date": "2026-01-21", "dateISO": "2026-01-21", "summary": "One NRC comment says Mississippi's own definitions in Rule 1.1.2 (which include the state ALARA definition) duplicate or conflict with the adopted federal definitions and should be removed from one place or the other. These are radioactive-materials compatibility items, not X-ray changes.", "sourceUrls": [ "https://www.nrc.gov/docs/ML2602/ML26021A068.pdf" ] }, { "title": "NRC proposed ALARA rule", "kind": "proposed_rule", "status": "Proposed", "date": "2026-07-15", "dateISO": "2026-07-15", "summary": "If finalized, it would reach Mississippi registrants through the 'current revision' wording in Rule 1.4.1.", "sourceUrls": [] }, { "title": "Miss. Code §41-58-3 sunset", "kind": "other", "status": "Justia's 2024 code lists it as repealed effective 7/1/2028; HB 259 (2023) was titled as deleting the sunset", "date": "2028-07-01", "dateISO": "2028-07-01", "summary": "Possible sunset of the medical radiation technologist law; status unresolved.", "sourceUrls": [ "https://law.justia.com/codes/mississippi/title-41/chapter-58/" ] } ], "notable": [ "Appendix C automatically exempts certain procedures (angiograms, myelograms, arthrograms, biliary drainage, nephrostomies, fluoroscopic biopsies) from the above-table scatter shielding rule 1.6.5(8)(b); MSDH may not grant the exemption where pre-fitted sterile barrier covers are practical.", "A qualified expert must measure and post fluoroscopic entrance exposure rates every year.", "Fluoroscopes need a 5-minute cumulative timer with an audible signal.", "Rule 1.6.3(1)(j) cross-references Rules 1.4.5-1.4.7, which no longer exist in Subchapter 4.", "No 2025-2026 X-ray rule changes or 2026 fluoroscopy/apron bills were found, based on limited searching." ], "openQuestions": [ "Does Rule 1.4.1's adoption of 'the current revision' of Part 20 pick up later NRC changes automatically under Mississippi law, or must MSDH re-adopt them? Ask MSDH Radiological Health or check Miss. Code §25-43.", "What is the effective date of the current Chapter 1 text, and did MSDH re-file it after the NRC's January 2026 comments? Check the Administrative Bulletin and msdh.ms.gov/page/resources/7544.pdf.", "What authority do PAs/NPs and limited operators have for fluoroscopy, and what are the ARRT and continuing-education requirements? Needs MSDH Chapter 7 (7.1.2, 7.3, 7.5), Board of Medical Licensure Part 2621, and Miss. Code §41-58-1 to -5.", "Is there a technologist law sunset? HB 259 (2023) was titled as deleting it, but Justia lists a 7/1/2028 repeal.", "Does MSDH read 'whole body protective barriers' to include engineered systems used instead of aprons?" ], "sources": [ { "title": "MS Admin. Code Title 15, Part 21, Subpart 78, Ch. 1 (Secretary of State PDF)", "url": "https://www.sos.ms.gov/adminsearch/ACCode/00000213c.pdf" }, { "title": "Cornell LII, 15 Miss. Code R. 21-78-1.6.3", "url": "https://www.law.cornell.edu/regulations/mississippi/15-Miss-Code-R-SS-21-78-1-6-3" }, { "title": "Cornell LII, 15 Miss. Code R. 19-60-7.6.1 (Exceptions)", "url": "https://www.law.cornell.edu/regulations/mississippi/15-Miss-Code-R-SS-19-60-7-6-1" }, { "title": "eCFR 10 CFR 20.1101", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-B/section-20.1101" }, { "title": "eCFR 10 CFR Part 20, Subpart C", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" }, { "title": "eCFR 10 CFR 20.1502", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-F/section-20.1502" }, { "title": "NRC letter to MSDH, 21 Jan 2026", "url": "https://www.nrc.gov/docs/ML2602/ML26021A068.pdf" }, { "title": "Justia, Miss. Code Title 41, Ch. 58 index", "url": "https://law.justia.com/codes/mississippi/title-41/chapter-58/" }, { "title": "Fusion Medical Staffing, MS radiology license guide (secondary)", "url": "https://www.fusionmedstaff.com/licenses/radiology/mississippi/" } ] }, { "code": "MO", "name": "Missouri", "pageUrl": "https://orsif.org/guidelines/us/states/missouri", "regulator": { "name": "Missouri Radiation Control Program (MRCP), Section for Health Standards and Licensure, Missouri Department of Health and Senior Services (DHSS)", "url": "https://health.mo.gov/providers/radiation-control" }, "nrcAgreementState": false, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Missouri's X-ray rules (19 CSR 20-10, filed in 1964 and never amended) contain no ALARA wording; the closest is a state statute barring exposure to \"unnecessary radiation.\" The rules use old-style dose limits: 5 rems (50 mSv) a year for the whole body, with the lens of the eye included, and there is no embryo/fetus limit and no way for a worker to declare a pregnancy. Aprons, apron inspections, thyroid shields and eyewear are not required, and engineered shielding systems are not mentioned; the only fluoroscopy shielding rule requires shielding such as curtains, used as needed, to keep the dose rate to the fluoroscopist and assistants at or below 50 mR per hour. There is no state operator license or training requirement, except for mammography.", "whereAlaraLives": { "category": "none", "explanation": "ALARA appears nowhere in the rules. 19 CSR 20-10 is a single chapter shared by radiation machines and radioactive materials. Missouri is not an Agreement State, so NRC Part 20 changes do not pull through. The only related principle is the statutory \"unnecessary radiation\" wording in RSMo 192.430, which applies to all sources of radiation.", "citation": "19 CSR 20-10 (whole chapter); RSMo 192.430" }, "eyeLensLimitMsv": 50, "answers": { "agreement_state": { "question": "Agreement State", "status": "no", "answer": "No. Missouri is not an NRC Agreement State; DHSS sends radioactive-materials questions to NRC Region III, and the state rules exempt NRC-licensed sources.", "citation": "NRC list of Agreement States, updated October 29, 2026; 19 CSR 20-10.020(1)(E)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "19 CSR 20-10 (\"Protection Against Ionizing Radiation\"), sections.010-.200, is the only general radiation protection chapter. Relevant sections are.040,.050,.060,.120,.130 and.190. The statute is RSMo 192.400-192.490. The text is in force but very outdated: it was filed in 1964 and shows no amendments.", "citation": "19 CSR 20-10.010-.200", "sourceUrls": [ "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" ], "quote": "Original rule filed Nov. 9, 1964, effective Dec. 9, 1964.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "no", "answer": "No. The rules contain no ALARA or similar wording. The statute has a general prohibition on exposure to \"unnecessary radiation,\" which is not ALARA's optimization-below-the-limits wording.", "citation": "RSMo 192.430", "sourceUrls": [ "https://revisor.mo.gov/main/OneSection.aspx?bid=9782&hl=§ion=192.430" ], "quote": "All sources of radiation shall be shielded, transported, handled, used and kept so as to prevent all users thereof and all persons within effective range of them from being exposed to unnecessary radiation.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rems (50 mSv) per year and 3 rems (30 mSv) per quarter for the whole body. Higher annual doses are allowed under conditions: the quarterly limit is met, prior dose is determined, and the lifetime total stays under MPAD = (N-18) × 5 rems. The research infers this could reach 12 rems (120 mSv) a year. The public limit is 0.5 rem (5 mSv) a year.", "citation": "19 CSR 20-10.040(1), Table I, (1)(A)-(C), (3)", "sourceUrls": [ "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" ], "quote": "During any calendar quarter, the maximum dose of three (3) rems, listed in Column B of Table I, is not exceeded;", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "partial", "answer": "There is no separate lens limit. The lens is grouped with the whole body at 5 rems (50 mSv) a year, subject to the same exception. There is no 20 mSv ICRP limit.", "citation": "19 CSR 20-10.040(1), Table I", "sourceUrls": [ "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" ], "quote": "Whole body, head and trunk, major portion of the bone marrow, gonads or lens of eye.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Skin of a large body area: 30 rems (300 mSv) per year and 10 rems (100 mSv) per quarter. Hands and forearms, feet and ankles: 75 rems (750 mSv) per year and 25 rems (250 mSv) per quarter.", "citation": "19 CSR 20-10.040(1), Table I", "sourceUrls": [ "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" ], "quote": "Whole body, head 5 rems 3 rems and trunk, major portion of the bone marrow, gonads or lens of eye. Skin of large body 30 rems 10 rems area. Hands and forearms, 75 rems 25 rems feet and ankles", "quoteMatchedToSource": true, "confidence": "medium" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "no", "answer": "No. Missouri's rules set no separate dose limit for the embryo or fetus of a pregnant worker, and they have no way for a worker to declare a pregnancy. Pregnant workers fall under the general worker limits.", "citation": "19 CSR 20-10.040 (Maximum Permissible Exposure Limits); full chapter 19 CSR 20-10", "sourceUrls": [ "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "A dosimeter is required for anyone who could reasonably receive more than 50 millirems (0.5 mSv) in a week, taking aprons into account. The research calculates this as about 26 mSv a year. Monitoring of radiation-machine workers is not required if a Qualified Expert sets operating conditions under which no one could exceed 25 mrem in 7 days or 325 mrem in 13 weeks.", "citation": "19 CSR 20-10.050(1), (3), (4)", "sourceUrls": [ "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" ], "quote": "Personnel monitoring shall be required for each individual for whom there is any reasonable possibility of receiving a weekly dose of all radiation exceeding fifty (50) millirems, taking into consideration the use of protective gloves, aprons or other radiation-limiting devices.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "no", "answer": "No. The rules do not say where workers who wear aprons must place their badge, and they set no two-badge method or method for estimating whole-body dose. Aprons and gloves are only taken into account when deciding whether a worker needs to wear a badge at all.", "citation": "19 CSR 20-10.050 (Personnel Monitoring and Radiation Surveys)", "sourceUrls": [ "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" ], "quote": "taking into consideration the use of protective gloves, aprons or other radiation-limiting devices.", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "partial", "answer": "Aprons, a minimum lead equivalence, thyroid shields and eyewear are not required. The only fluoroscopy rule on staff protection requires accessory shielding, including shielding between patient and fluoroscopist, as needed to keep the dose rate at the fluoroscopist's and assistants' position at or below 50 mR/hour. The ambulatory surgical center rule also references NCRP recommendations.", "citation": "19 CSR 20-10.130(2)", "sourceUrls": [ "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" ], "quote": "Accessory shielding devices (such as cones, curtains, bucky slot covers, shielding between patient and fluoroscopist) shall be used as required to reduce the exposure dose rate to not more than fifty (50) milliroentgens per hour", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "No. Missouri's rules do not require protective aprons or other protective clothing to be inspected. Facilities with fluoroscopy must have a yearly radiation survey by a qualified expert, but neither the rules nor the state's survey guidance say that the survey covers aprons.", "citation": "19 CSR 20-10.050 and 19 CSR 20-10.130; MRCP Qualified Expert FAQ", "sourceUrls": [ "https://health.mo.gov/sites/health/files/media/pdf/2026/03/QE-FAQ_0.pdf" ], "quote": "Class A: Annual surveys: These include licensed Hospitals; licensed Ambulatory Surgery Centers; any facility with the following type of equipment: CT, fluoroscopy, radiation therapy, mammography;", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Missouri's rules do not mention engineered shielding systems and do not require aprons. The fluoroscopy rule instead requires shielding devices, such as curtains and shielding between the patient and the fluoroscopist, to be used as needed to keep the dose rate where staff stand at or below 50 milliroentgens per hour.", "citation": "19 CSR 20-10.130(2)", "sourceUrls": [ "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" ], "quote": "(2) Accessory shielding devices (such as cones, curtains, bucky slot covers, shielding between patient and fluoroscopist) shall be used as required to reduce the exposure dose rate to not more than fifty (50) milliroentgens per hour in the area adjacent to the machine", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "no", "answer": "No state limit on who may operate fluoroscopy, and no X-ray operator license exists. Exceptions: mammography requires ARRT registration, and Medicare-certified portable X-ray suppliers must use ARRT-registered operators. DHSS reads the statute to require a licensed practitioner's order for medical X-rays.", "citation": "MRCP guidance \"Requirements for X-ray Operators in Missouri\"; MRCP guidance on physician orders (last revised Aug 2015)", "sourceUrls": [ "https://health.mo.gov/sites/health/files/media/pdf/2026/03/xray-operator-requirements.pdf" ], "quote": "In other words, a person does NOT have to be licensed to operate x-ray equipment, and in fact no such license exists in Missouri.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "no", "answer": "No statewide fluoroscopy training requirement exists, and standards are largely left to each facility. Mammography is the exception.", "citation": "MRCP guidance \"Requirements for X-ray Operators in Missouri\"", "sourceUrls": [ "https://health.mo.gov/sites/health/files/media/pdf/2026/03/xray-operator-requirements.pdf" ], "quote": "setting the standards for training and experience is largely left up to the individual facility", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Joint Task Force on Radiologic Technologist Licensure", "kind": "other", "status": "Created by 2019 law; was to report by January 15, 2020", "date": "", "dateISO": null, "summary": "Background only. A 2019 law (S.B. 275) created the task force. Technologist licensure bills were filed in earlier years (e.g., SB 624, 2021). It was not confirmed whether any 2025 or 2026 licensure bill was filed. No 2025-2026 changes were found affecting these topics.", "sourceUrls": [ "https://revisor.mo.gov/main/OneSection.aspx?section=334.1135" ] } ], "notable": [ "Missouri has no OSHA State Plan, so federal OSHA (29 CFR 1910.1096) covers most private-sector workers. MRCP's dental guidance treats facilities as subject to both the state rules and OSHA, and describes OSHA's monitoring trigger as 25 mR per week. Public-sector workers may not be covered.", "A possible accidental dose above twice the limit must be reported to DHSS within 7 days.", "Employers must tell workers their annual exposure on request, and give a dose summary when employment ends.", "The fluoroscopy equipment limits (6 R/min at the tabletop, 5-minute cumulative timer) date from 1964.", "Older versions of the hospital licensing rule tied radiation protection to 19 CSR 20-10; the current text was not confirmed." ], "openQuestions": [ "2025-2026 legislation: only the 2026 Senate bill list was checked. Search House bills for technologist licensure or radiation protection.", "Whether the current 19 CSR 30-20 hospital rule still requires following 19 CSR 20-10, and whether it covers aprons or monitoring.", "OSHA 1910.1096: the exact quarterly limits and monitoring trigger, and how they apply to hospital X-ray staff and public employers in Missouri.", "Whether MRCP or its Qualified Experts expect apron checks, badge placement or NCRP-based dose methods during annual Class A surveys.", "Whether DHSS's five-year rule review report (RSMo 536.175, June 2024) slates 19 CSR 20-10 for revision.", "Whether the Board of Registration for the Healing Arts or the Board of Nursing has fluoroscopy-specific rules for PAs, APRNs or others." ], "sources": [ { "title": "Missouri Secretary of State, Code of State Regulations, 19 CSR 20-10 Protection Against Ionizing Radiation (official PDF)", "url": "https://www.sos.mo.gov/cmsimages/adrules/csr/current/19csr/19c20-10.pdf" }, { "title": "DHSS, Radiation Control", "url": "https://health.mo.gov/providers/radiation-control" }, { "title": "DHSS, Laws, Regulations & Manuals", "url": "https://health.mo.gov/providers/radiation-control/laws-regulations-manuals" }, { "title": "DHSS, Guidance and Frequently Asked Questions", "url": "https://health.mo.gov/providers/radiation-control/guidance-and-frequently-asked-questions" }, { "title": "MRCP, Requirements for X-ray Operators in Missouri", "url": "https://health.mo.gov/sites/health/files/media/pdf/2026/03/xray-operator-requirements.pdf" }, { "title": "MRCP, Need for Physician Order for X-rays", "url": "https://health.mo.gov/sites/health/files/media/pdf/2026/03/Physician-oversight-for-medical-xrays.pdf" }, { "title": "MRCP, Detailed Qualified Expert Questions (FAQ)", "url": "https://health.mo.gov/sites/health/files/media/pdf/2026/03/QE-FAQ_0.pdf" }, { "title": "MRCP, QE Surveys and Shielding Evaluations (Grid, updated 8/18)", "url": "https://health.mo.gov/sites/health/files/media/pdf/2026/03/QE-surveys-and-shielding-evaluations-Grid.pdf" }, { "title": "MRCP, Guidance for Dental Facilities: Radiation Badges and Shielding (Aug 2015)", "url": "https://health.mo.gov/sites/health/files/media/pdf/2026/03/Guidance-for-Dental-Facilities-Radiation-badges-and-shielding.pdf" }, { "title": "Missouri Revisor of Statutes, RSMo 192.430 (search-result excerpt)", "url": "https://revisor.mo.gov/main/OneSection.aspx?bid=9782&hl=§ion=192.430" }, { "title": "Missouri Revisor of Statutes, RSMo 334.1135", "url": "https://revisor.mo.gov/main/OneSection.aspx?section=334.1135" }, { "title": "DHSS, Proposed Rules", "url": "https://health.mo.gov/about/proposed-rules" }, { "title": "DHSS, Pre-Rulemaking, Stakeholder Feedback", "url": "https://health.mo.gov/pre-rulemaking-stakeholder-feedback" }, { "title": "Missouri Senate, 2026 Bill List", "url": "https://www.senate.mo.gov/BillTracking/Bills/BillList?year=2026&session=R" }, { "title": "Cornell LII (secondary), 19 CSR 30-30.020 Administration Standards for Ambulatory Surgical Centers", "url": "https://www.law.cornell.edu/regulations/missouri/19-CSR-30-30-020" }, { "title": "Cornell LII (secondary), 19 CSR 20-10.040 /.050 (used to cross-check the text)", "url": "https://www.law.cornell.edu/regulations/missouri/19-CSR-20-10-050" }, { "title": "OSHA, State Plans (search-result excerpt)", "url": "https://www.osha.gov/stateplans" } ] }, { "code": "MT", "name": "Montana", "pageUrl": "https://orsif.org/guidelines/us/states/montana", "regulator": { "name": "Montana Department of Public Health and Human Services (DPHHS)", "url": "https://dphhs.mt.gov/oig/radiationmachineregistration" }, "nrcAgreementState": false, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "The research for this state ended before every question was fully answered, so some answers may be incomplete." }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Montana's X-ray rules date mostly from 1980, and ALARA appears only as advisory \"should\" language in general standards shared by all licensees and registrants. Dose limits are quarterly: the lens is grouped with the whole body at 1¼ rem (12.5 mSv) per quarter, and there is no separate embryo/fetus limit, so pregnant workers fall under the same quarterly limits as other workers. Everyone in the fluoroscopy room except the patient must wear an apron of at least 0.25 mm lead equivalent, with the dosimeter at the collar outside the apron, but the rules do not require apron inspection and do not address thyroid shields, eyewear or apron alternatives. Limited-permit operators may not perform fluoroscopy, and the rules do not spell out physician operation or supervision of fluoroscopy.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "ALARA appears only in ARM 37.14.701, in Subchapter 7, which applies to all licensees and registrants. No ALARA wording was found in the X-ray rules reviewed (37.14.1003,.1006,.1012). 37.14.1003(5) references 10 CFR part 20 for shielding design only.", "citation": "ARM 37.14.701(1); ARM 37.14.1003(5)(a)" }, "eyeLensLimitMsv": 50, "answers": { "agreement_state": { "question": "Agreement State", "status": "no", "answer": "No. Montana is not an NRC Agreement State. ARM 37.14.101 still refers to an agreement with the NRC, which appears to be leftover 1980 wording.", "citation": "NRC list of Agreement States, updated October 29, 2026; ARM 37.14.101", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.law.cornell.edu/regulations/montana/Mont-Admin-R-37-14-101" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "ARM 37.14 Subchapter 10, \"X-Rays in the Healing Arts\" (37.14.1001-1022), with fluoroscopy in 37.14.1006 and 37.14.1003. General standards are in Subchapter 7 (37.14.701-758). Most rules took effect 3/28/1980, and 37.14.1002 and 37.14.1003 were revised 10/31/2003. The research read the text on Cornell LII and Justia (current through September 20, 2024).", "citation": "ARM 37.14.701-758; ARM 37.14.1001-1022", "sourceUrls": [ "https://rules.mt.gov/gateway/ChapterHome.asp?Chapter=37.14", "https://www.law.cornell.edu/regulations/montana/department-37/chapter-37.14" ], "quote": "Subchapter 37.14.7 - Standards for Protection Against Radiation (Rule 37.14.701 to 37.14.758)", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "partial", "answer": "Advisory only: efforts \"should\" be made rather than \"shall.\" The rule applies to all licensees and registrants, including X-ray registrants. It does not require an ALARA program.", "citation": "ARM 37.14.701(1)-(2)", "sourceUrls": [ "https://regulations.justia.com/states/montana/department-37/chapter-37-14/subchapter-37-14-7/rule-37-14-701" ], "quote": "every reasonable effort should be made to maintain radiation exposures, and releases of radioactive material in effluents to unrestricted areas, as low as is reasonably achievable.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "1¼ rem (12.5 mSv) per calendar quarter. Up to 3 rem (30 mSv) per quarter is allowed if the lifetime 5(N-18) rem limit is met and dose history is documented on form MRH-30. Limits are quarterly and are not expressed as TEDE.", "citation": "ARM 37.14.705(1)-(3)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-37.14.705" ], "quote": "As used in (3), \"dose to the whole body\" shall be deemed to include any dose to the whole body, gonads, active blood-forming organs, head and trunk, or lens of eye.", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "partial", "answer": "There is no separate lens limit. The lens is grouped with the whole body at 1¼ rem (12.5 mSv) per quarter. No modern lens limit (such as ICRP's 20 mSv) has been adopted.", "citation": "ARM 37.14.705(1)-(3)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-37.14.705" ], "quote": "As used in (3), \"dose to the whole body\" shall be deemed to include any dose to the whole body, gonads, active blood-forming organs, head and trunk, or lens of eye.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Hands, forearms, feet and ankles: 18¾ rem (187.5 mSv) per quarter. Skin of whole body: 7½ rem (75 mSv) per quarter.", "citation": "ARM 37.14.705(2)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-37.14.705" ], "quote": "no licensee or registrant shall possess, use, receive, or transfer sources of radiation in such a manner as to cause any individual in a restricted area to receive in any period of 1 calendar quarter", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "no", "answer": "Montana's rules set no separate dose limit for the embryo or fetus of a pregnant worker. A pregnant worker falls under the same quarterly worker limits as everyone else, including 1 1/4 rem (12.5 mSv) per quarter to the whole body.", "citation": "ARM 37.14.705; ARM Subchapter 37.14.7 (Standards for Protection Against Radiation)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-37.14.705" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Generally required if a worker is likely to exceed 25% of a quarterly limit (5% for workers under 18). The X-ray rules require monitoring for at least a 13-week period starting each January. For fluoroscopy, monitoring is required for everyone who enters a controlled area.", "citation": "ARM 37.14.1006(3)(h); 37.14.721(1); 37.14.1003(3); 37.14.1012(3)(a)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-37.14.1006" ], "quote": "Notwithstanding ARM 37.14.721, personnel monitoring is required for each individual who enters a controlled area.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "When an apron is worn, the badge goes at the collar outside the apron. The research found no two-badge method and no method for calculating effective dose equivalent.", "citation": "ARM 37.14.1003(3)", "sourceUrls": [ "https://regulations.justia.com/states/montana/department-37/chapter-37-14/subchapter-37-14-10/rule-37-14-1003" ], "quote": "When a protective apron is worn, the monitoring device shall be worn at the collar outside of the apron.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "partial", "answer": "Aprons of at least 0.25 mm lead equivalent are required for everyone in the fluoroscopy room except the patient. Thyroid shields and eyewear are not addressed in the rules reviewed.", "citation": "ARM 37.14.1006(3)(d)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-37.14.1006" ], "quote": "Protective aprons of at least 0.25 millimeters lead equivalent shall be worn in the fluoroscopy room by each person except the patient.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Montana's X-ray rules require everyone in the fluoroscopy room except the patient to wear an apron of at least 0.25 mm lead equivalent. They do not require aprons or other protective apparel to be inspected periodically.", "citation": "ARM 37.14.1006 and ARM 37.14.1003", "sourceUrls": [ "https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-37.14.1006" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "no", "answer": "Not addressed. The only related provision is a general waiver that applies if the registrant shows equivalent protection by other means; it does not mention aprons or engineered systems.", "citation": "ARM 37.14.1003(1)", "sourceUrls": [ "https://regulations.justia.com/states/montana/department-37/chapter-37-14/subchapter-37-14-10/rule-37-14-1003" ], "quote": "The department may waive compliance with the specific requirements of this subchapter by an existing machine or installation if the registrant demonstrates, to the department's satisfaction, achievement through other means of radiation protection equivalent to that required by this chapter.", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Limited permit holders who completed the 104-hour training may not perform fluoroscopy, although they may assist a physician during fluoroscopic exams of the GI tract. A radiologic technology student who has finished the first two semesters of an accredited program and holds a limited permit may operate portable fluoroscopy equipment. Rules on physician operation and supervision of fluoroscopy are not spelled out in these provisions.", "citation": "ARM 24.204.504(3)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/montana/ARM-24-204-504" ], "quote": "Limited permit holders who completed the 104-hour training are not authorized or permitted to perform fluoroscopy procedures due to the difficulty in monitoring, limiting, and controlling the accumulative doses", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "The RT license is based on ARM 24.204.408 and MCA 37-14-302; a secondary source says Montana requires ARRT certification/registration. Limited permits require 104 hours of training and exclude fluoroscopy. No state fluoroscopy permit, physician fluoroscopy training rules or continuing education requirements were found.", "citation": "ARM 24.204.408; MCA 37-14-302; ARM 24.204.504", "sourceUrls": [ "https://boards.bsd.dli.mt.gov/_docs/rts/rt-checklist.pdf", "https://www.forsythtech.edu/wp-content/uploads/2024/05/Radiography-2024-ADA.pdf" ], "quote": "License Requirements for a Radiologic Technologist License: [ARM 24.204.408, 37-14-302,", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [], "notable": [ "The core rules (effective 3/28/1980) follow the pre-1994 federal model: quarterly limits, the 5(N-18) lifetime formula, \"dose\" rather than TEDE, and no declared-pregnant-worker provision.", "The fluoroscopist must dark-adapt their eyes for 20 minutes, and a cumulative timer must signal at no more than 5 minutes.", "Only persons whose presence is necessary may be in the fluoroscopy room (37.14.1006(3)(e)), and occupationally exposed staff may not routinely hold patients in radiography (37.14.1012(3)(b)).", "Every installation must have a radiation safety officer, whose duties include investigating each known or suspected excessive exposure (37.14.1003(4)(b)-(c)).", "Overexposures above 37.14.705 limits must be reported in writing within 30 days (37.14.756).", "The licensing board's web page refers to the \"Montana Allied Healthcare Board,\" while the rules still name the Board of Radiologic Technologists." ], "openQuestions": [ "The research for Montana ended early, so the answers on who may operate the equipment, operator training and pending changes are incomplete.", "Read MCA Title 37, ch. 14 (37-14-301 to 37-14-306) for physician and practitioner licensing exemptions, PA/NP authority and supervision, and read ARM 24.204 in full for continuing education and fluoroscopy training.", "Review ARM 37.14 Subchapter 17 (37.14.1701-1721) for prenatal-exposure or worker-instruction rules, and check the full text of 37.14.706,.708 and.729.", "Search the Montana Administrative Register for 2025-2026 DPHHS notices on ARM 37.14 and the 2025 legislative session for related bills, and ask DPHHS whether a modernization of the rules is planned.", "Confirm the current rule text on the official ARM site (rules.mt.gov).", "Check whether the Board of Radiologic Technologists has been merged into an \"Allied Healthcare Board.\"", "Ask DPHHS what the ARM 37.14.101 reference to an agreement with the NRC means." ], "sources": [ { "title": "DPHHS, Radiation Machine Registration", "url": "https://dphhs.mt.gov/oig/radiationmachineregistration" }, { "title": "Administrative Rules of Montana, Chapter 37.14 index (official)", "url": "https://rules.mt.gov/gateway/ChapterHome.asp?Chapter=37.14" }, { "title": "Cornell LII, ARM Chapter 37.14 and Subchapters 7 and 10 indexes", "url": "https://www.law.cornell.edu/regulations/montana/department-37/chapter-37.14" }, { "title": "Cornell LII, ARM 37.14.1006", "url": "https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-37.14.1006" }, { "title": "Cornell LII, ARM 37.14.705", "url": "https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-37.14.705" }, { "title": "Cornell LII, ARM 37.14.1012", "url": "https://www.law.cornell.edu/regulations/montana/Mont-Admin-r-37.14.1012" }, { "title": "Cornell LII, ARM 37.14.101", "url": "https://www.law.cornell.edu/regulations/montana/Mont-Admin-R-37-14-101" }, { "title": "Justia, ARM 37.14.1003", "url": "https://regulations.justia.com/states/montana/department-37/chapter-37-14/subchapter-37-14-10/rule-37-14-1003" }, { "title": "Justia, ARM 37.14.701", "url": "https://regulations.justia.com/states/montana/department-37/chapter-37-14/subchapter-37-14-7/rule-37-14-701" }, { "title": "Justia, ARM 37.14.721", "url": "https://regulations.justia.com/states/montana/department-37/chapter-37-14/subchapter-37-14-7/rule-37-14-721" }, { "title": "Cornell LII, ARM 24.204.504 (search excerpt)", "url": "https://www.law.cornell.edu/regulations/montana/ARM-24-204-504" }, { "title": "Montana Board of Radiologic Technologists licensure page", "url": "https://boards.bsd.dli.mt.gov/radiologic-technologists/" }, { "title": "Board RT licensing checklist (updated 02/11/25)", "url": "https://boards.bsd.dli.mt.gov/_docs/rts/rt-checklist.pdf" }, { "title": "Forsyth Tech state licensure summary (secondary)", "url": "https://www.forsythtech.edu/wp-content/uploads/2024/05/Radiography-2024-ADA.pdf" }, { "title": "NRC Agreement States", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "NE", "name": "Nebraska", "pageUrl": "https://orsif.org/guidelines/us/states/nebraska", "regulator": { "name": "Nebraska Department of Health and Human Services (DHHS), Division of Public Health, Office of Radiological Health", "url": "https://dhhs.ne.gov/Pages/radiation-control.aspx" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Nebraska requires X-ray registrants, including fluoroscopy facilities, to keep doses ALARA under 180 NAC 4, a chapter shared with radioactive-materials licensees; Chapter 6 has only related \"minimize exposure\" language. Dose limits follow the federal values, including 150 mSv for the lens of the eye. The rules set badge placement and effective-dose formulas for staff wearing aprons, and require aprons or whole body protective barriers of at least 0.25 mm lead equivalent. Nebraska does not require scheduled apron inspections, and engineered protection systems are not addressed by name, though on its face a whole body barrier can stand in for an apron; whether a given engineered system qualifies is undefined. Fluoroscopy must be directed by a licensed practitioner; medical radiographers may assist but limited radiographers may not. LB 912 (2026) lets nurse practitioners perform fluoroscopy after approved training.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "ALARA appears in 180 NAC 4, which covers both radioactive-materials licensees and X-ray registrants. Chapter 6 has X-ray-specific \"minimize personnel exposure\" language (§ 6-003.13) but does not use the ALARA term in the sections read; §§ 6-001 and 6-002 were not read.", "citation": "180 NAC 4-001.02 and 4-004.02; 180 NAC 6-003.13" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Nebraska is an NRC Agreement State.", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Title 180 NAC Chapter 6, \"Diagnostic X-Rays in the Healing Arts\" (amended effective 11/4/2020; fluoroscopy at § 6-005), plus 180 NAC 4, \"Standards for Protection Against Radiation\" (amended 6/7/2021). Chapters 1, 2, 4, 5, 6, 8, 10, 15, 16, 18 and 20 apply to X-ray registrants. Chapter 6 was read on Cornell LII because the official site did not load, so currency is uncertain.", "citation": "180 NAC 4; 180 NAC 6.", "sourceUrls": [ "https://dhhs.ne.gov/Pages/Radiation-Control-Regulations.aspx" ], "quote": "X-ray Registrants: 1, 2, 4, 5, 6, 8, 10, 15, 16, 18, & 20", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Licensees and registrants, including X-ray/fluoroscopy registrants, must keep occupational and public doses ALARA. A radiation protection program and an annual program review are also required.", "citation": "180 NAC 4-004.02", "sourceUrls": [ "https://dhhs.ne.gov/Documents/180-NAC-4.pdf" ], "quote": "The licensee or registrant must use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "50 mSv (5 rem) total effective dose equivalent per year.", "citation": "180 NAC 4-005.01", "sourceUrls": [ "https://dhhs.ne.gov/Documents/180-NAC-4.pdf" ], "quote": "(i) The total effective dose equivalent being equal to 0.05 Sv (5 rem)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "150 mSv (15 rem) per year. Nebraska has not adopted a lower limit such as the ICRP's 20 mSv.", "citation": "180 NAC 4-005.01", "sourceUrls": [ "https://dhhs.ne.gov/Documents/180-NAC-4.pdf" ], "quote": "A lens dose equivalent of 0.15 Sv (15 rem)", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "500 mSv (50 rem) per year to the skin of the whole body or any extremity.", "citation": "180 NAC 4-005.01(B)(ii)", "sourceUrls": [ "https://dhhs.ne.gov/Documents/180-NAC-4.pdf" ], "quote": "A shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy.", "citation": "180 NAC 4-012.01", "sourceUrls": [ "https://dhhs.ne.gov/Documents/180-NAC-4.pdf" ], "quote": "does not exceed 5 mSv (0.5 rem)", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Dosimeters are required for adults likely to exceed 10% of a limit (5 mSv whole body, 15 mSv lens, 50 mSv skin or extremity); minors above 1 mSv deep, 1.5 mSv lens or 5 mSv skin; declared pregnant women likely to exceed 1 mSv; and anyone entering high or very high radiation areas. \"Individuals working with medical fluoroscopic equipment\" are a separate category, which may require monitoring regardless of the 10% threshold; how the regulator applies this is unclear.", "citation": "180 NAC 4-022.01(A)-(E)", "sourceUrls": [ "https://dhhs.ne.gov/Documents/180-NAC-4.pdf" ], "quote": "(A) Adults likely to receive, in one year from sources external to the body, a dose in excess of 10% of the limits in 180 NAC 4-005.01; and\" … \"(E) Individuals working with medical fluoroscopic equipment", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "A single badge goes at the collar outside the apron. An optional second badge goes at the waist under the apron and is mandatory for declared pregnant women. The lens badge goes at the collar or nearer the eye. Effective dose is the deep dose from one collar badge; or that dose × 0.3 if the badge reads above 25% of the limit; or 1.5 × the waist reading + 0.04 × the collar reading with two badges. An NRC-approved method is also allowed.", "citation": "180 NAC 4-005.03(A)-(B); 4-022.01(E)(i)-(iii)", "sourceUrls": [ "https://dhhs.ne.gov/Documents/180-NAC-4.pdf" ], "quote": "the sum of the deep dose equivalent reported for the individual monitoring device located at the waist under the protective apron multiplied by 1.5 and the deep dose equivalent reported for the individual monitoring device located at the neck outside the protective apron multiplied by 0.04.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Staff and others needed for the procedure must be protected from scatter by aprons or whole body protective barriers of at least 0.25 mm lead equivalent; anyone in the useful beam needs at least 0.5 mm. Registrants must keep enough leaded aprons and gloves for all unshielded personnel. No thyroid shield or eyewear requirement was found.", "citation": "180 NAC 6-003.08(A)-(B); 6-003.12(F); 6-005.02(B)(ii)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/nebraska/180-Neb-Admin-Code-ch-6-SS-003" ], "quote": "(B) The x-ray operator, other staff, ancillary personnel, and other persons required for the medical procedure must be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Nebraska's rules do not require protective aprons to be inspected on a schedule, whether by fluoroscopy or by a visual check. The rules only require facilities to have enough leaded aprons and protective gloves for all staff who are not otherwise shielded, and require aprons or whole body barriers of at least 0.25 mm lead equivalent.", "citation": "180 NAC 6-003.08, 6-003.12(F), 6-003.20(F) and 6-005.02", "sourceUrls": [ "https://www.law.cornell.edu/regulations/nebraska/180-Neb-Admin-Code-ch-6-SS-003" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered radiation protection systems are not specifically addressed. However, § 6-003.08(B) allows aprons or whole body protective barriers of at least 0.25 mm lead equivalent, so on its face a whole-body barrier can stand in for an apron; whether a given engineered system qualifies is undefined. No Nebraska bill or rule on this was found.", "citation": "180 NAC 6-003.08(B); 6-005.02(B)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/nebraska/180-Neb-Admin-Code-ch-6-SS-003" ], "quote": "The x-ray operator, other staff, ancillary personnel, and other persons required for the medical procedure must be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Fluoroscopy must be directed by a licensed practitioner, and only a licensed practitioner may perform interpretative procedures. Medical radiographers may use fluoroscopy but not perform interpretative procedures, and may work with CRNAs and (since about July 2026) nurse practitioners. Limited radiographers may not use fluoroscopy. CRNAs may use fluoroscopy with a licensed medical radiographer. NPs may perform fluoroscopy after approved training under LB 912. Physician assistants: not found.", "citation": "180 NAC 6-005.04(A)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/nebraska/180-Neb-Admin-Code-ch-6-SS-005" ], "quote": "Images formed by the use of fluoroscopic x-ray systems must be under the direction of and interpreted by a licensed practitioner of the healing arts.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Medical radiographers must complete a board-approved program and exam; ARRT registration counts as proof. All operators must be competent in the unit's standard operating procedures and know the written safety procedures. CRNA training is set by 180 NAC 23 (text not retrieved). NPs need jointly approved training; a proposed 180 NAC 25 (4 hours of classroom training, 5 supervised procedures, 1 hour of CE per renewal) has not been shown to be adopted. No physician fluoroscopy training requirement was found.", "citation": "Neb. Rev. Stat. §§ 38-1915(2)-(3), 38-2315(5); 180 NAC 6-005.04(D), 6-003.07; 180 NAC 23", "sourceUrls": [ "https://nebraskalegislature.gov/FloorDocs/109/PDF/Slip/LB912.pdf" ], "quote": "(3) Presentation of proof of registration in radiography with the American Registry of Radiologic Technologists is proof of meeting the requirements of subdivisions (2)(a) and (c) of this section.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "LB 912 (2026)", "kind": "bill", "status": "Enacted; approved by the Governor April 14, 2026", "date": "2026-04-14", "dateISO": "2026-04-14", "summary": "Amends § 38-1915 to let radiographers use fluoroscopy with nurse practitioners, and § 38-2315(5) to allow NP fluoroscopy after approved training. Incorporated LB 936 via AM2578. Operative three calendar months after the April 17, 2026 adjournment (about July 17, 2026, by this research's calculation).", "sourceUrls": [ "https://nebraskalegislature.gov/FloorDocs/109/PDF/Slip/LB912.pdf" ] }, { "title": "LB 936 (2026)", "kind": "bill", "status": "Indefinitely postponed after being folded into LB 912", "date": "2026-04-17", "dateISO": "2026-04-17", "summary": "Its provisions were incorporated into LB 912.", "sourceUrls": [ "https://www.nebraskalegislature.gov/bills/view_bill.php?DocumentID=62987" ] }, { "title": "Proposed 180 NAC 25 (NP fluoroscopy training)", "kind": "other", "status": "Proposed in the 2025 credentialing review; rulemaking status not found", "date": "2025-09-05", "dateISO": "2025-09-05", "summary": "Would require at least 4 hours of post-graduate classroom training, at least 5 supervised procedures, and 1 hour of CE per renewal, with the UNMC course or an equivalent as the approved program.", "sourceUrls": [ "https://dhhs.ne.gov/licensure/Credentialing%20Review%20Docs/NPDirRpt2025.pdf" ] } ], "notable": [ "Under-table scatter must be blocked by at least 0.25 mm lead equivalent.", "Above-table scatter shielding of at least 0.25 mm lead equivalent is required in addition to aprons unless the person is 120 cm from the beam center; where a sterile field prevents it, shielding must be kept up \"to the degree possible.\"", "Typical and maximum air kerma rates must be measured annually and after relevant maintenance.", "Fluoroscopy may not be used to position patients for general radiography.", "Fluoroscopy time, number of images and operator name must be recorded for each exam.", "New or modified installations need a shielding plan review (§ 6-003.19).", "\"Individuals working with medical fluoroscopic equipment\" are listed as a separate monitoring category in § 4-022.01(E)." ], "openQuestions": [ "Verify Chapters 4 and 6 against the official Secretary of State site or the Office of Radiological Health; the Chapter 8 title mismatch suggests revisions.", "Does § 4-022.01(E) require monitoring of all fluoroscopy workers regardless of the 10% threshold?", "Chapter 6 scope and definitions (§§ 6-001, 6-002), including any definition of \"whole body protective barrier,\" were not reviewed.", "DHHS Regulatory Guide 6.2 may cover apron inspection, thyroid and eye protection, and badge practice.", "The text of 180 NAC 23 (CRNA training) was not retrieved.", "Physician assistant authority, physician training, and radiographer CE (172 NAC 93) were not found.", "Rulemaking status of the proposed 180 NAC 25 (NP training) is unknown.", "Does DHHS plan changes to 180 NAC 4-004.02 in response to the NRC's ALARA/graded-approach rule?" ], "sources": [ { "title": "Nebraska DHHS, Radiation Control, References & Resources", "url": "https://dhhs.ne.gov/Pages/Radiation-Control-Regulations.aspx" }, { "title": "Nebraska DHHS, Title 180 Control of Radiation", "url": "https://dhhs.ne.gov/Pages/Title-180.aspx" }, { "title": "180 NAC 4, Standards for Protection Against Radiation", "url": "https://dhhs.ne.gov/Documents/180-NAC-4.pdf" }, { "title": "DHHS notice of public hearing, 180 NAC 4 (December 2, 2019)", "url": "https://dhhs.ne.gov/Radiation%20Control%20%20Documents/19171%20-%20180%20NAC%204%20Public%20Hearing%20Draft%20for%20Web.pdf" }, { "title": "Cornell LII, Title 180 index", "url": "https://www.law.cornell.edu/regulations/nebraska/health-and-human-services-system/title-180" }, { "title": "Cornell LII, 180 NAC 6 index", "url": "https://www.law.cornell.edu/regulations/nebraska/health-and-human-services-system/title-180/chapter-6" }, { "title": "Cornell LII, 180 NAC 6 § 003", "url": "https://www.law.cornell.edu/regulations/nebraska/180-Neb-Admin-Code-ch-6-SS-003" }, { "title": "Cornell LII, 180 NAC 6 § 004", "url": "https://www.law.cornell.edu/regulations/nebraska/180-Neb-Admin-Code-ch-6-SS-004" }, { "title": "Cornell LII, 180 NAC 6 § 005", "url": "https://www.law.cornell.edu/regulations/nebraska/180-Neb-Admin-Code-ch-6-SS-005" }, { "title": "Cornell LII, 180 NAC 15 index", "url": "https://www.law.cornell.edu/regulations/nebraska/health-and-human-services-system/title-180/chapter-15" }, { "title": "DHHS X-ray Registrations", "url": "https://dhhs.ne.gov/Pages/Radiation-Control-X-Ray-Registrations.aspx" }, { "title": "DHHS Regulatory Guide 6.2", "url": "https://dhhs.ne.gov/Guidance%20Docs/Regulatory%20Guide%206.2.pdf" }, { "title": "LB 912 (2026), slip law", "url": "https://nebraskalegislature.gov/FloorDocs/109/PDF/Slip/LB912.pdf" }, { "title": "LB 936 (2026), bill history", "url": "https://www.nebraskalegislature.gov/bills/view_bill.php?DocumentID=62987" }, { "title": "DHHS Credentialing Review Final Report, Nurse Practitioners (Sept. 5, 2025)", "url": "https://dhhs.ne.gov/licensure/Credentialing%20Review%20Docs/NPDirRpt2025.pdf" }, { "title": "Nebraska Association of Nurse Anesthetists support letter", "url": "https://dhhs.ne.gov/licensure/Credentialing%20Review%20Docs/CRNursePracNANAsupport.pdf" }, { "title": "Justia, Neb. Rev. Stat. § 38-1916 (2023)", "url": "https://law.justia.com/codes/nebraska/chapter-38/statute-38-1916/" }, { "title": "DHHS compilation of CRNA statutes", "url": "https://dhhs.ne.gov/licensure/Documents/Nursing-Certified%20Registered%20Nurse%20Anesthetist%20Act.pdf" }, { "title": "APTA, imaging in Nebraska", "url": "https://www.orthopt.org/uploads/content_files/files/Imaging%20Nebraska.pdf" }, { "title": "Nebraska Dept. of Veterans' Affairs, legislative page", "url": "https://veterans.nebraska.gov/legislative-issues" } ] }, { "code": "NV", "name": "Nevada", "pageUrl": "https://orsif.org/guidelines/us/states/nevada", "regulator": { "name": "Radiation Control Program (RCP), Nevada Division of Public and Behavioral Health (DPBH), Department of Health and Human Services", "url": "https://www.dpbh.nv.gov" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Nevada's radiation rules are in NAC Chapter 459, where one shared set of Standards for Protection Against Radiation (NAC 459.320 to 459.374) covers both radioactive-materials licensees and X-ray registrants and holds the ALARA requirement, though whether its wording reaches workers' X-ray exposure is a matter of interpretation, so a federal NRC change to ALARA could affect fluoroscopy rules. Nevada uses the federal dose limits of 50 mSv whole body, 150 mSv lens of the eye, 500 mSv skin and extremities, and 5 mSv over a pregnancy for a declared pregnant worker, and workers must be monitored if they are likely to exceed 10% of a limit, with the dosimeter worn at the collar outside the apron. Staff must use 0.25 mm lead-equivalent aprons or whole-body barriers, or keep their distance, but aprons do not have to be inspected on any schedule, and engineered alternatives to aprons are not addressed. Under NRS 653, fluoroscopy may be performed by ARRT-certified license holders, by grandfathered persons, or under narrow exceptions.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The ALARA requirement (459.320(3)) and its definition (459.0205) sit in sections that apply to both materials licensees and X-ray registrants. No X-ray-specific ALARA wording was found in the X-ray sections read, but NAC 459.556 was not checked. A federal change could reach X-ray registrants through these shared rules.", "citation": "NAC 459.320(2)-(3); NAC 459.0192" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Nevada is an NRC Agreement State.", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "All rules are in NAC Chapter 459: general applicability NAC 459.118; Standards for Protection Against Radiation NAC 459.320-459.374 (all licensees and registrants); X-rays in the Healing Arts NAC 459.400-459.624, with fluoroscopy at NAC 459.566-459.578; employee notices NAC 459.780-459.794.", "citation": "NAC 459.118; NAC 459.320(1)", "sourceUrls": [ "https://www.leg.state.nv.us/nac/nac-459.html" ], "quote": "The provisions of NAC 459.320 to 459.374, inclusive, establish standards for protection against radiation hazards.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes, with a caveat. NAC 459.320(3) requires licensees and registrants to keep exposures ALARA. The wording pairs exposures with effluent releases, so its reach to occupational X-ray exposure is a matter of interpretation. The ALARA definition expressly includes registered activities.", "citation": "NAC 459.320(3); NAC 459.0205", "sourceUrls": [ "https://www.law.cornell.edu/regulations/nevada/NAC-459-320" ], "quote": "a licensee or registrant shall make every reasonable effort to maintain exposures and releases of radioactive materials in effluents to unrestricted areas, as low as is reasonably achievable.", "quoteMatchedToSource": true, "confidence": "medium" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "Total effective dose equivalent of 5 rems (50 mSv) per year.", "citation": "NAC 459.325", "sourceUrls": [ "https://www.leg.state.nv.us/nac/nac-459.html" ], "quote": "(1) A total effective dose equivalent of 5 rems (50 millisieverts); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rems (150 mSv) per year. No lower limit has been adopted.", "citation": "NAC 459.325", "sourceUrls": [ "https://www.leg.state.nv.us/nac/nac-459.html" ], "quote": "(b) A lens dose equivalent of 15 rems (150 millisieverts); and", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rems (500 mSv) per year to the skin of the whole body or any extremity.", "citation": "NAC 459.325", "sourceUrls": [ "https://www.leg.state.nv.us/nac/nac-459.html" ], "quote": "(c) A shallow-dose equivalent to the skin of the whole body or the skin of any extremity of 50 rems (500 millisieverts).", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo over the entire pregnancy for a woman who has declared her pregnancy.", "citation": "NAC 459.333", "sourceUrls": [ "https://www.leg.state.nv.us/nac/nac-459.html" ], "quote": "a licensee or registrant shall ensure that the dose equivalent to an embryo during the entire pregnancy, resulting from occupational exposure of a woman who has declared her pregnancy, does not exceed 0.5 rem (5 millisieverts).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Adults likely to receive more than 10% of any NAC 459.325 limit in a year from external sources must be monitored. Minors must be monitored above 0.1 rem deep dose, 0.15 rem lens dose, or 0.5 rem skin or extremity dose. Declared pregnant women are also covered.", "citation": "NAC 459.339(1)(a)-(b)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/nevada/NAC-459-339" ], "quote": "(a) Adults who are likely to receive in 1 year, from sources of radiation external to the body, a dose in excess of 10 percent of the limits specified in NAC 459.325;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "When an apron is worn, at least one dosimeter goes at the collar outside the apron. The recorded whole-body dose is the highest dose to any critical organ. No two-badge or effective-dose calculation method was found; the 2015 DPBH dosimetry bulletin was not read.", "citation": "NAC 459.558", "sourceUrls": [ "https://www.leg.state.nv.us/nac/nac-459.html" ], "quote": "When an apron is worn, the monitoring device must be worn at the collar outside the apron.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Staff must wear aprons or use whole-body barriers of at least 0.25 mm lead equivalent, or stand at a set distance (at least 2 meters, per a search excerpt). NAC 459.578 adds fluoroscopy scatter shielding below and above the table. No general thyroid-shield or eyewear requirement was found.", "citation": "NAC 459.554; NAC 459.578(1)-(2)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/nevada/NAC-459-578", "https://www.leg.state.nv.us/nac/nac-459.html" ], "quote": "protective aprons or whole body protective barriers of not less than 0.25 mm lead equivalent.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Nevada's X-ray rules require staff to be protected by aprons or whole body barriers of at least 0.25 mm lead equivalent, but they do not require aprons or other protective apparel to be inspected on any schedule. Checking aprons is left to each facility's own safety procedures.", "citation": "NAC 459.552, 459.554 and 459.578 (X-Rays in the Healing Arts, NAC 459.400 to 459.624)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/nevada/NAC-459-554" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered systems that replace aprons are not addressed. Whole-body protective barriers are an alternative to aprons, and the Division may grant exceptions to the above-table barrier rule where a sterile field prevents their use.", "citation": "NAC 459.578(3); NAC 459.06455", "sourceUrls": [ "https://www.law.cornell.edu/regulations/nevada/NAC-459-578" ], "quote": "Upon application to the Division with adequate justification, exceptions to subsection 2 may be made in some special procedures where a sterile field will not permit the use of the normal protective barriers or where the protective barriers would interfere with the procedures.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Fluoroscopy may be performed by ARRT-certified state license holders, by people performing fluoroscopy on January 1, 2020 who meet the exception's conditions, and under limited NRS 653.620 exceptions. Exemptions for physicians, PAs and NPs are unconfirmed.", "citation": "NRS 653.640; NRS 653.620; NAC 459.552; NAC 459.568", "sourceUrls": [ "https://www.leg.state.nv.us/NRS/NRS-653.html" ], "quote": "A person shall not perform fluoroscopy except as authorized in this section and NRS 653.620.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "License holders need ARRT certification to perform fluoroscopy. A grandfather clause covers people performing fluoroscopy on January 1, 2020. No required training hours, continuing education, or physician fluoroscopy training rule was found.", "citation": "NRS 653.640; NRS 653 grandfather clause; NAC 653", "sourceUrls": [ "https://archive.leg.state.nv.us/Session/81st2021/Exhibits/Senate/CL/SCL1353C.pdf" ], "quote": "A holder of a license may perform fluoroscopy: (a) If he or she is certified by the American Registry of Radiologic Technologists, or its successor.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "R027-26", "kind": "proposed_rule", "status": "Draft (initial draft I and LCB draft P); adoption not confirmed", "date": "", "dateISO": null, "summary": "Would require monitoring when protective clothing or devices are worn (amending NAC 459.339 and 459.558), require registrants to supply monitoring to people who must wear protective clothing, restate who may perform fluoroscopy, and raise machine fees.", "sourceUrls": [ "https://www.leg.state.nv.us/Register/2026Register/R027-26P.pdf" ] }, { "title": "R025-26", "kind": "proposed_rule", "status": "Second revised draft (RP2); adoption not confirmed", "date": "", "dateISO": null, "summary": "Amends machine registration (NAC 459.150-459.154) and NAC 459.554 (documenting protocols), and adds a requirement that CT systems used for CT fluoroscopy have policies and training to reduce staff exposure.", "sourceUrls": [ "https://www.leg.state.nv.us/Register/2026Register/R025-26RP2.pdf" ] }, { "title": "R053-26", "kind": "proposed_rule", "status": "Informational statement; adoption not confirmed", "date": "", "dateISO": null, "summary": "Concerns dental lead aprons under NAC 459.554.", "sourceUrls": [ "https://www.leg.state.nv.us/Register/2026Register/R053-26NI.pdf" ] }, { "title": "R073-25", "kind": "proposed_rule", "status": "Revised draft; adoption not confirmed", "date": "", "dateISO": null, "summary": "Updates the radioactive-materials rules for NRC compatibility.", "sourceUrls": [ "https://www.leg.state.nv.us/Register/2025Register/R073-25RP1.pdf" ] } ], "notable": [ "NAC 459.578 sets fluoroscopy scatter-control requirements for staff that go beyond aprons: under-table shielding, above-table drapes or panels, or 120 cm distance.", "Nevada has a dedicated personnel-monitoring rule for X-ray users (NAC 459.558) with the collar-outside-apron rule. It also bans deliberately exposing a dosimeter to show a false dose and calls for action when readings rise sharply or approach the limits.", "DPBH posts the NRC's embryo/fetus dose regulatory guide and a generic NAC 459.321 radiation protection program for machine registrants.", "Employee notice and inspection rights (NAC 459.780-459.794) apply to registrants." ], "openQuestions": [ "Rule sections not fully read: NAC 459.321, 459.3205, 459.554, 459.556, 459.5585 and 459.5595. These need checking for program-level ALARA wording, which federal provisions are adopted by reference (and whether by a fixed date), the exact apron and distance language, and any thyroid or eyewear rules.", "ALARA scope: whether DPBH reads NAC 459.320(3) as covering occupational X-ray exposure. Ask the RCP directly.", "Dosimetry methods: the DPBH Personnel Dosimetry Technical Bulletin (2015-03-27) may set two-badge or effective-dose calculation methods.", "Apron inspection: not found; check the DPBH machine-registrant guidance and inspection checklists.", "Operators: the full text of NRS 653.620, NRS 653.640 and NAC 653 on exemptions for physicians, physician assistants and nurse practitioners, supervision, training hours and continuing education.", "Status of R025-26, R027-26 and R053-26: check the Nevada Register / LCB adopted-regulation list and the DPBH public hearing pages.", "2025 legislation: no search was done for 2025 Nevada bills touching NRS 459 or 653. Check NELIS.", "Currency: the Cornell LII copies were cached in August 2026, and some quotes come from search excerpts. Verify against the official NAC (Rev. 6/28/2026) before publishing." ], "sources": [ { "title": "NAC Chapter 459, official (Rev. 6/28/2026)", "url": "https://www.leg.state.nv.us/nac/nac-459.html" }, { "title": "Cornell LII, NAC 459.320", "url": "https://www.law.cornell.edu/regulations/nevada/NAC-459-320" }, { "title": "Cornell LII, NAC 459.578", "url": "https://www.law.cornell.edu/regulations/nevada/NAC-459-578" }, { "title": "Cornell LII, NAC 459.339 (search excerpt)", "url": "https://www.law.cornell.edu/regulations/nevada/NAC-459-339" }, { "title": "Cornell LII, NAC 459.554 (search excerpt)", "url": "https://www.law.cornell.edu/regulations/nevada/NAC-459-554" }, { "title": "Cornell LII, NAC 459.552 (search excerpt)", "url": "https://www.law.cornell.edu/regulations/nevada/NAC-459-552" }, { "title": "DPBH, Radiation Incidents, Statutes", "url": "https://www.dpbh.nv.gov/regulatory/radiation-control-programs/radiation-incidents-and-emergency-response/statutes/" }, { "title": "DPBH, RCP Overview", "url": "https://www.dpbh.nv.gov/about/dpbh-overview/rcp-overview/" }, { "title": "DPBH, Exposure limits summary", "url": "https://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Reg/Radiation-Incidents/Docs/Exposurelimits.pdf" }, { "title": "DPBH, Generic Radiation Protection Program (NAC 459.321)", "url": "https://www.dpbh.nv.gov/siteassets/regulatory/rpm/docs/generic-radiation-protection-program-website.pdf" }, { "title": "DPBH, Rural Authorization registration form", "url": "https://www.dpbh.nv.gov/siteassets/regulatory/mammo/dta/forms/Registration_Form_for_Rural_Authorization_Rev.072021.pdf" }, { "title": "NRS Chapter 653", "url": "https://www.leg.state.nv.us/NRS/NRS-653.html" }, { "title": "DPBH fluoroscopy technical bulletin (2021 Senate exhibit)", "url": "https://archive.leg.state.nv.us/Session/81st2021/Exhibits/Senate/CL/SCL1353C.pdf" }, { "title": "R043-20 Public Hearing Notice", "url": "https://dpbh.nv.gov/uploadedFiles/dpbhnvgov/content/Reg/Radiation-Machines/Docs/R043-20-Public-Hearing-Notice.pdf" }, { "title": "R027-26I", "url": "https://www.leg.state.nv.us/Register/2026Register/R027-26I.pdf" }, { "title": "R027-26P", "url": "https://www.leg.state.nv.us/Register/2026Register/R027-26P.pdf" }, { "title": "R025-26RP1", "url": "https://www.leg.state.nv.us/Register/2026Register/R025-26RP1.pdf" }, { "title": "R025-26RP2", "url": "https://www.leg.state.nv.us/Register/2026Register/R025-26RP2.pdf" }, { "title": "R053-26 Informational Statement", "url": "https://www.leg.state.nv.us/Register/2026Register/R053-26NI.pdf" }, { "title": "R073-25RP1", "url": "https://www.leg.state.nv.us/Register/2025Register/R073-25RP1.pdf" } ] }, { "code": "NH", "name": "New Hampshire", "pageUrl": "https://orsif.org/guidelines/us/states/new-hampshire", "regulator": { "name": "NH Department of Health and Human Services, Division of Public Health Services, Radiological Health Section (DHHS/RHS), Radiation Machines Program", "url": "https://www.dhhs.nh.gov/programs-services/environmental-health-and-you/radiological-health/new-hampshire-radiation-machines" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "New Hampshire's ALARA requirement is in He-P 4020.04(b), a unified part covering both materials licensees and X-ray registrants, and He-P 4045.03(p) applies He-P 4020-4022 to all X-ray workers. Occupational dose limits match the federal ones: 50 mSv whole body, 150 mSv lens, 500 mSv skin/extremities, and 5 mSv to the embryo/fetus, and anyone working with medical fluoroscopic equipment must be individually monitored regardless of expected dose. Scatter protection may come from either aprons or whole-body barriers of at least 0.5 mm lead equivalent, with no regular apron inspection required, and engineered systems are not named. Limited operators are barred from fluoroscopy, and the current status of the main X-ray parts (He-P 4045 and He-P 4046) is uncertain.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "ALARA is in He-P 4020.04(b), a unified part applying to both materials licensees and machine registrants. He-P 4045.03(p) applies He-P 4020-4022 to everyone associated with X-ray operation. No separate X-ray occupational-ALARA language was found, though He-P 4046.03-.05 were not read.", "citation": "He-P 4020.02; He-P 4045.03(p)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. New Hampshire is an NRC Agreement State, with its agreement dating from May 16, 1966.", "citation": "NRC list of Agreement States, updated October 29, 2026; He-P 4001.01", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://gc.nh.gov/rules/state_agencies/he-p4001-4022.html" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Yes. Chapter He-P 4000 contains the general standards (He-P 4019-4022) and the machine rules (He-P 4040, 4041, 4045, 4046). Fluoroscopy is covered at He-P 4046.02-4046.05. He-P 4020 was readopted effective 7-23-24. The current status of He-P 4045/4046 is uncertain.", "citation": "He-P 4020.01(a); He-P 4046.01", "sourceUrls": [ "https://gc.nh.gov/rules/state_agencies/he-p4001-4022.html", "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4046.01" ], "quote": "He-P 4020 through He-P 4023 establish standards for protection against ionizing radiation resulting from activities conducted pursuant to licenses or registrations issued by the department of health and human services radiological health section (DHHS/RHS).", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Licensees and registrants must use procedures and engineering controls to keep occupational and public doses ALARA, run a radiation protection program, and review it at least every 12 months.", "citation": "He-P 4020.04(b)", "sourceUrls": [ "https://gc.nh.gov/rules/state_agencies/he-p4001-4022.html" ], "quote": "The licensee or registrant shall use procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem) = 50 mSv per year total effective dose equivalent. Any single organ or tissue other than the lens is limited to 500 mSv.", "citation": "He-P 4020.05(a)(1)", "sourceUrls": [ "https://gc.nh.gov/rules/state_agencies/he-p4001-4022.html" ], "quote": "The total effective dose equivalent being equal to 0.05 Sv (5 rem); or b. The sum of the deep-dose equivalent and the committed dose equivalent to any individual organ or tissue other than the lens of the eye being equal to 0.5 Sv (50 rem)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) = 150 mSv per year. No lower ICRP-style limit has been adopted.", "citation": "He-P 4020.05(a)", "sourceUrls": [ "https://gc.nh.gov/rules/state_agencies/he-p4001-4022.html" ], "quote": "A lens-dose equivalent of 0.15 Sv (15 rem); and b. A shallow-dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem) = 500 mSv shallow-dose equivalent to the skin or any extremity.", "citation": "He-P 4020.05(a)", "sourceUrls": [ "https://gc.nh.gov/rules/state_agencies/he-p4001-4022.html" ], "quote": "A lens-dose equivalent of 0.15 Sv (15 rem); and b. A shallow-dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman for the whole pregnancy.", "citation": "He-P 4020.12(a)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4020.12" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to an embryo or fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Employers must supply and require individual dosimeters for adults likely to receive more than 10 percent of the annual adult limits, for declared pregnant women likely to receive more than 1 mSv (0.1 rem) over the pregnancy, and for minors above set levels. Anyone working with medical fluoroscopic equipment must be monitored regardless of expected dose.", "citation": "He-P 4022.02(b)", "sourceUrls": [ "https://gc.nh.gov/rules/state_agencies/he-p4001-4022.html" ], "quote": "Declared pregnant women likely to receive during the entire pregnancy, from radiation sources external to the body, a deep dose equivalent in excess of 1 mSv (0.1 rem); (4) Individuals entering a high or very high radiation area; and (5) Individuals working with medical fluoroscopic equipment.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "With a single dosimeter at the neck outside the apron, the deep-dose reading is reported as the effective dose equivalent. Otherwise deep-dose equivalent is used unless the effective dose is determined by a dosimetry method acceptable to DHHS/RHS. No named two-badge method was found, and He-P 4022.03 was not read.", "citation": "He-P 4020.05(c) and (g)", "sourceUrls": [ "https://gc.nh.gov/rules/state_agencies/he-p4001-4022.html" ], "quote": "when one individual monitoring device is used and it is located at the neck outside the protective apron, the reported deep-dose equivalent shall be the effective dose equivalent for external radiation", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Yes. Everyone in the room except the patient must be protected from scatter by aprons or whole-body barriers of at least 0.5 mm lead equivalent. Enough garments or barriers must be provided, and each must be labeled with its lead equivalence. No thyroid shield or eyewear requirement was found.", "citation": "He-P 4045.03(i), (n)(6), (n)(7)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4045.03" ], "quote": "shall be protected from scatter radiation by either protective aprons or whole body protective barriers, of not less than 0.5 millimeter lead equivalent material.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "New Hampshire's X-ray rules do not require protective aprons or other protective apparel to be inspected on a regular schedule. The rules only require facilities to keep enough lead equivalent garments or barriers for staff and to label each item with its lead equivalence.", "citation": "He-P 4045.03(n)(6)-(7); see also He-P 4046.01, 4046.02, 4046.05 and 4045.05", "sourceUrls": [ "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4045.03" ], "quote": "All protective apparel or barriers shall be clearly labeled with its lead equivalence.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Addressed indirectly. Whole-body protective barriers of at least 0.5 mm lead equivalent are accepted as an alternative to aprons. Engineered radiation protection systems are not mentioned by name.", "citation": "He-P 4045.03(i)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4045.03" ], "quote": "shall be protected from scatter radiation by either protective aprons or whole body protective barriers, of not less than 0.5 millimeter lead equivalent material.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Partly found. RSA 328-J requires a license to perform medical imaging, and limited X-ray machine operators may not perform fluoroscopy. Students and residents may perform imaging under supervision. Physician, PA and NP exemptions were not verified.", "citation": "RSA 328-J:12, III", "sourceUrls": [ "https://gc.nh.gov/rsa/html/XXX/328-J/328-J-mrg.htm" ], "quote": "Persons licensed as limited x-ray machine operators shall perform tasks only within the scope of the specific permit issued to them by the executive director and under the direct supervision of a licensed practitioner or licensed radiographer", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Partly found. Operators must be instructed in the manufacturer's safe operating procedures and be competent. Diagnostic operators must show competence in listed areas, including personnel protection and dosimetry. ARRT, fluoroscopy permit, training-hour and continuing-education requirements were not verified.", "citation": "He-P 4045.03(b), (d)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4045.03" ], "quote": "Persons who operate radiation or MRI machines shall be instructed in the manufacturer's safe operating procedures and be competent in the safe use of the equipment.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "He-P 4045 (except 4045.03), 4046 and 4047 possible lapse", "kind": "other", "status": "Last readopted effective 7-21-15 with listed expiration 7-21-25; no later readoption shown in filing history; status unsettled", "date": "7-21-25", "dateISO": null, "summary": "Main X-ray parts may have expired or may remain in force while a readoption is pending.", "sourceUrls": [ "https://gc.nh.gov/rules/Filing_history/sourcehe-p.html" ] }, { "title": "He-P 4040 interim rule (registration)", "kind": "adopted_rule", "status": "Interim rule effective 4-24-26, expiring 10-21-26 (#14566); unclear whether replaced by a final rule", "date": "4-24-26", "dateISO": null, "summary": "Interim registration rule.", "sourceUrls": [ "https://gc.nh.gov/rules/Filing_history/sourcehe-p.html" ] }, { "title": "He-P 4070 interim rule (fees)", "kind": "adopted_rule", "status": "Interim rule effective 4-22-26, expiring 10-19-26 (#14562); unclear whether replaced by a final rule", "date": "4-22-26", "dateISO": null, "summary": "Interim fees rule.", "sourceUrls": [ "https://gc.nh.gov/rules/Filing_history/sourcehe-p.html" ] }, { "title": "He-P 4022 readoption with amendments", "kind": "adopted_rule", "status": "Effective 7-1-25 (#14303)", "date": "7-1-25", "dateISO": null, "summary": "Surveys and monitoring part readopted with amendments.", "sourceUrls": [ "https://gc.nh.gov/rules/Filing_history/sourcehe-p.html" ] }, { "title": "He-P 4019 and He-P 4041 readoptions", "kind": "adopted_rule", "status": "Effective 7-1-25 (#14301, #14300)", "date": "7-1-25", "dateISO": null, "summary": "Notices/instructions to workers and definitions readopted.", "sourceUrls": [ "https://gc.nh.gov/rules/Filing_history/sourcehe-p.html" ] }, { "title": "He-P 4043 readoption", "kind": "adopted_rule", "status": "Effective 8-8-25 (#14336)", "date": "8-8-25", "dateISO": null, "summary": "He-P 4043 readopted.", "sourceUrls": [ "https://gc.nh.gov/rules/Filing_history/sourcehe-p.html" ] }, { "title": "He-P 4020 readoption", "kind": "adopted_rule", "status": "Effective 7-23-24 (#14028)", "date": "7-23-24", "dateISO": null, "summary": "Standards for Protection Against Radiation readopted. This contains the ALARA text (He-P 4020.04(b)) that would be relevant if NH matches the NRC proposed ALARA change.", "sourceUrls": [ "https://gc.nh.gov/rules/Filing_history/sourcehe-p.html" ] } ], "notable": [ "Workers likely to receive more than 1 mSv a year must be instructed on health risks, ways to reduce exposure, and the purpose of protective devices (He-P 4019.04).", "Fluoroscopic exposure must be on a continuous-pressure (dead-man) control (He-P 4046.02(d)).", "Fluoroscopes must be image-intensified or digital (He-P 4046.02(a)).", "Hand-held fluoroscopic screens are banned unless listed by CRCPD or accepted by FDA (He-P 4001.06).", "Only staff and others who must be present may be in the room during exposure (He-P 4045.03(h)), and people may not be used routinely to hold patients (He-P 4045.03(n)(4)).", "Hospital licensing rules include He-P 802.39 Cardiac Catheterization Services (table of contents only; not read).", "Operator licensing is handled by OPLC and its Advisory Board of Medical Imaging and Radiation Therapy, not by RHS." ], "openQuestions": [ "Are He-P 4045 and 4046 still in force given the 7-21-25 expiration? Has the He-P 4040 interim rule been replaced by a final rule?", "What does He-P 4022.03 (badge location) say?", "Do He-P 4046.03-4046.05 contain requirements on drapes, thyroid shields, eyewear or apron inspection, and does He-P 4041.02 define 'whole body protective barrier'?", "Under full RSA 328-J and Plc 1300, may physicians, PAs and NPs operate fluoroscopy, and what supervision, credentials and continuing education apply?", "Are there 2025-2026 bills on medical imaging or radiation protection?", "Does He-P 802.39 set any staff radiation-safety requirements?" ], "sources": [ { "title": "NH General Court, He-P 4001-4022", "url": "https://gc.nh.gov/rules/state_agencies/he-p4001-4022.html" }, { "title": "NH General Court, filing history for He-P rules", "url": "https://gc.nh.gov/rules/Filing_history/sourcehe-p.html" }, { "title": "NH General Court, He-P table of contents", "url": "https://gc.nh.gov/rules/state_agencies/he-p.html" }, { "title": "Cornell LII, He-P 4000 chapter index", "url": "https://www.law.cornell.edu/regulations/new-hampshire/title-He/subtitle-He-P/chapter-He-P-4000" }, { "title": "Cornell LII, He-P 4020 part index", "url": "https://www.law.cornell.edu/regulations/new-hampshire/title-He/subtitle-He-P/chapter-He-P-4000/part-He-P-4020" }, { "title": "Cornell LII, § 4020.12", "url": "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4020.12" }, { "title": "Cornell LII, He-P 4022 part index", "url": "https://www.law.cornell.edu/regulations/new-hampshire/title-He/subtitle-He-P/chapter-He-P-4000/part-He-P-4022" }, { "title": "Cornell LII, He-P 4045 part index", "url": "https://www.law.cornell.edu/regulations/new-hampshire/title-He/subtitle-He-P/chapter-He-P-4000/part-He-P-4045" }, { "title": "Cornell LII, § 4045.02", "url": "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4045.02" }, { "title": "Cornell LII, § 4045.03", "url": "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4045.03" }, { "title": "Cornell LII, He-P 4046 part index", "url": "https://www.law.cornell.edu/regulations/new-hampshire/title-He/subtitle-He-P/chapter-He-P-4000/part-He-P-4046" }, { "title": "Cornell LII, § 4046.01", "url": "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4046.01" }, { "title": "Cornell LII, § 4046.02", "url": "https://www.law.cornell.edu/regulations/new-hampshire/N-H-Admin-Code-SS-He-P-4046.02" }, { "title": "NH DHHS Radiation Machines Program", "url": "https://www.dhhs.nh.gov/programs-services/environmental-health-and-you/radiological-health/new-hampshire-radiation-machines" }, { "title": "NH DHHS Radiological Health", "url": "https://www.dhhs.nh.gov/programs-services/environmental-health-and-you/radiological-health" }, { "title": "RSA 328-J", "url": "https://gc.nh.gov/rsa/html/XXX/328-J/328-J-mrg.htm" }, { "title": "Plc 1300", "url": "https://gc.nh.gov/rules/state_agencies/plc1300.html" }, { "title": "OPLC laws and rules page", "url": "https://www.oplc.nh.gov/advisory-board-medical-imaging-and-radiation-therapy-laws-and-rules" }, { "title": "ASRT radiologist assistant statute summary", "url": "https://www.asrt.org/docs/default-source/govtrel/gr18_fed_ra_resource_cmsqanda.pdf" } ] }, { "code": "NJ", "name": "New Jersey", "pageUrl": "https://orsif.org/guidelines/us/states/new-jersey", "regulator": { "name": "New Jersey Department of Environmental Protection (NJDEP), Radiation Protection Element, Bureau of X-Ray Compliance", "url": "https://dep.nj.gov/rpp/bxc/" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "New Jersey's X-ray rules (N.J.A.C. 7:28) contain their own operator ALARA requirement (7:28-15.9(a)12) and also incorporate 10 CFR Part 20 by reference with automatic updating, so an NRC rule removing ALARA from Part 20 could change the shared part but not the X-ray-specific sentence. Dose limits are federal: 50 mSv whole body, 150 mSv lens, 500 mSv skin/extremities, and 5 mSv embryo/fetus; no lower eye limit has been adopted. Everyone in a fluoroscopy room during exposure must wear a 0.25 mm lead-equivalent apron, aprons must be checked annually for breaks, and the rules do not address engineered shielding systems used in place of aprons. Licensed practitioners may operate fluoroscopy; technologists may only assist with a physician present; radiologist assistants may perform delegated fluoroscopy; nurses, NPs, and PAs are not licensed practitioners.", "whereAlaraLives": { "category": "both", "explanation": "X-ray-specific ALARA in 7:28-15.9(a)12 is independent of Part 20. Subchapter 6 also incorporates Part 20's ALARA definition (amended to cover registered machines) and 20.1101. Under the automatic-update clause in 7:28-1.6(c), an NRC removal of ALARA from Part 20 could change the shared part, but not 15.9(a)12.", "citation": "N.J.A.C. 7:28-1.6(c); 7:28-6.1(d)2; 7:28-15.9(a)12" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. New Jersey is an NRC Agreement State; N.J.A.C. 7:28-1.6 builds NRC regulations into state law.", "citation": "NRC list of Agreement States, updated October 29, 2026; N.J.A.C. 7:28-1.6", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "N.J.A.C. 7:28, Radiation Protection Programs: Subchapter 15 (Medical Diagnostic X-ray Installations; 15.5 fluoroscopy, 15.9 individual radiation safety), plus 7:28-7, 7:28-19, 7:28-22, and Subchapter 6 incorporating 10 CFR Part 20 by reference. DEP courtesy copy last amended October 20, 2025; chapter expires February 19, 2027.", "citation": "N.J.A.C. 7:28-6.1(a); 7:28-15.1(a)", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ], "quote": "this subchapter incorporates by reference 10 CFR Part 20, Standards for Protection Against Radiation.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes, as an operator requirement: no one may operate an X-ray machine unless they understand and use ALARA principles. Whether the federal ALARA program duty (10 CFR 20.1101(b), written for 'the licensee') binds X-ray registrants is unclear.", "citation": "N.J.A.C. 7:28-15.9(a)12; 7:28-6.1(d)2; 10 CFR 20.1101(b)", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ], "quote": "No person shall operate an ionizing-radiation-producing machine unless that person understands and uses the principles of radiation safety to keep radiation exposure as low as reasonably achievable.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) per year total effective dose equivalent, via 10 CFR 20.1201 applied to licensees or registrants.", "citation": "N.J.A.C. 7:28-6.1(d)14-16; 10 CFR 20.1201(a)", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ], "quote": "10 CFR 20.1201, replace “licensee” with “licensee or registrant,” except in 10 CFR 20.1201(e)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year; no lower limit adopted.", "citation": "N.J.A.C. 7:28-6.1(d)14-16; 10 CFR 20.1201(a)", "sourceUrls": [ "https://www.law.cornell.edu/cfr/text/10/20.1201" ], "quote": "A lens dose equivalent of 15 rems (0.15 Sv)", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) per year shallow dose to skin or extremities.", "citation": "10 CFR 20.1201(a)(2)(ii), incorporated by N.J.A.C. 7:28-6.1", "sourceUrls": [ "https://www.law.cornell.edu/cfr/text/10/20.1201" ], "quote": "A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant worker over the pregnancy; declared-pregnant students reference NCRP Report 116's 50 mrem (0.5 mSv) per month.", "citation": "10 CFR 20.1208(a), incorporated by N.J.A.C. 7:28-6.1", "sourceUrls": [ "https://www.law.cornell.edu/cfr/text/10/20.1208" ], "quote": "The licensee shall ensure that the dose equivalent to the embryo/fetus during the entire pregnancy, due to the occupational exposure of a declared pregnant woman , does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Registrants must supply and require dosimeters for anyone in a controlled area likely to exceed 25 mrem (0.25 mSv) in any 7 consecutive days, minors likely to exceed 10 mrem (0.1 mSv) in 7 days, anyone entering a high radiation area, and at least one visitor per group. Whether the federal 10% rule also applies to registrants is uncertain.", "citation": "N.J.A.C. 7:28-7.4(a); 7:28-5.3(a)2", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ], "quote": "Each individual who enters a controlled area under such circumstances that he receives, or is likely to receive, a dose in excess of 25 millirems in any period of seven consecutive days;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "No general placement rule for fluoroscopy staff. Handheld-unit operators wear a collar badge outside protective garments plus a ring badge; declared-pregnant students in fluoroscopy wear one badge at the neck outside the apron and one at the waist under it. No state-approved effective dose method found.", "citation": "N.J.A.C. 7:28-15.3(l)2; 7:28-19.13(f)14iii; 10 CFR 20.1201(c)", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ], "quote": "One device shall be worn at the neck level outside the protective apron and the other under the protective apron at the waist level;", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Everyone in a radiographic or fluoroscopic room during any exposure must wear an apron of at least 0.25 mm lead equivalent. Gloves of at least 0.25 mm lead equivalent are required when hands must be in the beam. A drape of at least 0.5 mm lead equivalent is required between patient and fluoroscopist. Thyroid shields are required only for handheld-unit operators. No eyewear requirement found.", "citation": "N.J.A.C. 7:28-15.9(a)1; 7:28-15.5(b)13-14; 7:28-15.3(l)6", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ], "quote": "Individuals who are present in a radiographic or fluoroscopic room during any exposure shall wear protective aprons of at least 0.25 mm lead equivalent during every exposure.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. The fluoroscopy QC program requires an integrity check of aprons, gloves, gonadal and thyroid shields initially and annually (no breaks), done by appropriately trained facility personnel. The method (visual or fluoroscopic) is not specified.", "citation": "N.J.A.C. 7:28-22.6(a)2, Table 2, item 6", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ], "quote": "Lead Aprons, Gloves, Gonadal and Thyroid Shield Integrity Check Initially and annually No breaks in protective garments", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "no", "answer": "New Jersey's rules do not address engineered shielding systems used in place of aprons. Everyone in a fluoroscopy room during an exposure must wear an apron of at least 0.25 mm lead equivalent. A shield such as a drape giving at least 0.5 mm lead equivalent must also be placed between the patient and the fluoroscopist, but this is in addition to aprons, not instead of them.", "citation": "N.J.A.C. 7:28-15.9(a)1; N.J.A.C. 7:28-15.5(b)12 to 14; N.J.A.C. 7:28-2.5", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ], "quote": "Protective shielding, such as a drape, shall be in place between the patient and fluoroscopist and shall provide protection equivalent to at least 0.5 millimeters of lead;", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Licensed practitioners (physicians, osteopaths, podiatrists, dentists, chiropractors) may operate within their licenses without a technologist license. Licensed diagnostic technologists may only assist in fluoroscopy with a licensed physician physically in the room directing. Limited licenses exclude fluoroscopy. Radiologist assistants may perform delegated fluoroscopy under a radiologist. Students may not start exposures during fluoroscopy. Nurses, NPs, and PAs are not licensed practitioners.", "citation": "N.J.A.C. 7:28-15.1(d); 7:28-19.1(c)1; 7:28-19.2; 7:28-19.4(b)6, (i); N.J.A.C. 13:35-6.20A", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ], "quote": "Licensed practitioners do not include dental hygienists, nurses, nurse practitioners, physician assistants or radiologist assistants.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Technologists need a state diagnostic license (Board exam, or Board acceptance of ARRT or another state's license). Radiologist assistants need an RA license, a diagnostic license, and ARRT (or Board-approved) RA certification. No continuing education, separate fluoroscopy permit, or physician fluoroscopy training requirement was found.", "citation": "N.J.A.C. 7:28-19.7(b); 7:28-19.3(a)3; 7:28-19.9(d); 7:28-15.9(a)9", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ], "quote": "the Board may accept a valid active certificate issued by the American Registry of Radiologic Technologists (ARRT) or a valid active certificate or license as a radiologic technologist issued by another state", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "Amendments to N.J.A.C. 7:28-3, -14, -15 and -16 (57 N.J.R. 977(a))", "kind": "adopted_rule", "status": "Adopted October 20, 2025", "date": "2025-10-20", "dateISO": "2025-10-20", "summary": "Proposed May 19, 2025. Changed 15.5 and 15.9 and added handheld-unit rules; the 0.25 mm apron rule and the ALARA sentence remain.", "sourceUrls": [ "https://dep.nj.gov/rules/notice-of-rule-adoptions/" ] }, { "title": "N.J.A.C. 7:28 chapter expiration / readoption", "kind": "other", "status": "Readoption due; no proposal found", "date": "2027-02-19", "dateISO": "2027-02-19", "summary": "Chapter expires February 19, 2027, so a readoption is due.", "sourceUrls": [ "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" ] }, { "title": "S3513", "kind": "bill", "status": "Introduced; in Senate Commerce Committee; appears pending", "date": "2026-02-12", "dateISO": "2026-02-12", "summary": "Would change age and education requirements for technologists.", "sourceUrls": [ "https://legiscan.com/NJ/bill/S3513/2026?guid=6c4YgO6Xy3jMy99wJc2WA7" ] }, { "title": "A2416", "kind": "bill", "status": "Appears pending", "date": "", "dateISO": null, "summary": "Would change age and education requirements for technologists.", "sourceUrls": [ "https://neruca.org/state-updates/new-jersey" ] }, { "title": "NRC final Part 20 ALARA rule", "kind": "other", "status": "Potential automatic carryover", "date": "", "dateISO": null, "summary": "Because of the automatic-update clause in 7:28-1.6(c), the NRC's final Part 20 rule could carry over into Subchapter 6.", "sourceUrls": [] } ], "notable": [ "Licensed staff may not be ordered to hold patients except in life-threatening situations; no one may be routinely assigned to hold (15.9(a)2).", "Each facility must give operators written safety rules and get a signed acknowledgment (15.9(a)9).", "Fluoroscopy requires a QA program with an annual medical physicist survey, not more than 14 months apart (7:28-22.6).", "Radiologist-assistant schools must log fluoroscopy time and have radiologists review it weekly (19.17(e)3).", "No one may cause a technologist or radiologist assistant to be in the primary beam unless the licensed practitioner deems it essential, and then only with protective garments over any body part in the beam (19.3(d)).", "An automatic-update clause (7:28-1.6(c)) makes NRC amendments to incorporated federal rules flow into the NJ rule." ], "openQuestions": [ "Do 10 CFR 20.1101 and 20.1502 (which say 'licensee') bind X-ray registrants? Ask the Bureau of X-Ray Compliance or Commission on Radiation Protection.", "Will NJDEP apply the 7:28-1.6(c) automatic-update clause to the final NRC rule, especially for registrants?", "What apron inspection method (visual or fluoroscopic) does DEP's fluoroscopy QC guidance specify?", "Has DEP approved any effective-dose methods (NCRP 122, Webster) in guidance or letters?", "Confirm radiologist-assistant supervision levels for delegated fluoroscopy in the official N.J.A.C. 13:35-6.20A text.", "Watch for a 7:28 readoption proposal before February 19, 2027.", "The 2025 adoption notice (with responses to comments) and the official LexisNexis N.J.A.C. text were not reviewed." ], "sources": [ { "title": "NJDEP, N.J.A.C. 7:28 Radiation Protection Programs (courtesy copy, last amended Oct 20, 2025)", "url": "https://www.nj.gov/dep/rpp/RPRP_Rules/njac_7_28.pdf" }, { "title": "NJDEP Bureau of X-Ray Compliance (search-result text only)", "url": "https://dep.nj.gov/rpp/bxc/" }, { "title": "NJDEP Technologist Licensing Information (search-result text only)", "url": "https://dep.nj.gov/rpp/lic_info/" }, { "title": "NJDEP Notice of Rule Adoptions (search-result text only)", "url": "https://dep.nj.gov/rules/notice-of-rule-adoptions/" }, { "title": "NJDEP Regulatory Update slides, Nov 2025 (search-result text only)", "url": "https://dep.nj.gov/wp-content/uploads/srp/24th_annual_njdep_awma_reg_slides.pdf" }, { "title": "Cornell LII, N.J.A.C. 7:28-6.1", "url": "https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-7-28-6-1" }, { "title": "Cornell LII, N.J.A.C. 7:28-15.9 (out of date)", "url": "https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-7-28-15-9" }, { "title": "Cornell LII, N.J.A.C. 13:35-6.20A", "url": "https://www.law.cornell.edu/regulations/new-jersey/N-J-A-C-13-35-6-20A" }, { "title": "Cornell LII, 10 CFR 20.1201", "url": "https://www.law.cornell.edu/cfr/text/10/20.1201" }, { "title": "Cornell LII, 10 CFR 20.1208", "url": "https://www.law.cornell.edu/cfr/text/10/20.1208" }, { "title": "Cornell LII, 10 CFR 20.1003", "url": "https://www.law.cornell.edu/cfr/text/10/20.1003" }, { "title": "eCFR, 10 CFR 20.1502", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-F/section-20.1502" }, { "title": "GovInfo, 10 CFR (1-1-25 edition), 20.1101", "url": "https://www.govinfo.gov/content/pkg/CFR-2025-title10-vol1/pdf/CFR-2025-title10-vol1-sec20-1201.pdf" }, { "title": "LegiScan, NJ S3513 (2026)", "url": "https://legiscan.com/NJ/bill/S3513/2026?guid=6c4YgO6Xy3jMy99wJc2WA7" }, { "title": "NERUCA, New Jersey bill tracker (A2416)", "url": "https://neruca.org/state-updates/new-jersey" } ] }, { "code": "NM", "name": "New Mexico", "pageUrl": "https://orsif.org/guidelines/us/states/new-mexico", "regulator": { "name": "New Mexico Environment Department (NMED), Environmental Protection Division, Radiation Control Bureau (RCB), Radiation Machine Program; rules adopted by the Environmental Improvement Board", "url": "https://www.env.nm.gov/rcb/radiation-machine-program-supporting-safe-use-across-new-mexico/" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "New Mexico's ALARA requirement is in 20.3.4 NMAC (404(B)), which covers both X-ray registrants and radioactive-materials licensees; the 1995-era X-ray rule 20.3.6 never uses the term ALARA but requires procedures that minimize personnel exposure. Annual dose limits are 50 mSv whole body, 150 mSv lens, 500 mSv skin/extremity, and 5 mSv embryo/fetus over a declared pregnancy, and 20.3.4 includes fluoroscopy apron badge-placement and effective-dose rules. Aprons or whole-body protective barriers of at least 0.25 mm Pb eq are required, and the rules allow such barriers as an alternative to aprons, though engineered systems are not named; a pending 20.3.6 rewrite would add annual apron integrity checks. Licensed practitioners may operate without an imaging license, technologists need ARRT-based licensure, and limited licensees may not use fluoroscopy.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The binding ALARA requirement is in 20.3.4.404(B), which covers both licensees and registrants, and the 20.3.1.6(B) objective also refers to ALARA. Current 20.3.6 never uses the term; its closest wording is the 'minimize… personnel exposure' language in 602(A)(1)(i). The pending draft would add an ALARA objective in 20.3.6.6(B).", "citation": "20.3.4.404(B); 20.3.1.6(B); 20.3.6.602(A)(1)(i); proposed 20.3.6.6(B)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. New Mexico is not on the non-Agreement list, consistent with a May 1, 2026 NRC letter reviewing New Mexico's 20.3.4 revisions for compatibility.", "citation": "NRC list of Agreement States, updated October 29, 2026; NRC letter ML26117A340", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "20.3.6 NMAC, \"X-Rays in the Healing Arts\" (history notes 5-3-95, recompiled 11/27/01; about 30 years old, with a replacement pending). General standards are in 20.3.4 NMAC (effective 4/30/2009, later amended). Related rules are 20.3.1 and 20.3.2 NMAC.", "citation": "20.3.6 NMAC; 20.3.4.2 NMAC (scope)", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0006.html", "https://www.srca.nm.gov/parts/title20/20.003.0004.html" ], "quote": "Except as specifically provided in other parts of this chapter, this part applies to persons licensed or registered by the department to receive, possess, use, transfer or dispose of sources of radiation.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. 20.3.4.404(B) requires each licensee or registrant to keep occupational doses ALARA, which covers X-ray and fluoroscopy registrants. The radiation protection program must be reviewed every 12 months and covered with all employees at hire and annually thereafter (amended 5/1/2024).", "citation": "20.3.4.404(B) NMAC", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0004.html" ], "quote": "The licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are ALARA.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) total effective dose equivalent per year for adults; 50 rem (500 mSv) sum of deep dose and committed dose to any organ other than the lens.", "citation": "20.3.4.405(A) NMAC", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0004.html" ], "quote": "more limiting of: (a) the total effective dose equivalent being equal to 5 rems (0.05 sievert); or (b) the sum of the deep dose equivalent and the committed dose equivalent to any individual organ or tissue other than the lens of the eye being equal to 50 rems (0.5 sievert)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year. No lower limit has been adopted, and the 2026 draft keeps 15 rems.", "citation": "20.3.4.405(A)", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0004.html" ], "quote": "(a) a lens dose equivalent of 15 rems (0.15 sievert); and (b) a shallow dose equivalent of 50 rems (0.5 sievert) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) shallow dose per year to the skin of the whole body or any extremity.", "citation": "20.3.4.405(A)", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0004.html" ], "quote": "(a) a lens dose equivalent of 15 rems (0.15 sievert); and (b) a shallow dose equivalent of 50 rems (0.5 sievert) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant woman over the entire pregnancy.", "citation": "20.3.4.412(A)", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0004.html" ], "quote": "licensee or registrant shall ensure that the dose equivalent to the embryo/fetus during the entire pregnancy, due to the occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 millisieverts)", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Monitoring is required for adults likely to exceed 10% of the annual limits; minors above 1 mSv deep dose, 1.5 mSv lens or 5 mSv skin/extremity; declared pregnant women likely to exceed 1 mSv; and people entering high radiation areas. Paragraph (5) separately lists individuals working with medical fluoroscopic equipment, which may mean all fluoroscopy workers must be badged; its intent is unclear.", "citation": "20.3.4.417(A)(1)-(5)", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0004.html" ], "quote": "(1) adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of the limits in Subsection A of 20.3.4.405 NMAC;", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "With an apron, the whole-body badge goes at the unshielded location of highest exposure, typically the collar; the eye badge goes at the neck outside the apron or closer to the eye. A declared pregnant woman needs a second badge at the waist under the apron. Effective dose rules: a single collar badge counts as the deep dose; if that reading exceeds 25% of the limit it may be multiplied by 0.3; with two badges, effective dose = 1.5 × waist badge + 0.04 × neck badge; other methods need department approval. 20.3.6.602(A)(1)(j) also requires a collar badge outside the apron; the draft would delete this.", "citation": "20.3.4.405(C)(1)-(2); 20.3.4.417(A)(5), (C); 20.3.6.602(A)(1)(j)", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0004.html" ], "quote": "when only one individual monitoring device is used and it is located at the neck outside the protective apron, and the reported dose exceeds 25 percent of the limit specified in Subsection A of this section, the reported deep dose equivalent value multiplied by 0.3", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Staff must be protected by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent, and any body part in the useful beam needs 0.5 mm. For fluoroscopy scatter, under-table scatter must be attenuated by 0.25 mm Pb eq; above the tabletop, staff must be 120 cm from the beam center or behind 0.25 mm Pb-eq drapes or panels in addition to the apron. The Department may require additional devices. No thyroid shield or eyewear requirement was found. The draft requires a sufficient number of protective apparel to be available.", "citation": "20.3.6.602(A)(1)(e); 20.3.6.604(I)", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0006.html" ], "quote": "staff and ancillary personnel shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 mm lead equivalent;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "No current requirement. The pending 20.3.6 draft would require annual integrity evaluation and lead-equivalence labeling of all protective apparel and auxiliary shields, without specifying the method. This is proposed, not in force.", "citation": "proposed 20.3.6.602(A)(9) (February 2026 draft and EIB 26-54 version)", "sourceUrls": [ "https://www.env.nm.gov/rcb/wp-content/uploads/sites/16/2026/02/20.3.6-Full-Reg-Amend-Strikethrough-Draft.pdf" ], "quote": "All protective apparel and auxiliary shields shall be evaluated annually for integrity and clearly labeled with their lead equivalence.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered radiation protection systems are not addressed by name. The rules allow whole-body protective barriers of at least 0.25 mm Pb eq as an alternative to aprons; drapes, panels and curtains under 604(I)(2) are in addition to the apron. The draft would replace 604(I) with 21 CFR 1020.32. No bill or rule like Arizona's or Illinois's was found.", "citation": "20.3.6.602(A)(1)(e)(ii); 20.3.6.604(I)(2)", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0006.html" ], "quote": "the radiation has passed through not less than 0.25 mm lead equivalent material (e.g., drapes, Bucky-slot cover, sliding or folding panel, or self supporting curtains) in addition to any lead equivalency provided by the protective apron", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Licensed practitioners (medicine, dentistry, podiatry, chiropractic, osteopathy) need no imaging license. Students may operate under supervision. NMED-licensed radiographers work under a licensed practitioner's supervision, and radiologist assistants (ARRT RRA) work under a radiologist. Limited-practice licensees may not use fluoroscopy. RNs may not perform ionizing procedures unless licensed. PAs and NPs are not licensed practitioners, and no EIB-approved certification program for them was found.", "citation": "20.3.20.7, 20.3.20.100, 20.3.20.310 NMAC; NMSA 61-14E-7", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0020.html" ], "quote": "perform procedures outside their scope of practice including, but not limited to procedures involving the use of contrast media, fluoroscopic equipment, mammography, computed tomography,", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Technologists need an ARRT credential for licensure (24-month licenses; continuing education follows the credentialing organization; limited licensees need 24 Category A hours). No separate fluoroscopy permit or set training hours were found. No physician fluoroscopy training requirement was found in NMED rules (Medical Board rules not checked). Registrants must ensure operators are adequately instructed. The draft adds that operators meet department qualifications.", "citation": "20.3.20.300,.301,.330 NMAC; 20.3.6.602(A)(1)(b)", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0020.html" ], "quote": "must comply with all continuing education, continuing competency, and registration requirements of the credentialing organization for which they hold a credential or certification.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "EIB 26-54 (R): NMED petition to amend 20.3.1, 20.3.2, 20.3.3, 20.3.4, 20.3.6 and 20.3.20 NMAC", "kind": "proposed_rule", "status": "Public hearing Nov 6, 2026, 1 p.m., Roundhouse, Santa Fe and online; comments accepted until the hearing closes", "date": "2026-11-06", "dateISO": "2026-11-06", "summary": "Rewrites 20.3.6 as 'Medical Diagnostic and Interventional X-ray and Imaging Systems': adds FGI provisions, medical-event reporting, CR/DR QC, annual apron integrity evaluation and a radiation safety program requirement; incorporates 21 CFR 1020.30-.32; deletes the existing fluoroscopy and scatter-control text and the collar-badge text. Makes a 20.3.4.453 citation correction (dose limits and ALARA unchanged) and updates 20.3.20 credentialing organizations.", "sourceUrls": [ "https://cloud.env.nm.gov/resources/_translator.php/ZjA3YTc2OWQ0YjcyOWZhZDQxZWQxODZjOV8yNDAxNDc~.pdf" ] }, { "title": "20.3.4.404 amendment (program review with all employees)", "kind": "adopted_rule", "status": "Adopted", "date": "2024-05-01", "dateISO": "2024-05-01", "summary": "Requires the radiation protection program to be covered with all employees before beginning their job duties and annually thereafter.", "sourceUrls": [ "https://www.srca.nm.gov/parts/title20/20.003.0004.html" ] }, { "title": "20.3.4 reference error correction reviewed by NRC", "kind": "other", "status": "NRC reviewed as final; no 2026 amendment shown in the official online 20.3.4", "date": "2026-05-01", "dateISO": "2026-05-01", "summary": "Correction of a regulatory reference error in 20.3.4 NMAC, submitted April 14, 2026; possibly the same 20.3.4.453 fix pending before the EIB.", "sourceUrls": [ "https://www.nrc.gov/docs/ML2611/ML26117A340.pdf" ] } ], "notable": [ "New Mexico puts fluoroscopy-specific dosimetry (badge placement and effective-dose formulas) directly into its Part 4 standards.", "The pending rewrite would replace NM's own fluoroscopy scatter-control rule (604(I)) with FDA performance standards and drop the Department's explicit power to require additional protective devices where staff could reach a quarter of the limit.", "The 2024 amendment requires covering the radiation protection program with all employees at hire and annually.", "RCB reports more than 2,000 registered machine facilities.", "No 2025-2026 NM bills on fluoroscopy or apron alternatives were found; the 2026 memorials SM27 and HM55 concern downwinder compensation (RECA)." ], "openQuestions": [ "What the EIB adopts after the Nov 6, 2026 hearing on EIB 26-54 and when it takes effect; the full petition could not be opened, and RCB-posted drafts may differ from it.", "Whether 20.3.4.417(A)(5) requires badges for all fluoroscopy workers regardless of the 10% threshold (ask RCB at RCB.XRAYMachines@env.nm.gov).", "Whether the 2026 20.3.4 correction described by the NRC is the same 20.3.4.453 fix still pending before the EIB.", "Whether any board has an EIB-approved imaging certification program that would let PAs or NPs operate fluoroscopy (check MIRTAC minutes and Medical Board rules, 16.10 NMAC).", "Physician fluoroscopy training requirements in Medical Board rules or hospital credentialing were not checked.", "Whether RCB would treat engineered radiation protection systems as 'whole body protective barriers'; no guidance was found.", "Whether the draft 20.3.6 objective's 'As Low As Reasonably Possible (ALARA)' wording will be corrected before adoption." ], "sources": [ { "title": "20.3.4 NMAC, Standards for Protection Against Radiation (NM State Records Center & Archives)", "url": "https://www.srca.nm.gov/parts/title20/20.003.0004.html" }, { "title": "20.3.6 NMAC, X-Rays in the Healing Arts (NM SRCA)", "url": "https://www.srca.nm.gov/parts/title20/20.003.0006.html" }, { "title": "20.3.1 NMAC, General Provisions (NM SRCA)", "url": "https://www.srca.nm.gov/parts/title20/20.003.0001.html" }, { "title": "20.3.20 NMAC, Medical Imaging and Radiation Therapy Licensure (NM SRCA)", "url": "https://www.srca.nm.gov/parts/title20/20.003.0020.html" }, { "title": "RCB, 20.3.6 strikethrough draft (Feb 2026, RTAC)", "url": "https://www.env.nm.gov/rcb/wp-content/uploads/sites/16/2026/02/20.3.6-Full-Reg-Amend-Strikethrough-Draft.pdf" }, { "title": "RCB, 20.3.6 draft, EIB 26-54 version", "url": "https://cloud.env.nm.gov/resources/_translator.php/MzQwZTU5NWQ2NjVlNjNmYTZkZGIzMTNlNl8yMjc0MTY~.pdf" }, { "title": "RCB, 20.3.6 draft, EIB 26-54 version (alternate link)", "url": "https://service.web.env.nm.gov/urls/FQaVbuSk" }, { "title": "RCB, 20.3.4 draft (EIB 26-54)", "url": "https://service.web.env.nm.gov/urls/rswpeFHb" }, { "title": "RCB, 20.3.20 draft (EIB 26-54)", "url": "https://service.web.env.nm.gov/urls/YcMJaJCX" }, { "title": "RCB, Public Involvement Plan (8/25/2026)", "url": "https://service.web.env.nm.gov/urls/NTVcCIhD" }, { "title": "EIB Notice of Public Hearing, EIB 26-54 (R)", "url": "https://cloud.env.nm.gov/resources/_translator.php/ZjA3YTc2OWQ0YjcyOWZhZDQxZWQxODZjOV8yNDAxNDc~.pdf" }, { "title": "RCB, public notices of rulemakings", "url": "https://www.env.nm.gov/rcb/public-notices-of-radioactive-materials-licensing-actions-and-rulemakings/" }, { "title": "NMED, Docketed Matters", "url": "https://www.env.nm.gov/opf/docketed-matters/" }, { "title": "RCB, Radiation Machine Program page", "url": "https://www.env.nm.gov/rcb/radiation-machine-program-supporting-safe-use-across-new-mexico/" }, { "title": "RCB, bureau home page", "url": "https://www.env.nm.gov/rcb/" }, { "title": "NRC letter, Final Revisions to New Mexico 20.3.4 NMAC (May 1, 2026)", "url": "https://www.nrc.gov/docs/ML2611/ML26117A340.pdf" }, { "title": "NMSA 61-14E-7, via Justia (secondary)", "url": "https://law.justia.com/codes/new-mexico/chapter-61/article-14e/section-61-14e-7/" }, { "title": "NRC Agreement State list", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "NY", "name": "New York", "pageUrl": "https://orsif.org/guidelines/us/states/new-york", "regulator": { "name": "New York State Department of Health (NYSDOH), Center for Environmental Health, Bureau of Environmental Radiation Protection (BERP); within New York City, NYC Department of Health and Mental Hygiene (DOHMH) Office of Radiological Health", "url": "https://www.health.ny.gov/environmental/radiological/radon/registration.htm" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "New York requires everyone who uses an X-ray machine, including fluoroscopy, to keep workers' doses ALARA under §16.5(a), part of the General Provisions of 10 NYCRR Part 16 that apply to both X-ray registrants and radioactive-materials licensees. The fluoroscopy rules contain no ALARA wording of their own. Part 16 was repealed and replaced effective July 22, 2026. Dose limits match the federal ones: 50 mSv per year whole body, 150 mSv per year lens of the eye and 500 mSv per year skin and extremities. Everyone in the fluoroscopy room must wear garments of at least 0.25 mm lead equivalent, except around tabletop mini C-arms; a new 2026 provision allows an equivalent dose reduction method instead, if measurements show it works. Only practitioners, licensed technologists and supervised students may apply X-rays to patients. Radiographers may operate fluoroscopy only with a physician in the room, and PAs currently cannot (bill S352/A9148 is in committee). NYC runs its own program under Health Code Article 175, which adds annual apron inspection.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The ALARA duty is in §16.5(a), part of the General Provisions that apply to both X-ray equipment operators and radioactive-materials possessors. No ALARA wording was found in the X-ray sections §§16.50-16.70. A change to §16.5(a) to match an NRC compatibility change would therefore affect X-ray registrants too, unless the state wrote separate X-ray language.", "citation": "10 NYCRR 16.0; 16.5(a); 16.50-16.70" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. New York is an NRC Agreement State.", "citation": "NRC list of Agreement States, updated October 29, 2026; NYSDOH Assessment of Public Comment, Part 16 adoption (2026).", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://regs.health.ny.gov/sites/default/files/pdf/recently_adopted_regulations/Ionizing%20Radiation.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "10 NYCRR Part 16, \"Ionizing Radiation,\" effective 07/22/2026. The General Provisions (§§16.1-16.26) serve as the general radiation protection rules. The Radiation Equipment sections are §§16.50-16.70, with fluoroscopy in §16.58. In NYC, NYC Health Code Article 175 also applies.", "citation": "10 NYCRR 16.0; 16.58", "sourceUrls": [ "https://regs.health.ny.gov/content/section-160-introductory-note" ], "quote": "Sections of this Part set forth under the heading \"General Provisions\" (sections 16.1-16.26) contain provisions applicable to radiation equipment operators and persons in possession of radioactive materials, including general radiation protection requirements.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Anyone operating a radiation installation or using a radiation source, including X-ray and fluoroscopy equipment, must keep occupational doses ALARA.", "citation": "10 NYCRR 16.5(a) (effective 07/22/2026)", "sourceUrls": [ "https://regs.health.ny.gov/content/section-165-responsibility-radiation-safety" ], "quote": "(a) achieves occupational doses, and doses to any member of the public, as low as is reasonably achievable (ALARA). Such effort shall include, to the extent practicable, the use of procedures and engineering controls which are based on sound radiation protection principles;", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem) = 50 mSv per year total effective dose equivalent. The organ limit is 500 mSv.", "citation": "10 NYCRR 16.6(a)(1)(i) (effective 07/22/2026)", "sourceUrls": [ "https://regs.health.ny.gov/content/section-166-occupational-dose-limits" ], "quote": "The total effective dose equivalent being equal to 0.05 Sv (5 rem); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) = 150 mSv per year. No lower ICRP-style limit has been adopted.", "citation": "10 NYCRR 16.6(a)(1), (e), (f) (effective 07/22/2026)", "sourceUrls": [ "https://regs.health.ny.gov/content/section-166-occupational-dose-limits" ], "quote": "(a) A lens dose equivalent of 0.15 Sv (15 rem), and (b) A shallow dose equivalent of 0.50 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Shallow dose equivalent of 0.50 Sv (50 rem) = 500 mSv per year to the skin of the whole body or any extremity.", "citation": "10 NYCRR 16.6(a)(1), (e), (f) (effective 07/22/2026)", "sourceUrls": [ "https://regs.health.ny.gov/content/section-166-occupational-dose-limits" ], "quote": "(a) A lens dose equivalent of 0.15 Sv (15 rem), and (b) A shallow dose equivalent of 0.50 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant worker over the whole pregnancy.", "citation": "10 NYCRR 16.6(f)(1) (effective 07/22/2026)", "sourceUrls": [ "https://regs.health.ny.gov/content/section-166-occupational-dose-limits" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant worker, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Dosimeters are required for: adults likely to exceed 10% of the limits; minors above set thresholds; declared pregnant workers likely to exceed 1 mSv over the pregnancy; and anyone operating fluoroscopy equipment, whatever their expected dose. Processing must be by an NVLAP-accredited processor.", "citation": "10 NYCRR 16.11(a)(1)-(4)", "sourceUrls": [ "https://regs.health.ny.gov/content/section-1611-personnel-monitoring" ], "quote": "(4) individuals entering a high or very high radiation area, or operating fluoroscopy equipment; and", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "Badge placement: whole-body badge at the unshielded spot likely to get the highest dose; lens badge at the neck outside the apron or closer to the eye; fetal badge at the waist under the apron. For physicians wearing aprons during fluoroscopy, effective dose may be calculated as one neck badge outside the apron × 0.3, or as (waist badge under the apron × 1.5) + (neck badge outside × 0.04). Otherwise, deep dose stands in for effective dose unless a department-approved method is used. NCRP 122 and the Webster method are not named.", "citation": "10 NYCRR 16.11(b); 16.6(a)(2)(ii)", "sourceUrls": [ "https://regs.health.ny.gov/content/section-166-occupational-dose-limits" ], "quote": "(a) When only one individual monitoring device is used and it is located at the neck outside the protective apron, the reported deep dose equivalent value multiplied by 0.3 shall be the effective dose equivalent for external radiation", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Everyone in the fluoroscopy room must wear garments of at least 0.25 mm lead equivalent, except with tabletop mini C-arms. Part 16 has no thyroid shield or eyewear requirement.", "citation": "10 NYCRR 16.58(b)(2)-(3) (effective 07/22/2026)", "sourceUrls": [ "https://regs.health.ny.gov/content/section-1658-fluoroscopic-installations-excluding-veterinary-installations" ], "quote": "Other than tabletop mini C-arms, protective garments of at least 0.25 mm lead equivalent material each shall be worn by the physician, nurse, radiologic technologist and all other persons within the fluoroscopic room.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "partial", "answer": "Not found in state rules. NYC Article 175 requires annual inspection of protective garments; garments used by fluoroscopy operators must be checked by visual, tactile and X-ray imaging methods. The NYC section number is uncertain.", "citation": "NYC Health Code §175.47(g) (as cited in the NYC penalty schedule)", "sourceUrls": [ "https://codelibrary.amlegal.com/codes/newyorkcity/latest/NYCrules/0-0-0-118663" ], "quote": "Protective garments that are used by operators conducting fluoroscopic procedures must be checked using all three methods listed.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "yes", "answer": "Yes. Since 07/22/2026, a dose reduction method equivalent to protective garments may be used instead of garments if measurements show it works. The method, measurements and any approval process are not defined. NYC §175.53 separately allows movable 0.25 mm lead-equivalent shields where sterile fields or special procedures prevent normal barriers.", "citation": "10 NYCRR 16.58(b)(2); NYC Health Code §175.53", "sourceUrls": [ "https://regs.health.ny.gov/content/section-1658-fluoroscopic-installations-excluding-veterinary-installations" ], "quote": "In lieu of wearing protective garments, the use of a method of dose reduction equivalent to protective garments is acceptable, provided that measurements are made demonstrating its effectiveness.", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Only professional practitioners, people licensed under PHL Article 35 working within their scope, and supervised students may apply X-rays to patients. Licensed radiographers may operate fluoroscopy only under the personal supervision of a physician, who must be in the room. PAs and NPs may order X-rays but may not operate fluoroscopy unless they also hold an Article 35 license.", "citation": "10 NYCRR 16.19(a); 16.2(134)-(135); 10 NYCRR 89.2(a)(4)-(5); 89.1(9)", "sourceUrls": [ "https://regs.health.ny.gov/content/section-1619-limitations-application-radiation-humans", "https://regs.health.ny.gov/content/section-892-practice-radiologic-technology" ], "quote": "(5) operating fluoroscopy equipment under the personal supervision of a physician, except where direct supervision is required by this part;", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Technologists need an NYSDOH license under Part 89, with continuing education equal to 12 credit hours per year of the registration cycle; there is no separate fluoroscopy permit. No physician-specific fluoroscopy training requirement was found. Registrants must ensure personnel are supervised, instructed and competent, give radiation safety instruction before work and at least annually, and run an in-service training program.", "citation": "10 NYCRR 89.20; 16.5(f); 16.13(c); 16.23", "sourceUrls": [ "https://regs.health.ny.gov/content/section-1613-notices-instructions-and-reports-workers-inspections" ], "quote": "Instruction shall be given before an individual begins work likely to result in receiving an occupational dose or before an individual begins work in a restricted area and at least annually thereafter.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "Repeal and replacement of 10 NYCRR Part 16 (Ionizing Radiation)", "kind": "adopted_rule", "status": "Adopted; effective July 22, 2026", "date": "2026-07-22", "dateISO": "2026-07-22", "summary": "Renamed \"eye dose\" to \"lens dose\"; removed planned special exposures; added annual radiation protection program review and acceptance testing, recording of high patient fluoroscopy doses, patient dose management in fluoroscopy following ACR-AAPM / NCRP Report 168, air-kerma display rules for fluoroscopes, and the apron-alternative language. About 154 public comments were received.", "sourceUrls": [ "https://regs.health.ny.gov/regulations/recently-adopted" ] }, { "title": "S352 / A9148 (physician assistants using fluoroscopy)", "kind": "bill", "status": "REFERRED TO HEALTH; has not passed either house", "date": "2026-01-07", "dateISO": "2026-01-07", "summary": "Would let PAs use fluoroscopy after 40 hours of didactic training, 40 hours of clinical training and a competency exam.", "sourceUrls": [ "https://www.nysenate.gov/legislation/bills/2025/S352" ] } ], "notable": [ "The apron rule does not apply to tabletop mini C-arms (16.58(b)(2)).", "The apron-based effective-dose formulas are written for \"physicians\"; it is unclear whether nurses and technologists may use them.", "Workers have inspection-related rights, including requesting inspections and having a representative accompany inspectors (16.13(f)-(g)).", "Drafting problems: 16.11(a)(2) reads as if two versions were merged, and 16.11(b)(2) cites \"16.6(h)(1),\" which does not exist (the embryo/fetus provision is 16.6(f)).", "NYC has its own, sometimes stricter, X-ray rules (Article 175, including annual garment inspection); counties such as Suffolk also run radiation control units that inspect facilities.", "Cornell LII still shows the pre-2026 text (e.g., \"eye dose equivalent\").", "No New York response to the NRC's July 2026 ALARA proposal was found." ], "openQuestions": [ "Agency guidance on the apron alternative (16.58(b)(2)): what counts as an \"equivalent\" method and what measurements are needed.", "State apron inspection: Part 16 has no explicit rule; facility QA manuals or BERP inspection guidance may expect it.", "NYC Article 175: current section numbers for garment inspection (§175.46 vs §175.47(g)), any NYC ALARA wording for X-ray registrants, thyroid and eyewear rules, and how NYC and State jurisdiction over X-ray units divide.", "Technologist requirements: whether ARRT certification is required and the exact continuing-education cycle (Part 89 §§89.10/89.20).", "Physician fluoroscopy training: no state requirement found; hospital credentialing or NYSED rules might apply.", "Response to the NRC ALARA proposal: no NYSDOH comment or plan found.", "Whether county radiation programs (e.g., Suffolk County) enforce added requirements." ], "sources": [ { "title": "10 NYCRR §16.0 Introductory note", "url": "https://regs.health.ny.gov/content/section-160-introductory-note" }, { "title": "10 NYCRR Part 16 table of contents", "url": "https://regs.health.ny.gov/content/part-16-ionizing-radiation" }, { "title": "10 NYCRR §16.1", "url": "https://regs.health.ny.gov/content/section-161-applicability-and-inapplicability-part" }, { "title": "10 NYCRR §16.2 Definitions", "url": "https://regs.health.ny.gov/content/section-162-definitions" }, { "title": "10 NYCRR §16.5", "url": "https://regs.health.ny.gov/content/section-165-responsibility-radiation-safety" }, { "title": "10 NYCRR §16.6", "url": "https://regs.health.ny.gov/content/section-166-occupational-dose-limits" }, { "title": "10 NYCRR §16.11", "url": "https://regs.health.ny.gov/content/section-1611-personnel-monitoring" }, { "title": "10 NYCRR §16.13", "url": "https://regs.health.ny.gov/content/section-1613-notices-instructions-and-reports-workers-inspections" }, { "title": "10 NYCRR §16.19", "url": "https://regs.health.ny.gov/content/section-1619-limitations-application-radiation-humans" }, { "title": "10 NYCRR §16.23", "url": "https://regs.health.ny.gov/content/section-1623-quality-assurance-programs-diagnostic-facilities" }, { "title": "10 NYCRR §16.58", "url": "https://regs.health.ny.gov/content/section-1658-fluoroscopic-installations-excluding-veterinary-installations" }, { "title": "NYSDOH adopted rule \"Ionizing Radiation\" (July 22, 2026; summary, full text, assessment of public comment)", "url": "https://regs.health.ny.gov/sites/default/files/pdf/recently_adopted_regulations/Ionizing%20Radiation.pdf" }, { "title": "NYSDOH Recently Adopted Regulations", "url": "https://regs.health.ny.gov/regulations/recently-adopted" }, { "title": "NYSDOH X-ray Equipment Registration page", "url": "https://www.health.ny.gov/environmental/radiological/radon/registration.htm" }, { "title": "10 NYCRR §89.2", "url": "https://regs.health.ny.gov/content/section-892-practice-radiologic-technology" }, { "title": "10 NYCRR §89.1 (Cornell LII, secondary)", "url": "https://www.law.cornell.edu/regulations/new-york/10-NYCRR-89.1" }, { "title": "Part 89 amendments, effective 11/2/2016", "url": "https://regs.health.ny.gov/sites/default/files/pdf/recently_adopted_regulations/Practice%20of%20Radiologic%20Technology.pdf" }, { "title": "10 NYCRR §16.6, previous version (Cornell LII, for comparison)", "url": "https://www.law.cornell.edu/regulations/new-york/10-NYCRR-16.6" }, { "title": "Pre-2026 Part 16 General Provisions (NRC ADAMS ML18218A278)", "url": "https://www.nrc.gov/docs/ML1821/ML18218A278.pdf" }, { "title": "NY Senate S352 (2025-2026)", "url": "https://www.nysenate.gov/legislation/bills/2025/S352" }, { "title": "NY Senate S352 bill text", "url": "https://legislation.nysenate.gov/pdf/bills/2025/s352" }, { "title": "LegiScan S352 status", "url": "https://legiscan.com/NY/bill/S00352/Regular%20Session" }, { "title": "NYC Health Code Article 175, garment inspection (American Legal Publishing)", "url": "https://codelibrary.amlegal.com/codes/newyorkcity/latest/NYCrules/0-0-0-118663" }, { "title": "NYC Health Code §175.53", "url": "https://codelibrary.amlegal.com/codes/newyorkcity/latest/NYCrules/0-0-0-117525" }, { "title": "NYC DOHMH fixed-penalty schedule (2025)", "url": "https://rules.cityofnewyork.us/wp-content/uploads/2025/06/Ch.-7_NOA_Fixed-Penalties_6-12-25.pdf" }, { "title": "NYC DOHMH Board of Health notice (NRC ML111390288)", "url": "https://www.nrc.gov/docs/ML1113/ML111390288.pdf" } ] }, { "code": "NC", "name": "North Carolina", "pageUrl": "https://orsif.org/guidelines/us/states/north-carolina", "regulator": { "name": "NC Department of Health and Human Services, Division of Health Service Regulation, Radiation Protection Section", "url": "https://radiation.ncdhhs.gov/" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "North Carolina requires X-ray and fluoroscopy facilities to keep worker doses ALARA by adopting 10 CFR 20.1101 into one state rule, 10A NCAC 15.1601, which covers both X-ray registrants and radioactive-materials licensees and adopts the federal text \"including subsequent amendments and editions,\" so a final NRC rule removing ALARA could carry over to X-ray users. Dose limits are the federal ones: 50 mSv per year whole body, 150 mSv lens of the eye (no lower ICRP-style limit), 500 mSv skin and extremities, and 5 mSv for the fetus of a declared pregnant worker. Staff in the room must wear apparel of at least 0.25 mm lead equivalent or use whole-body protective equipment of the same rating, and the rules say where to wear the badge when such equipment replaces an apron but do not require that apparel to be inspected on any schedule. Current rules require only facility training for fluoroscopy operators, no license or certification, but a rule proposed for January 1, 2027 would limit fluoroscopy to physicians, NPs and PAs under general physician supervision, ARRT-registered technologists, and supervised students.", "whereAlaraLives": { "category": "both", "explanation": "ALARA lives mainly in shared rule.1601, which covers both registrants and radioactive-materials licensees and adopts Part 20 \"including subsequent amendments and editions,\" so on its face an NRC change to 20.1101 would apply to X-ray registrants unless NC amends.1601. Older X-ray rule.0603 also requires measures to \"minimize patient and personnel exposure.\" The proposed replacement (.0604) does not appear to keep that sentence, and the readopted.0605 refers only to optimizing patient dose.", "citation": "10A NCAC 15.1601(b);.0603(a)(1)(I) (current older text)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. North Carolina is on the NRC's list of Agreement States, updated October 29, 2026.", "citation": "NRC list of Agreement States, updated October 29, 2026; 10A NCAC 15.0104 (amended effective October 1, 2026)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "http://reports.oah.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2015%20-%20radiation%20protection/chapter%2015%20rules.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "10A NCAC 15 Section.0600, \"X-Rays in the Healing Arts\" (.0601-.0607;.0611 covers CT), with machine registration in Section.0200..0601,.0602 and.0605-.0607 were readopted effective August 1, 2026;.0603 and.0604 still carry older text and are re-proposed. Standards for protection against radiation are in 10A NCAC 15.1601, which adopts most of 10 CFR Part 20 by reference for registrants and licensees alike. The old state rules.1602-.1649 were repealed effective October 1, 2023.", "citation": "10A NCAC 15.0601(e);.1601", "sourceUrls": [ "http://reports.oah.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2015%20-%20radiation%20protection/chapter%2015%20rules.pdf" ], "quote": "The requirements of this Section are in addition to those in Sections .0100, .0200, .1000, .1100, and .1600 of this Chapter.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Rule.1601 makes X-ray registrants follow 10 CFR 20.1101 (reading \"licensee\" as \"registrant\"); 20.1101(b) is the ALARA requirement. State guidance (Rev. 11/17/16) also tells registrants to describe their ALARA procedures, though it cites the old repealed rule numbers.", "citation": "10A NCAC 15.1601(b)(3)(D) and (b)(7); 10 CFR 20.1101(b)", "sourceUrls": [ "https://www.govinfo.gov/content/pkg/CFR-2025-title10-vol1/pdf/CFR-2025-title10-vol1-sec20-1201.pdf" ], "quote": "The licensee shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) TEDE per year, via 10 CFR 20.1201 adopted through.1601(b)(8).", "citation": "10 CFR 20.1201(a), via.1601", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1201" ], "quote": "The total effective dose equivalent being equal to 5 rems (0.05 Sv)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year; NC has not adopted a lower lens limit.", "citation": "10 CFR 20.1201(a), via.1601", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1201" ], "quote": "A lens dose equivalent of 15 rems (0.15 Sv)", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) per year for skin and extremities.", "citation": "10 CFR 20.1201(a)(2)(ii)", "sourceUrls": [ "https://www.govinfo.gov/content/pkg/CFR-2025-title10-vol1/pdf/CFR-2025-title10-vol1-sec20-1201.pdf" ], "quote": "(ii) A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant worker over the whole pregnancy.", "citation": "10 CFR 20.1208(a), via.1601", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1208" ], "quote": "does not exceed 0.5 rem (5 mSv)", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Under 10 CFR 20.1502 (via.1601(b)(24)), a badge is required for adults likely to get more than 10% of a 20.1201(a) limit in a year, for declared pregnant workers likely to get more than 0.1 rem (1 mSv) over the pregnancy, and for minors under lower thresholds. Operators of handheld dental units must always use a badge (.0605(k)(2)).", "citation": "10 CFR 20.1502(a)", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-F/section-20.1502" ], "quote": "Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of the limits in § 20.1201(a)", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "The badge is worn at the collar, outside the apparel, or on the torso if protective equipment replaces apparel. A fetal badge goes at the waist under any apparel. If more than one badge is worn, each dose must be labeled by where it was worn; state guidance (Rev. 3/24/15) describes a two-badge setup (collar outside plus waist under). No state-approved effective dose method (no NCRP 122 or Webster) was found, so under 20.1201(c) deep-dose equivalent must be used unless the state agency approves a method.", "citation": "10A NCAC 15.0605(m) (readopted effective August 1, 2026)", "sourceUrls": [ "http://reports.oah.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2015%20-%20radiation%20protection/chapter%2015%20rules.pdf" ], "quote": "(1) The individual monitoring device shall be worn at the collar, outside the apparel. (2) If protective equipment is used in place of protective apparel, the individual radiation monitoring device shall be worn on the torso.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Yes. Everyone in the room except the patient must be protected from scatter by apparel or whole-body equipment of at least 0.25 mm lead equivalent, and any body part that could be in the primary beam needs at least 0.5 mm lead equivalent. Thyroid shields and eyewear are not required; guidance only calls them \"advisable.\" The guidance also says aprons \"must\" be 0.5 mm at 150 kVp, which conflicts with the 0.25 mm in the rule.", "citation": "10A NCAC 15.0605(h)(1);.0603(a)(1)(E)(ii)", "sourceUrls": [ "https://radiation.ncdhhs.gov/xray/documents/leadapronsgud.pdf", "http://reports.oah.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2015%20-%20radiation%20protection/chapter%2015%20rules.pdf" ], "quote": "protected from scatter radiation by protective apparel or whole-body protective equipment of 0.25 mm lead equivalent or greater material.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "North Carolina's X-ray rules require staff in the room to wear protective apparel or use whole-body protective equipment of at least 0.25 mm lead equivalent, but they do not require that apparel to be inspected or tested on any schedule. Non-binding state guidance recommends checking aprons fluoroscopically at least once a year where possible.", "citation": "10A NCAC 15.0601 to.0611 (Section.0600, X-rays in the healing arts), including Rule.0605(h)(1)(B)", "sourceUrls": [ "https://radiation.ncdhhs.gov/xray/documents/leadapronsgud.pdf" ], "quote": "Lead aprons should be checked fluoroscopically at least on an annual basis for their shielding integrity.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Addressed in general terms. The rules accept \"whole-body protective equipment\" of 0.25 mm lead equivalent as an alternative to apparel and say where to wear the badge when equipment is used in place of apparel. \"Protective equipment\" is not defined (only \"protective apparel\" is, in.0602(33)), and there is no approval process or performance standard specific to engineered systems.", "citation": "10A NCAC 15.0605(h)(1)(B), (m)(2)", "sourceUrls": [ "http://reports.oah.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2015%20-%20radiation%20protection/chapter%2015%20rules.pdf" ], "quote": "If protective equipment is used in place of protective apparel, the individual radiation monitoring device shall be worn on the torso.", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Now: no credential is required; registrants must train operators (.0603(a)(1)(B)) and exposures must be authorized by a licensed practitioner (.0605(b)(1)). Proposed.0603 (effective January 1, 2027): fluoroscopy limited to physicians, NPs/PAs under the general supervision of a trained physician (the 2025 draft said personal supervision), ARRT-registered technologists (Radiography), and students under personal supervision. Angiography: physicians, ARRT technologists, CCI-credentialed RCIS/RCES staff, and supervised students. RNs are not listed.", "citation": "Proposed 10A NCAC 15.0603(i)(2)-(3)", "sourceUrls": [ "https://info.ncdhhs.gov/dhsr/rules/2025/RadiationProposed/10ANCAC15-0603.pdf" ], "quote": "individuals who operate fluoroscopy radiation machines shall be a physician as defined in Rule .0103(b)(8) of this Chapter or an advanced practitioner provider (APP) as defined in Rule .0602(2) of this Section under the general supervision of a physician", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Now: facility training only. Proposed: ARRT registration for technologists; non-radiologist physicians and NPs/PAs would need fluoroscopy training in four topics, with no hours specified. Training records must be kept, and operators would have 36 months after the effective date to comply. No state fluoroscopy permit or continuing-education requirement was found.", "citation": "Proposed.0603(c), (m), (n)", "sourceUrls": [ "https://info.ncdhhs.gov/dhsr/rules/2025/RadiationProposed/10ANCAC15-0603.pdf" ], "quote": "For individuals other than radiologists and ARRT-registered technologists, instruction and training to operate fluoroscopic and angiographic radiation machines shall include: (1) radiation quantities and units; (2) biological effects of ionizing radiation", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "Readoption of 10A NCAC 15.0601,.0602,.0605-.0607", "kind": "adopted_rule", "status": "Readopted", "date": "August 1, 2026", "dateISO": "2026-08-01", "summary": "Readopted X-ray rules;.0607 now adopts FDA equipment standards (21 CFR 1020.32 for fluoroscopy) including future amendments.", "sourceUrls": [ "https://info.ncdhhs.gov/DHSR/rules/rpr2025-2.html" ] }, { "title": "Amendments to 10A NCAC 15.1601", "kind": "adopted_rule", "status": "Amended effective May 1, 2025 and October 1, 2026", "date": "October 1, 2026", "dateISO": "2026-10-01", "summary": "The April 1, 2026 NC Register notice says the purpose was moving NRC comments into the relevant rules.", "sourceUrls": [ "https://files.nc.gov/oah/documents/2026-04/Volume-40-Issue-19-April-1-2026_2.pdf?VersionId=zFk6pzQr2A0q8a7iZw57fR_mBL_baoie" ] }, { "title": "Proposed 10A NCAC 15.0603 (operator requirements) and.0604 (facility responsibilities); repeal of.0611", "kind": "proposed_rule", "status": "Re-published August 17, 2026; hearing September 9, 2026; comments through October 16, 2026; status after October 2026 unverified", "date": "January 1, 2027", "dateISO": "2027-01-01", "summary": "Would set operator qualifications and training for fluoroscopy and angiography. Proposed effective date January 1, 2027. The first 2025 round drew comments from the NC Board of Nursing, NC Nurses Association, NC Healthcare Association, Duke, UNC, WakeMed and Advocate Health, among others.", "sourceUrls": [ "https://info.ncdhhs.gov/dhsr/rules/2025/RadiationProposed/10ANCAC15-0603.pdf" ] }, { "title": "HB 590 / SB 415", "kind": "bill", "status": "HB 590 passed the House 108-0 on June 25, 2025; referred to Senate Rules on June 26, 2025", "date": "June 26, 2025", "dateISO": "2025-06-26", "summary": "Would license imaging staff; exempts nurse practitioners, physician assistants and CRNAs performing fluoroscopy.", "sourceUrls": [ "https://www.ncleg.gov/BillLookup/2025/H590" ] } ], "notable": [ "Mismatched cross-references: the older.0603 still points to repealed rules.1604,.1614 and.1640, and the readopted.0605 cites \".1601(a)(8)\" and \"(a)(53)\" where the dose list is actually in.1601(b).", "Overlapping text: the older.0603 and the new.0605 both contain apron and badge rules.", "Patient holding: no worker may be the one who always holds patients (.0605(f)).", "Hand-held fluoroscopic screens are banned (.0110(3)).", "The older.0603(a)(1)(E)(iv) requires extra protection where non-occupationally exposed staff could get one-fourth of the maximum permissible dose.", "State apron guidance says aprons \"must\" be 0.5 mm at 150 kVp, which conflicts with the rule's 0.25 mm." ], "openQuestions": [ "Status of proposed.0603/.0604: has the Commission adopted them, has the Rules Review Commission approved them, or did 10+ objections send them to legislative review? Check the DHSR page and the RRC agendas.", "Which version is current: one 2026-linked PDF carries an 8/11/2025 date header. Confirm against the NC Register for August 17, 2026 (Vol. 41, Issue 04).", "Effect of an NRC change: does NC read \"subsequent amendments\" in.1601 as automatically picking up a final NRC change to 20.1101, and does the Radiation Protection Section plan its own ALARA language for X-ray users? Ask the Section at (919) 814-2250.", "Effective dose methods: does the agency approve any method for calculating effective dose under aprons (for example Webster or NCRP 122)? Ask the Radiology Compliance Branch.", "Mismatched cross-references: these may be fixed in the January 2027 package. Check the final text.", "Apron inspection: no rule requirement was found. Check inspection checklists or license and registration conditions." ], "sources": [ { "title": "OAH, 10A NCAC 15 Chapter compilation (PDF)", "url": "http://reports.oah.state.nc.us/ncac/title%2010a%20-%20health%20and%20human%20services/chapter%2015%20-%20radiation%20protection/chapter%2015%20rules.pdf" }, { "title": "NC DHSR, Radiation Protection Rules (rule actions page)", "url": "https://info.ncdhhs.gov/DHSR/rules/rpr2025-2.html" }, { "title": "Proposed.0603 (2026)", "url": "https://info.ncdhhs.gov/dhsr/rules/2025/RadiationProposed/10ANCAC15-0603.pdf" }, { "title": "Proposed.0604 (2026)", "url": "https://info.ncdhhs.gov/dhsr/rules/2025/RadiationProposed/10ANCAC15-0604.pdf" }, { "title": "Proposed.0604 (2025 version)", "url": "https://info.ncdhhs.gov/dhsr/rules/2025/RadiationProposed/10A_NCAC_15_0604.pdf" }, { "title": "DHSR notice memo, August 17, 2026", "url": "https://info.ncdhhs.gov/dhsr/rules/2025/RadiationProposed/Notification_of_proposed_readoption_rules.pdf?ver=3" }, { "title": "NC Register Vol. 40, Issue 19 (April 1, 2026)", "url": "https://files.nc.gov/oah/documents/2026-04/Volume-40-Issue-19-April-1-2026_2.pdf?VersionId=zFk6pzQr2A0q8a7iZw57fR_mBL_baoie" }, { "title": "NCRPS, \"The Use and Care of Lead Protective Equipment\"", "url": "https://radiation.ncdhhs.gov/xray/documents/leadapronsgud.pdf" }, { "title": "NCRPS, Medical Radiation Protection Program Guide", "url": "https://radiation.ncdhhs.gov/xray/documents/healartsprog.pdf" }, { "title": "NCRPS, General Registration Requirements", "url": "https://radiation.ncdhhs.gov/xray/documents/registration.pdf" }, { "title": "10 CFR 20.1101 (1-1-25 CFR edition)", "url": "https://www.govinfo.gov/content/pkg/CFR-2025-title10-vol1/pdf/CFR-2025-title10-vol1-sec20-1201.pdf" }, { "title": "eCFR 10 CFR 20.1201", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1201" }, { "title": "eCFR 10 CFR 20.1208", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1208" }, { "title": "eCFR 10 CFR 20.1502", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-F/section-20.1502" }, { "title": "NCGA, House Bill 590 (2025-2026)", "url": "https://www.ncleg.gov/BillLookup/2025/H590" }, { "title": "NCGA, House Bill 590 (2025-2026) PDF", "url": "https://www.ncleg.gov/Sessions/2025/Bills/House/PDF/H590v3.pdf" } ] }, { "code": "ND", "name": "North Dakota", "pageUrl": "https://orsif.org/guidelines/us/states/north-dakota", "regulator": { "name": "Radiation Control Program (X-Ray Program), Division of Waste Management, North Dakota Department of Environmental Quality (NDDEQ)", "url": "https://deq.nd.gov/wm/radiation/x-ray.aspx" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "North Dakota requires ALARA for X-ray and fluoroscopy registrants by adopting 10 CFR Part 20 as of May 9, 2022, in a chapter shared with radioactive-materials licensees, so NRC changes are not automatic. Dose limits are federal: 50 mSv whole body, 150 mSv lens, 500 mSv skin and extremities, and 5 mSv to the embryo/fetus. Staff must be protected from scatter by \"protective aprons or whole body protective barriers\" of at least 0.25 mm lead equivalent; the rules do not require aprons to be inspected periodically, and engineered protection systems are not named. Fluoroscopy may be performed only by licensed practitioners or persons licensed by the Medical Imaging and Radiation Therapy Board; physician assistants' scope excludes medical imaging.", "whereAlaraLives": { "category": "both", "explanation": "The binding ALARA duty is in the shared chapter 33.1-10-04.2 (covering both radioactive-materials licensees and X-ray registrants) through adoption of 10 CFR 20.1101 as of May 9, 2022, so an NRC change would not alter North Dakota's text automatically and NDDEQ would have to amend 33.1-10-04.2-01. Chapter 33.1-10-06 defines ALARA but has no operative sentence using the term. It separately requires exposure-minimizing procedures for personnel, which would remain even if Part 20 changed.", "citation": "NDAC 33.1-10-04.2-01; 33.1-10-06-02(9); 33.1-10-06-03(1)(a)(10)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. North Dakota is not on the NRC list of non-Agreement States. State rules substitute the state department for \"NRC\".", "citation": "NRC list of Agreement States, updated October 29, 2026; NDAC 33.1-10-04.2-01(3)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://ndlegis.gov/information/acdata/pdf/33.1-10-04.2.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "NDAC ch. 33.1-10-06, \"X-Rays in the Healing Arts\" (fluoroscopy at 33.1-10-06-05; effective January 1, 2019, with no later amendments), plus NDAC ch. 33.1-10-04.2, \"Standards for Protection Against Radiation.\" Chapter 33.1-10-04.2 adopts 10 CFR Part 20 \"as they exist on May 9, 2022\" (amended effective January 1, 2023) and adds fluoroscopy-specific sections 04.2-02 to 04.2-04.", "citation": "NDAC 33.1-10-06-01; 33.1-10-04.2-01", "sourceUrls": [ "https://ndlegis.gov/information/acdata/pdf/33.1-10-06.pdf", "https://ndlegis.gov/information/acdata/pdf/33.1-10-04.2.pdf" ], "quote": "This chapter establishes requirements, for which a registrant is responsible, for use of x-ray equipment and imaging systems by or under the supervision of an individual authorized by and licensed in accordance with state statutes to engage in the healing arts or veterinary medicine.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. 10 CFR 20.1101(b) is adopted by reference, and the chapter applies to registrants as well as licensees.", "citation": "NDAC 33.1-10-04.2-01, adopting 10 CFR 20.1101(b)", "sourceUrls": [ "https://deq.nd.gov/publications/WM/Radiation/FullRules/33.1-10-04.2.pdf" ], "quote": "The licensee shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "medium" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "TEDE of 5 rem (50 mSv) per year, or 50 rem (500 mSv) to any organ other than the lens, whichever is more limiting (federal limits adopted by reference).", "citation": "10 CFR 20.1201(a)(1)(i), adopted by NDAC 33.1-10-04.2-01", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1201" ], "quote": "The total effective dose equivalent being equal to 5 rems (0.05 Sv); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year. No lower limit (such as ICRP's 20 mSv) has been adopted.", "citation": "NDAC 33.1-10-04.2-01 adopting 10 CFR 20.1201", "sourceUrls": [ "https://deq.nd.gov/publications/WM/Radiation/FullRules/33.1-10-04.2.pdf" ], "quote": "(i) A lens dose equivalent of 15 rems (0.15 Sv), and (ii) A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Shallow-dose equivalent of 50 rem (500 mSv) to the skin or any extremity.", "citation": "NDAC 33.1-10-04.2-01 adopting 10 CFR 20.1201", "sourceUrls": [ "https://deq.nd.gov/publications/WM/Radiation/FullRules/33.1-10-04.2.pdf" ], "quote": "(i) A lens dose equivalent of 15 rems (0.15 Sv), and (ii) A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant woman over the whole pregnancy.", "citation": "NDAC 33.1-10-04.2-01, adopting 10 CFR 20.1208(a)", "sourceUrls": [ "https://deq.nd.gov/publications/WM/Radiation/FullRules/33.1-10-04.2.pdf" ], "quote": "The licensee shall ensure that the dose equivalent to the embryo/fetus during the entire pregnancy, due to the occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Under adopted 10 CFR 20.1502, a dosimeter is required for adults likely to exceed 10% of the limits, for declared pregnant women likely to exceed 1 mSv, and for minors above set levels. Separately, 33.1-10-04.2-02 requires dose monitoring for people working with medical fluoroscopy and states no threshold; NDDEQ's reading of that section is unconfirmed.", "citation": "NDAC 33.1-10-04.2-02; 10 CFR 20.1502(a) as adopted", "sourceUrls": [ "https://ndlegis.gov/information/acdata/pdf/33.1-10-04.2.pdf" ], "quote": "Each registrant shall provide dose monitoring and shall monitor occupational exposure to ensure compliance for: 1. Occupational dose limits to adults pursuant to 10 CFR 20.1201.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "With an apron, the whole-body badge is worn at the collar outside the apron and the fetal badge at the waist under the apron. Approved effective-dose methods are: a single collar badge (multiplied by 0.3 if the reading exceeds 25% of the limit), or two badges (1.5 × waist + 0.04 × collar). The 0.3 and two-badge methods require leaded glasses, a thyroid shield, a wraparound apron, scatter barriers, minimized beam-on time, formal training, a QA program and dose monitoring. The rule does not name NCRP 122 or Webster, though the two-badge coefficients match the Webster (1989) equation.", "citation": "NDAC 33.1-10-04.2-03, -04; 33.1-10-06-03(1)(a)(11)(a)", "sourceUrls": [ "https://ndlegis.gov/information/acdata/pdf/33.1-10-04.2.pdf" ], "quote": "the effective dose equivalent for external radiation shall be assigned the value of the sum of the deep dose equivalent reported for the individual monitoring device located at the waist under the protective apron multiplied by one and five-tenths and the deep dose equivalent reported for the individual monitoring device located at the neck (collar) outside the protective apron multiplied by four-hundredths.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Operators and required staff must be protected from scatter by aprons or whole-body barriers of at least 0.25 mm lead equivalent (0.5 mm if the body could be struck by the useful beam). Facilities must keep enough leaded aprons and gloves for personnel not otherwise shielded. Fluoroscopy rooms need drapes or curtains of at least 0.25 mm lead equivalent in addition to the apron, unless the person is at least 120 cm from the beam center. Thyroid shields and eyewear are not generally required.", "citation": "NDAC 33.1-10-06-03(1)(a)(6)(a)-(b), (9)(g); 33.1-10-06-05(9); 33.1-10-04.2-04(4)(b)", "sourceUrls": [ "https://ndlegis.gov/information/acdata/pdf/33.1-10-06.pdf" ], "quote": "The x-ray operator, other staff, ancillary personnel, and other persons required for the x-ray procedure shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than twenty-five one-hundredths millimeter lead equivalent material.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "North Dakota's rules do not require protective aprons or other protective clothing to be inspected periodically. They require only that staff be protected by aprons or barriers of at least 0.25 mm lead equivalent, and that each facility keep enough leaded aprons and gloves for all staff involved in X-ray work.", "citation": "NDAC 33.1-10-06-03(1)(a)(6) and (9)(g); NDAC chapters 33.1-10-06 and 33.1-10-04.2 (full text)", "sourceUrls": [ "https://ndlegis.gov/information/acdata/pdf/33.1-10-06.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered systems are not addressed by name. The scatter-protection rule allows \"protective aprons or whole body protective barriers,\" and protective barrier is defined broadly. Drapes and curtains count as scatter barriers in fluoroscopy, and sterile-field exceptions are available. No rule, bill or guidance like Arizona SB 1121 or Illinois' 32 Ill. Adm. Code 360 was found, and there is no NDDEQ interpretation.", "citation": "NDAC 33.1-10-06-03(1)(a)(6)(b); 33.1-10-06-02(98); 33.1-10-06-05(9)(b)-(c)", "sourceUrls": [ "https://ndlegis.gov/information/acdata/pdf/33.1-10-06.pdf" ], "quote": "The department may grant exceptions to subdivision b of this subsection in some special procedures where a sterile field will not permit the use of the normal protective barriers.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Performing fluoroscopy requires a license under NDCC ch. 43-62 unless the person is a licensed practitioner (physician, APRN, chiropractor, dentist or podiatrist). Radiographers work under general supervision and radiologist assistants under a radiologist. RCIS/RCES may assist only under personal supervision. Legacy fluoroscopy technologists are limited to GI fluoroscopy, and limited operators may not perform fluoroscopy. Physician assistants' scope excludes medical imaging. \"Panning\" and activating fluoroscopy count as performing imaging.", "citation": "NDCC 43-62-01(3), (5), 43-62-02, 43-62-03(1), 43-62-14.1; NDAC 114-02-01-01(4)-(5), 114-02-01-05, -06 (eff. April 1, 2018); NDCC 43-17-02.1; NDAC 33.1-10-06 App. I", "sourceUrls": [ "https://ndlegis.gov/cencode/t43c62.pdf", "https://ndlegis.gov/information/acdata/pdf/114-02-01.pdf", "https://ndlegis.gov/cencode/t43c17.pdf", "https://www.ndmirtboard.com/CE/requirements.asp" ], "quote": "Licensure requirements are for only those individuals PERFORMING imaging (\"panning\" and activation of fluoroscopy is considered performing medical imaging).", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "All operators except physicians (MD/DO), chiropractors and podiatrists must be instructed in the Appendix F safety topics; general diagnostic operators need ARRT eligibility or certification, or department approval, plus 24 CEUs per two years (12 for limited operators). Radiographers need ARRT or the state exam. RCIS/RCES need the CCI registry plus 12 hours of fluoroscopy safety education every two years; fluoroscopy technologists need 6 hours per renewal. APRN guidance (not binding) calls for 40 classroom hours, 40 logged cases and a national exam. No state fluoroscopy training requirement was found for physicians.", "citation": "NDAC 33.1-10-06-03(1)(a)(2)-(3), Apps. F, G, K; NDAC 114-02-01-05, -06; NDCC 43-62-14.1(6); Board of Nursing/Imaging Board joint statement (December 2024)", "sourceUrls": [ "https://ndlegis.gov/information/acdata/pdf/33.1-10-06.pdf", "https://ndlegis.gov/information/acdata/pdf/114-02-01.pdf", "https://www.ndbon.org/2024/12/nd-board-of-nursing-and-nd-medical-imaging-and-radiation-therapy-board-joint-position-statement-advanced-practice-registered-nurses-supervising-performing-fluoroscopy/" ], "quote": "Biennially shall complete twelve hours of fluoroscopy safety and relevant radiation protection continuing education.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Pending NRC Part 20 rule", "kind": "other", "status": "NRC final rule expected late November 2026; no North Dakota rulemaking found", "date": "", "dateISO": null, "summary": "Because North Dakota adopted Part 20 as of a fixed date (May 9, 2022), the NRC change would require the state to amend 33.1-10-04.2-01 itself. No proposed or recently adopted 2025-2026 change to the X-ray, standards or operator rules was found.", "sourceUrls": [] } ], "notable": [ "North Dakota has its own fluoroscopy rules for monitoring, badge placement and dose calculation (33.1-10-04.2-02 to -04). They apply to X-ray registrants and tie the reduced-dose calculations to wearing leaded glasses, a thyroid shield and a wraparound apron.", "The X-ray chapter dates from the film era. Section 06-05(9)(b) cites \"paragraph 5\" of 06-03(1)(a) for the apron rule, which is actually in paragraph 6, an apparently stale cross-reference.", "NDDEQ says inspection frequency \"ranges from yearly (mammography facilities) to once every seven years (veterinarian)\"; no frequency was given for fluoroscopy.", "Plans for new or modified X-ray rooms, including shielding, must be approved in advance (33.1-10-06-03(2))." ], "openQuestions": [ "Does NDDEQ read 33.1-10-04.2-02 to require dosimeters for everyone working with medical fluoroscopy, regardless of the 10% threshold?", "Does NDDEQ accept a whole-body protective barrier, such as a suspended or engineered shielding system, in fluoroscopy, and does 06-03(1)(a)(6)(b) apply to fluoroscopy at all given the stale \"paragraph 5\" cross-reference?", "Is apron inspection addressed in 33.1-10-10.1 or in NDDEQ inspection checklists or guidance?", "How are \"personal supervision\" and \"general supervision\" defined in NDAC 114-01-02, and what does Imaging Board guidance say about scrub techs and nurses who pan the table?", "Can a physician assistant who also holds a 43-62 license perform fluoroscopy, and is there any physician fluoroscopy training requirement through the Board of Medicine or hospital credentialing?", "Will NDDEQ amend 33.1-10-04.2-01 after the NRC final rule, and will the 2027 Legislative Assembly consider imaging or apron-alternative bills?", "What does the agency-wide NDDEQ public-notice page (https://deq.nd.gov/PublicNotice.aspx) show? It did not load when the research read it." ], "sources": [ { "title": "NDDEQ, X-Ray Program page", "url": "https://deq.nd.gov/wm/radiation/x-ray.aspx" }, { "title": "NDAC art. 33.1-10, chapter index", "url": "https://ndlegis.gov/information/acdata/html/33.1-10.html" }, { "title": "NDAC ch. 33.1-10-06, X-Rays in the Healing Arts (official)", "url": "https://ndlegis.gov/information/acdata/pdf/33.1-10-06.pdf" }, { "title": "NDAC ch. 33.1-10-04.2, Standards for Protection Against Radiation (official)", "url": "https://ndlegis.gov/information/acdata/pdf/33.1-10-04.2.pdf" }, { "title": "NDDEQ compilation of 33.1-10-04.2 with the adopted 10 CFR Part 20 text", "url": "https://deq.nd.gov/publications/WM/Radiation/FullRules/33.1-10-04.2.pdf" }, { "title": "NDAC ch. 33.1-10-01, General Provisions", "url": "https://ndlegis.gov/information/acdata/pdf/33.1-10-01.pdf" }, { "title": "NDCC ch. 43-62, Medical Imaging and Radiation Therapy", "url": "https://ndlegis.gov/cencode/t43c62.pdf" }, { "title": "NDCC ch. 43-17 (physician assistant scope, 43-17-02.1)", "url": "https://ndlegis.gov/cencode/t43c17.pdf" }, { "title": "NDAC 50-03-01, Physician Assistants", "url": "https://ndlegis.gov/prod/acdata/pdf/50-03-01.pdf" }, { "title": "NDAC ch. 114-02-01, Initial Licensure (Imaging Board)", "url": "https://ndlegis.gov/information/acdata/pdf/114-02-01.pdf" }, { "title": "Imaging Board, License Requirements for RCIS & RCES", "url": "https://www.ndmirtboard.com/CE/requirements.asp" }, { "title": "Board of Nursing/Imaging Board Joint Position Statement on APRNs and fluoroscopy", "url": "https://www.ndbon.org/2024/12/nd-board-of-nursing-and-nd-medical-imaging-and-radiation-therapy-board-joint-position-statement-advanced-practice-registered-nurses-supervising-performing-fluoroscopy/" }, { "title": "NDDEQ, New or Changed Rules", "url": "https://deq.nd.gov/wm/NewOrChangedRules/" }, { "title": "NDDEQ, Radiation Control Program Public Notices", "url": "https://deq.nd.gov/WM/PublicNotices/Radiation.aspx" }, { "title": "NDDEQ rule notice (onsite wastewater, May 2026)", "url": "https://ndlegis.gov/sites/default/files/rule-changes/notices/deq051426notice.pdf" }, { "title": "2025 special-session bill 25.1385 (physician assistant compact)", "url": "https://ndlegis.gov/assembly/69-2025/special/documents/25-1385-01000.pdf" }, { "title": "Health Physics Society, \"Webster's weighting factor\" (secondary, background only)", "url": "https://hps.org/publicinformation/ate/q10019/" } ] }, { "code": "OH", "name": "Ohio", "pageUrl": "https://orsif.org/guidelines/us/states/ohio", "regulator": { "name": "Ohio Department of Health, Bureau of Environmental Health and Radiation Protection (BEHRP), X-ray Program", "url": "https://odh.ohio.gov/know-our-programs/xray-program/-x-ray-program" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Ohio requires X-ray and fluoroscopy registrants to keep doses ALARA under its general radiation protection chapter (OAC 3701:1-38), which is shared with radioactive-materials licensees, while the fluoroscopy rules only mention ALARA reviews by hospital QA committees. Dose limits match NRC levels: 50 mSv whole body, 150 mSv lens, 500 mSv skin and extremities, and 5 mSv over a declared pregnancy. Everyone in the fluoroscopy room must use a whole-body barrier or an apron of at least 0.25 mm lead equivalent, unless the facility's radiation expert documents a distance and time at which a person is unlikely to receive more than 2 millirem (0.02 mSv) in an hour or 100 millirem (1 mSv) in a year; aprons must be checked annually, and the rules do not specifically name engineered shielding systems. Physicians are exempt from radiologic licensing, licensed radiographers' scope includes fluoroscopy, and all fluoroscopy operators need 2 hours of fluoroscopy-specific training.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The binding ALARA duty is in 3701:1-38-11(D)(2), in a chapter that applies to both radioactive-materials licensees and radiation-generating equipment handlers. Chapter 3701:1-66 only mentions ALARA reviews in hospital QA committee minutes (3701:1-66-04(C)(4)(c)) and does not restate the standard.", "citation": "OAC 3701:1-38-07(A), 3701:1-38-11(D)(2), 3701:1-66-04(C)(4)(c)." }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Ohio is an NRC Agreement State, based on the NRC list (updated 2026-10-29), which does not name Ohio among non-Agreement States. OAC 3701:1-38-07(A) refers to equivalent NRC or agreement state regulations.", "citation": "NRC list of Agreement States, updated October 29, 2026; OAC 3701:1-38-07(A).", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "General standards are in OAC Chapter 3701:1-38, which covers both radioactive-materials licensees and X-ray registrants (key rules -07, -11, -12, -14). X-ray and fluoroscopy rules are in OAC Chapter 3701:1-66 (-01, -02, -04, -07). Operator licensing is in OAC Chapter 3701-72 and ORC Chapter 4773.", "citation": "OAC 3701:1-38-07(A); OAC 3701:1-66-02 (introductory paragraph).", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/chapter-3701:1-38" ], "quote": "The rules in Chapter 3701:1-38 of the Administrative Code apply to facilities that receive, possess, use, transfer, or dispose of radioactive material, and to handlers of radiation-generating equipment.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Licensees and registrants must use procedures and engineering controls to keep occupational and public doses ALARA. They must also have a documented radiation protection program and review it at least every 12 months. The air-emissions dose constraint applies only to licensees.", "citation": "OAC 3701:1-38-11(D)(2) (effective 2011-09-01).", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-38-11" ], "quote": "The licensee or registrant shall use, to the extent practicable, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem) = 50 mSv per year TEDE.", "citation": "OAC 3701:1-38-12(A)(1)(a)", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-38-12" ], "quote": "The total effective dose equivalent being equal to 0.05 sievert (five rem); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) = 150 mSv per year. Ohio has not adopted a lower limit such as 20 mSv.", "citation": "OAC 3701:1-38-12(A)(1)-(2), (G), (H) (effective 2010-10-04; five-year review due 2027-01-20).", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-38-12" ], "quote": "(a) A lens dose equivalent of 0.15 sievert (fifteen rem), and (b) A shallow-dose equivalent of 0.5 sievert (fifty rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem) = 500 mSv per year to the skin of the whole body or any extremity.", "citation": "OAC 3701:1-38-12(A)(1)-(2), (G), (H) (effective 2010-10-04; five-year review due 2027-01-20).", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-38-12" ], "quote": "(a) A lens dose equivalent of 0.15 sievert (fifteen rem), and (b) A shallow-dose equivalent of 0.5 sievert (fifty rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. If an apron is worn, the fetal dose is taken from the mother's lower torso region (3701:1-38-12(H)(4)).", "citation": "OAC 3701:1-38-12(H)(1)", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-38-12" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to an embryo or fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed five millisievert (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "A badge must be supplied and worn by: adults likely to receive more than 10% of an annual limit (5 mSv TEDE, 15 mSv lens, 50 mSv skin or extremity); minors above set levels; declared pregnant women likely to receive more than 1 mSv over the pregnancy; and anyone entering high or very high radiation areas. Anyone taking part in fluoroscopic procedures must wear a monitoring device unless the IRRP or a radiation expert determines those thresholds are unlikely to be exceeded.", "citation": "OAC 3701:1-38-14(B)(1); OAC 3701:1-66-02(G)(5).", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-66-02" ], "quote": "Any radiation worker participating in fluoroscopic, veterinary, or mobile or portable x-ray procedures is obligated to wear an individual monitoring device unless the IRRP or radiation expert determines it is unlikely the radiation worker will receive in excess of the doses specified...", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "With an apron, the whole-body badge is typically worn at the neck. The lens badge goes at the neck outside the apron or near the eye. A fetal badge goes at the waist under the apron, and a second badge is required for a declared pregnant woman. Effective dose is calculated as follows: one neck badge outside the apron × 0.3; with two badges, (waist badge under the apron × 1.5) + (neck badge outside the apron × 0.04); or ANSI/NCRP/director-approved methods. Badges must be processed by an NVLAP-accredited processor.", "citation": "OAC 3701:1-38-12(A)(4)(b); OAC 3701:1-38-14(C)(1)-(5).", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-38-12" ], "quote": "When only one individual monitoring device is used and it is located at the neck outside the protective apron, the reported deep dose equivalent value multiplied by 0.3 shall be the effective dose equivalent for external radiation", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Anyone in the room during fluoroscopy must stand behind a whole-body protective barrier or wear an apron of at least 0.25 mm lead equivalent. This may be skipped at a distance and for a time a radiation expert has documented in the QA program as unlikely to exceed 2 mrem in any hour or 100 mrem a year. Lead gloves are required for hands in the useful beam, and 0.5 mm lead equivalent for any body part in the useful beam. Enough aprons and gloves must be available. No thyroid shield or eyewear requirement was found. A 2025 PMC review lists Ohio as requiring 0.50 mm, which conflicts with the primary text.", "citation": "OAC 3701:1-66-07(B)(1)-(2) (effective 2024-12-13); OAC 3701:1-66-02(G)(2), (G)(4).", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-66-07" ], "quote": "Any individual who is in the room during the fluoroscopic procedure will be adequately protected by standing behind a whole body protective barrier or will wear a protective lead apron of not less than 0.25 millimeter lead equivalent.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. An annual evaluation of the integrity of all necessary protective apparel is required. The method is not specified.", "citation": "OAC 3701:1-66-02(J)(11) (effective 2024-12-13).", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-66-02" ], "quote": "(11) Annual evaluation of the integrity of all necessary protective apparel.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Ohio lets anyone in the fluoroscopy room stand behind a whole-body protective barrier instead of wearing a lead apron of at least 0.25 mm lead equivalent. A facility may also skip both if its radiation expert documents a distance and time at which a person is unlikely to receive more than 2 millirem (0.02 mSv) in an hour or 100 millirem (1 mSv) in a year. The rules do not specifically name engineered shielding systems.", "citation": "OAC 3701:1-66-07(B)(1)", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-66-07" ], "quote": "Any individual who is in the room during the fluoroscopic procedure will be adequately protected by standing behind a whole body protective barrier or will wear a protective lead apron of not less than 0.25 millimeter lead equivalent.", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Physicians are exempt from radiologic licensing. Licensed radiographers' scope includes fluoroscopy, under the general supervision of a licensed practitioner. General X-ray machine operators' scope excludes fluoroscopy. In cardiac catheterization, RNs, RCIS staff and certain pre-1995 conditionally licensed operators may only move the patient, move the unit and reset the timer, under in-room personal supervision. PA and NP authority was not settled.", "citation": "ORC 4773.02 (effective 2019-10-17); OAC 3701-72-01, 3701-72-04 (effective 2025-08-31).", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/chapter-3701-72" ], "quote": "The following radiologic procedure tasks will be performed only by an Ohio licensed practitioner, radiographer, nuclear medicine technologist, radiation therapist or general x-ray machine operator within his/her scope of practice:", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "All fluoroscopy operators, physicians included, and anyone likely to exceed 1 mSv a year from fluoroscopy need at least 2 hours of fluoroscopy-specific radiation protection training. The training must be approved by the facility's radiation expert, be equipment-specific and be documented. 1 hour of retraining is required whenever a person exceeds 30% of the allowable occupational dose in a calendar year. Radiographers need an ODH license (ARRT certification waives the Ohio exam) and 24 CE credits to renew. No separate state fluoroscopy permit was found for physicians.", "citation": "OAC 3701:1-66-07(F)-(G); OAC 3701-72-02.", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-66-07" ], "quote": "All individuals operating fluoroscopic equipment, and individuals likely to receive an annual effective dose equivalent in excess of one millisievert (one hundred millirem) from participating in fluoroscopic procedures, will receive at least two hours of radiation protection training specific to fluoroscopy", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Draft amendments to OAC Chapters 3701:1-38, 3701:1-66, 3701-72 and 3701-83", "kind": "other", "status": "Draft posted for public comment, not yet formally proposed; comments closing 2026-10-08", "date": "2026-09-08", "dateISO": "2026-09-08", "summary": "ODH posted draft rules for radiation protection standards, radiation-generating equipment, operator licensing and health care facilities. Their contents were not reviewed.", "sourceUrls": [ "https://odh.ohio.gov/health-rules-laws-and-forms/draft-rules" ] }, { "title": "OAC 3701:1-66-01 definitions", "kind": "adopted_rule", "status": "Effective", "date": "2026-02-16", "dateISO": "2026-02-16", "summary": "Recently adopted definitions rule. Changes were not compared with the prior version.", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/chapter-3701:1-66" ] }, { "title": "OAC Chapter 3701-72 radiologic licensing", "kind": "adopted_rule", "status": "Effective", "date": "2025-08-31", "dateISO": "2025-08-31", "summary": "Recently adopted operator licensing rules.", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/chapter-3701-72" ] }, { "title": "OAC 3701:1-66-02, -04 and -07", "kind": "adopted_rule", "status": "Effective", "date": "2024-12-13", "dateISO": "2024-12-13", "summary": "Recently adopted general obligations, QA program and medical fluoroscopic equipment rules.", "sourceUrls": [ "https://codes.ohio.gov/ohio-administrative-code/chapter-3701:1-66" ] }, { "title": "Draft amendments to OAC Chapter 3701:1-67 (radiation therapy)", "kind": "other", "status": "Draft", "date": "2025-11-24", "dateISO": "2025-11-24", "summary": "Draft amendments to the radiation therapy rules, not fluoroscopy.", "sourceUrls": [] }, { "title": "Bill on supervision of general X-ray machine operators by CNPs and PAs", "kind": "bill", "status": "Bill number and status unconfirmed", "date": "2026-02-27", "dateISO": "2026-02-27", "summary": "An LSC analysis (seen only as a search snippet) describes a bill letting general X-ray machine operators work under the direct supervision of certified nurse practitioners and physician assistants.", "sourceUrls": [ "https://www.legislature.ohio.gov/download?key=27255" ] } ], "notable": [ "Registrants doing FGI procedures must have a radiation dose review committee that includes a physician and a technologist who perform the procedures and meets at least annually (3701:1-66-04(D)).", "Hospital QA must include a quarterly review of occupational exposure records by a certified radiation expert (3701:1-66-04(C)(5)(b)) and policies on pregnant workers (3701:1-66-04(B)(12)).", "Cumulative air kerma or dose-area product must be recorded for interventional, cardiac, pediatric and pregnant-patient cases (3701:1-66-07(B)(3)).", "Mobile units and C-arms with SID under 45 cm are exempt from the bucky-slot shield and drape rules. Mini C-arms may be exempt from the apron/barrier rule if a radiation expert documents low dose (3701:1-66-07(D)-(E)).", "Facilities must have procedures to prevent deceptive exposure of dosimeters (3701:1-38-14(A)(5)).", "Fluoroscopy training of 2 hours applies to all operators, physicians included.", "A 2025 PMC review article lists Ohio as requiring 0.50 mm aprons, but the primary text sets 0.25 mm." ], "openQuestions": [ "What do the 2026-09-08 drafts for 3701:1-38, 3701:1-66 and 3701-72 say, in particular on ALARA, the lens limit, apron rules or engineered systems, and when will they be formally proposed?", "Does ORC 3748.04 require Ohio's rules to stay compatible with the NRC, so that an NRC ALARA change would bind Ohio?", "Can physician assistants and nurse practitioners activate fluoroscopy in Ohio? What are the number and status of the bill described in the 2026-02-27 LSC analysis?", "Would ODH treat an engineered radiation protection system as a whole-body protective barrier, or would it need a variance under 3701:1-66-02(A)?", "Is there any thyroid or eye protection requirement elsewhere, for example in ODH guidance or the 3701-83 rules?", "What changed in 3701:1-66-01 (effective 2026-02-16)?" ], "sources": [ { "title": "ODH, X-ray Program page", "url": "https://odh.ohio.gov/know-our-programs/xray-program/-x-ray-program" }, { "title": "ODH, Draft Rules page", "url": "https://odh.ohio.gov/health-rules-laws-and-forms/draft-rules" }, { "title": "OAC 3701:1-38-11, radiation protection standards, general provisions", "url": "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-38-11" }, { "title": "OAC 3701:1-38-12, occupational dose limits", "url": "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-38-12" }, { "title": "OAC 3701:1-38-14, survey and monitoring requirements", "url": "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-38-14" }, { "title": "OAC Chapter 3701:1-38 (including -01 definitions and -07 scope)", "url": "https://codes.ohio.gov/ohio-administrative-code/chapter-3701:1-38" }, { "title": "OAC 3701:1-66-02, general obligations", "url": "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-66-02" }, { "title": "OAC 3701:1-66-07, medical fluoroscopic equipment", "url": "https://codes.ohio.gov/ohio-administrative-code/rule-3701:1-66-07" }, { "title": "OAC Chapter 3701:1-66 (including -01 and -04)", "url": "https://codes.ohio.gov/ohio-administrative-code/chapter-3701:1-66" }, { "title": "OAC Chapter 3701-72, radiologic licensing", "url": "https://codes.ohio.gov/ohio-administrative-code/chapter-3701-72" }, { "title": "ORC 4773.02", "url": "https://codes.ohio.gov/ohio-revised-code/section-4773.02" }, { "title": "Ohio LSC bill analysis, 2026-02-27 (search snippet only, page could not be fetched)", "url": "https://www.legislature.ohio.gov/download?key=27255" }, { "title": "\"Variability in State-Level Regulations Regarding Occupational Radiation Exposure\" (PMC, secondary source)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12230476/" } ] }, { "code": "OK", "name": "Oklahoma", "pageUrl": "https://orsif.org/guidelines/us/states/oklahoma", "regulator": { "name": "Oklahoma State Department of Health (OSDH), Consumer Health Service (X-Ray program) for diagnostic X-ray including fluoroscopy; Department of Environmental Quality (DEQ), Land Protection Division, Radiation Management Section for radioactive materials and therapeutic, industrial and analytical X-ray", "url": "https://www.oklahoma.gov/health/services/licensing-inspections/consumer-health-service/licensure/x-ray.html" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Oklahoma splits radiation regulation between two agencies: OSDH regulates diagnostic X-ray, including fluoroscopy, under OAC 310:281, while DEQ regulates radioactive materials and therapeutic and industrial X-ray under OAC 252:410, which excludes OSDH-regulated diagnostic X-ray facilities. Chapter 281's only ALARA sentence covers unrestricted areas, not worker doses (DEQ's adoption of 10 CFR 20.1101 does not apply to fluoroscopy), and worker dose limits are the standard US values: 50 mSv whole body, 150 mSv lens, 500 mSv skin and extremities, and 5 mSv embryo/fetus. Lead aprons or whole-body barriers (0.25 or 0.5 mm lead equivalent) are required and must be checked annually, and while the rules do not name engineered shielding systems, they accept whole-body protective barriers of at least 0.25 mm lead equivalent in place of aprons for protecting staff from scatter radiation. Oklahoma does not license radiologic technologists, and fluoroscopy must be used by or under the supervision of a licensed practitioner.", "whereAlaraLives": { "category": "xray_specific", "explanation": "The fluoroscopy ALARA sentence is in OSDH's own Chapter 281, a separate rule from a separate agency. DEQ's 252:410-20-1 adopts 10 CFR 20.1101 but applies only to sources under DEQ jurisdiction, and 252:410-1-1(b) excludes OSDH diagnostic X-ray facilities. An NRC Part 20 compatibility change would flow most directly into the DEQ rule, not Chapter 281. Hospitals that also hold a DEQ radioactive-materials license are under both rules.", "citation": "OAC 252:410-20-1(a), (c)(2); 252:410-1-1(b); OAC 310:281-9-1(b)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Oklahoma is an NRC Agreement State. DEQ runs the program, and the DEQ rule states the agreement relationship.", "citation": "NRC list of Agreement States, updated October 29, 2026; OAC 252:410-1-1(c)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://oklahoma.gov/content/dam/ok/en/deq/documents/deqmainresources/410.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Fluoroscopy and diagnostic X-ray are covered by OAC Title 310, Chapter 281, \"Diagnostic X-Ray Systems.\" Subchapter 9 is \"Standards for Protection Against Radiation\" and Subchapter 11 is \"Use of X-Rays in the Healing Arts and Veterinary Medicine\"; fluoroscopy controls are in 310:281-11-7. The latest amendment shown is 38 Ok Reg 1954, effective 9-11-2021. DEQ's OAC 252:410 Subchapter 20 adopts parts of 10 CFR 20 by reference for radioactive materials and non-diagnostic X-ray only.", "citation": "OAC 310:281-9-1(a)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "This subchapter establishes standards for protection against radiation hazards. Except as otherwise specifically provided, this subchapter applies to all permittees.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "partial", "answer": "Only partly. Chapter 281's single ALARA sentence covers exposures to unrestricted areas. No wording was found requiring occupational doses to be kept ALARA, and no radiation protection program requirement was found. The closest occupational provision, 11-7(b)(3), requires the fluoroscopic field to be reduced \"to the absolute minimum required\" when sterile fields rule out drapes or barriers.", "citation": "OAC 310:281-9-1(b)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "In addition to complying with the requirements set forth in this subchapter, every reasonable effort shall be made to maintain radiation exposures to unrestricted areas to as low as is reasonably achievable.", "quoteMatchedToSource": true, "confidence": "medium" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) per year total effective dose equivalent.", "citation": "OAC 310:281-9-2(b)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "(1) Total effective dose equivalent (TEDE) is 5 Rems; (2) Deep dose equivalent (DDE) and committed dose equivalent (CDE) to any individual organ or tissue (other than the lens of the eye) are 50 Rems;", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year. No lower lens limit, such as the ICRP's 20 mSv, has been adopted.", "citation": "OAC 310:281-9-2(b)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "(3) Lens dose equivalent (LDE) is 15 Rems; and (4) Shallow dose equivalent (SDE) to the skin or any extremity is 50 Rems.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) per year to the skin or any extremity.", "citation": "OAC 310:281-9-2(b)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "(3) Lens dose equivalent (LDE) is 15 Rems; and (4) Shallow dose equivalent (SDE) to the skin or any extremity is 50 Rems.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. The rule also adopts NCRP 91 guidance of no more than 0.05 rem (0.5 mSv) per month.", "citation": "OAC 310:281-9-40", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "No percentage threshold by default. Dosimeters must be issued to everyone who enters a controlled or high radiation area and to everyone who uses or operates any source of radiation. OSDH may grant a written exemption if no one is likely to exceed 25% of the annual limits (5% for people under 18). For fluoroscopy where sterile fields prevent drapes or barriers, everyone in the room except the patient must have monitoring devices. Dental-only operators are exempt.", "citation": "OAC 310:281-9-12(a)-(b); 310:281-11-7(b)(2)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "Each permittee shall supply and require the use of appropriate personnel monitoring equipment to: (1) each individual who enters a controlled radiation area; (2) each individual who enters a high radiation area; and (3) each individual who uses or operates any source of radiation.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "With an apron, the whole-body badge is worn at the unshielded location likely to get the highest dose, typically the collar. The lens badge goes at the collar or closer to the eye, outside the apron; the embryo/fetus badge at the waist under the apron; the extremity badge on the extremity likely to get the highest dose. Wear periods are no more than three months. Effective dose equivalent may be assigned by one of three methods: the collar badge deep dose equivalent; the collar badge × 0.3; or 1.5 × the waist badge under the apron + 0.04 × the collar badge outside it. The factors match NCRP 122, but the rule does not name it. 11-4(d)(1) requires the collar badge reading to be recorded as whole-body dose, which may conflict with 9-3(c).", "citation": "OAC 310:281-9-12(d); 310:281-9-3(c); 310:281-11-4(d)(1)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "the EDE for external radiation is assigned the value of the sum of the DDE reported for the personal monitoring device located at the waist under the protective apron multiplied by 1.5 and the DDE reported for the personal monitoring device located at the neck (collar) outside the protective apron multiplied by 0.04.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "In general radiography, staff must be protected from scatter by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent; anyone whose body may be struck by the direct beam needs 0.5 mm lead-equivalent apron, gloves or shielding. In fluoroscopy, the setup must keep scatter to the body (except head, neck and extremities) behind at least 0.25 mm lead equivalent, with drapes, curtains or viewing shields counting in addition to any apron. Where sterile fields prevent drapes or barriers, everyone except the patient must wear 0.5 mm lead-equivalent aprons. Thyroid shields and protective eyewear are not addressed.", "citation": "OAC 310:281-11-6(c); 310:281-11-7(a)-(b)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "All persons, except the patient, in the room where fluoroscopy is performed, shall wear protective aprons which provide a shielding equivalent of 0.5 millimeter of lead.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes, annually. Aprons, gloves and shields must be checked for defects and the check recorded; defective items must be replaced or removed from service until repaired. The inspection method is not specified.", "citation": "OAC 310:281-11-4(d)(2)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "Protective equipment including aprons, gloves, and shields shall be checked annually for defects, such as holes, cracks, and tears to assure reliability and integrity. A record of this test shall be made and maintained for inspection by the Department.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rules do not mention engineered shielding systems by name, but they accept whole-body protective barriers of at least 0.25 mm lead equivalent in place of protective aprons for protecting staff from scatter radiation. For fluoroscopy, the setup and procedures must make sure scatter reaching the body (other than head, neck and extremities) passes through at least 0.25 mm lead equivalent material.", "citation": "OAC 310:281-11-6(c)(2)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "Staff and ancillary personnel shall be protected from primary scatter (once-scattered) radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent material.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "All use must be by or under the supervision of a person licensed under Oklahoma law to practice the relevant healing art. The rules do not list operator categories or define fluoroscopy supervision levels. Oklahoma does not license radiologic technologists (per secondary sources). Radiologist assistants, licensed by the Board of Medical Licensure and Supervision, may operate a fluoroscopic unit under general supervision of the supervising radiologist (rule dated Eff. 6-25-09, possibly out of date).", "citation": "OAC 310:281-11-1(a); OAC 435:60-7-3(a)(16)", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "All usage of such systems under this Subchapter shall be made by or under the supervision of an individual licensed in accordance with Oklahoma law to practice the healing art or veterinary medicine in which a diagnostic x-ray system is used.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Operators need only be instructed in, and able to show competence with, the permittee's operating and safety procedures, and must be given written procedures. No state fluoroscopy permit, ARRT requirement, training hours, continuing education or physician fluoroscopy training requirement was found. CT has a specific-training requirement; fluoroscopy has none. Radiologist assistants must be ARRT-registered R.R.A.s who completed an ARRT-accredited program.", "citation": "OAC 310:281-11-4(f); OAC 435:60-3-2", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" ], "quote": "Individuals who operate diagnostic x-ray systems shall be instructed in and be able to demonstrate competence with the permittee's operating and safety procedures.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "OSDH Chapter 281 amendment (38 Ok Reg 1954)", "kind": "adopted_rule", "status": "Adopted 1-25-2021, approved by HJR 1046, effective 9-11-2021; no 2025 or 2026 proposal to amend Chapter 281 found", "date": "2021-09-11", "dateISO": "2021-09-11", "summary": "Changed suggested exposure limits to mandatory limits and exempted dental cone beam CT and non-diagnostic CT systems from survey requirements.", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/organization/recently-adopted-amendments/permanent-rule-adoptions/OSDH281-PREAMBLE-RULE-STATE.pdf" ] }, { "title": "SB 439 (2025, Sen. Bergstrom)", "kind": "bill", "status": "Introduced 1/8/2025; final status unconfirmed", "date": "2025-01-08", "dateISO": "2025-01-08", "summary": "Relates to diagnostic X-ray systems and requires the Board of Dentistry to enforce certain laws; appears aimed at dental X-ray.", "sourceUrls": [ "https://www3.oklegislature.gov/cf_pdf/2025-26%20INT/SB/SB439%20INT.PDF" ] }, { "title": "DEQ OAC 252:410, OAR Docket #25-651", "kind": "proposed_rule", "status": "Proposed permanent rule published 8/15/2025, comments closed 9/25/2025; not on the 11/6/2025 or 1/21/2026 EQB agendas reviewed; adoption status unconfirmed", "date": "2025-08-15", "dateISO": "2025-08-15", "summary": "Would update the 10 CFR incorporation date to January 1, 2025, to maintain compatibility with federal regulations. Affects DEQ licensees, not OSDH fluoroscopy rules.", "sourceUrls": [ "https://oklahoma.gov/content/dam/ok/en/omma/content/rulemaking-process/okregister/Volume-42_Issue-23.pdf" ] }, { "title": "OSDH online X-ray permitting portal", "kind": "other", "status": "Implemented", "date": "2026-04-22", "dateISO": "2026-04-22", "summary": "OSDH moved X-ray permitting to an online portal.", "sourceUrls": [] }, { "title": "Radiation Management Advisory Council sunset", "kind": "other", "status": "Sunset per a DEQ advisory-councils page seen in search results", "date": "2026-07-01", "dateISO": "2026-07-01", "summary": "The DEQ Radiation Management Advisory Council was sunset.", "sourceUrls": [] } ], "notable": [ "310:281-9-2(c) still lets a permittee allow a whole-body dose greater than the annual standard, provided it stays under 3 rem (30 mSv) per calendar quarter and dose history is documented. This is pre-1994-style wording that sits awkwardly with the 5 rem TEDE limit.", "11-4(d)(1) requires the collar badge to be recorded as whole-body dose, which may conflict with the reduced effective-dose methods in 9-3(c).", "Incidents must be reported immediately at 25 rem whole body, 150 rem skin or 375 rem extremities, and within 24 hours at 5, 30 or 75 rem (9-31).", "Dosimetry must be processed by an NVLAP-accredited processor (9-12(c)).", "People may not be used routinely to hold patients or film, and holders must be protected (11-6(e)).", "63 O.S. § 1-1505 requires OSDH X-ray rules to be \"consistent with nationally recognized standards.\"", "No Oklahoma bill or rule on engineered protection systems comparable to Arizona SB 1121 or the pending Illinois rule was found.", "Minors are limited to 10% of the adult dose limits (9-5)." ], "openQuestions": [ "Confirm on the Oklahoma Office of Administrative Rules site (rules.ok.gov) that no amendment to Chapter 281 after 9-11-2021 exists; OSDH's posted PDFs were used instead of the official portal.", "Final status of SB 439 (2025); check oklegislature.gov BillInfo for the 2025-2026 sessions.", "Adoption status and effective date of DEQ Docket #25-651; check the DEQ Land Protection Division proposed-rules page and later Oklahoma Register issues.", "Whether OSDH reads any Chapter 281 provision, or the 63 O.S. \"nationally recognized standards\" clause, as requiring occupational ALARA; ask OSDH Consumer Health Service, (405) 426-8250.", "Whether physician assistants, nurse practitioners or unlicensed technologists may run fluoroscopy, and under what supervision, under Medical, Osteopathic and Nursing board scope-of-practice rules, which were not reviewed.", "Whether OSDH would accept engineered whole-body shielding in place of aprons under 11-6(c)(2) and 11-7; no guidance found.", "Confirm on oklegislature.gov that the radiologic technologist licensure bills (SB 1329 in 2018; HB 2041 committee substitute in 2019-20) were not enacted." ], "sources": [ { "title": "OSDH, X-Ray program page", "url": "https://www.oklahoma.gov/health/services/licensing-inspections/consumer-health-service/licensure/x-ray.html" }, { "title": "OSDH, OAC 310:281 Diagnostic X-Ray Systems", "url": "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/CHAPTER%20281.%20DIAGNOSTIC%20X-RAY%20SYSTEMS.pdf" }, { "title": "OSDH, OAC 310:281 (alternate posted copy)", "url": "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/protective-health/consumer-health-services/xray/cpd.diagnostic-x-ray-systems-title310.chapter281.pdf" }, { "title": "OSDH, 2021 permanent rule preamble and rule text for Chapter 281", "url": "https://oklahoma.gov/content/dam/ok/en/health/health2/aem-documents/organization/recently-adopted-amendments/permanent-rule-adoptions/OSDH281-PREAMBLE-RULE-STATE.pdf" }, { "title": "DEQ, OAC 252:410 Radiation Management", "url": "https://oklahoma.gov/content/dam/ok/en/deq/documents/deqmainresources/410.pdf" }, { "title": "DEQ, Radiation Management Permits page", "url": "https://oklahoma.gov/deq/permits/land-permits/radiation-management.html" }, { "title": "Oklahoma Register Vol. 42 No. 23 (Aug. 15, 2025), DEQ notice of proposed rulemaking", "url": "https://oklahoma.gov/content/dam/ok/en/omma/content/rulemaking-process/okregister/Volume-42_Issue-23.pdf" }, { "title": "DEQ Environmental Quality Board agenda, Nov. 6, 2025", "url": "https://oklahoma.gov/content/dam/ok/en/deq/documents/executive-offices/events/Nov%202025-EQB%20final%20agenda.pdf" }, { "title": "DEQ Environmental Quality Board agenda, Jan. 21, 2026", "url": "https://oklahoma.gov/content/dam/ok/en/deq/documents/executive-offices/Final%20Agenda%20Jan%202026%20EQB%20meeting.pdf" }, { "title": "Board of Medical Licensure and Supervision, OAC 435:60 Radiologist Assistants", "url": "https://www.okmedicalboard.org/radiologist_assistants/download/573/RARULES.pdf" }, { "title": "Justia, 63 O.S. § 1-1505 (secondary)", "url": "https://law.justia.com/codes/oklahoma/title-63/section-63-1-1505/" }, { "title": "SB 439 (2025), introduced text", "url": "https://www3.oklegislature.gov/cf_pdf/2025-26%20INT/SB/SB439%20INT.PDF" }, { "title": "Maven Imaging, Oklahoma portable X-ray regulations (secondary)", "url": "https://www.mavenimaging.com/blog/oklahoma-portable-x-ray-regulations" }, { "title": "Heartland Physics, registering an X-ray machine in Oklahoma (secondary)", "url": "https://www.heartlandphysics.com/post/how-to-register-an-x-ray-machine-in-oklahoma-a-simple-step-by-step-guide" }, { "title": "PMC, \"Variability in State-Level Regulations Regarding Occupational Radiation Exposure\" (secondary)", "url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC12230476/" } ] }, { "code": "OR", "name": "Oregon", "pageUrl": "https://orsif.org/guidelines/us/states/oregon", "regulator": { "name": "Oregon Health Authority (OHA), Public Health Division, Center for Health Protection, Radiation Protection Services (RPS), X-ray program", "url": "https://www.oregon.gov/oha/ph/healthyenvironments/radiationprotection/pages/index.aspx" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Oregon's X-ray and radioactive-materials rules share division OAR 333-120, where the ALARA requirement applies to each licensee or registrant, and the X-ray rules (OAR 333-106) add a separate \"minimize\" duty. Dose limits include 50 mSv per year for the whole body and 150 mSv per year for the lens of the eye. Staff need aprons or whole-body protective barriers of at least 0.25 mm lead equivalent, and aprons must be inspected annually; engineered radiation protection systems are not mentioned by name, but in fluoroscopy, scatter must be blocked by an additional 0.25 mm lead equivalent, such as drapes, panels or curtains, beyond the apron unless enough distance is kept. Fluoroscopy may be operated by radiologists, trained non-radiologist physicians, OBMI-licensed technologists, permitted physician associates and radiology assistants, and PH 28-2026 tightened training for non-radiologist physicians.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The ALARA requirement sits in shared division 120 (333-120-0020), which applies to licensees and registrants alike. Division 106 has no ALARA requirement of its own, only a separate \"minimize\" duty and ALARA as a training topic. A rewrite of 333-120-0020 would likely change the explicit ALARA duty for X-ray registrants; the research calls this an observation, not a legal conclusion.", "citation": "OAR 333-120-0020(2); 333-120-0015(8); 333-106-0045(1); 333-106-0050" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. This is per the NRC list, and Oregon's rule text confirms it.", "citation": "NRC list of Agreement States, updated October 29, 2026; OAR 333-120-0000(1)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1315" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "X-ray and fluoroscopy rules are in OAR chapter 333, division 106, \"X-Rays in the Healing Arts\" (fluoroscopy at 333-106-0201 to -0245). General standards for both licensees and registrants are in OAR 333-120, \"Standards for Protection Against Radiation.\" Division 106 applies in addition to other divisions. Registration rules are in divisions 100 and 101, which were not reviewed. The fetched division pages were cut off: division 106 at about 0360 and division 120 at about 0630.", "citation": "OAR 333-106-0001; OAR 333-120-0000(1)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1301", "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1315" ], "quote": "This division establishes standards for protection against ionizing radiation resulting from activities conducted under licenses and registrations issued by the Authority.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Each licensee or registrant must use procedures and engineering controls to keep occupational doses ALARA, and must review the radiation protection program at least once a year. The X-ray rules add a separate duty to minimize patient and personnel exposure (333-106-0045(1)). ALARA is also a required topic in operator safety training.", "citation": "OAR 333-120-0020(2); OAR 333-106-0045(1)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1315" ], "quote": "Each licensee or registrant must use, to the extent practicable, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "50 mSv (5 rem) total effective dose equivalent per year. Any organ or tissue except the lens: 500 mSv. Minors: 10% of the adult limits.", "citation": "OAR 333-120-0100(1)(a)(A)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1315" ], "quote": "The sum of the deep-dose equivalent and the committed dose equivalent to any individual organ or tissue other than the lens of the eye being equal to 0.5 Sv (50 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "150 mSv (15 rem) per year. Oregon has not adopted a lower limit such as the ICRP's 20 mSv.", "citation": "OAR 333-120-0100(1)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1315" ], "quote": "(A) A lens dose equivalent of 0.15 Sv (15 rem); and (B) A shallow-dose equivalent of 0.50 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Shallow dose of 500 mSv (50 rem) per year to the skin or any extremity.", "citation": "OAR 333-120-0100(1)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1315" ], "quote": "(A) A lens dose equivalent of 0.15 Sv (15 rem); and (B) A shallow-dose equivalent of 0.50 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy.", "citation": "OAR 333-120-0170(1)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1315" ], "quote": "The licensee or registrant must ensure that the dose equivalent to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman does not exceed five mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "A dosimeter must be worn by: adults likely to exceed 10% of an adult limit in a year; minors likely to exceed 10% of a minor's limit; declared pregnant women likely to exceed 1 mSv (0.1 rem) over the pregnancy; and anyone entering a high or very high radiation area. This applies to X-ray users through 333-106-0050.", "citation": "OAR 333-120-0210(1)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1315" ], "quote": "(a) Adults likely to receive, in one year from sources external to the body, a dose in excess of 10 percent of the limits in OAR 333-120-0100(1);", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "When an apron is worn, at least one badge goes at the collar outside the apron. A lens badge goes at the neck or closer to the eye, outside the apron. A second badge goes under the apron at the waist, and is required for a declared pregnant woman. Effective dose for fluoroscopy: (A) one neck badge, the deep dose counts as the effective dose; (B) one neck badge above 25% of the limit, deep dose × 0.3; (C) two badges, 1.5 × waist badge + 0.04 × neck badge. Other methods may be used if approved by the Authority. NCRP 122 and Webster are not named. The older 333-106-0050(1)(b) \"most critical organ\" language may be inconsistent with this.", "citation": "OAR 333-106-0050(1); 333-120-0100(3)(b); 333-120-0210(2)-(3)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1315", "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1301" ], "quote": "the sum of the deep dose equivalent reported for the individual monitoring device located at the waist under the protective apron multiplied by 1.5 and the deep dose equivalent reported for the individual monitoring device located at the neck outside the protective apron multiplied by 0.04.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Staff must be protected from scatter by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent. Any body part in the useful beam needs 0.5 mm lead equivalent. In fluoroscopy rooms, under-table scatter must be blocked by at least 0.25 mm lead equivalent. For above-table scatter, staff must be at least 120 cm from the beam center, or the scatter must pass through an additional 0.25 mm lead equivalent beyond the apron; exceptions may be granted on application. Thyroid shields and eyewear are not required for staff and appear only as training topics.", "citation": "OAR 333-106-0025(3); 333-106-0240", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1301" ], "quote": "Staff and ancillary personnel shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 mm lead equivalent.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. Aprons, gloves and shields must be checked annually for defects, with records kept. Defective items must be replaced or removed from service. Fluoroscopy may be used to check an item only if a visual and manual check suggests a problem.", "citation": "OAR 333-106-0045(12)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1301" ], "quote": "Protective equipment including aprons, gloves and shields shall be checked annually for defects, such as holes, cracks and tears to assure reliability and integrity.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rules do not name engineered shielding systems. However, staff may be protected from scatter by either protective aprons or whole-body protective barriers of at least 0.25 mm lead equivalent. In fluoroscopy, staff must either stand at least 120 cm from the center of the beam or be shielded by at least 0.25 mm lead equivalent material such as drapes, panels or curtains in addition to the apron, and the state may grant exceptions on request.", "citation": "OAR 333-106-0025(3)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1301" ], "quote": "Staff and ancillary personnel shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 mm lead equivalent.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Radiologists, with no supervision. Trained non-radiologist practitioners (MD, DO, DC, DPM, DVM), without supervision if the registrant arranges radiologist or physicist involvement. OBMI-licensed radiologic technologists, under radiologist personal or direct supervision, trained non-radiologist personal supervision, or personal supervision by an APRN with an OBMI Limited Fluoroscopy Supervision Permit. Physician associates with an OBMI permit and a collaborative agreement, with no supervision. Radiology assistants, under direct radiologist supervision. Students, under personal supervision. Trained veterinary operators. APRNs and nurses are not listed as operators.", "citation": "OAR 333-106-0205(3)-(4); 333-106-0005(41), (109)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=337503" ], "quote": "An advanced practice registered nurse (APRN) who has obtained an OBMI Limited Fluoroscopy Supervision Permit may provide personal supervision to radiologic technologists who have a permanent or temporary license issued from the OBMI to operate fluoroscopic equipment.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "All operators need training on a set curriculum, including dose reduction, protective devices, dosimeter placement and dose limits. OBMI-licensed radiographers, permitted physician associates, radiology assistants and radiologists are deemed to meet it. Non-radiologist practitioners need OHA-approved training unless they were operating before April 11, 2005; since PH 28-2026 this also applies when they supervise an operator in the room. No fluoroscopy training hours or continuing education were found in the RPS rules. OBMI rules were not reviewed.", "citation": "OAR 333-106-0205(2)-(4); 333-106-0005(89)-(90)", "sourceUrls": [ "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1301" ], "quote": "(b) Non-radiologist practitioners who have successfully completed a training program from an Oregon Health Authority (Authority) approved resource that meets section (2) of this rule, or have been operating fluoroscopic equipment prior to April 11, 2005;", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "Permanent Administrative Order PH 28-2026", "kind": "adopted_rule", "status": "Filed and effective 07/02/2026 (notice filed 04/29/2026; comment closed May 21, 2026)", "date": "2026-07-02", "dateISO": "2026-07-02", "summary": "Amended 333-106-0005 so supervision includes the duty to direct the work. Amended 333-106-0205 to require OHA-approved training for non-radiologist practitioners who operate fluoroscopy or supervise an operator in the room. Added rules for veterinary operators.", "sourceUrls": [ "https://www.oregon.gov/oha/PH/RULESREGULATIONS/Documents/PH_28-2026TrackedChanges.pdf" ] }, { "title": "RPS preliminary legislative concept on 2025-2031 funding (Radiation Advisory Committee slides, Feb 11, 2026)", "kind": "other", "status": "Lead only; seen as a search excerpt and not read", "date": "2026-02-11", "dateISO": "2026-02-11", "summary": "The slides mention a preliminary legislative concept on 2025-2031 funding.", "sourceUrls": [ "https://www.oregon.gov/oha/PH/HEALTHYENVIRONMENTS/RADIATIONPROTECTION/Documents/Radiation%20Advisory%20Committee/2026%20RAC%20Meetings/2026_Feb_11_RAC_%20Slides.pdf" ] } ], "notable": [ "Facilities must record cumulative fluoroscopy time for each exam, set time benchmarks, and run quality-assurance studies of each fluoroscopist at least every 12 months (333-106-0205(10)).", "The Radiation Safety Committee must take corrective action on fluoroscopists who exceed benchmarks more than 10% of the time.", "Typical entrance exposure rates must be posted in fluoroscopy rooms, and written procedures must list who is authorized to operate (333-106-0205(8)-(9)).", "Occupationally exposed personnel may not hold patients during radiographic exams (333-106-0040(3)).", "Deliberately exposing a dosimeter to give a false reading is prohibited (333-106-0050(2)).", "RPS provides an \"Instruction Concerning Prenatal Radiation Exposure\" document (333-120-0170 note).", "In the 2026 rulemaking, OHA declined to state that supervised ministerial assistance by support staff is not operation, saying patient positioning falls under OBMI's statute." ], "openQuestions": [ "The fetched rule text was cut off (division 106 at about 0360, division 120 at about 0630). The answer on engineered systems should be confirmed against the full divisions.", "OBMI permits (OAR chapter 337, ORS 688.405-688.915) were not reviewed: physician associate and APRN permit requirements, training hours or continuing education, and rules on unlicensed staff positioning patients.", "OHA's guidance on fluoroscopy training for non-radiologist physicians was found but not read: https://www.oregon.gov/oha/PH/HEALTHYENVIRONMENTS/RADIATIONPROTECTION/Documents/fluoro-training-non-rad-physicians.pdf", "2025-2026 Oregon bills were not searched (OLIS: https://olis.oregonlegislature.gov), including for apron or shielding bills and the RPS funding concept.", "No OHA/RPS statement was found on how it would respond to the NRC ALARA proposal. Ask RPS (971-673-0490) or check Radiation Advisory Committee minutes.", "It is unclear whether OHA has approved any other effective-dose method under 333-120-0100(3), and how it reconciles that rule with the \"critical organ\" language in 333-106-0050(1)(b).", "It is unclear whether any facility holds an exception under 333-106-0240(2)(c), or approval to use whole-body barriers in place of aprons." ], "sources": [ { "title": "Oregon Secretary of State, OAR 333 Division 106, X-Rays in the Healing Arts", "url": "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1301" }, { "title": "Oregon Secretary of State, OAR 333-106-0205 (single rule)", "url": "https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=337503" }, { "title": "Oregon Secretary of State, OAR 333 Division 120, Standards for Protection Against Radiation", "url": "https://secure.sos.state.or.us/oard/displayDivisionRules.action?selectedDivision=1315" }, { "title": "Oregon Secretary of State, OAR 333-120-0015 Definitions", "url": "https://secure.sos.state.or.us/oard/viewSingleRule.action?ruleVrsnRsn=308808" }, { "title": "OHA, Permanent Administrative Order PH 28-2026 (tracked changes)", "url": "https://www.oregon.gov/oha/PH/RULESREGULATIONS/Documents/PH_28-2026TrackedChanges.pdf" }, { "title": "OHA, Hearing Officer and Comment Report, 333-102/106/116/119", "url": "https://www.oregon.gov/oha/PH/RULESREGULATIONS/Documents/333-102%20106%20116%20119%20HO%20and%20Comment%20Report_FINAL_Redacted.pdf" }, { "title": "OHA Radiation Protection Services home page (search excerpt only)", "url": "https://www.oregon.gov/oha/ph/healthyenvironments/radiationprotection/pages/index.aspx" }, { "title": "OHA X-ray Devices page (search excerpt only)", "url": "https://www.oregon.gov/oha/ph/healthyenvironments/radiationprotection/xray/pages/index.aspx" }, { "title": "RPS Radiation Advisory Committee slides, Feb 11, 2026 (search excerpt only)", "url": "https://www.oregon.gov/oha/PH/HEALTHYENVIRONMENTS/RADIATIONPROTECTION/Documents/Radiation%20Advisory%20Committee/2026%20RAC%20Meetings/2026_Feb_11_RAC_%20Slides.pdf" }, { "title": "Oregon Department of Energy, NRC Rulemaking and Potential Hanford Impacts (search excerpt only)", "url": "https://www.oregon.gov/energy/safety-resiliency/Documents/NRC-Rulemaking-and-Potential-Hanford-Impacts.pdf" } ] }, { "code": "PA", "name": "Pennsylvania", "pageUrl": "https://orsif.org/guidelines/us/states/pennsylvania", "regulator": { "name": "Pennsylvania Department of Environmental Protection (DEP), Bureau of Radiation Protection, Radiation Control Division (X-ray Machine Program)", "url": "https://www.pa.gov/agencies/dep/programs-and-services/radiation-protection/radiation-control-division/x-ray-machine-program" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "The research for this state ended before every question was fully answered, so some answers may be incomplete." }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Pennsylvania DEP regulates X-ray and fluoroscopy machines. 25 Pa. Code Chapter 219 adopts 10 CFR Part 20 by reference and treats \"licensee\" as including X-ray \"registrant\", so the ALARA wording reaches X-ray users only through that shared federal text. If the NRC removes ALARA from Part 20, Pennsylvania X-ray users would likely be affected unless the state acts on its own. Chapter 221 has a narrower duty of its own to minimize staff exposure. Dose limits come from the federal rule, including a lens limit of 150 mSv per year with no lower state limit. Staff must wear aprons of at least 0.25 mm lead equivalent or use whole protective barriers, and the rules do not address engineered systems used instead of aprons. Fluoroscopy may be run by licensed practitioners, recognized radiologist assistants, or ARRT-certified people under a practitioner's personal supervision. Continuing education is required every 2 years for high-risk procedures and every 4 years for low-risk ones. The official PA Code site blocked direct fetching, so its text was read through search extracts and secondary copies, and the research ended before some questions could be fully answered.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The ALARA wording exists only in the shared rule (Chapter 219, through the adopted 10 CFR Part 20 text), which also covers radioactive-materials licensees. An NRC change to 10 CFR 20.1101 could therefore carry over to X-ray registrants. Section 221.11(i) has a narrower X-ray-specific duty to use procedures and equipment that minimize exposure, but it does not use the ALARA term or ALARA's program structure. Whether Pennsylvania's adoption of Part 20 is dynamic or static is unconfirmed.", "citation": "25 Pa. Code §§ 219.5, 219.6(3), 221.11(i)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Pennsylvania is not on the NRC's list of non-Agreement States. In 2025 it changed its rules after the NRC's periodic review for Agreement States' program compatibility.", "citation": "NRC list of Agreement States, updated October 29, 2026; 55 Pa.B. (issue 55-44)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.pacodeandbulletin.gov/Display/pabull?file=/secure/pabulletin/data/vol55/55-44/1468.html" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "25 Pa. Code Chapter 221, \"X-Rays in the Healing Arts\", covers X-ray and fluoroscopy (fluoroscopy in §§ 221.35a-221.43a; scattered radiation in § 221.42a). It adds to Chapter 219, \"Standards for Protection Against Radiation\", rather than replacing it. Section 219.5 adopts 10 CFR Part 20 by reference, and § 219.1 applies Chapter 219 to both licensees and registrants. Chapter 221 was last broadly amended effective 2019-01-24 (48 Pa.B. 6791), and the PA Code site lists it as current through 56 Pa.B. 1800 (March 28, 2026).", "citation": "25 Pa. Code § 221.1", "sourceUrls": [ "https://www.pacodeandbulletin.gov/Display/pacode?file=%2Fsecure%2Fpacode%2Fdata%2F025%2Fchapter221%2Fchap221toc.html" ], "quote": "A registrant or licensee who uses X-rays in the healing arts shall comply with this chapter. This chapter is in addition to, and not in substitution for, other applicable provisions of this article.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes, indirectly. Section 219.5 adopts 10 CFR Part 20, including the ALARA requirement in 20.1101(b), and § 219.6(3) says \"licensee\" includes \"registrant\". Pennsylvania's code does not reprint the ALARA text itself.", "citation": "10 CFR 20.1101(b), adopted by 25 Pa. Code §§ 219.5(a) and 219.6(3)", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-B/section-20.1101" ], "quote": "The licensee shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) TEDE per year, from 10 CFR Part 20 as adopted through § 219.5. Minors are limited to 10% of the adult limits.", "citation": "25 Pa. Code § 219.5; 10 CFR 20.1201(a)", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1201", "https://www.law.cornell.edu/cfr/text/10/20.1201" ], "quote": "The total effective dose equivalent being equal to 5 rems (0.05 Sv)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year, from the adopted federal rule. Pennsylvania has not adopted a lower lens limit; nothing found in Chapter 219 or 221 sets 20 mSv.", "citation": "25 Pa. Code § 219.5; 10 CFR 20.1201(a)", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1201", "https://www.law.cornell.edu/cfr/text/10/20.1201" ], "quote": "(i) A lens dose equivalent of 15 rems (0.15 Sv)", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) per year to the skin or any extremity, from the adopted federal rule.", "citation": "25 Pa. Code § 219.5; 10 CFR 20.1201(a)", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1201", "https://www.law.cornell.edu/cfr/text/10/20.1201" ], "quote": "(ii) A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant worker over the whole pregnancy, from the adopted federal rule.", "citation": "10 CFR 20.1208(a)", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" ], "quote": "The licensee shall ensure that the dose equivalent to the embryo/fetus during the entire pregnancy, due to the occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "The federal threshold applies through § 219.5. Monitoring is required for adults likely to get more than 10% of an annual limit from external sources, and for declared pregnant workers likely to get more than 10% of the embryo/fetus limit (0.05 rem / 0.5 mSv). No Pennsylvania-specific threshold was found.", "citation": "25 Pa. Code § 219.5; 10 CFR 20.1502(a)", "sourceUrls": [ "https://deq.nd.gov/publications/WM/Radiation/NRCRules/10CFRPart20--Standards.pdf", "https://www.nrc.gov/docs/ml0037/ML003739548.pdf" ], "quote": "(1) Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "No Pennsylvania-specific rule on badge location was found; the federal rule only says the assigned dose must be for the part of the body with the highest exposure. Section 219.6(8) lets X-ray exposures be weighted in a manner specified by DEP, so that with DEP approval effective dose equivalent replaces deep dose equivalent. No Pennsylvania text names a two-badge method, NCRP 122, Webster, or a collar location.", "citation": "25 Pa. Code § 219.6(8)", "sourceUrls": [ "https://www.pacodeandbulletin.gov/Display/pacode?file=%2Fsecure%2Fpacode%2Fdata%2F025%2Fchapter219%2Fchap219toc.html" ], "quote": "exposures involving the use of X-rays may be weighted, in a manner specified by the Department, so that, with Department approval, the effective dose equivalent may be substituted for the deep dose equivalent", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Everyone needed for the procedure must be protected by aprons or whole protective barriers of at least 0.25 mm lead equivalent, or stand out of the direct beam with the nearest part of the body at least 2 m from both the tube and the image receptor. Body parts in the useful beam need at least 0.5 mm lead equivalent, measured at 60 kV. Section 221.42a requires shielding against scatter from under and above the table unless the person is at least 120 cm away. Thyroid shields and eyewear are not addressed in the sections reviewed.", "citation": "25 Pa. Code §§ 221.11(e)(1)-(2), 221.42a", "sourceUrls": [ "https://www.law.cornell.edu/regulations/pennsylvania/25-Pa-Code-SS-221-11" ], "quote": "All persons required for the medical procedure shall be protected from the stray radiation by protective aprons or whole protective barriers of at least 0.25 millimeter lead equivalent or shall be so positioned that the persons are not in the direct line of the useful beam", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "No. Pennsylvania's X-ray rules require staff in the room to wear protective aprons or use whole protective barriers of at least 0.25 millimeter lead equivalent, but they do not require aprons or other protective clothing to be checked on a schedule.", "citation": "25 Pa. Code §§ 221.11, 221.35a, 221.42a", "sourceUrls": [ "https://www.law.cornell.edu/regulations/pennsylvania/25-Pa-Code-SS-221-11" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered systems used in place of aprons are not addressed by name. Section 221.11(e)(2) accepts \"whole protective barriers\" of 0.25 mm lead equivalent as an alternative to aprons, but the term is not defined in the text reviewed. Section 221.42a(b)(2) treats drapes, panels and curtains as shielding needed in addition to the apron.", "citation": "25 Pa. Code §§ 221.11(e)(2), 221.42a(b)(2)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/pennsylvania/25-Pa-Code-SS-221-42a" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Section 221.35a(b) limits clinical fluoroscopy to: licensed practitioners within their scope of practice (medicine, surgery, dentistry, osteopathy, podiatry or chiropractic); DEP-recognized radiologist assistants under direct supervision; ARRT-certified people (or equivalent) under personal supervision; and residents, radiologist-assistant trainees and student technologists in training, under personal supervision. Auxiliary personnel must also follow 49 Pa. Code (§ 215.24(b)). DEP's FAQ says physician assistants may perform fluoroscopy under an approved contract with a medical provider that lists the procedures, and nurse practitioners only if ARRT-registered. The FAQ also says trained residents and PAs may work under direct supervision, which appears looser than the rule text for trainees.", "citation": "25 Pa. Code §§ 221.35a(b), 221.2, 215.24(b); DEP FAQ", "sourceUrls": [ "https://www.law.cornell.edu/regulations/pennsylvania/25-Pa-Code-SS-221-35a", "https://files.dep.state.pa.us/RadiationProtection/RadiationControlDivision/RCDPortalFiles/FAQ%20for%20new%20XRAY%20regs.pdf" ], "quote": "Certified Registered Nurse Practitioners can only perform fluoroscopic procedures if they are registered by the American Registry of Radiologic Technologists (ARRT) as a certified x-ray technologist.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "The registrant must make sure operators and supervisors are trained and competent in the topics listed in § 221.16(a)(1), including fluoroscopic outputs, high-level control and dose management. People who operate or supervise high-risk procedures (skin dose that could exceed 2 Gy) must be certified by a DEP-recognized professional organization. Continuing education is required every 2 years for high-risk procedures and every 4 years for low-risk ones, and high-risk education must cover facility- and unit-specific patient dose management. Records are kept for 5 years. No state fluoroscopy permit or minimum training hours were found. The FAQ lets graduates of accredited programs who are not yet ARRT-certified work under direct supervision for 6 months.", "citation": "25 Pa. Code §§ 221.11(b), 221.16, Appendix A", "sourceUrls": [ "https://www.law.cornell.edu/regulations/pennsylvania/25-Pa-Code-SS-221-11", "http://pacodeandbulletin.gov/display/pacode?file=/secure/pacode/data/025/chapter221/s221.16.html" ], "quote": "An individual who performs high-risk procedures shall complete continuing education every 2 years. In addition to the topics in this paragraph, the continuing education must include facility and X-ray unit-specific methods to manage patient dose.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Nuclear Regulatory Commission Consistency Rule - Incorporation by Reference", "kind": "adopted_rule", "status": "Adopted in 2025", "date": "", "dateISO": null, "summary": "Environmental Quality Board rule that amended §§ 215.1, 217.171, 219.5(b) and others to exclude reactor-related Part 20 sections. It does not change ALARA, dose limits or X-ray rules. The URL path suggests about November 1, 2025; the exact publication and effective dates are unconfirmed.", "sourceUrls": [ "https://www.pacodeandbulletin.gov/Display/pabull?file=/secure/pabulletin/data/vol55/55-44/1468.html" ] }, { "title": "Radiological Health and Radon Certification Fees (proposed rulemaking #7-591)", "kind": "proposed_rule", "status": "Adopted by the Board as a proposal on 2026-08-11 and published with a 30-day comment period", "date": "2026-10-10", "dateISO": "2026-10-10", "summary": "Fee changes only, to Chapters 218 and 240.", "sourceUrls": [ "https://www.pacodeandbulletin.gov/secure/pabulletin/data/vol56/56-41/56-41.pdf" ] } ], "notable": [ "Facilities doing fluoroscopy-guided interventional (FGI) procedures must have written procedures that identify authorized users, set dose notification levels and substantial radiation dose levels, and are reviewed every 12 months (§ 221.35a(d)).", "A qualified medical physicist must evaluate each fluoroscope at intervals of no more than 14 months, including any changes that may impact patient and personnel exposure (§ 221.35a(c)).", "Fluoroscopic tables must keep staff from unshielded under-table scatter (§ 221.42a(a)).", "A person may not be used routinely to hold patients or image receptors (§ 221.11(h)).", "Injuries to patients must be reported under § 219.229 (§ 221.11(n)).", "DEP's site says registrants should expect inspections at least every four years.", "No Pennsylvania action was found on the NRC's July 2026 Part 20/ALARA proposal, on any bill about engineered apron alternatives, or on any proposed lens-limit change; the legislature's website was not checked." ], "openQuestions": [ "Whether Pennsylvania's adoption of Part 20 is dynamic or static. If dynamic, a final NRC rule removing ALARA from 10 CFR 20.1101(b) could take effect for Pennsylvania X-ray registrants without state rulemaking. Check 25 Pa. Code § 215.1 or ask DEP's Bureau of Radiation Protection.", "Which effective-dose method DEP approves under § 219.6(8) (for example NCRP 122 or Webster), and where badges must be worn.", "Whether apron inspection, thyroid shields or eyewear are addressed elsewhere in Chapter 221 or in DEP inspection guidance.", "Whether there are Pennsylvania bills for the 2025-2026 session on lead-apron alternatives, a lower lens limit, or ALARA (check palegis.us).", "The exact publication and effective dates of the 2025 NRC consistency rule.", "The State Board of Medicine and Osteopathic Board rules in 49 Pa. Code (named in § 215.24(b)) on which auxiliary staff may do radiologic procedures and how; these were not reviewed.", "How the undated DEP FAQ's \"direct supervision\" for trained residents and PAs, and its PA contract mechanism, compare with the rule text and current DEP practice.", "All quotes should be checked against the official pacodeandbulletin.gov pages." ], "sources": [ { "title": "PA Code, 25 Pa. Code Chapter 221", "url": "https://www.pacodeandbulletin.gov/Display/pacode?file=%2Fsecure%2Fpacode%2Fdata%2F025%2Fchapter221%2Fchap221toc.html" }, { "title": "PA Code, 25 Pa. Code Chapter 219", "url": "https://www.pacodeandbulletin.gov/Display/pacode?file=%2Fsecure%2Fpacode%2Fdata%2F025%2Fchapter219%2Fchap219toc.html" }, { "title": "PA Code § 221.16", "url": "http://pacodeandbulletin.gov/display/pacode?file=/secure/pacode/data/025/chapter221/s221.16.html" }, { "title": "Cornell LII, 25 Pa. Code §§ 221.1, 221.2, 221.11, 221.35a, 221.42a, 219.1, 219.51, 215.24", "url": "https://www.law.cornell.edu/regulations/pennsylvania/25-Pa-Code-SS-221-11" }, { "title": "Justia, 25 Pa. Code § 219.5", "url": "https://regulations.justia.com/states/pennsylvania/title-25/part-i/subpart-d/article-v/chapter-219/subchapter-a/section-219-5" }, { "title": "Justia, 25 Pa. Code § 219.6", "url": "https://regulations.justia.com/states/pennsylvania/title-25/part-i/subpart-d/article-v/chapter-219/subchapter-a/section-219-6" }, { "title": "DEP X-ray Machine Program", "url": "https://www.pa.gov/agencies/dep/programs-and-services/radiation-protection/radiation-control-division/x-ray-machine-program" }, { "title": "DEP Continuing Education Requirements", "url": "https://www.pa.gov/agencies/dep/programs-and-services/radiation-protection/radiation-control-division/x-ray-machine-program/continuing-education-requirements" }, { "title": "DEP, Register a Radiation-Producing Machine", "url": "https://www.pa.gov/services/dep/register-a-radiation-producing-machine" }, { "title": "DEP FAQ on the 2019 X-ray rule revisions", "url": "https://files.dep.state.pa.us/RadiationProtection/RadiationControlDivision/RCDPortalFiles/FAQ%20for%20new%20XRAY%20regs.pdf" }, { "title": "Pa. Bulletin, NRC Consistency Rule (55 Pa.B., issue 55-44)", "url": "https://www.pacodeandbulletin.gov/Display/pabull?file=/secure/pabulletin/data/vol55/55-44/1468.html" }, { "title": "Pa. Bulletin Vol. 56 No. 41 (Oct. 10, 2026), fee rulemaking", "url": "https://www.pacodeandbulletin.gov/secure/pabulletin/data/vol56/56-41/56-41.pdf" }, { "title": "EQB Rolling Regulatory Agenda", "url": "https://files.dep.state.pa.us/publicparticipation/Public%20Participation%20Center/PubPartCenterPortalFiles/Environmental%20Quality%20Board/Rolling_Reg_Agenda.pdf" }, { "title": "eCFR 10 CFR 20.1101", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-B/section-20.1101" }, { "title": "eCFR 10 CFR 20.1201", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1201" }, { "title": "10 CFR Part 20 copy (ND DEQ, secondary, older)", "url": "https://deq.nd.gov/publications/WM/Radiation/NRCRules/10CFRPart20--Standards.pdf" }, { "title": "NRC Regulatory Guide 8.36", "url": "https://www.nrc.gov/docs/ml0037/ML003739548.pdf" }, { "title": "NRC, Effective dose equivalent guidance (for contrast only)", "url": "https://www.nrc.gov/docs/ML1126/ML11262A167.pdf" }, { "title": "NRC Agreement State list", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "RI", "name": "Rhode Island", "pageUrl": "https://orsif.org/guidelines/us/states/rhode-island", "regulator": { "name": "Rhode Island Department of Health (RIDOH), Center for Health Facilities Regulation, Radiation Control Program (\"Rhode Island Radiation Control Agency (RCA)\")", "url": "https://health.ri.gov/about-us/ridoh-programs-centers-divisions/radiation-control-program" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Rhode Island (an Agreement State) has no ALARA wording of its own for X-ray users; ALARA applies through 216-RICR-40-20-1, which adopts the fixed 2021 edition of 10 CFR Part 20 and deems \"licensee\" to include \"registrant,\" so the requirement sits in a rule shared with radioactive-materials licensees. Dose limits are the federal ones: 50 mSv whole body, 150 mSv lens of the eye, 500 mSv skin and extremities, and 5 mSv embryo/fetus. Stationary fluoroscopy systems must have drapes, curtains or shields available and used as supplemental protection, and where sterile fields prevent their use, everyone in the fluoroscopy room except the patient must wear 0.25 mm lead-equivalent garments that are checked for integrity annually; the general X-ray rule also accepts \"whole-body protective barriers\" for scatter protection, but engineered apron replacements are never mentioned by name. Fluoroscopy is operated by licensed radiographers or by exempt practitioners, and all fluoroscopy operators and supervisors need 4 hours of training (8 for interventional work) plus refreshers every 2 years.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "ALARA reaches X-ray registrants only through Part 1's adoption of the fixed 2021 edition of 10 CFR Part 20, which is shared with radioactive-materials licensees. NRC changes do not flow in automatically; RIDOH would have to amend Part 1. Part 4 has no ALARA wording; §4.3.10(B), which requires minimizing exposure, is the closest language, and the research does not treat it as an ALARA requirement.", "citation": "216-RICR-40-20-1 §1.2; 216-RICR-40-20-4 §4.3.10(B)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Rhode Island is not on the NRC list of non-Agreement States (updated 2026-10-29), so it is one of the 41 Agreement States.", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Yes. The X-ray/fluoroscopy rule is 216-RICR-40-20-4, Medical Diagnostic and Interventional X-Ray and Imaging Systems. Fluoroscopy is in §4.5 and training in §4.3.3. Per Cornell LII, §4.5 was amended effective 11/28/2023. Part 4 adopts the ACR-AAPM fluoroscopy standard (2021) and NCRP 168 by reference. The general standards rule is 216-RICR-40-20-1, which applies to licensees and registrants and adopts 10 CFR Part 20 (2021) by reference; its effective date is unconfirmed, possibly 5/25/2022. Facility registration is in 216-RICR-40-20-3.", "citation": "216-RICR-40-20-4 §4.1(B)", "sourceUrls": [ "https://rules.sos.ri.gov/regulations/part/216-40-20-4" ], "quote": "This Part establishes requirements, for which a registrant is responsible, for use of diagnostic and interventional X-ray equipment and imaging systems by, or under the supervision of, an individual authorized by and licensed", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes, but only indirectly. Part 1 adopts 10 CFR Part 20 (2021), including 20.1101(b) (ALARA), and deems \"licensee\" to include \"registrant.\"", "citation": "216-RICR-40-20-1 §1.2(A)-(C)(5), §1.6; 10 CFR 20.1101(b) (2021 edition adopted)", "sourceUrls": [ "https://rules.sos.ri.gov/regulations/part/216-40-20-1" ], "quote": "Any reference to licensee shall be deemed to include registrant.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) total effective dose equivalent per year, via 10 CFR 20.1201 adopted by reference.", "citation": "216-RICR-40-20-1 §1.7.1(A); 10 CFR 20.1201(a)", "sourceUrls": [ "https://rules.sos.ri.gov/regulations/part/216-40-20-1" ], "quote": "For the purpose of this Part, the occupational dose limits for adults are defined by 10 C.F.R. § 20.1201.", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year. No lower lens limit has been adopted.", "citation": "216-RICR-40-20-1 §1.7.1(A); 10 CFR 20.1201(a)(2)(i)", "sourceUrls": [ "https://www.govinfo.gov/content/pkg/CFR-2025-title10-vol1/pdf/CFR-2025-title10-vol1-sec20-1201.pdf" ], "quote": "A lens dose equivalent of 15 rems (0.15 Sv), and", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) shallow-dose equivalent to the skin and extremities per year.", "citation": "10 CFR 20.1201(a)(2)(ii)", "sourceUrls": [ "https://www.govinfo.gov/content/pkg/CFR-2025-title10-vol1/pdf/CFR-2025-title10-vol1-sec20-1201.pdf" ], "quote": "(i) A lens dose equivalent of 15 rems (0.15 Sv), and (ii) A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant worker for the whole pregnancy.", "citation": "10 CFR 20.1208(a)", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1208" ], "quote": "The licensee shall ensure that the dose equivalent to the embryo/fetus during the entire pregnancy, due to the occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Monitoring is required for adults likely to exceed 10% of the adult limits in a year, declared pregnant women likely to exceed 1 mSv (0.1 rem) deep dose during the pregnancy, minors above lower thresholds, and anyone entering a high or very high radiation area.", "citation": "216-RICR-40-20-1 §1.10.3(A); 10 CFR 20.1502(a)", "sourceUrls": [ "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-F/section-20.1502" ], "quote": "Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of the limits in § 20.1201(a),", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "Yes, state-specific rules apply. A single badge is worn at the neck outside the apron; if the reported dose is above 25% of the limit, effective dose equivalent = deep dose × 0.3. With two badges (waist under the apron, neck outside it), effective dose equivalent = 1.5 × waist + 0.04 × neck. A declared pregnant woman needs a waist badge under the apron; if it reads more than 0.5 mSv in a month, a medical physicist should be consulted. The eye-dose badge goes at the neck or an unshielded spot closer to the eye. The extremity badge goes on the extremity likely to receive the highest dose.", "citation": "216-RICR-40-20-1 §1.7.1(B)(1)-(2); §1.10.3(B)-(C)", "sourceUrls": [ "https://rules.sos.ri.gov/regulations/part/216-40-20-1" ], "quote": "When only one individual monitoring device is used to determine the effective dose equivalent for external radiation pursuant to § 1.7.1(B) of this Part, it shall be located at the neck outside the protective apron.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Yes. Stationary fluoroscopy systems need drapes, curtains or shields, used for everyone except the patient. Where sterile fields prevent their use, everyone except the patient must wear garments of at least 0.25 mm lead equivalent. Anyone in the direct beam needs 0.5 mm. Scatter protection requires 0.25 mm garments or whole-body barriers. Facilities must keep enough aprons, gloves and collars available. No thyroid shield or eyewear requirement was found.", "citation": "216-RICR-40-20-4 §4.5.12(A)-(B); §4.3.6(A)(1)-(2); §4.3.9(E)", "sourceUrls": [ "https://rules.sos.ri.gov/regulations/part/216-40-20-4" ], "quote": "All persons, except the patient, in the room where fluoroscopy is performed shall wear protective garments that provide a lead equivalent shielding of at least twenty-five one hundredths of one millimeter (0.25 mm);", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. All protective apparel and auxiliary shields must be evaluated annually for integrity and labeled with their lead equivalence. The method is not specified.", "citation": "216-RICR-40-20-4 §4.3.9(E)(1)", "sourceUrls": [ "https://rules.sos.ri.gov/regulations/part/216-40-20-4" ], "quote": "All protective apparel and auxiliary shields shall be evaluated annually for integrity and clearly labeled with their lead equivalence.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Not addressed by name. The general rule accepts whole-body protective barriers as an alternative to protective garments for scatter protection, and for stationary fluoroscopy systems, ancillary shielding such as drapes, self-supporting curtains or viewing shields must be available and used as supplemental protection. Where sterile fields prevent drapes or barriers, protective garments are required.", "citation": "216-RICR-40-20-4 §4.5.12(A)", "sourceUrls": [ "https://rules.sos.ri.gov/regulations/part/216-40-20-4" ], "quote": "For stationary fluoroscopic systems, ancillary shielding, such as drapes, self-supporting curtains, or viewing shields, shall be available and used as supplemental protection for all individuals other than the patient in the room during a fluoroscopy procedure.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Licensed (ARRT-certified) radiographers under the general supervision of a licensed practitioner. Exempt from the technologist license: licensed practitioners within their field (physicians, chiropractors, podiatrists, nurse practitioners, physician assistants), ARRT radiologist assistants, supervised medical students, medical physicists and supervised radiologic technology students. For interventional (FGI) procedures, the Radiation Protocol Committee identifies authorized users. No fluoroscopy-specific supervision rule was found.", "citation": "216-RICR-40-20-4 §4.1(B), §4.3.3(A), §4.5.13(F)(1); R.I. Gen. Laws §§ 5-68.1-2(7), 5-68.1-4(a); 216-RICR-40-05-34 §34.2(A)(14), (20)", "sourceUrls": [ "https://webserver.rilegislature.gov/Statutes/TITLE5/5-68.1/5-68.1-4.htm" ], "quote": "A licensed practitioner when practicing within his or her field of expertise.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "Everyone who operates or supervises fluoroscopy, physicians included, needs at least 4 hours of training before performing fluoroscopy. Interventional (FGI) work needs 8 hours of Agency-approved training, including 1 hour hands-on. Training is given by a Qualified Medical Physicist or an Agency-approved individual. Refreshers are required every 24 months (2 hours in-service or CME), and records are kept for 3 years. Radiographers need ARRT certification. There is no separate fluoroscopy permit, and no continuing-education requirement for license renewal was found.", "citation": "216-RICR-40-20-4 §4.3.3(C)-(G); 216-RICR-40-05-34 §34.4(A)", "sourceUrls": [ "https://rules.sos.ri.gov/regulations/part/216-40-20-4" ], "quote": "All individuals operating, or supervising the operation of, fluoroscopic X-ray systems shall have completed a minimum of four (4) hours training, prior to performing fluoroscopy procedures", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [], "notable": [ "Facilities doing interventional (FGI) procedures must have a Radiation Protocol Committee (physician, Qualified Medical Physicist, lead technologist) that meets at least every 12 months and sets protocols, dose notification levels and substantial radiation dose levels (§4.5.13).", "Part 4 adopts the ACR-AAPM fluoroscopy standard (2021) and NCRP Report 168 (2010) by reference (§4.1.1).", "No individual may be used routinely to hold patients or image receptors; holders must be instructed and protected (§4.3.9).", "Only people required for the procedure (plus trainees, or a parent or guardian) may be near the patient while the tube is energized (§4.3.6(A)).", "Prior occupational dose must be recorded on Agency Form RCA-2 or equivalent (§1.7.5).", "Deliberately exposing a badge to give a false reading is prohibited (§1.10.2(B)).", "Pending changes for 2025-2026 were not found. Part 4 was last amended effective 11/28/2023, Part 34 was refiled effective 01/04/2022, and Part 1 has a 2022 version. RIDOH Regulatory News (about March-May 2026) listed no radiation-rule items, and one search found no bill on apron alternatives. The search was not exhaustive." ], "openQuestions": [ "Confirm that the 2021 edition of 10 CFR Part 20 matches the current eCFR and 2025 GovInfo text that was read.", "Confirm Part 1's effective date (probably May 2022).", "Search fully for 2025-2026 rulemaking and bills, and ask whether RIDOH plans to follow the NRC's \"graded approach\" change.", "Check whether the incorporated ACR-AAPM (2021) standard and NCRP Report 168 contain binding staff-protection, eyewear or shielding provisions.", "Clarify how §4.3.6 applies to fluoroscopy compared with §4.5.12, and whether \"whole-body protective barriers\" or a §1.5.2 exemption would cover an engineered apron-replacement system.", "Confirm whether any continuing-education requirement applies to radiographer license renewal." ], "sources": [ { "title": "RI Code of Regulations, 216-RICR-40-20-4, Medical Diagnostic and Interventional X-Ray and Imaging Systems", "url": "https://rules.sos.ri.gov/regulations/part/216-40-20-4" }, { "title": "216-RICR-40-20-4 PDF", "url": "https://risos-apa-production-public.s3.amazonaws.com/DOH/REG_13025_20231108161924027.pdf" }, { "title": "RI Code of Regulations, 216-RICR-40-20-1, General Provisions and Standards for Protection Against Radiation", "url": "https://rules.sos.ri.gov/regulations/part/216-40-20-1" }, { "title": "216-RICR-40-20-1 PDF", "url": "https://risos-apa-production-public.s3.amazonaws.com/DOH/REG_12702_20220505142928890.pdf" }, { "title": "RI Code of Regulations, 216-RICR-40-05-34, Licensing of Radiographers, Nuclear Medicine Technologists, and Radiation Therapists", "url": "https://rules.sos.ri.gov/Regulations/part/216-40-05-34" }, { "title": "R.I. Gen. Laws § 5-68.1-4 (License required)", "url": "https://webserver.rilegislature.gov/Statutes/TITLE5/5-68.1/5-68.1-4.htm" }, { "title": "R.I. Gen. Laws § 5-68.1-2 (Definitions)", "url": "https://webserver.rilegislature.gov/Statutes/TITLE5/5-68.1/5-68.1-2.htm" }, { "title": "RIDOH Radiation Control Program page", "url": "https://health.ri.gov/about-us/ridoh-programs-centers-divisions/radiation-control-program" }, { "title": "RIDOH Regulatory News", "url": "https://health.ri.gov/ridoh-feed-regulations" }, { "title": "Cornell LII, 216-RICR-40-20-4.5 (secondary; used for amendment dates)", "url": "https://www.law.cornell.edu/regulations/rhode-island/216-RICR-40-20-4.5" }, { "title": "eCFR 10 CFR 20.1101", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-B/section-20.1101" }, { "title": "eCFR 10 CFR Part 20 Subpart C", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C" }, { "title": "eCFR 10 CFR 20.1208", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-C/section-20.1208" }, { "title": "GovInfo 10 CFR 20.1201 (2025 edition)", "url": "https://www.govinfo.gov/content/pkg/CFR-2025-title10-vol1/pdf/CFR-2025-title10-vol1-sec20-1201.pdf" }, { "title": "eCFR 10 CFR 20.1502", "url": "https://www.ecfr.gov/current/title-10/chapter-I/part-20/subpart-F/section-20.1502" }, { "title": "NRC Agreement State list", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "SC", "name": "South Carolina", "pageUrl": "https://orsif.org/guidelines/us/states/south-carolina", "regulator": { "name": "SC Department of Environmental Services (SCDES), Bureau of Land & Waste Management, Radiation Protection Program, Division of Electronic Products", "url": "https://des.sc.gov/programs/bureau-land-waste-management/radiation-protection-program/x-ray-regulations" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "South Carolina regulates X-rays under a separate rule, R.61-64 (Title B), administered by SCDES (formerly DHEC), whose Part III requires registrants to keep doses ALARA, while radioactive-materials licensees follow R.61-63 (Title A). Dose limits are the standard US values, including a 150 mSv lens limit, and all fluoroscopy personnel must be monitored, with badges at the collar outside the apron and formulas set for one-badge and two-badge dose estimates. Staff must be protected by aprons or whole-body barriers of at least 0.25 mm lead equivalent, so a whole-body barrier meeting that standard is an accepted alternative to an apron even though engineered systems that replace aprons are not addressed by name, and aprons and gloves must be inspected annually. Only licensed practitioners or SCRQSA-certified technologists may operate X-ray equipment, and PAs, NPs and CRNAs need an SCRQSA fluoroscopy certificate.", "whereAlaraLives": { "category": "xray_specific", "explanation": "The registrant ALARA duty is in R.61-64 (Title B) RHB 3.3.2. Licensees have a separately worded duty in R.61-63 RHA 3.4.2. RHB 3.5 applies Title A dose-limit rules to registrants that are also licensees. In this research's reading, an NRC compatibility change would directly affect R.61-63, while changing R.61-64 would require a separate SCDES rulemaking.", "citation": "R.61-64 RHB 3.3.2 and RHB 3.5; R.61-63 RHA 3.1 and RHA 3.4.2" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. South Carolina is an NRC Agreement State. Its radioactive-materials rule is R.61-63 (Title A).", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "S.C. Code Ann. Regs. 61-64, X-Rays (Title B). Part III covers Standards for Protection Against Radiation (RHB 3.1-3.30). Part IV covers Use of X-Rays in the Health Professions, including RHB 4.2 general safety and RHB 4.9 fluoroscopic systems. Radioactive-materials licensees follow the separate R.61-63 Part III.", "citation": "R.61-64 Parts III-IV; R.61-63 Part III", "sourceUrls": [ "https://www.scstatehouse.gov/coderegs/Chapter%2061-64.pdf", "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-64.pdf" ], "quote": "PART III - STANDARDS FOR PROTECTION AGAINST RADIATION", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. X-ray registrants must use procedures and engineering controls to keep occupational and public doses ALARA. They also need a written radiation protection program, a Radiation Safety Officer and investigative limits.", "citation": "R.61-64 RHB 3.3.2 (last amended eff. May 26, 2023)", "sourceUrls": [ "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-64.pdf" ], "quote": "procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (0.05 Sv), or 50 mSv, TEDE per year.", "citation": "R.61-64 RHB 3.4.1", "sourceUrls": [ "https://www.scstatehouse.gov/coderegs/Chapter%2061-64.pdf" ], "quote": "An annual limit, which is the more limiting of: 3.4.1.1.1 The total effective dose equivalent being equal to 5 rem (0.05 Sv); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (0.15 Sv), or 150 mSv. South Carolina has not adopted the ICRP 20 mSv lens limit.", "citation": "R.61-64 RHB 3.4.1", "sourceUrls": [ "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-64.pdf" ], "quote": "3.4.1.2.1 An eye dose equivalent of 15 rem (0.15 Sv), and 3.4.1.2.2 A shallow dose equivalent of 50 rem (0.5 Sv) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Shallow dose of 50 rem (0.5 Sv), or 500 mSv, to the skin or any extremity.", "citation": "R.61-64 RHB 3.4.1", "sourceUrls": [ "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-64.pdf" ], "quote": "3.4.1.2.1 An eye dose equivalent of 15 rem (0.15 Sv), and 3.4.1.2.2 A shallow dose equivalent of 50 rem (0.5 Sv) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. An extra badge worn under the apron is available on request and must be read at least monthly.", "citation": "R.61-64 RHB 3.8.1", "sourceUrls": [ "https://www.scstatehouse.gov/coderegs/Chapter%2061-64.pdf" ], "quote": "The registrant shall ensure that the dose to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Individual monitoring is required for anyone likely to exceed 10% of the applicable limits. All personnel working with medical fluoroscopic equipment must be monitored regardless of expected dose. Dosimeters are read at least quarterly, returned within 45 days, and processed by an NVLAP-accredited processor.", "citation": "R.61-64 RHB 3.12.4.1.1-3.12.4.1.4; 3.12.3.1.4; 3.12.1", "sourceUrls": [ "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-64.pdf" ], "quote": "3.12.4.1.4 Personnel working with medical fluoroscopic equipment.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "A single badge is worn at the collar outside the apron. With one collar badge, effective dose = deep dose × 0.3. With two badges, effective dose = 1.5 × waist badge under the apron + 0.04 × neck badge outside the apron. The RSO may choose effective dose as the record, subject to semi-annual observation visits, and SCDES may revoke its use. Guidance B2 says the outside badge is the permanent record when two badges are worn.", "citation": "R.61-64 RHB 3.12.3.1.2, 3.12.5, 3.12.6, 4.2.14.1.2", "sourceUrls": [ "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-64.pdf" ], "quote": "the reported deep dose equivalent value multiplied by 0.3 shall be the effective dose for external radiation", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Staff must be protected from scatter by aprons or whole-body barriers of at least 0.25 mm lead equivalent. Body parts in the useful beam need at least 0.5 mm lead equivalent. Facilities must have enough aprons and gloves. Fluoroscopy also requires at least 0.25 mm lead equivalent drapes or curtains against scatter. Thyroid shields and eyewear for staff are not addressed.", "citation": "R.61-64 RHB 4.2.9.1-4.2.9.4, 4.2.12.7, 4.9.8", "sourceUrls": [ "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-64.pdf" ], "quote": "protected from the direct scattered radiation by protective aprons or whole body protective barriers of not less than 0.25 mm lead equivalent material.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Aprons and gloves must be checked at least annually for cracks and holes. Checks are documented and records kept for 2 years or until the next inspection, whichever is later. The method is not specified.", "citation": "R.61-64 RHB 4.2.8", "sourceUrls": [ "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-64.pdf" ], "quote": "Protective aprons and gloves shall be checked at least annually for cracks and holes that could compromise the radiation protection it provides.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "South Carolina does not name engineered shielding systems. Its rules do require the X-ray operator, other staff and ancillary persons to be protected from scattered radiation by protective aprons or by whole-body protective barriers of at least 0.25 mm lead equivalent. A whole-body barrier meeting that standard is therefore an accepted alternative to an apron.", "citation": "S.C. Code Regs. § 61-64.IV.RHB 4.2.9.2", "sourceUrls": [ "https://www.law.cornell.edu/regulations/south-carolina/R-61-64-IV-RHB-4.2" ], "quote": "The x-ray operator, other staff, and ancillary persons shall be protected from the direct scattered radiation by protective aprons or whole body protective barriers of not less than 0.25 mm lead equivalent material.", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Only licensed practitioners or SCRQSA-certified technologists working under a licensed practitioner's direction may operate X-ray equipment. Only licensed practitioners may use fluoroscopy to position a patient. Others may use fluoroscopy only with a licensed practitioner physically in the room. PAs, NPs and CRNAs need the SCRQSA Limited Practice Radiographer, Fluoroscopy certificate, and the presence rule appears to apply to them (this research's reading). Students and residents may operate under supervision without a certificate.", "citation": "R.61-64 RHB 1.2.8, 1.2.9, 4.2.2, 4.2.13.4; S.C. Code §§44-74-20, -30, -40", "sourceUrls": [ "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-64.pdf", "https://www.scstatehouse.gov/code/t44c074.php" ], "quote": "It shall be unlawful for a person other than a licensed practitioner to use fluoroscopy when the licensed practitioner is not physically present in the room", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Technologists need an SCRQSA certificate (ARRT-certified technologists qualify without an exam) and 24 hours of CE every 2 years. PAs, NPs and CRNAs need 40 hours of didactic and 40 hours of clinical fluoroscopy training, a letter from the supervising radiologist, a passing ARRT Fluoroscopy exam (75%) and 8 hours of CE every 2 years; this has applied since Sept. 1, 2023. Registrants must document facility-specific training. No physician fluoroscopy training requirement was found.", "citation": "S.C. Code §§44-74-40, -60(D)(5); R.61-64 RHB 4.2.2.7; SCRQSA Fluoroscopy Guidelines; SCRQSA CE page", "sourceUrls": [ "https://www.scrqsa.org/page/Fluoro", "https://www.scrqsa.org/page/A3" ], "quote": "you must complete 40 hours of didactic training in fluoroscopy, and an additional 40 hours of clinical training.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "R.61-64 mammography amendment (Doc. 5449)", "kind": "adopted_rule", "status": "Proposed Feb. 27, 2026; exempt from General Assembly review; hearing canceled; listed in SCDES PDF history as April 24, 2026 (Vol. 50, Issue 4)", "date": "2026-04-24", "dateISO": "2026-04-24", "summary": "Incorporates FDA MQSA amendments; changes Parts V and X only, not occupational protections.", "sourceUrls": [ "https://testweb.scstatehouse.gov/state_register.php?first=FILE&pdf=1&file=Sr50-2.pdf" ] }, { "title": "R.61-64 and R.61-63 amendments (Doc. 5328)", "kind": "adopted_rule", "status": "Amended May 23, 2025; document not read", "date": "2025-05-23", "dateISO": "2025-05-23", "summary": "Appears to be the DHEC-to-DES name change.", "sourceUrls": [] }, { "title": "R.61-63 amendment (Doc. 5454)", "kind": "adopted_rule", "status": "Amended July 24, 2026; substance not checked", "date": "2026-07-24", "dateISO": "2026-07-24", "summary": "ALARA is still in RHA 3.4.2 of the current PDF.", "sourceUrls": [ "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-63.pdf" ] }, { "title": "R.61-63 Name Change package Notice of Drafting", "kind": "proposed_rule", "status": "Notice of Drafting published", "date": "2026-07-24", "dateISO": "2026-07-24", "summary": "Further name-change package for R.61-63; substance not checked.", "sourceUrls": [] }, { "title": "2026 Act No. 146 (H.4189)", "kind": "bill", "status": "Enacted; effective May 15, 2026", "date": "2026-05-15", "dateISO": "2026-05-15", "summary": "Substituted the new agency name in S.C. Code §§44-74-50 and -60.", "sourceUrls": [] }, { "title": "S.732 (2025-26) Protecting Children from Cancer-Causing Radiation Act", "kind": "bill", "status": "Unverified; seen only in search results", "date": "", "dateISO": null, "summary": "Concerns pediatric patient imaging.", "sourceUrls": [] } ], "notable": [ "Registrants must set monthly or quarterly investigative limits (RHB 3.3.6).", "SCDES may require, case by case, a radiation protection committee that includes the RSO and representatives from all X-ray areas and meets at least every 12 months (RHB 3.3.3).", "Fluoroscopy logs must record fluoroscopy time or timer resets (RHB 4.2.15.2).", "Fluoroscopic systems must have a 5-minute cumulative timer with an audible alarm (RHB 4.9.7).", "All fluoroscopy staff are monitored regardless of expected dose.", "Guidance B2 makes the outside badge the permanent record when two badges are worn, while the rule lets the RSO choose an effective-dose record instead; the two may be worth reconciling with SCDES.", "Anyone who exceeds an annual limit may receive no further occupational exposure for the rest of the calendar year (RHB 3.4.1.3)." ], "openQuestions": [ "What the May 23, 2025 amendments (Doc. 5328) changed in R.61-64 and R.61-63, and what the July 24, 2026 R.61-63 amendment (Doc. 5454) covers.", "Whether SCDES plans to change the R.61-63 or R.61-64 ALARA text in response to the NRC's proposed rule.", "Whether 'whole body protective barriers' (RHB 4.2.9.2) covers engineered systems used instead of aprons.", "Whether the RHB 1.2.9 physical-presence rule applies to SCRQSA-certified PAs, NPs and CRNAs.", "Whether any physician fluoroscopy training is required by hospital credentialing or the SC Board of Medical Examiners.", "The status of S.732 (2025-26)." ], "sources": [ { "title": "SCDES, Regulation 61-64 X-Rays (Title B), unofficial PDF", "url": "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-64.pdf" }, { "title": "SC Code of Regulations, Chapter 61-64 (Legislative Council)", "url": "https://www.scstatehouse.gov/coderegs/Chapter%2061-64.pdf" }, { "title": "Cornell LII, S.C. Code Regs. 61-64.IV RHB 4.2", "url": "https://www.law.cornell.edu/regulations/south-carolina/R-61-64-IV-RHB-4.2" }, { "title": "SCDES, Regulation 61-63 Radioactive Materials (Title A), unofficial PDF", "url": "https://des.sc.gov/sites/des/files/Library/Regulations/R.61-63.pdf" }, { "title": "S.C. Code Title 44, Chapter 74, Medical Radiation Health and Safety Act", "url": "https://www.scstatehouse.gov/code/t44c074.php" }, { "title": "SC State Register Vol. 50, Issue 2 (Feb. 27, 2026), Doc. 5449", "url": "https://testweb.scstatehouse.gov/state_register.php?first=FILE&pdf=1&file=Sr50-2.pdf" }, { "title": "SCDES, Regulations Currently Under Amendment & Recently Finalized", "url": "https://des.sc.gov/permits-regulations/regulations-regulatory-updates/regulations-currently-under-amendment-recently-finalized" }, { "title": "SCDES, X-Ray Regulations page", "url": "https://des.sc.gov/programs/bureau-land-waste-management/radiation-protection-program/x-ray-regulations" }, { "title": "SCDES, Regulatory Guide B2, Medical Facilities (Sept. 2025)", "url": "https://www.des.sc.gov/sites/des/files/Documents/BLWM/RadProtection/B2_Medical.pdf" }, { "title": "SCDES, X-Ray Facility Compliance & Safety (Nov. 3, 2025)", "url": "https://www.des.sc.gov/sites/des/files/Documents/EAC/ComplianceEssentials.pdf" }, { "title": "SCRQSA, Fluoroscopy Guidelines", "url": "https://www.scrqsa.org/page/Fluoro" }, { "title": "SCRQSA, Continuing Education", "url": "https://www.scrqsa.org/page/A3" }, { "title": "SCRQSA, Fluoroscopy Certification FAQ", "url": "https://cdn.ymaws.com/www.scrqsa.org/resource/resmgr/fluoroscopy/scrqsa_fluoroscopy_certifica.pdf" }, { "title": "NRC Agreement States", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "SD", "name": "South Dakota", "pageUrl": "https://orsif.org/guidelines/us/states/south-dakota", "regulator": { "name": "South Dakota Department of Health (Health Facility Licensure, Office of Licensure & Certification)", "url": "https://doh.sd.gov/healthcare-professionals/health-facility-licensure/prepare-for-x-ray-facility-inspection/" }, "nrcAgreementState": false, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "South Dakota's X-ray rules (ARSD 44:03:01) contain no ALARA language for worker doses; the state is not an NRC Agreement State, and its X-ray rule shares no ALARA text with materials licensees. Worker dose limits are 50 mSv whole body, 150 mSv lens of the eye, 500 mSv skin and extremities, and 5 mSv to the embryo/fetus of a declared pregnant worker. Protective devices must be used when possible and checked annually, but there is no minimum lead equivalence for staff aprons, no mention of thyroid shields or eyewear, and nothing on engineered shielding systems used instead of aprons. Fluoroscopy is limited to licensed practitioners of the healing arts or people under their supervision, and operators need ARRT certification, another state's license, or 80 hours of training, plus 8 hours of continuing education every two years; the state does not license radiologic technologists.", "whereAlaraLives": { "category": "none", "explanation": "There is no ALARA requirement in South Dakota's rules, either shared or X-ray-specific. The few radioactive-material provisions in chapter 44:03:01 contain no ALARA language, and materials users hold NRC licenses directly.", "citation": "ARSD 44:03:01:04,:10,:15,:16" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "no", "answer": "No. South Dakota is not an NRC Agreement State; applicants for a state radioactive-material license must submit their current NRC license.", "citation": "NRC list of Agreement States, updated October 29, 2026; ARSD 44:03:01:04; SDCL 34-21-3 (title)", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Yes. All radiation rules are in ARSD Article 44:03, chapter 44:03:01 (Radiation Control), under SDCL chapter 34-21. The fluoroscopy standard adopts 21 C.F.R. 1020.30 and 1020.31 as in effect April 1, 2022. There is no separate Standards for Protection Against Radiation part; dose limits and monitoring are in 44:03:01:10. Most sections were last amended by 50 SDR 41, effective October 11, 2023.", "citation": "ARSD 44:03:01 (esp. 44:03:01:08.03, 44:03:01:10)", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "A fluoroscopic X ray system must meet the specifications in 21 C.F.R. 1020.30 and 1020.31, in effect on April 1, 2022.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "no", "answer": "No. Neither \"as low as reasonably achievable\" nor \"ALARA\" appears in Article 44:03. The nearest language concerns minimum patient exposure with good image quality, not worker doses.", "citation": "ARSD 44:03:01:10(3); 44:03:01:10.01", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "(3) Procedures and auxiliary equipment produce images of good diagnostic quality with minimum patient radiation exposure;", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "Total effective dose equivalent of 5 rem (50 mSv) per year. A separate limit of 50 rem (500 mSv) per year applies to any single organ or tissue other than the lens of the eye.", "citation": "ARSD 44:03:01:10(15)", "sourceUrls": [ "https://rules.sd.gov/Uploads/778_OrginalDraftRules.pdf" ], "quote": "(15) The licensee of the radiation source must control the occupational dose to individual adults, except for planned special exposures, to the following annual dose limit, which is the more limiting of:", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year. No lower ICRP-style limit (such as 20 mSv) has been adopted.", "citation": "ARSD 44:03:01:10(15)(c)", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "(c) The annual limit to the lens of the eye is a lens dose equivalent of fifteen rem or 0.15 Sv; and", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Shallow dose equivalent of 50 rem (500 mSv) per year to skin and extremities.", "citation": "ARSD 44:03:01:10(15)(d)", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "(d) The annual limit to the skin and the extremities is a shallow dose equivalent of fifty rem or 0.5 Sv;", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus for the whole pregnancy, once the worker declares her pregnancy in writing.", "citation": "ARSD 44:03:01:10(16)", "sourceUrls": [ "https://rules.sd.gov/Uploads/778_OrginalDraftRules.pdf" ], "quote": "(16) When a woman declares her pregnancy in writing, the licensee of the radiation source must ensure that the dose equivalent to an embryo or fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (five mSv);", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Individual monitoring is required for adults likely to receive more than 10% of the annual limits in a year, declared pregnant women likely to receive more than 0.1 rem (1 mSv) during the pregnancy, anyone entering a high or very high radiation area, and minors likely to receive more than 0.1 rem (1 mSv) in a year. Each badge may be worn by only one person, and a control badge must travel with each shipment.", "citation": "ARSD 44:03:01:10(10)-(13)", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "(a) Adults likely to receive in one year, a dose in excess of ten percent of the limits in subdivision (15) of this section;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "When an apron is worn, the badge goes at the collar outside the apron. A declared pregnant worker wears a badge at the abdomen under any lead. Records must show where each badge was worn and whether it was outside or under protective clothing. For effective dose equivalent during fluoroscopy with an apron: (a) one collar badge, deep dose equivalent counts as is; (b) one collar badge, deep dose equivalent × 0.3, with conditions identical to (a); (c) two badges, 1.5 × waist badge under apron + 0.04 × collar badge outside apron. Other methods need department approval. The rule does not name NCRP 122 or Webster.", "citation": "ARSD 44:03:01:10(12), (20), and the closing paragraph of 44:03:01:10", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "(b) When a protective apron is worn, the individual monitoring device must be worn on the collar outside of the protective apron;", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "partial", "answer": "General rule only. Special personal protective devices must be used when possible and kept accessible and in good condition. The rules set no specific apron requirement for fluoroscopy staff and no minimum lead equivalence for staff aprons (the 0.5 mm figure applies only to patient gonad shields). Thyroid shields and eyewear are not mentioned.", "citation": "ARSD 44:03:01:10.01; 44:03:01:08.03(1)", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "Special personal protective devices must be used to protect eyes, skin, bone, and certain active blood-forming organs from unnecessary radiation exposure when possible The licensee must ensure devices are readily accessible and in good working condition.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. Protective equipment must be checked annually for defects, with a written record. Defective equipment must be replaced or taken out of service until repaired. No inspection method is specified.", "citation": "ARSD 44:03:01:10.01", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "The licensee shall check equipment used to reduce radiation exposure annually for defects. The licensee shall make and maintain a record of this test.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "not_found", "answer": "Not addressed. Nothing in Article 44:03 deals with engineered shielding systems used instead of aprons, though general terms such as \"equipment used to reduce radiation exposure\" are not limited to aprons.", "citation": "ARSD 44:03:01:01(24), (31); 44:03:01:10.01; 44:03:01:10.02", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "(24) \"Protective apron,\" an apron made of radiation absorbing materials used to reduce radiation exposure;", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Only a licensed practitioner of the healing arts, or someone under that practitioner's supervision, may use fluoroscopy or C-arm systems. The level of supervision is not defined, and PAs and NPs are not named. Hand-held fluoroscopes are banned, and fluoroscopy may not be used just to position patients for general radiography.", "citation": "ARSD 44:03:01:08(4)-(6); 44:03:01:01(20); 44:03:01:10(2)", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "(6) The use of fluoroscopy and c-arm X ray systems by a person other than a licensed practitioner of the healing arts unless under the supervision of a licensed practitioner of the healing arts;", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Operators need ARRT certification or registration, a radiologic technology license from another state, or 80 documented hours of training from a qualified instructor, plus 8 hours of continuing education every two years. There is no fluoroscopy-specific training topic or state fluoroscopy permit, and no rule requiring fluoroscopy training for physicians was found. The state does not license radiologic technologists.", "citation": "ARSD 44:03:01:14.01, 14.02, 14.03", "sourceUrls": [ "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" ], "quote": "Any person who is certified or registered by the American Registry of Radiologic Technologists (AART), licensed in radiologic technology by another state, or who has documented eighty hours of orientation and training in the operation of X-radiation producing equipment by a qualified instructor, may operate X-radiation producing equipment", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Rulemaking docket 778 (50 SDR 41), Radiation Control", "kind": "adopted_rule", "status": "Effective 10/11/2023; no pending changes found for 2025-2026", "date": "10/11/2023", "dateISO": "2023-10-11", "summary": "Most recent revision of chapter 44:03:01; public hearing held 08/22/2023. The DOH pending-rules list (generated 11-03-2026) shows no radiation dockets.", "sourceUrls": [ "https://rules.sd.gov/detail.aspx?Id=778" ] }, { "title": "2006 proposal to create a Board of Radiologic Technology", "kind": "bill", "status": "Outcome not checked; the rules still do not license technologists", "date": "2006", "dateISO": "2006", "summary": "The only related bill found; no 2025 or 2026 bill on technologist licensing or fluoroscopy was found.", "sourceUrls": [] } ], "notable": [ "Fluoroscope exposure at the operator's eyes above the screen and at the waist behind the leaded drapes may not exceed 50 mR/h (roughly 0.5 mSv/h) (44:03:01:08.03(1)).", "A qualified expert must measure fluoroscopy reference air kerma rates annually and after relevant maintenance; results must be posted unless the unit shows air kerma in real time (44:03:01:10.05).", "Only people needed for the procedure may be present during a radiographic exposure; people holding patients must be protected and may not be used routinely.", "There is no radiation protection program, radiation safety officer or ALARA program requirement.", "Machines are surveyed every 3 years; shielding plans are reviewed before construction, and the DOH says it uses NCRP Reports 49 and 147.", "SDCL 34-21-25 and 34-21-27 (titles only reviewed) deal with individual exposure records and giving them to employees.", "Drafting issues: 10(15)(b) appears to swap the definitions of deep dose equivalent and committed dose equivalent, and 10(20)(a) and (b) have identical conditions but different multipliers." ], "openQuestions": [ "What level of supervision is required for non-practitioners using fluoroscopy, and do PAs or NPs count as a licensed practitioner of the healing arts? Ask the DOH and check SDCL 36-4A and 36-9A.", "Must physicians meet the operator requirements in 44:03:01:14.01? The rule exempts practitioners only from continuing education. Ask the DOH.", "Which single-badge formula does the DOH apply under 44:03:01:10(20)(a) versus (b) (1.0 vs 0.3), or does it use a different approved method?", "Full text of SDCL 34-21-3, -4.1, -25 and -27 was not read; only section titles were reviewed.", "The 2025-2026 bill search was limited. Check the 2027 session at sdlegislature.gov and sign up for rules.sd.gov notices for any new 44:03 docket." ], "sources": [ { "title": "Administrative Rules of South Dakota, Article 44:03 Radiation Safety (full text, LRC)", "url": "https://sdlegislature.gov/api/Rules/Rule/44:03.html?all=true" }, { "title": "ARSD Chapter 44:03:01 (LRC; fetch was cut off)", "url": "https://sdlegislature.gov/api/Rules/Rule/44:03:01.html?all=true" }, { "title": "SD DOH, \"Prepare for X-ray Facility Inspection\" (updated Oct 27, 2026)", "url": "https://doh.sd.gov/healthcare-professionals/health-facility-licensure/prepare-for-x-ray-facility-inspection/" }, { "title": "SDCL chapter 34-21, table of contents", "url": "https://sdlegislature.gov/api/Statutes/34-21.html" }, { "title": "rules.sd.gov, docket 778 (Radiation Control, effective 10/11/2023)", "url": "https://rules.sd.gov/detail.aspx?Id=778" }, { "title": "2023 draft rules for docket 778 (history only)", "url": "https://rules.sd.gov/Uploads/778_OrginalDraftRules.pdf" }, { "title": "rules.sd.gov, DOH pending rules list", "url": "https://rules.sd.gov/agency.aspx?agency=DOH%20%20Department%20of%20Health" }, { "title": "Minnesota State Community and Technical College, licensure disclosure (secondary)", "url": "https://www.minnesota.edu/academics/professional-licensure-disclosures/radiologic-technology" } ] }, { "code": "TN", "name": "Tennessee", "pageUrl": "https://orsif.org/guidelines/us/states/tennessee", "regulator": { "name": "Tennessee Department of Environment and Conservation (TDEC), Division of Radiological Health (DRH)", "url": "https://www.tn.gov/environment/permits/radiological-health/xray-registration.html" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Tennessee (TDEC Division of Radiological Health, an NRC Agreement State) places occupational ALARA for X-ray registrants in the shared chapter 0400-20-05, not in the X-ray chapter 0400-20-06, so an NRC-driven change could affect X-ray users. Dose limits are federal-style: 50 mSv whole body, 150 mSv lens, 500 mSv skin/extremity, and 5 mSv embryo/fetus. Aprons of at least 0.25 mm Pb are required for everyone in the fluoroscopy room except the patient, along with scatter drapes or panels; engineered apron alternatives are not addressed, and the rules set no inspection schedule for aprons. The radiation rules require operators only to be instructed and competent, Board of Medical Examiners certification applies only in physicians' offices, and the state has no known license for hospital fluoroscopy operators.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "Occupational ALARA is only in Chapter 0400-20-05, which covers licensees and registrants together. The X-ray chapter has only \"not exposed to radiation unnecessarily\" (.04(8)) and patient exposure \"as low as practicable\" (.05(2)(d)5). Rule 0400-20-06-.03 and.06-.10 were not read in full.", "citation": "0400-20-05-.40; 0400-20-06-.04(8)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Tennessee is an NRC Agreement State. TDEC's comment on docket NRC-2025-1205 concerned the byproduct-material modernization rule, not the Part 20 ALARA proposal.", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Chapter 0400-20-06, \"Use of X-Ray Apparatus\" (medical rule.05 last amended effective 3/3/2024; March 2024 revised PDF). General standards are in Chapter 0400-20-05, \"Standards for Protection Against Radiation\" (March 2024 revised). Related chapters are 0400-20-04 General Provisions (rev. Sept 2025) and 0400-20-10 Licensing and Registration (rule.24). These may not be the latest editions.", "citation": "Tenn. Comp. R. & Regs. 0400-20-05 and 0400-20-06", "sourceUrls": [ "https://publications.tnsosfiles.com/rules/0400/0400-20/0400-20.htm" ], "quote": "0400-20-05 Standards for Protection Against Radiation (Transferred from 1200-02-05 which was repealed) 0400-20-06 Use of X-Ray Apparatus", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Rule 0400-20-05-.40 requires each licensee and registrant (including X-ray users) to keep occupational doses ALARA through its radiation protection program. Rule.56(2) applies ALARA to declared pregnant workers. The exact final wording of.40(2) was read only in fragments.", "citation": "0400-20-05-.40(1)-(2); 0400-20-05-.56(2)", "sourceUrls": [ "https://publications.tnsosfiles.com/rules_all/2018/0400-20-05.20240303.pdf" ], "quote": "Using ALARA the licensee or registrant shall make efforts to avoid substantial variation above a uniform monthly exposure rate to a declared pregnant woman.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) per year total effective dose equivalent; minors are limited to 10% of adult limits.", "citation": "0400-20-05-.50(1)(a)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-05-.50" ], "quote": "the licensee or registrant shall limit the occupational dose to individual adults to the following annual dose limits: (a) An annual limit that is the lesser of: 1. A total effective dose equivalent of 5 rems (0.05 Sv)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year; no lower limit adopted. Rule unchanged since 5/22/2012.", "citation": "0400-20-05-.50(1)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-05-.50" ], "quote": "A lens-dose equivalent to 15 rems (0.15 Sv), and 2. A shallow-dose equivalent of 50 rems (0.50 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) per year shallow-dose equivalent to the skin of the whole body or any extremity.", "citation": "0400-20-05-.50(1)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-05-.50" ], "quote": "A lens-dose equivalent to 15 rems (0.15 Sv), and 2. A shallow-dose equivalent of 50 rems (0.50 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant woman per pregnancy, with ALARA efforts to avoid substantial variation above a uniform monthly exposure rate.", "citation": "0400-20-05-.56(1)-(2)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-05-.56" ], "quote": "Using ALARA the licensee or registrant shall make efforts to avoid substantial variation above a uniform monthly exposure rate to a declared pregnant woman.", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Monitoring is required for: adults likely to exceed 10% of the.50 limits in a year from external sources; minors above 1 mSv deep, 1.5 mSv lens, or 5 mSv skin/extremity dose; and declared pregnant women likely to exceed 0.1 rem (1 mSv) deep dose during pregnancy. The X-ray rules also require monitoring of anyone who holds patients.", "citation": "0400-20-05-.71(1)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-05-.71" ], "quote": "Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of the limits in Rule 0400-20-05-.50;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "partial", "answer": "The medical fluoroscopy rule sets no badge location or two-badge method. \"Collar outside the leaded apron\" wording appears elsewhere in 0400-20-06, apparently in the veterinary rule (unconfirmed). The deep-dose reading is used unless a Division- or NRC-approved dosimetry method is used; no named method was found. UT System policy RSP28 (institutional, not a state rule) uses 1.5×under-apron + 0.04×collar for two badges, or 0.3×collar for one badge.", "citation": "0400-20-05-.50(3); 0400-20-06 (2019 edition, rule section unconfirmed)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-05-.50" ], "quote": "the deep-dose equivalent must be used in place of the effective dose equivalent, unless the effective dose equivalent is determined by a dosimetry method approved by the Division or by the Nuclear Regulatory Commission.", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Aprons are required for everyone in the fluoroscopy room except the patient. A protective apron is defined as at least 0.25 mm lead equivalent. Gloves are required when the fluoroscopist's hands may approach the primary beam. Thyroid shields and eyewear were not found in the rules read.", "citation": "0400-20-06-.05(2)(d)6-7;.05(2)(b)3(ii); definition \"(46) Protective apron\" in 0400-20-06 (2019 edition)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-06-.05" ], "quote": "The registrant shall provide protective aprons, and shall require their use by the physician, nurse, technician, and for all other persons within the fluoroscopic room, except the patient.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Tennessee's X-ray rules do not require protective aprons or other protective clothing to be inspected on a schedule. They say only that the effectiveness of protective equipment must not be impaired. Facilities must provide aprons and gloves and require their use.", "citation": "Tenn. Comp. R. & Regs. 0400-20-06-.04 and 0400-20-06-.05", "sourceUrls": [ "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-06-.04" ], "quote": "The effectiveness of protective equipment shall not be impaired.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "no", "answer": "Not addressed as such; no rule or bill on engineered apron-replacement systems was found. Aprons are mandatory in fluoroscopy, and fixed scatter shielding of at least 0.25 mm Pb is also required. General medical X-ray allows aprons or whole-body protective barriers. Rule.04(9) allows waivers for existing equipment if equivalent protection is shown through other means.", "citation": "0400-20-06-.05(2)(d)12;.05(2)(b)3(ii);.04(9)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-06-.05" ], "quote": "This requirement cannot be met only by wearing a protective apron. Exceptions to this requirement may be made in some special procedures. The attenuation required here shall be at least equivalent to that of 0.25 millimeters of lead, (e.g., drapes, folding panel, or self-supporting curtains).", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "The radiation rules require operators to be instructed and competent. In physicians' offices, operators need a Board of Medical Examiners certificate, with exemptions for MDs, trainees, students and recent graduates. The scope rule for limited certificate holders appears to exclude fluoroscopy (only a fragment was read). The 2023 law (Public Chapter 325) abolished the imaging board, and no state operator license for hospital fluoroscopy was found. No rule was found for PAs or NPs.", "citation": "0400-20-06-.04(4); 0880-05-.03; HB1388 (113th General Assembly)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-06-.04" ], "quote": "The registrant shall assure that all x-ray apparatus under his control is operated only by individuals instructed in safe operating procedures and competent in safe use of the apparatus.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "In physicians' offices, full certification requires ARRT certification; limited certification requires a board-approved course plus clinical experience. No DRH training hours, fluoroscopy permit, or physician fluoroscopy training requirement was found. The 2021 proposed rules barring limited licensees from fluoroscopy were withdrawn May 12, 2022.", "citation": "0880-05-.04/.05; Tennessee Department of Health form PH-3549; rule filing 07-25-21", "sourceUrls": [ "https://www.tn.gov/content/dam/tn/health/documents/PH-3549.pdf" ], "quote": "FULL CERTIFICATION (FEE OF $50.00 PLUS $10.00 STATE REGULATORY FEE) MUST BE ARRT", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "DRH rulemaking hearing notice supporting nuclear and fusion deployment and a fusion fee mechanism (filing 08-35-25)", "kind": "proposed_rule", "status": "Rulemaking hearing noticed", "date": "2025", "dateISO": "2025", "summary": "Supports nuclear and fusion deployment and creates a fusion fee mechanism; did not appear to change fluoroscopy provisions.", "sourceUrls": [ "https://publications.tnsosfiles.com/rules_filings/08-35-25.pdf" ] }, { "title": "New fusion rules, Chapter 0400-20-14", "kind": "adopted_rule", "status": "Effective June 9, 2026", "date": "2026-06-09", "dateISO": "2026-06-09", "summary": "New fusion rules filed March 11, 2026; did not appear to change fluoroscopy provisions.", "sourceUrls": [ "https://publications.tnsosfiles.com/rules/0400/0400-20/0400-20-14.20260609.pdf" ] }, { "title": "Amendment to 0400-20-06-.05 (filing 12-02-23)", "kind": "adopted_rule", "status": "Effective", "date": "2024-03-03", "dateISO": "2024-03-03", "summary": "Latest amendment to the medical X-ray rule.", "sourceUrls": [ "https://publications.tnsosfiles.com/rules_filings/12-02-23.pdf" ] }, { "title": "Board of Medical Examiners X-ray supervision amendment (contrast supervision) and HB 2113", "kind": "other", "status": "Board vote reported Nov 17, 2025 by a vendor blog; not verified", "date": "2025-11-17", "dateISO": "2025-11-17", "summary": "Amendment to X-ray supervision rules on contrast supervision; a related bill, HB 2113, is described.", "sourceUrls": [ "https://www.tethersupervision.com/blog/tennessee-advances-amendment-to-x-ray-rules-to-modernize-contrast-supervision" ] } ], "notable": [ "Fluoroscopy rooms must have under-table and above-table scatter shielding of at least 0.25 mm Pb (.05(2)(d)11-12).", "A cumulative fluoroscopy timer must interrupt the beam or sound a continuous alarm at no more than 5 minutes (.05(2)(d)10).", "Pregnant women and people under 18 may not hold patients.", "The patient exposure-rate rule still uses older roentgen-based wording (\"as low as practicable,\" 10 R/min).", "No Tennessee-specific requirement for a fluoroscopy radiation safety officer or medical physicist was found.", "Removing ALARA from the shared chapter 0400-20-05 to match an NRC change would leave the X-ray chapter with no explicit occupational ALARA requirement." ], "openQuestions": [ "What is the exact wording of 0400-20-05-.40(2), and is there an edition of 0400-20-05 or 0400-20-06 newer than March 2024?", "Which rule contains the \"collar outside the leaded apron\" text (probably 0400-20-06-.06)? Does 0400-20-06-.03 define thyroid shields or protective barriers?", "What do the current 0880-05 rules say in.08 (continuing education),.10 (scope, fluoroscopy) and.12 (supervision)? What is the status of the Nov 2025 supervision amendment and HB 2113?", "May PAs or NPs operate fluoroscopy under Board of Medical Examiners/PA committee, Board of Nursing, or Health Facilities Commission (0720-14) rules?", "Did TDEC comment on the NRC's July 2026 Part 20 ALARA proposal, and does DRH plan compatibility rulemaking?", "Does DRH expect any apron inspection under.04(7)?", "Are there 2026 Tennessee bills on radiation shielding or apron alternatives? These were searched only once." ], "sources": [ { "title": "TDEC DRH, X-Ray Registration", "url": "https://www.tn.gov/environment/permits/radiological-health/xray-registration.html" }, { "title": "Secretary of State, Chapter 0400-20 index", "url": "https://publications.tnsosfiles.com/rules/0400/0400-20/0400-20.htm" }, { "title": "Chapter 0400-20-05 (March 2024)", "url": "https://publications.tnsosfiles.com/rules_all/2018/0400-20-05.20240303.pdf" }, { "title": "Chapter 0400-20-05 (Sept 2017)", "url": "https://publications.tnsosfiles.com/rules/0400/0400-20/0400-20-05.20170912.pdf" }, { "title": "Chapter 0400-20-06 (Dec 2019)", "url": "https://publications.tnsosfiles.com/rules/0400/0400-20/0400-20-06.20191209.pdf" }, { "title": "Chapter 0400-20-06 (March 2024)", "url": "https://publications.tnsosfiles.com/rules/0400/0400-20/0400-20-06.20240303.pdf" }, { "title": "Cornell LII, 0400-20-06-.05", "url": "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-06-.05" }, { "title": "Cornell LII, 0400-20-06-.04", "url": "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-06-.04" }, { "title": "Cornell LII, 0400-20-05-.50", "url": "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-05-.50" }, { "title": "Cornell LII, 0400-20-05-.56", "url": "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-05-.56" }, { "title": "Cornell LII, 0400-20-05-.71", "url": "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0400-20-05-.71" }, { "title": "Cornell LII, 0880-05-.03", "url": "https://www.law.cornell.edu/regulations/tennessee/Tenn-Comp-R-Regs-0880-05-.03" }, { "title": "Board of Medical Examiners Chapter 0880-05 (2008)", "url": "https://publications.tnsosfiles.com/rules/0880/0880-05.pdf" }, { "title": "Tennessee Department of Health form PH-3549", "url": "https://www.tn.gov/content/dam/tn/health/documents/PH-3549.pdf" }, { "title": "HB1388 bill text", "url": "https://capitol.tn.gov/Bills/113/Bill/HB1388.pdf" }, { "title": "HB1388 fiscal note", "url": "https://capitol.tn.gov/Bills/113/Fiscal/HB1388.pdf" }, { "title": "BillTrack50, TN HB1388", "url": "https://www.billtrack50.com/billdetail/1552687" }, { "title": "Public Chapter 1029 (2012)", "url": "https://www.tn.gov/content/dam/tn/health/documents/pc1029.pdf" }, { "title": "Radiologic Imaging Board rule filing 07-25-21", "url": "https://publications.tnsosfiles.com/rules_filings/07-25-21.pdf" }, { "title": "Rule filing 12-02-23", "url": "https://publications.tnsosfiles.com/rules_filings/12-02-23.pdf" }, { "title": "Rule filing 08-35-25", "url": "https://publications.tnsosfiles.com/rules_filings/08-35-25.pdf" }, { "title": "Chapter 0400-20-14 (June 2026)", "url": "https://publications.tnsosfiles.com/rules/0400/0400-20/0400-20-14.20260609.pdf" }, { "title": "UT System policy RSP28", "url": "https://policy.tennessee.edu/procedure/rsp28-adjustment-to-wearers-dosimeter-reading/" }, { "title": "RadCare vendor blog", "url": "https://radcareservices.com/blog/lead-apron-requirements-tennessee/" }, { "title": "Tether Supervision vendor blog", "url": "https://www.tethersupervision.com/blog/tennessee-advances-amendment-to-x-ray-rules-to-modernize-contrast-supervision" } ] }, { "code": "TX", "name": "Texas", "pageUrl": "https://orsif.org/guidelines/us/states/texas", "regulator": { "name": "Texas Department of State Health Services (DSHS), Radiation Control Program", "url": "https://www.dshs.texas.gov/texas-radiation-control" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Texas (DSHS Radiation Control Program, Agreement State since 1963) requires ALARA for X-ray registrants in a machine-only rule (25 TAC §289.231), separate from the materials rule (§289.202), and §289.227 also requires that operators keep their own dose ALARA during an exposure. Dose limits match federal: 50 mSv whole body, 150 mSv lens, 500 mSv skin/extremity, 5 mSv embryo/fetus. Fluoroscopy requires at least 0.25 mm Pb-equivalent shielding for the body except the head, neck and limbs, and drapes, self-supporting curtains or viewing shields count toward it, so engineered apron alternatives are partly addressed though not named; 0.35 mm aprons are required only when sterile fields or special procedures prevent those barriers, and aprons are inspected annually. Operation must be by or under a licensed practitioner, and the 8-hour FGI training rule is not enforced.", "whereAlaraLives": { "category": "xray_specific", "explanation": "ALARA appears in §289.231(l), a rule limited to radiation machines, and in §289.227(i)(10), the operator-position requirement. Radioactive materials have the separate §289.202, so an NRC-driven change there would not automatically change §289.231. §289.202 itself was not read.", "citation": "25 TAC §289.231(b)(2); §289.231(l); §289.227(i)(10)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Texas signed its agreement on January 10, 1963, effective March 1, 1963; the NRC calls Texas the fifth Agreement State.", "citation": "NRC list of Agreement States, updated October 29, 2026; Agreement under Section 274 of the Atomic Energy Act", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.nrc.gov/agreement-states/texas" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "25 TAC §289.231 (machine-only standards for protection, last amended effective Dec 29, 2011), §289.227 (healing arts X-ray and fluoroscopy, effective May 1, 2013), and §289.226 (registration). Radioactive materials fall under the separate §289.202.", "citation": "25 TAC §289.231(a)-(b); §289.227", "sourceUrls": [ "https://www.dshs.texas.gov/texas-radiation-control/laws-rules-radiation-control-program", "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/231fn_12_2011.pdf" ], "quote": "this section applies to persons who receive, possess, use, or transfer radiation machines", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. Machine registrants must use procedures and engineering controls to keep occupational and public doses ALARA, and the operator's position during an exposure must keep the operator's dose ALARA.", "citation": "25 TAC §289.231(l); §289.227(i)(10)", "sourceUrls": [ "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/231fn_12_2011.pdf" ], "quote": "The registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) TEDE per year; minors 10% of adult limits.", "citation": "25 TAC §289.231(m)(1)(A)-(D); §289.227(i)(3)", "sourceUrls": [ "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/231fn_12_2011.pdf" ], "quote": "An annual limit shall be the TEDE being equal to 5 rems (0.05 Sv).", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) LDE per year; Texas has not adopted the ICRP 20 mSv limit.", "citation": "25 TAC §289.231(m)(1)(A)-(D)", "sourceUrls": [ "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/231fn_12_2011.pdf" ], "quote": "an LDE of 15 rems (0.15 Sv)", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) SDE per year to the skin of the whole body or any extremity.", "citation": "25 TAC §289.231(m)(1)(B)(ii)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/texas/25-Tex-Admin-Code-SS-289-231" ], "quote": "(ii) an SDE of 50 rems (0.5 Sv) to the skin of the whole body, or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant worker over the whole pregnancy. Large swings above a uniform monthly rate are to be avoided, citing NCRP Report 91's 0.5 mSv/month guidance.", "citation": "25 TAC §289.231(m)(1)(D)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/texas/25-Tex-Admin-Code-SS-289-231" ], "quote": "(D) If a woman declares her pregnancy, the registrant shall ensure that the DE to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Dosimeters are required for adults likely to exceed 10% of a limit per year; minors likely to exceed 1 mSv DDE, 1.5 mSv LDE or 5 mSv SDE; declared pregnant workers likely to exceed 1 mSv DDE over the pregnancy; and anyone entering a high or very high radiation area. Operators of only minimal-threat machines are exempt.", "citation": "25 TAC §289.231(n)(1)-(2)", "sourceUrls": [ "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/231fn_12_2011.pdf" ], "quote": "adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10% of the limits", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "The badge is typically worn at the collar outside the apron and the fetal badge at the waist under the apron. EDE for fluoroscopy with an apron: one collar badge counts as the reported reading, or reading × 0.3 if it exceeds 25% of the limit; with two badges, 1.5 × waist badge plus 0.04 × collar badge. The rule does not name NCRP 122 as the source.", "citation": "25 TAC §289.231(m)(3)-(6); §289.231(q)(1)(B)-(E)", "sourceUrls": [ "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/231fn_12_2011.pdf" ], "quote": "When a protective apron is worn, the location of the individual monitoring device is typically at the neck (collar).", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "The fluoroscopy system must shield the body (except head, neck and extremities) with at least 0.25 mm lead-equivalent material. Where sterile fields or special procedures prohibit normal barriers, everyone in the room except the patient must wear 0.35 mm lead-equivalent aprons. Protective devices generally must be at least 0.25 mm lead-equivalent. No thyroid shield or eyewear requirement was found.", "citation": "25 TAC §289.227(m)(8)(A)-(B); §289.227(i)(4)(A)", "sourceUrls": [ "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/227_fn__5__2013.pdf" ], "quote": "All persons, except the patient, in the room where fluoroscopy is performed shall wear protective aprons that provide a shielding equivalent of 0.35 mm of lead.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Yes. Aprons, gloves and shields must be checked annually by sight, touch or X-ray imaging. Defective items must be replaced or removed from service, and each check must be recorded.", "citation": "25 TAC §289.227(i)(4)(B)", "sourceUrls": [ "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/227_fn__5__2013.pdf" ], "quote": "Protective devices, including aprons, gloves, and shields shall be checked annually for defects such as holes, cracks, and tears.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Texas does not name engineered shielding systems, but it addresses them in part. In fluoroscopy, scattered radiation must pass through at least 0.25 mm of lead-equivalent material before reaching any part of a person's body except the head, neck and limbs, and that material can be drapes, self-supporting curtains or viewing shields as well as any apron. Everyone in the room except the patient must wear 0.35 mm lead-equivalent aprons only when sterile fields or special procedures prevent the use of those normal barriers.", "citation": "25 TAC §289.227(m)(8)(A)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/texas/25-Tex-Admin-Code-SS-289-227" ], "quote": "The material may be, but is not limited to, drapes, self-supporting curtains, or viewing shields, in addition to any lead equivalency provided by a protective apron.", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Use must be by or under supervision of a Texas-licensed physician, chiropractor or podiatrist, and operators must meet Occupations Code ch. 601 credentialing. FGI procedures are limited to radiologists, radiation oncologists, physicians and their ch. 601 delegates. Technologist, PA and nurse scope under the new TMB Chapter 186 was not verified.", "citation": "25 TAC §289.227(b)(1), (i)(5), (m)(9)(C)(i)(I); former 22 TAC §194.17 (repealed)", "sourceUrls": [ "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/227_fn__5__2013.pdf" ], "quote": "All usage of such machines under this section shall be made by or under the supervision of a practitioner of the healing arts.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Non-radiologist physicians and their delegates must complete 8 hours of Category 1 CME in radiation safety plus 1 hour of hands-on training before FGI procedures, but DSHS has delayed enforcement indefinitely. Technologist certification goes through the TMB under ch. 601; details were not verified.", "citation": "25 TAC §289.227(m)(9)(E); DSHS §289.227 Q&A", "sourceUrls": [ "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/RegGuides/289.227-q-a.pdf", "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/227_fn__5__2013.pdf" ], "quote": "shall complete a minimum of 8 hours of Category 1 CMEU in radiation safety awareness training prior to performing FGI procedures", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "Proposed amendment to §289.228 (industrial radiation machines)", "kind": "proposed_rule", "status": "Open for comment until November 23, 2026", "date": "", "dateISO": null, "summary": "The only rule listed on the DSHS proposed-rules page. No changes to §289.227 or §289.231 were found.", "sourceUrls": [ "https://www.dshs.texas.gov/texas-radiation-control/laws-rules-radiation-control-program/proposed-rules-comment-radiation" ] }, { "title": "Proposed amendment to §289.229 (radiation therapy machines)", "kind": "proposed_rule", "status": "Proposed in the Texas Register", "date": "2026-09-18", "dateISO": "2026-09-18", "summary": "Would define \"remote operation.\"", "sourceUrls": [ "https://www.sos.texas.gov/texreg/archive/September182026/Proposed%20Rules/25.HEALTH%20SERVICES.html" ] }, { "title": "Texas Medical Board repeal of Chapter 194 and move to Chapter 186", "kind": "adopted_rule", "status": "Chapter 194 repealed; date not confirmed", "date": "", "dateISO": null, "summary": "Technologist rules moved from 22 TAC ch. 194 to ch. 186.", "sourceUrls": [ "https://www.law.cornell.edu/regulations/texas/title-22/part-9/chapter-194" ] }, { "title": "DSHS Sunset review", "kind": "other", "status": "Under review", "date": "", "dateISO": null, "summary": "DSHS is under Sunset review.", "sourceUrls": [] } ], "notable": [ "Every registrant doing FGI procedures needs a radiation protocol committee including a physician, a licensed medical physicist and the RSO, meeting at least every 14 months. It sets protocols and reference levels, and patient dose data (cumulative air kerma or DAP) must be recorded.", "Each operator must read the written operating and safety procedures at least once a year, with documentation.", "DSHS posts enforcement actions, including §289.227 penalties: https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/DiscEnfActions/newradiationdisciplinaryactions.pdf", "The 8-hour FGI training rule is on the books but not enforced (delayed, per FluoroSafety, since January 13, 2015).", "The §289.230 (mammography) revision is dated 06/06/25.", "Texas bills on apron alternatives were not searched." ], "openQuestions": [ "Current TMB technologist rules (22 TAC Chapter 186): who may run fluoroscopy (technologists, cardiovascular-category technologists, PAs, NPs, RNs), what supervision is needed, and any fluoroscopy, ARRT or CE requirements.", "§289.202 ALARA text, and whether DSHS would carry an NRC ALARA change over to §289.231.", "Whether the SOS official versions of §§289.227 and 289.231 match the DSHS PDFs.", "Whether the §289.231(m)(3) badge coefficients come from NCRP Report 122.", "Whether DSHS would accept an engineered shielding system under §289.227(m)(8)(A), or would require a variance or exemption.", "2025-2026 Texas bills on apron alternatives or fluoroscopy operators (check https://capitol.texas.gov).", "Current enforcement status of the FGI training rule; the DSHS delay letter was unreadable." ], "sources": [ { "title": "DSHS Radiation Control Program home", "url": "https://www.dshs.texas.gov/texas-radiation-control" }, { "title": "DSHS Laws and Rules page", "url": "https://www.dshs.texas.gov/texas-radiation-control/laws-rules-radiation-control-program" }, { "title": "25 TAC §289.231 (DSHS PDF, December 2011)", "url": "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/231fn_12_2011.pdf" }, { "title": "25 TAC §289.231 (Cornell LII, secondary)", "url": "https://www.law.cornell.edu/regulations/texas/25-Tex-Admin-Code-SS-289-231" }, { "title": "25 TAC §289.227 (DSHS PDF, May 2013)", "url": "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/Rules/227_fn__5__2013.pdf" }, { "title": "25 TAC §289.227 (Cornell LII, secondary)", "url": "https://www.law.cornell.edu/regulations/texas/25-Tex-Admin-Code-SS-289-227" }, { "title": "DSHS §289.227 Q&A (search snippet only)", "url": "https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/RegGuides/289.227-q-a.pdf" }, { "title": "DSHS Draft Rules page", "url": "https://www.dshs.texas.gov/texas-radiation-control/laws-rules-radiation-control-program/draft-rules-public-comment" }, { "title": "DSHS Proposed Rules page", "url": "https://www.dshs.texas.gov/texas-radiation-control/laws-rules-radiation-control-program/proposed-rules-comment-radiation" }, { "title": "Texas Register, Sept. 18, 2026, Proposed Rules, Title 25", "url": "https://www.sos.texas.gov/texreg/archive/September182026/Proposed%20Rules/25.HEALTH%20SERVICES.html" }, { "title": "NRC, Texas Agreement State page", "url": "https://www.nrc.gov/agreement-states/texas" }, { "title": "NRC agreement documents", "url": "https://scp.nrc.gov/special/regs/tx_frnagreements.pdf" }, { "title": "NRC agreement documents", "url": "https://www.nrc.gov/docs/ML1232/ML12320A016.pdf" }, { "title": "Cornell LII, 22 TAC ch. 194 (repealed)", "url": "https://www.law.cornell.edu/regulations/texas/title-22/part-9/chapter-194" }, { "title": "FluoroSafety (secondary, training delay)", "url": "https://fluorosafety.com/texas-radiation-safety-awareness/" }, { "title": "Medical Economics (secondary, old Chapter 194 summary)", "url": "https://www.medicaleconomics.com/view/texas-medical-standards-governing-screening-and-diagnostic-medical-testing-offices" } ] }, { "code": "UT", "name": "Utah", "pageUrl": "https://orsif.org/guidelines/us/states/utah", "regulator": { "name": "Utah Department of Environmental Quality, Division of Waste Management and Radiation Control (DWMRC), X-ray Program; operator licensing by the Division of Professional Licensing (DOPL)", "url": "https://deq.utah.gov/dwmrc/x-ray" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Utah requires everyone who uses X-ray machines, including fluoroscopy, to keep worker doses ALARA under R313-15-101, a rule shared with radioactive-materials licensees and cross-referenced by the X-ray registration rules, and R313-28 has its own wording requiring steps to minimize personnel exposure. Yearly dose limits are 50 mSv whole body, 150 mSv lens (no lower limit adopted), 500 mSv skin and extremities, and 5 mSv to the fetus of a declared pregnant worker over the pregnancy. Monitored fluoroscopy workers typically wear a collar dosimeter outside the apron, and the rule gives one-badge and two-badge formulas, while staff must be protected by protective aprons or barriers; the rules say nothing about engineered shielding systems as an apron substitute or about thyroid shields or eyewear, and do not require aprons to be inspected on a schedule. Operators must be licensed under Utah Code Title 58, Chapter 54, and exemptions are unconfirmed.", "whereAlaraLives": { "category": "both", "explanation": "The ALARA term itself is only in R313-15-101, shared by radioactive-materials licensees and X-ray registrants. X-ray rules R313-16-225(2)(a) and R313-16-290(1) cross-reference it. R313-28-31(7) has its own wording requiring steps to minimize personnel exposure, which does not depend on R313-15.", "citation": "R313-15-101; R313-16-225(2)(a); R313-16-290(1); R313-28-31(7)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Utah is not on the NRC's list of non-Agreement States, and a 2026 five-year review notice says the NRC has reviewed Utah's general provisions (R313-12) for compatibility.", "citation": "NRC list of Agreement States, updated October 29, 2026; Notice of five-year review, R313-12 (effective 04/06/2026), Utah State Digest, May 1, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://rules.utah.gov/wp-content/uploads/d20260501.pdf" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "R313-28, Use of X-Rays in the Healing Arts (effective 09/15/2025; fluoroscopy in R313-28-40); R313-16, registration and inspection of radiation machines (effective 05/16/2025); R313-15, Standards for Protection Against Radiation (shared general rule, read via Cornell LII).", "citation": "R313-28; R313-16; R313-15", "sourceUrls": [ "http://adminrules.utah.gov/Rule/724" ], "quote": "Rule R313-28: Use of X-Rays in the Healing Arts Effective Date: 09/15/2025", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. R313-15-101(2) applies to every licensee or registrant, and R313-16-225(2)(a) requires each X-ray registrant's radiation safety program to comply with R313-15-101.", "citation": "R313-15-101(2); R313-16-225(2)(a)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R313-15-101" ], "quote": "The licensee or registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "Total effective dose equivalent of 0.05 Sv (5 rem) = 50 mSv per year, or 0.50 Sv (50 rem) = 500 mSv to any organ other than the lens, whichever is more limiting.", "citation": "R313-15-201(1)(a)(i)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R313-15-201" ], "quote": "An annual limit, which is the more limiting of: (i) The total effective dose equivalent being equal to 0.05 Sv (5 rem); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) = 150 mSv per year. Utah has not adopted a lower limit such as the ICRP's 20 mSv.", "citation": "R313-15-201(1)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R313-15-201" ], "quote": "(i) A lens dose equivalent of 0.15 Sv (15 rem), and (ii) A shallow dose equivalent of 0.50 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.50 Sv (50 rem) = 500 mSv shallow dose equivalent per year to the skin or any extremity.", "citation": "R313-15-201(1)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R313-15-201" ], "quote": "(i) A lens dose equivalent of 0.15 Sv (15 rem), and (ii) A shallow dose equivalent of 0.50 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant worker for the whole pregnancy.", "citation": "R313-15-208(1)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R313-15-208" ], "quote": "The licensee or registrant shall ensure that the dose equivalent to the embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed five mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Adults likely to receive more than 10% of the R313-15-201(1) limits in a year must be monitored; declared pregnant women must be monitored if likely to exceed 1 mSv (0.1 rem) deep dose over the pregnancy. Individuals working with medical fluoroscopic equipment are listed separately, but a registrant need not issue dosimeters if a survey shows the worker is unlikely to exceed 10% of the limits and is neither a minor nor a declared pregnant woman.", "citation": "R313-15-502(1)(a), (c), (e), (e)(iv)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R313-15-502" ], "quote": "A registrant is not required to supply and require the use of individual monitoring devices provided the registrant has conducted a survey, pursuant to Section R313-15-501, that demonstrates that the working environment the individual encounters will not likely result in a dose in excess of ten percent…", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "Whole-body badge at the most exposed unshielded spot, typically the collar when an apron is worn. Lens badge at the collar outside the apron or closer to the eye; fetal badge at the waist under the apron. With one neck badge outside the apron, if the reported dose exceeds 25% of the limit, effective dose = deep dose x 0.3. With two badges, effective dose = 1.5 x waist (under apron) + 0.04 x neck (outside apron); the second badge is required for a declared pregnant woman. The rule states the formulas directly and does not name NCRP 122 or Webster. Possible drafting error: R313-15-201 cross-references 502(1)(d) instead of (1)(e).", "citation": "R313-15-201(3)(b)(ii)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R313-15-201" ], "quote": "the sum of the deep dose equivalent reported for the individual monitoring device located at the waist under the protective apron multiplied by 1.5 and the deep dose equivalent reported for the individual monitoring device located at the neck outside the protective apron multiplied by 0.04.", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "The operator and other staff must be protected from scatter by protective aprons or barriers unless distance keeps exposure within the R313-15-201 limits. Facilities must have enough aprons and gloves for unshielded staff. Any part of a non-patient's body in the useful beam needs at least 0.5 mm lead equivalent. There is no general minimum apron thickness for fluoroscopy; the 0.5 mm figure for aprons applies only to hand-held units. Fluoroscopes need at least 0.25 mm lead-equivalent scatter shielding, with exceptions. Thyroid shields and eyewear are not mentioned.", "citation": "R313-28-31(2)(d)(i)-(ii), (2)(g)(vi); R313-28-40(12)", "sourceUrls": [ "http://adminrules.utah.gov/Rule/724" ], "quote": "the x-ray operator, other staff, ancillary personnel, and other individuals needed for the medical procedure shall be protected from primary beam scatter by protective aprons or barriers unless it can be shown that by virtue of distances used EXPOSURE levels are reduced to the limits specified in Section R313-15-201", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Utah's X-ray rules require protective aprons or barriers for staff and say facilities must keep enough protective aprons and gloves available. They do not require protective aprons or other protective apparel to be inspected on a schedule, whether by fluoroscopy or by looking them over.", "citation": "Utah Admin. Code R313-28 (including R313-28-31 General and Administrative Requirements and the fluoroscopy requirements)", "sourceUrls": [ "http://adminrules.utah.gov/Rule/724" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "no", "answer": "Not expressly addressed; engineered radiation protection systems are not mentioned. The rule allows 'protective aprons or barriers' and defines a protective barrier broadly. Drapes, bucky-slot covers and self-supporting curtains are listed as shielding in addition to the apron.", "citation": "R313-28-20 (definition); R313-28-31(2)(d)(ii); R313-28-40(12)(b)(i)", "sourceUrls": [ "http://adminrules.utah.gov/Rule/724" ], "quote": "\"Protective barrier\" means a barrier of radiation absorbing material used to reduce radiation exposure.", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Operators of diagnostic X-ray systems must be licensed under Utah Code Title 58, Chapter 54. Radiologic technologists work under the general supervision of a radiologist or radiology practitioner. Radiology practical technicians do limited procedures under supervision. Radiologist assistants work under the indirect supervision of a radiologist. Exemptions for physicians, PAs or NPs (58-54-306), and whether practical technicians may do fluoroscopy, could not be confirmed.", "citation": "R313-28-350; Utah Code 58-54-102", "sourceUrls": [ "http://adminrules.utah.gov/Rule/724" ], "quote": "Operators of diagnostic x-ray systems must be licensed to practice in Utah in accordance with Title 58 Chapter 54.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Registrants must document that operators are trained in choosing technique factors and in safe operation. Operators must be instructed in the facility's written radiation safety program, and hand-held units require the manufacturer's training. Radiologist assistant licensure involves ARRT certification. No fluoroscopy permit, required training hours or physician fluoroscopy training was found in R313-28. Full technologist licensure and continuing-education rules were not retrieved.", "citation": "R313-28-350(1); R313-28-31(2)(b), (6)(c)", "sourceUrls": [ "http://adminrules.utah.gov/Rule/724" ], "quote": "The registrant shall document that the operator of diagnostic x-ray equipment is trained in the proper choice of technique factors to be used and in the safe and effective operation of the x-ray equipment.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "Amendments to R313-12, R313-14, R313-16, R313-28, R313-30 and R313-35", "kind": "adopted_rule", "status": "Approved unanimously for final adoption by the Waste Management and Radiation Control Board; R313-16 effective 05/16/2025", "date": "2025-03-01", "dateISO": "2025-03-01", "summary": "Proposed in the March 1, 2025 Bulletin. R313-28 shows a last change of 09/15/2025; not confirmed whether that is the same package or what it changed.", "sourceUrls": [ "https://rules.utah.gov/wp-content/uploads/b20250301.pdf" ] }, { "title": "Five-year review continuations for R313-12, R313-16 and R313-28", "kind": "other", "status": "Continuations filed", "date": "2026-04-06", "dateISO": "2026-04-06", "summary": "Notices of continuation filed for R313-12, R313-16 and R313-28, effective April 6, 2026.", "sourceUrls": [ "https://rules.utah.gov/wp-content/uploads/d20260501.pdf" ] }, { "title": "R313-15 amendment", "kind": "adopted_rule", "status": "Amended in 2023", "date": "2023-08-01", "dateISO": "2023-08-01", "summary": "Amended per the Bulletin of August 1, 2023, which included a 'Protective apron' definition.", "sourceUrls": [ "https://rules.utah.gov/wp-content/uploads/b20230801.pdf" ] } ], "notable": [ "Facilities using fluoroscopy must be inspected at least once a year (R313-16-290, Table 1).", "Fluoroscopy entrance exposure rates must be measured annually and posted where the fluoroscopist can see them (R313-28-40(7)).", "A fluoroscopy timer may not exceed 5 minutes without resetting (R313-28-40(11)).", "The one-badge 0.3 factor applies only once the neck badge exceeds 25% of the limit.", "Possible drafting error: R313-15-201 cross-references R313-15-502(1)(d) for fluoroscopy monitoring, but the fluoroscopy item is (1)(e).", "No Utah proposal was found on removing ALARA, on engineered shielding, or on lens limits, and no Utah response to the NRC's July 2026 proposal; searches ran out before a thorough check." ], "openQuestions": [ "Check the Cornell/Justia R313-15 text against the official page (https://adminrules.utah.gov/public/rule/R313-15/Current%20Rules), including the 502(1)(d)/(e) cross-reference.", "Read Utah Code 58-54-306 and 58-1-307 to see whether physicians, PAs and NPs may operate fluoroscopy without a 58-54 licence.", "Read R156-54 for the radiology practical technician's scope (including fluoroscopy), technologist exam and certification requirements, and continuing education.", "Look up the Bulletin filing for the R313-28 change of 09/15/2025.", "Confirm there is no apron inspection requirement anywhere in R313-15 or R313-16.", "Ask DWMRC (X-ray and Technical Support Section, 801-536-0200) whether Utah plans changes in response to the NRC ALARA proposal, and check Board agendas for late 2026." ], "sources": [ { "title": "R313-28, Use of X-Rays in the Healing Arts (official, effective 09/15/2025)", "url": "http://adminrules.utah.gov/Rule/724" }, { "title": "R313-16, Radiation Machines (official, effective 05/16/2025)", "url": "http://adminrules.utah.gov/Rule/716" }, { "title": "Cornell LII, R313-15 index and §§101, 201, 208, 502, 503", "url": "https://www.law.cornell.edu/regulations/utah/environmental-quality/title-R313/rule-R313-15" }, { "title": "Justia, R313-15-502", "url": "https://regulations.justia.com/states/utah/environmental-quality/title-r313/rule-r313-15/section-r313-15-502/" }, { "title": "eLaws, R313-15-502 (current through 11/1/2019)", "url": "http://utrules.elaws.us/uac/r313-15-502(1)(a)/" }, { "title": "Utah DEQ X-Ray Program", "url": "https://deq.utah.gov/waste-management-and-radiation-control/x-ray-program" }, { "title": "Utah DEQ Permit Guide", "url": "https://deq.utah.gov/permits/permit-guide/permit-guide-introduction" }, { "title": "Utah Code 58-54-102", "url": "https://le.utah.gov/xcode/Title58/Chapter54/C58-54-S102_1800010118000101.xml" }, { "title": "Utah Code Title 58 Chapter 54 PDF", "url": "https://le.utah.gov/xcode/Title58/Chapter54/C58-54_1800010118000101.pdf" }, { "title": "DOPL Radiologic Technology Laws and Rules", "url": "https://commerce.utah.gov/dopl/radiologic-technology/laws-and-rules/" }, { "title": "Utah State Digest, May 1, 2026", "url": "https://rules.utah.gov/wp-content/uploads/d20260501.pdf" }, { "title": "Utah State Bulletin, March 1, 2025", "url": "https://rules.utah.gov/wp-content/uploads/b20250301.pdf" }, { "title": "Utah State Bulletin, August 1, 2023", "url": "https://rules.utah.gov/wp-content/uploads/b20230801.pdf" }, { "title": "Waste Management and Radiation Control Board minutes", "url": "https://www.utah.gov/pmn/files/1269289.pdf" } ] }, { "code": "VT", "name": "Vermont", "pageUrl": "https://orsif.org/guidelines/us/states/vermont", "regulator": { "name": "Vermont Department of Health, Radiological Health Program", "url": "https://www.healthvermont.gov/environment/radiological-health/x-rays" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Vermont's Radiological Health Rule Part A (effective January 1, 2024) has its own X-ray ALARA requirement (§ 7.1.2), separate from Part B, which adopts 10 CFR Part 20 by reference, and its worker dose limits match the NRC's: 50 mSv whole body, 150 mSv lens of the eye, 500 mSv skin and extremities, and 5 mSv to the fetus of a declared pregnant worker. Staff must be protected by aprons or whole-body barriers of at least 0.25 mm lead equivalent, and for fluoroscopy the rule also accepts drapes, panels or curtains of the same rating, though it does not name engineered shielding systems. Department guidance says aprons and thyroid collars shall be visually inspected for defects at least monthly, and the Department treats that wording as a requirement, though the rule text itself does not state one. Technologists need ARRT certification, including post-primary certification for cardiac or vascular interventional work, and non-radiologist practitioners need an OPR radiation-competency endorsement unless exempt.", "whereAlaraLives": { "category": "both", "explanation": "The X-ray ALARA requirement is Vermont's own text in Part A § 7.1.2. Separately, Part B adopts 10 CFR Part 20, including § 20.1101, by reference without an edition date. The NRC proposal would affect Part B directly but not Part A.", "citation": "Part A §§ 2.3, 7.1.2; Part B §§ 1.2.5, 6.2.1-6.2.2" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Per the NRC list (updated 2026-10-29); Part B adopts NRC materials regulations, which fits.", "citation": "NRC list of Agreement States, updated October 29, 2026; Radiological Health Rule Part B, § 1.2.6.6", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Yes. Vermont's Radiological Health Rule (Code Vt. R. 13-140-030), effective 1/1/2024. Part A covers radiation-producing machines: § 7.0 has the protection standards, § 8.0 covers healing-arts X-ray and § 8.13 covers fluoroscopy. Part B covers radioactive materials and adopts 10 CFR Part 20. Part C covers Vermont Yankee.", "citation": "Radiological Health Rule Part A §§ 2.1, 7.0, 8.0, 8.13; Part B § 6.2", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "Part A of this Rule establishes standards for the control of ionizing radiation-producing machines for the protection of occupational and public health and safety.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. X-ray registrants must have a radiation protection program, use procedures and engineering controls to keep doses ALARA, and review the program at least annually.", "citation": "Part A § 7.1.2 (definition in § 3.9)", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "The registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem), or 50 mSv, per year total effective dose equivalent.", "citation": "Part A § 7.2.1.1.1", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "An annual limit, which is the more limiting of: 7.2.1.1.1. The total effective dose equivalent being equal to 0.05 Sv (5 rem); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem), or 150 mSv, per year. Vermont has not adopted the ICRP's 20 mSv.", "citation": "Part A § 7.2.1.2.1", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "A lens dose equivalent of 0.15 Sv (15 rem); and … A shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem), or 500 mSv, shallow dose equivalent to the skin of the whole body or any extremity.", "citation": "Part A § 7.2.1.2.2", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "A lens dose equivalent of 0.15 Sv (15 rem); and … A shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant worker for the whole pregnancy. The registrant must try to avoid large swings above a steady monthly rate.", "citation": "Part A § 7.5.1", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "The registrant shall ensure that the dose equivalent to an embryo/fetus during the entire pregnancy, due to the occupational exposure of a declared pregnant worker, does not exceed 5 mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Dosimeters are required for adults likely to exceed 10% of any adult limit in a year (5 mSv whole body, 15 mSv lens, 50 mSv skin/extremity), for minors above lower thresholds, for declared pregnant workers likely to exceed 1 mSv during the pregnancy, and for anyone entering a high or very high radiation area. The Department may approve alternatives to continuous badging in writing. Dosimeters must be processed by an NVLAP-accredited processor.", "citation": "Part A §§ 7.8.1.1-7.8.1.4, 7.8.2", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of the limits in 7.2.1.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "Yes, for machine sources. One badge at the neck outside the apron: if the reading exceeds 25% of the limit, effective dose equivalent = reading × 0.3. Two badges: (waist under apron × 1.5) + (neck × 0.04). The fetal badge goes under the apron at the waist. The non-binding March 2026 guidance conflicts with these placements.", "citation": "Part A §§ 7.2.4.3.1, 7.2.4.3.2, 7.5.4", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "When only one individual monitoring device is used and it is located at the neck outside the protective apron, and the reported dose exceeds 25% of the limit specified in 7.2.1, the reported deep dose equivalent value multiplied by 0.3 shall be the effective dose equivalent for external radiation", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Aprons or whole-body barriers of at least 0.25 mm lead equivalent are required for staff in the room; the general rule also allows staying 2 m away instead. Fluoroscopy requires an additional 0.25 mm Pb above and below the table unless the person is at least 120 cm from the center of the X-ray field. A person who could be struck by the direct beam needs at least 0.5 mm Pb. Thyroid shields and eyewear are recommended only in guidance.", "citation": "Part A §§ 8.8.1.2, 8.9.4, 8.9.5.1, 8.13.5.1-8.13.5.3", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "The x-ray operator, other staff, ancillary personnel and other persons required for the medical procedure shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent material.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "partial", "answer": "The Department's Lead Aprons guidance says lead or lead-equivalent aprons and thyroid collars shall be visually inspected for defects at least monthly and replaced if damaged. The Department says that \"shall\" in its guidance marks an inspection requirement, though the rule text itself does not state one.", "citation": "X-Ray Facility Tips: Lead Aprons", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/env-rad-lead-aprons.pdf" ], "quote": "Lead or lead-equivalent aprons and thyroid collars shall be visually inspected for defects at least monthly, and replaced if they are damaged.", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rule does not name engineered shielding systems, but it accepts whole-body protective barriers of at least 0.25 mm lead equivalent as an alternative to aprons. For fluoroscopy it also accepts drapes, panels or self-supporting curtains of at least 0.25 mm lead equivalent, or keeping staff at a set distance.", "citation": "Part A § 8.8.1.2", "sourceUrls": [ "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "The x-ray operator, other staff, ancillary personnel and other persons required for the medical procedure shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 millimeter lead equivalent material.", "quoteMatchedToSource": true, "confidence": "high" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Use must be by, or under the general supervision of, a Vermont-licensed practitioner. Licensed radiologic technologists may operate. Exempt licensed practitioners need an OPR competency endorsement unless they are ABR-certified radiologists or ABIM-certified interventional cardiologists or electrophysiologists. PA authority is unclear. Delegation to unauthorized staff is barred.", "citation": "Rule Part A §§ 3.28, 8.2.6, 8.2.6.1; 26 V.S.A. §§ 2801(6), 2802, 2803, 2804, 2857; OPR Admin. Rules 2.4", "sourceUrls": [ "https://legislature.vermont.gov/statutes/fullchapter/26/051", "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" ], "quote": "Use of a radiation machine in the healing arts shall be by or under the general supervision of a Vermont-licensed veterinarian, physician, chiropractor, dentist, podiatrist, or other Vermont-licensed health care practitioner authorized to do so within their scope of practice.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "Technologists need an ARRT-approved program and ARRT radiography certification, plus post-primary certification for cardiac- or vascular-interventional work, and 24 hours of CE every two years. Endorsed practitioners need an approved radiation-safety course (for fluoroscopy, \"Fluoroscopic Safety Explained for Physicians\") and must keep fluoroscopy logs. No state fluoroscopy permit or set number of training hours was found.", "citation": "26 V.S.A. §§ 2804, 2812(b)(5), 2821a, 2821b; OPR Administrative Rules Parts 2-3; Rule Part A §§ 7.18, 8.4.1, 8.10.1.2", "sourceUrls": [ "https://legislature.vermont.gov/statutes/fullchapter/26/051" ], "quote": "The Director shall recognize and follow the ARRT and NMTCB postprimary certification process in the following postprimary practice categories: mammography, computed tomography (CT), cardiac-interventional radiography, vascular-interventional radiography, and positron emission tomography (PET).", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Reforming and Modernizing the NRC's Radiation Protection Framework", "kind": "proposed_rule", "status": "Proposed (NRC)", "date": "2026-07-15", "dateISO": "2026-07-15", "summary": "Would require Agreement States to revise their equivalent of 10 CFR 20.1101(b) to be essentially identical to the NRC's and remove ALARA; in Vermont this would affect Part B.", "sourceUrls": [ "https://www.federalregister.gov/documents/2026/07/15/2026-14208/reforming-and-modernizing-the-nrcs-radiation-protection-framework" ] }, { "title": "Act 119 (2026), OPR professions act", "kind": "bill", "status": "Signed June 8, 2026", "date": "2026-06-08", "dateISO": "2026-06-08", "summary": "No change to the radiology chapter found; it changes Board of Medical Practice background checks, including for radiologist assistants.", "sourceUrls": [ "https://legislature.vermont.gov/Documents/2026/Docs/ACTS/ACT119/ACT119%20As%20Enacted.pdf" ] }, { "title": "Department X-ray guidance reissue", "kind": "guidance", "status": "Reissued", "date": "March 2026", "dateISO": "2026-03", "summary": "The Department reissued its X-ray facility guidance; not a rule change.", "sourceUrls": [ "https://www.healthvermont.gov/environment/radiological-health/x-rays" ] }, { "title": "OPR Application Instructions for Ionizing Radiation Privileges", "kind": "guidance", "status": "Updated", "date": "February 2026", "dateISO": "2026-02", "summary": "OPR updated its endorsement instructions; not a rule change.", "sourceUrls": [ "https://outside.vermont.gov/dept/sos/office_professional_regulation/professions/radiologic_technology/radiologic_technology_ionizing_radiation_privileges_application_instructions.pdf" ] } ], "notable": [ "Fluoroscopically guided interventions require written high-dose policies, skin dose recorded in the chart, and a Radiation Safety Officer dose review at 2 Gy or more; exam records must include the operator's name and be kept 5 years.", "Monitored workers get a written dose report at least once a year, and former workers can request one.", "Doses from other employers count against the current year's limit.", "A Qualified Expert must design room shielding and re-evaluate it when workload rises.", "The fluoroscopy guidance stresses training for everyone in the room, ergonomics and apron weight, wrap-around aprons, and sharing dosimetry reviews with staff.", "The guidance uses 'shall' for monthly apron checks that the rule does not require and conflicts with the rule on badge placement." ], "openQuestions": [ "Part B § 6.2.1 adopts 10 CFR Part 20 with no edition date, so it is unclear whether a final NRC rule would apply automatically or only after Vermont amends its rule.", "It is not known whether Vermont commented on the NRC proposal or plans to change Part A § 7.1.2 to match.", "Whether a physician assistant may actuate fluoroscopy is unsettled.", "'Whole body protective barrier' is undefined, so whether an engineered shielding system qualifies in place of an apron needs a Department interpretation.", "The guidance conflicts with the rule on monthly apron checks and badge placement; it is unclear which the Department enforces at inspections.", "The OPR rules (2017) still use 'Board' language, and the 2026 'acts affecting statutes' index could not be opened." ], "sources": [ { "title": "Vermont Department of Health, Radiological Health Rule (effective 1/1/2024)", "url": "https://www.healthvermont.gov/sites/default/files/document/reg-radiological-health.pdf" }, { "title": "Vermont Department of Health, X-rays (registration and guidance page)", "url": "https://www.healthvermont.gov/environment/radiological-health/x-rays" }, { "title": "Vermont Department of Health, X-Ray Facility Tips, Lead Aprons (March 2026)", "url": "https://www.healthvermont.gov/sites/default/files/document/env-rad-lead-aprons.pdf" }, { "title": "Vermont Department of Health, X-Ray Facility Tips, Radiation Protection for Fluoroscopy (March 2026)", "url": "https://www.healthvermont.gov/sites/default/files/document/env-rad-radiation-protection-for-fluoroscopy.pdf" }, { "title": "Vermont Department of Health, X-Ray Facility Tips, Personnel Dosimeters (March 2026)", "url": "https://www.healthvermont.gov/sites/default/files/document/env-rad-personnel-dosimeters.pdf" }, { "title": "Vermont Department of Health, Proposed Health Rules", "url": "https://www.healthvermont.gov/laws-regulations/laws/proposed-health-rules" }, { "title": "Vermont Department of Health, Rules and Regulations", "url": "https://www.healthvermont.gov/laws-regulations/laws/rules-and-regulations" }, { "title": "Vermont Statutes Online, 26 V.S.A. chapter 51 (Radiology)", "url": "https://legislature.vermont.gov/statutes/fullchapter/26/051" }, { "title": "Vermont Statutes Online, 26 V.S.A. § 2857 (Radiologist assistants)", "url": "https://legislature.vermont.gov/statutes/section/26/052/02857" }, { "title": "OPR, Administrative Rules of the Board of Radiologic Technology (eff. 8/1/2017)", "url": "https://outside.vermont.gov/dept/sos/office_professional_regulation/professions/radiologic_technology/radiologic_technology_administrative_rules.pdf" }, { "title": "OPR, Application Instructions for Ionizing Radiation Privileges (Feb. 2026)", "url": "https://outside.vermont.gov/dept/sos/office_professional_regulation/professions/radiologic_technology/radiologic_technology_ionizing_radiation_privileges_application_instructions.pdf" }, { "title": "OPR, Radiologic Technology Forms & Instructions", "url": "https://sos.vermont.gov/radiologic-technology/forms-instructions" }, { "title": "Act 119 (2026), OPR professions act", "url": "https://legislature.vermont.gov/Documents/2026/Docs/ACTS/ACT119/ACT119%20As%20Enacted.pdf" }, { "title": "Cornell LII, 13-140-030 Code Vt. R.", "url": "https://www.law.cornell.edu/regulations/vermont/13-030-Code-Vt-R-13-140-030-X" }, { "title": "Federal Register, NRC proposed rule (July 15, 2026)", "url": "https://www.federalregister.gov/documents/2026/07/15/2026-14208/reforming-and-modernizing-the-nrcs-radiation-protection-framework" }, { "title": "NRC Agreement States list", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "VA", "name": "Virginia", "pageUrl": "https://orsif.org/guidelines/us/states/virginia", "regulator": { "name": "Virginia Department of Health (VDH), Office of Radiological Health (ORH), X-ray Machine Program; regulations adopted by the State Board of Health", "url": "https://www.vdh.virginia.gov/radiological-health/radiological-health/x-ray-machine-program/medical-x-ray-machines/" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "The research for this state ended before every question was fully answered, so some answers may be incomplete." }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Virginia regulates X-ray users in one chapter, 12VAC5-481, where the only explicit ALARA requirement is in the shared Part IV (630 B), worded for the 'licensee', while the X-ray part (Part VI) has only a duty to 'minimize' exposure. Occupational limits are 50 mSv per year whole body, 150 mSv lens (a lower lens limit such as 20 mSv has not been adopted), 500 mSv skin and extremities, and 5 mSv for the embryo/fetus of a declared pregnant worker. Staff must be protected by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent, the rules do not require aprons to be inspected periodically, and engineered apron-replacement systems are not mentioned by name. Fluoroscopy may be operated by a licensed practitioner, or by a radiologic technologist or equivalent under direct supervision, and physician assistants need 40 hours of didactic instruction, 40 hours of supervised clinical experience, and a pass on the ARRT fluoroscopy exam.", "whereAlaraLives": { "category": "shared_with_materials", "explanation": "The only explicit ALARA requirement is 12VAC5-481-630 B, in the unified Part IV that also governs radioactive-materials licensees and is revised for compatibility with NRC changes to 10 CFR. The X-ray-specific Part VI never uses the term ALARA; it has only a general duty to minimize personnel exposure (1591 A 9) and scatter-control design rules (1611 M).", "citation": "12VAC5-481-630 B; 12VAC5-481-1591 A 9; Town Hall Action 5931" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Virginia is an NRC Agreement State.", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "All rules are in one chapter, 12VAC5-481 (Virginia Radiation Protection Regulations). The X-ray rules are in Part VI, \"Use of Diagnostic X-Rays in the Healing Arts\" (12VAC5-481-1581 through -1657, effective Aug. 27, 2015), which includes -1591 (general and administrative requirements) and -1611 (fluoroscopic equipment). The general standards are in Part IV, \"Standards for Protection Against Radiation\" (12VAC5-481-600 et seq.), which applies to both licensees and registrants. Part VI is in addition to the rest of the chapter.", "citation": "12VAC5-481-610 (Part IV scope); 12VAC5-481-1581 (Part VI purpose and scope)", "sourceUrls": [ "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section610/" ], "quote": "Part IV (12VAC5-481-600 et seq.) of this chapter applies to persons licensed or registered by the agency to receive, possess, use, transfer, or dispose of sources of radiation.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "partial", "answer": "Yes in effect, but the wording is not explicit for registrants. The ALARA rule in 12VAC5-481-630 B is in Part IV, which by its scope covers registrants, but the sentence is addressed to the \"licensee.\" The Part VI cross-reference (1591 A 10) applies only the dose-limit sections, not 630. Part VI has only a general duty to \"minimize\" patient and personnel exposure (1591 A 9).", "citation": "12VAC5-481-630 B; 12VAC5-481-10 (\"ALARA,\" \"Licensee,\" \"Registrant\"); 12VAC5-481-1591 A 9-10", "sourceUrls": [ "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section630/" ], "quote": "The licensee shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "medium" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "5 rem (50 mSv) per year total effective dose equivalent, or 50 rem (500 mSv) to any organ or tissue, whichever is more restrictive. This applies to X-ray workers via 12VAC5-481-1591 A 10. Minors are limited to 10% of the adult limits.", "citation": "12VAC5-481-640 A 1", "sourceUrls": [ "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section640/" ], "quote": "a. The total effective dose equivalent being equal to 5 rem (0.05 Sv); or", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "15 rem (150 mSv) per year. Virginia has not adopted a lower lens limit such as 20 mSv.", "citation": "12VAC5-481-640 A; -1591 A 10", "sourceUrls": [ "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section640/" ], "quote": "A lens dose equivalent of 15 rem (0.15 Sv), and … A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "50 rem (500 mSv) per year shallow-dose equivalent to the skin of the whole body or to any extremity.", "citation": "12VAC5-481-640 A; -1591 A 10", "sourceUrls": [ "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section640/" ], "quote": "A lens dose equivalent of 15 rem (0.15 Sv), and … A shallow-dose equivalent of 50 rem (0.5 Sv) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "500 mrem (5 mSv) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. Employers must also try to avoid substantial variation above a uniform monthly exposure rate.", "citation": "12VAC5-481-710; -1591 A 10", "sourceUrls": [ "https://law.lis.virginia.gov/admincodefull/title12/agency5/chapter481/partIV/" ], "quote": "substantial variation above a uniform monthly exposure rate", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Individual dosimeters are required for adults likely to receive more than 10% of the 640 A limits in a year from external sources (by this research's arithmetic, about 5 mSv whole body, 15 mSv lens, 50 mSv skin/extremity). They are also required for minors above set thresholds, for declared pregnant women likely to exceed 100 mrem (1 mSv) over the pregnancy, and for anyone entering a high or very high radiation area. The section is addressed to the \"licensee\" but covers unlicensed sources under the licensee's control.", "citation": "12VAC5-481-760 1", "sourceUrls": [ "https://law.lis.virginia.gov/admincodefull/title12/agency5/chapter481/partIV/" ], "quote": "Adults likely to receive, in one year from sources external to the body, a dose in excess of 10% of the limits in 12VAC5-481-640 A", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "12VAC5-481-770 covers the \"licensee or registrant\" and sets badge locations. The whole-body badge goes at the unshielded spot likely to get the highest exposure, typically the collar when an apron is worn. The lens badge goes at the collar outside the apron or closer to the eye. The embryo/fetus badge goes at the waist under the apron. The extremity badge goes on the extremity likely to get the highest dose. Effective dose equivalent may be used only with an agency-approved method; no named method (such as NCRP 122 or Webster) or two-badge formula was found.", "citation": "12VAC5-481-770 1-4; 12VAC5-481-640 C", "sourceUrls": [ "https://law.lis.virginia.gov/admincodefull/title12/agency5/chapter481/partIV/" ], "quote": "When a protective apron is worn, the location of the individual monitoring device is typically at the neck (collar)", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "partial", "answer": "Staff needed for the procedure must be protected from direct scatter by aprons or whole-body protective barriers of at least 0.25 mm lead equivalent, unless distance gives enough protection or the device has a low dose rate. Facilities must keep enough leaded aprons and gloves for personnel who are not otherwise shielded. Fluoroscopy design rules (1611 M) require scatter shielding under and above the table. Thyroid shields and protective eyewear were not found in the rules.", "citation": "12VAC5-481-1591 A 5 b, A 8 f; 12VAC5-481-1611 M", "sourceUrls": [ "https://law.lis.virginia.gov/admincodefull/title12/agency5/chapter481/partVI/" ], "quote": "shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 mm lead equivalent material.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Virginia's X-ray rules do not require protective aprons or gloves to be inspected periodically. They require facilities to have enough leaded aprons and gloves for all personnel who are otherwise unshielded, and staff must be protected by aprons or whole-body barriers of at least 0.25 mm lead equivalent, but no inspection schedule or method for this apparel is set.", "citation": "12VAC5-481, Part VI (Use of X-rays in the Healing Arts), including 12VAC5-481-1591 A 5 and A 8 f, 12VAC5-481-1600, and 12VAC5-481-1657", "sourceUrls": [ "https://law.lis.virginia.gov/admincodefull/title12/agency5/chapter481/partVI/" ], "quote": "All registrants of diagnostic x-ray imaging equipment may be required by the agency to establish and maintain a quality assurance program", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered radiation protection systems are not addressed by name. The rules allow \"whole body protective barriers\" (0.25 mm lead equivalent) instead of aprons, and accept drapes, Bucky-slot cover panels or self-supporting curtains in addition to aprons. The agency may grant exemptions where a sterile field prevents normal barriers. Bill searches for 2025-2026 could not be run.", "citation": "12VAC5-481-1591 A 5 b; 12VAC5-481-1611 M 2-3", "sourceUrls": [ "https://law.lis.virginia.gov/admincodefull/title12/agency5/chapter481/partVI/" ], "quote": "The agency may grant exemptions to subdivision 2 of this subsection where a sterile field will not permit the use of the normal protective barriers.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "Fluoroscopy may be operated only by a licensed practitioner of the healing arts, or by a radiologic technologist \"or equivalent\" under a practitioner's direct supervision. Students must be directly supervised. Operators must be licensed by the Department of Health Professions, ARRT-certified, or supervised students. Physician assistants may use fluoroscopy only under a practice agreement with a radiology or orthopedics physician and if it is in their protocol. Radiologic technologists-limited may not perform fluoroscopy. Nurse practitioners and others were not found.", "citation": "12VAC5-481-1611 N, O 2-3; 12VAC5-481-1591 A 14; 18VAC85-50-117; 18VAC85-101-130 B", "sourceUrls": [ "https://law.lis.virginia.gov/admincodefull/title12/agency5/chapter481/partVI/" ], "quote": "The operation of fluoroscopic x-ray systems by radiologic technologists or equivalent shall be performed under the direct supervision of a licensed practitioner of the healing arts.", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Physician assistants need at least 40 hours of didactic instruction and 40 hours of supervised clinical experience under the AAPA/ASRT Fluoroscopy Educational Framework, plus a pass on the ARRT Fluoroscopy Examination. Radiologic technologists need a Board of Medicine licence and graduation from an ARRT-acceptable program (seen only in a search snippet). No physician-specific fluoroscopy training requirement was found, and technologist continuing education was not found.", "citation": "18VAC85-50-117 (effective Feb. 13, 2015; amended through Nov. 9, 2022); 18VAC85-101", "sourceUrls": [ "https://law.lis.virginia.gov/admincode/title18/agency85/chapter50/section117/" ], "quote": "Successful passage of the American Registry of Radiologic Technologists (ARRT) Fluoroscopy Examination.", "quoteMatchedToSource": true, "confidence": "medium" } }, "changes": [ { "title": "Repeal 12VAC5-481 and promulgate 12VAC5-482 (NOIRA, VA.R. Doc. No. R23-7345)", "kind": "proposed_rule", "status": "Notice of Intended Regulatory Action; comments closed Jan. 14, 2026; no public hearing planned; publication of a proposed text not confirmed", "date": "2025-12-15", "dateISO": "2025-12-15", "summary": "The State Board of Health intends to repeal the whole radiation protection chapter and replace it with 12VAC5-482. The notice was filed Nov. 10, 2025. Public comments addressed the fluoroscopy sections (1601, 1611) and patient gonadal and fetal shielding, and a University of Virginia commenter asked VDH to revise the chapter rather than repeal it.", "sourceUrls": [ "https://register.dls.virginia.gov/details.aspx?id=12105" ] }, { "title": "HB 452 (2026)", "kind": "bill", "status": "Passed House Feb. 9, 2026; last Senate action seen was 'passed by for the day' Feb. 27, 2026; enactment suggested by the code but not confirmed", "date": "2026-02-27", "dateISO": "2026-02-27", "summary": "Would extend the radiologic technologist licensure exemption for hospital employees to people employed or engaged by hospitals, health systems, or affiliated urgent care centers. The bill text includes a July 1, 2029 sunset.", "sourceUrls": [ "https://www.billtrack50.com/billdetail/1927356" ] }, { "title": "Licensure by endorsement for radiologic technologists (18VAC85-101)", "kind": "adopted_rule", "status": "Approved by the Governor May 12, 2026; published June 1, 2026 (per a Town Hall search snippet)", "date": "2026-06-01", "dateISO": "2026-06-01", "summary": "Adds licensure by endorsement for radiologic technologists.", "sourceUrls": [] } ], "notable": [ "Annual radiation safety and equipment performance surveys of every fluoroscope are required, done by or under the direct supervision of an inspector who is physically on site (12VAC5-481-1611 P).", "Facilities must log cumulative fluoroscopy time and the number of recorded images for each exam (1611 O 5).", "No one may be used routinely to hold patients or image receptors (1591 A 8 d).", "Part IV ALARA and monitoring sections (630, 760) are addressed to the 'licensee', while the dosimeter-placement section (770) names 'licensee or registrant'. The Part VI dose-limit cross-reference (1591 A 10) does not include 630.", "The research for Virginia ended early, so some answers may be incomplete." ], "openQuestions": [ "Does VDH apply 12VAC5-481-630 B and -760 to X-ray-only registrants?", "Has VDH approved an effective-dose method under 640 C, such as NCRP 122 or Webster?", "Do ORH guidance documents address apron inspection, thyroid shields or eyewear?", "Has a proposed 12VAC5-482 text been published, and does it change ALARA, lens limits, or apron and barrier rules?", "HB 452: what are the final passage status, chapter number and effective date, and how does it affect who may operate fluoroscopy?", "Are there 2025-2026 Virginia bills or rule proposals on engineered radiation protection systems?", "What are the continuing education requirements for radiologic technologists, nurse practitioner fluoroscopy authority, and physician training requirements?" ], "sources": [ { "title": "Virginia Administrative Code, 12VAC5-481 Part IV (full text)", "url": "https://law.lis.virginia.gov/admincodefull/title12/agency5/chapter481/partIV/" }, { "title": "12VAC5-481-630", "url": "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section630/" }, { "title": "12VAC5-481-600", "url": "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section600/" }, { "title": "12VAC5-481-610", "url": "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section610/" }, { "title": "12VAC5-481-620", "url": "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section620/" }, { "title": "12VAC5-481-640", "url": "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section640/" }, { "title": "12VAC5-481-10, Definitions", "url": "https://law.lis.virginia.gov/admincode/title12/agency5/chapter481/section10/" }, { "title": "12VAC5-481 Part VI, Use of Diagnostic X-Rays in the Healing Arts", "url": "https://law.lis.virginia.gov/admincodefull/title12/agency5/chapter481/partVI/" }, { "title": "18VAC85-50-117, Authorization to use fluoroscopy (physician assistants)", "url": "https://law.lis.virginia.gov/admincode/title18/agency85/chapter50/section117/" }, { "title": "18VAC85-101-130, General requirements (radiologic technologist-limited)", "url": "https://law.lis.virginia.gov/admincode/title18/agency85/chapter101/section130/" }, { "title": "Code of Virginia § 54.1-2956.8:2", "url": "https://law.lis.virginia.gov/vacode/title54.1/chapter29/section54.1-2956.8:2/" }, { "title": "Code of Virginia Chapter 29 table of contents", "url": "https://law.lis.virginia.gov/vacode/title54.1/chapter29/" }, { "title": "Virginia Register, NOIRA 12VAC5-481 (Dec. 15, 2025)", "url": "https://register.dls.virginia.gov/details.aspx?id=12105" }, { "title": "Town Hall, NOIRA comment list", "url": "https://townhall.virginia.gov/L/comments.cfm?stageid=9831" }, { "title": "Town Hall, Action 5931", "url": "https://townhall.virginia.gov/l/ViewAction.cfm?actionid=5931" }, { "title": "VDH, Medical X-ray Machines", "url": "https://www.vdh.virginia.gov/radiological-health/radiological-health/x-ray-machine-program/medical-x-ray-machines/" }, { "title": "HB 452 (2026), BillTrack50", "url": "https://www.billtrack50.com/billdetail/1927356" }, { "title": "HB 452 (2026), LegiScan", "url": "https://legiscan.com/VA/text/HB452/id/3306523" }, { "title": "HB 452 (2026), FastDemocracy", "url": "https://fastdemocracy.com/bill-search/va/2026/bills/VAB00039788/" }, { "title": "NRC Agreement States", "url": "https://www.nrc.gov/agreement-states" } ] }, { "code": "WA", "name": "Washington", "pageUrl": "https://orsif.org/guidelines/us/states/washington", "regulator": { "name": "Washington State Department of Health (DOH), Office of Radiation Protection", "url": "https://doh.wa.gov/community-and-environment/radiation" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "In Washington, explicit ALARA language is in the shared radiation protection standards (ch. 246-221 WAC) but is addressed to specific licensees, while X-ray registrants must use procedures and equipment designed to minimize patient and personnel exposure. Fluoroscopy workers share the materials dose limits: 50 mSv whole body, 150 mSv lens, 500 mSv skin and extremities, and 5 mSv embryo/fetus. Everyone working in a fluoroscopy room must wear a collar dosimeter outside the apron and be shielded by aprons or whole-body barriers of at least 0.25 mm lead equivalent, but thyroid shields and eyewear are not required by name and apron inspections are not required. Licensed practitioners, certified radiologic technologists and registered X-ray technicians may operate X-ray equipment, and a DOH rewrite of the fluoroscopy rules is at the draft stage.", "whereAlaraLives": { "category": "both", "explanation": "Explicit ALARA text is in the shared chapters (246-221-005, 246-220-007) and is worded for licensees. The X-ray-specific registrant duty is the \"minimize... personnel exposure\" language in 246-225-020(2)(l), which does not use the term ALARA. Dose limits and monitoring rules followed by registrants sit in the shared chapter.", "citation": "WAC 246-220-007; WAC 246-221-005; WAC 246-225-020(2)(l)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes, per the NRC list (41 Agreement States; Washington is not on the non-Agreement list).", "citation": "NRC list of Agreement States, updated October 29, 2026", "sourceUrls": [ "https://www.nrc.gov/agreement-states" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Chapter 246-225 WAC, \"Radiation Protection - X-Rays in the Healing Arts\". General requirements are in WAC 246-225-020 and fluoroscopy rules in WAC 246-225-050. Chapter 246-221 WAC (Radiation Protection Standards) applies to both licensees and registrants. Related chapters are 246-220 and 246-222. WAC 246-225-020 was last amended in 1994 and WAC 246-225-050 effective 1/9/94.", "citation": "WAC 246-221-001(1); ch. 246-225 WAC", "sourceUrls": [ "https://apps.leg.wa.gov/wac/default.aspx?cite=246-221&full=true&pdf=true", "https://app.leg.wa.gov/wac/default.aspx?cite=246-225&full=true", "https://app.leg.wa.gov/wac/default.aspx?cite=246-225-050" ], "quote": "Except as otherwise specifically provided, this chapter applies to all licensees or registrants.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "unclear", "answer": "No explicit ALARA requirement for occupational dose addressed to X-ray registrants was found. WAC 246-221-005 and 246-220-007 are addressed to licensees. Registrants must use procedures and equipment \"designed to minimize patient and personnel exposure\" (WAC 246-225-020(2)(l)). DOH's practice is unconfirmed.", "citation": "WAC 246-220-007", "sourceUrls": [ "https://app.leg.wa.gov/wac/default.aspx?cite=246-220&full=true" ], "quote": "persons engaged in activities under licenses issued by the Washington state department of health pursuant to the Atomic Energy Act of 1954, as amended, shall, in addition to complying with the requirements set forth in chapter", "quoteMatchedToSource": true, "confidence": "medium" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "50 mSv (5 rem) TEDE per year. Alternative organ limit is 500 mSv.", "citation": "WAC 246-221-010(1)", "sourceUrls": [ "https://apps.leg.wa.gov/wac/default.aspx?cite=246-221&full=true&pdf=true" ], "quote": "The total effective dose equivalent being equal to 0.05 Sv (five rem)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "150 mSv (15 rem) per year. Washington has not adopted a lower limit such as 20 mSv.", "citation": "WAC 246-221-010(1)", "sourceUrls": [ "https://apps.leg.wa.gov/wac/default.aspx?cite=246-221&full=true&pdf=true" ], "quote": "A lens dose equivalent of 0.15 Sv (15 rem)", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "500 mSv (50 rem) shallow dose to skin and extremities per year.", "citation": "WAC 246-221-010(1)(b)(ii)", "sourceUrls": [ "https://apps.leg.wa.gov/wac/default.aspx?cite=246-221&full=true&pdf=true" ], "quote": "the skin of the extremities which are: (i) A lens dose equivalent of 0.15 Sv (15 rem); and (ii) A shallow dose equivalent of 0.50 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy.", "citation": "WAC 246-221-055(1)", "sourceUrls": [ "https://apps.leg.wa.gov/wac/default.aspx?cite=246-221&full=true&pdf=true" ], "quote": "does not exceed five mSv (0.5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Generally, adults likely to exceed 10% of the annual limits must be monitored, and declared pregnant women likely to exceed 1 mSv. For fluoroscopy, everyone operating a fluoroscope or working in the room during operation must wear a dosimeter regardless of expected dose. Extremity dosimeters are required if the hands could be exposed to the primary beam.", "citation": "WAC 246-221-090(1)(a),(c); WAC 246-225-020(2)(i)(iv)", "sourceUrls": [ "https://apps.leg.wa.gov/wac/default.aspx?cite=246-221&full=true&pdf=true", "https://apps.leg.wa.gov/wac/default.aspx?cite=246-225-020" ], "quote": "All persons involved in the operation of a fluoroscope and working within the fluoroscopy room during its operation shall wear a personnel dosimeter required under WAC 246-221-090", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "The badge is worn at the collar outside the apron. Lens monitoring uses the collar or an unshielded spot nearer the eye. The fetal badge goes at the waist under the apron. Two badges are allowed if each is labeled by body location. Deep-dose equivalent is used unless an NRC- or DOH-approved effective dose method is used; no named method appears in the rule text.", "citation": "WAC 246-225-020(2)(i)", "sourceUrls": [ "https://apps.leg.wa.gov/wac/default.aspx?cite=246-225-020" ], "quote": "When an apron is worn, the monitoring device shall be worn at the collar outside of the apron; and", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "partial", "answer": "Aprons or whole-body barriers of at least 0.25 mm lead equivalent are required, and at least 0.5 mm for body parts in the useful beam. Fluoroscopy scatter drapes or curtains of at least 0.25 mm are required in addition. Thyroid shields and eyewear are not required by name, but DOH may require additional protective devices.", "citation": "WAC 246-225-020(2)(e)(i),(ii),(iv); WAC 246-225-050(8)", "sourceUrls": [ "https://apps.leg.wa.gov/wac/default.aspx?cite=246-225-020", "https://app.leg.wa.gov/wac/default.aspx?cite=246-225-050" ], "quote": "The X-ray operator, other staff and ancillary personnel shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than 0.25 mm lead equivalent", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Washington's X-ray rules require protective aprons or barriers of at least 0.25 mm lead equivalent but do not require periodic inspection of aprons or other protective apparel.", "citation": "WAC 246-225-020(2)(e); WAC 246-225-050(8); WAC 246-225-010(71)", "sourceUrls": [ "https://app.leg.wa.gov/wac/default.aspx?cite=246-225&full=true" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "Engineered radiation protection systems are not addressed by name. The current rule allows whole-body protective barriers instead of aprons. The draft rules would keep barrier options and add a variance process (WAC 246-225B-080); these draft provisions are not law.", "citation": "WAC 246-225-020(2)(e)(ii) (current); draft WAC 246-225B-025(12)(b), -035(5) (proposed)", "sourceUrls": [ "https://doh.wa.gov/sites/default/files/2025-12/ORP-Rulemaking-XrayHealingArts-DraftRules.docx" ], "quote": "Personnel in the procedure room must wear at least 0.25 millimeter lead equivalent apron or stand behind a protective barrier while in the procedure room, unless operating the system from a protected control booth.", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "yes", "answer": "A health care practitioner licensed under Title 18 RCW, a certified radiologic technologist, or a registered X-ray technician. Radiologist assistants may operate fluoroscopy under general supervision, with direct supervision for listed exams. Only licensed practitioners may authorize exposure. The draft rule would require operation by a licensed health care provider.", "citation": "WAC 246-225-020(2)(b)(ii); WAC 246-926-300; WAC 246-926-020(5)-(6)", "sourceUrls": [ "https://apps.leg.wa.gov/wac/default.aspx?cite=246-225-020", "https://app.leg.wa.gov/wac/default.aspx?cite=246-926&full=true" ], "quote": "A medical X-ray machine operator shall be licensed, certified or registered by the department as either: (A) A health care practitioner, licensed under Title 18 RCW; or (B) A diagnostic or therapeutic radiologic technologist certified in accordance with chapter 18.84 RCW; or (C) An X-ray technician registered", "quoteMatchedToSource": true, "confidence": "high" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "There is no state fluoroscopy permit and no required physician training hours were found. Operators must be adequately instructed and able to demonstrate competence. Technologists need the ARRT exam, and their scope includes fluoroscopic procedures. No continuing education requirement was found. The draft rule would require annual training that includes ALARA.", "citation": "WAC 246-225-020(2)(b)(i); WAC 246-926-095(1), -135(1), -155(1)(e); draft WAC 246-225B-085", "sourceUrls": [ "https://apps.leg.wa.gov/wac/default.aspx?cite=246-225-020", "https://app.leg.wa.gov/wac/default.aspx?cite=246-926&full=true" ], "quote": "Individuals operating the X-ray equipment shall be adequately instructed in safe operating procedures and shall be able to demonstrate competence, upon request from the department, in the correct use of the equipment.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "X-rays in the Healing Arts rewrite (chapter 246-225; new fluoroscopy chapter 246-225B)", "kind": "proposed_rule", "status": "Draft stage. CR-101 filed 2024-01-24 and draft rules posted (file dated 2025-12). No CR-102 seen.", "date": "2024-01-24", "dateISO": "2024-01-24", "summary": "Would replace the all-persons badge rule with dosimetry for operators and patient-care staff using Class 2-4 systems. Would require a 0.25 mm apron and thyroid shield or a whole-body barrier. Would add a radiation safety program, dose benchmarks and annual staff training.", "sourceUrls": [ "https://doh.wa.gov/community-and-environment/radiation/rules/x-rays-healing-arts-rulemaking" ] }, { "title": "Federally Required Chapter Updates, Chapter 246-221, -231, -237, and -240 WAC", "kind": "other", "status": "Listed as active rulemaking; content and status unknown", "date": "", "dateISO": null, "summary": "Page could not be opened.", "sourceUrls": [ "https://doh.wa.gov/community-and-environment/radiation/rules" ] }, { "title": "HB 2113 (Chapter 10, Laws of 2026)", "kind": "bill", "status": "Enacted; effective 2026-06-11", "date": "2026-06-11", "dateISO": "2026-06-11", "summary": "Covers supervision of radiologic technologists, including IV contrast. Clarifies that licensed practitioners, including ARNPs, may supervise. Seen only in search snippets.", "sourceUrls": [ "https://app.leg.wa.gov/BillSummary/?BillNumber=2113&Year=2026" ] }, { "title": "WSR 25-16-010", "kind": "adopted_rule", "status": "Effective 2025-08-24", "date": "2025-08-24", "dateISO": "2025-08-24", "summary": "Amended chapter 246-926 for MRI technologists.", "sourceUrls": [] } ], "notable": [ "DOH says the fluoroscopy rules \"have not been updated in nearly 30 years\" and that fluoroscopy causes some of the highest doses to operators and staff.", "Current fluoroscopy rules require a 5-minute cumulative timer, recording of total fluoroscopy time per patient, and annual entrance exposure rate measurements (WAC 246-225-050).", "Cardiovascular invasive specialists are a separate certified role whose procedural tasks must be done under personal supervision (WAC 246-926-400).", "Washington retains the 150 mSv lens limit and has not adopted ICRP's 20 mSv." ], "openQuestions": [ "Whether DOH treats WAC 246-221-005 as binding on X-ray registrants despite the \"specific licensee\" wording (contact: Matthew Bullock, Radiation Health Physicist).", "Whether chapter 246-224 WAC contains ALARA or radiation-protection-program duties for registrants.", "Scope and status of the Federally Required Chapter Updates (246-221 and others), including any link to NRC compatibility changes (https://doh.wa.gov/node/18161).", "Whether a CR-102 has been filed for the 246-225 rewrite, and how the draft defines fluoroscope Classes 1-4.", "Full text of RCW 18.84.020, HB 2113's final text, and WAC 246-926-510 (not read in full).", "Profession-specific rules on whether physician assistants, nurse practitioners or nurses may operate fluoroscopy (not reviewed).", "Whether Appendix I (\"Good practices\") or Appendix II (competency) of chapter 246-225 mentions apron care (not verified).", "Whether DOH has approved an effective dose method such as NCRP Report 122." ], "sources": [ { "title": "Chapter 246-221 WAC, Radiation Protection Standards (official PDF, certified 11/8/2023)", "url": "https://apps.leg.wa.gov/wac/default.aspx?cite=246-221&full=true&pdf=true" }, { "title": "Chapter 246-220 WAC, General Provisions", "url": "https://app.leg.wa.gov/wac/default.aspx?cite=246-220&full=true" }, { "title": "WAC 246-225-020", "url": "https://apps.leg.wa.gov/wac/default.aspx?cite=246-225-020" }, { "title": "Chapter 246-225 WAC (full)", "url": "https://app.leg.wa.gov/wac/default.aspx?cite=246-225&full=true" }, { "title": "WAC 246-225-050", "url": "https://app.leg.wa.gov/wac/default.aspx?cite=246-225-050" }, { "title": "Chapter 246-926 WAC, Radiologic Imaging Professionals (last update 2/18/26)", "url": "https://app.leg.wa.gov/wac/default.aspx?cite=246-926&full=true" }, { "title": "DOH X-Rays in the Healing Arts Rulemaking page", "url": "https://doh.wa.gov/community-and-environment/radiation/rules/x-rays-healing-arts-rulemaking" }, { "title": "DOH draft rules (Word)", "url": "https://doh.wa.gov/sites/default/files/2025-12/ORP-Rulemaking-XrayHealingArts-DraftRules.docx" }, { "title": "DOH Rules, Radiation Protection", "url": "https://doh.wa.gov/community-and-environment/radiation/rules" }, { "title": "DOH Environmental Public Health Active Rulemaking", "url": "https://doh.wa.gov/about-us/executive-offices/prevention-safety-and-health/environmental-public-health/rulemaking/eph-active-rulemaking" }, { "title": "WA Board of Nursing notice of the 2024 CR-101 (secondary)", "url": "https://nursing.wa.gov/news/2024/washington-state-department-health-action-notice-rulemaking-x-rays-healing-arts" }, { "title": "RCW 18.84 (search snippet only)", "url": "https://app.leg.wa.gov/rcw/default.aspx?cite=18.84&full=true" }, { "title": "HB 2113 bill summary (search snippet only)", "url": "https://app.leg.wa.gov/BillSummary/?BillNumber=2113&Year=2026" }, { "title": "Board of Nursing 2026 bill report (search snippet only)", "url": "https://nursing.wa.gov/sites/default/files/2026-01/Bill-Report-2026.pdf" } ] }, { "code": "WV", "name": "West Virginia", "pageUrl": "https://orsif.org/guidelines/us/states/west-virginia", "regulator": { "name": "Radiological Health Program, Radiation, Toxics & Indoor Air Division, Office of Environmental Health Services (West Virginia Department of Health)", "url": "https://oehs.wvdhhr.org/rtia/radiological-health/" }, "nrcAgreementState": false, "agreementNote": "Letter of intent filed; not yet an Agreement State.", "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "West Virginia requires ALARA in Section 6 of 64CSR23 (2001), which is shared by all registrants, and Section 7 adds X-ray-specific minimization language. Dose limits are 50 mSv whole body, 150 mSv lens, 500 mSv skin and extremities, and 5 mSv to the embryo/fetus, and all fluoroscopy workers must be badged. Aprons or whole-body barriers of at least 0.25 mm lead equivalent are required, but there is no apron inspection rule and the rules do not mention engineered shielding systems by name. Technologists must be licensed and, from 1 July 2026, hold national certification to renew, while licensed practitioners are exempt and there is no physician fluoroscopy training rule.", "whereAlaraLives": { "category": "both", "explanation": "The formal ALARA duty (§6.4.b) is in Section 6, which is shared by all registrants, including radioactive-materials registrants (§11.1.b). Section 7 adds X-ray-specific minimization language (§7.3.a.9). §7.3.a.10 does not list §6.4, so ALARA reaches X-ray users through §6.1.a.", "citation": "64CSR23 §§6.1.a, 6.4.b, 7.3.a.9, 7.3.a.10, 11.1.b, 2.1; W. Va. Code §16-27B-5(d)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "no", "answer": "No. West Virginia is not an NRC Agreement State. The Governor sent a letter of intent on 9 January 2023, and HB 208 (2024) created the Radiation Control Act to support an agreement. The NRC showed no draft application submitted yet.", "citation": "NRC list of Agreement States, updated October 29, 2026; NRC West Virginia page; W. Va. Code §16-27B", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.nrc.gov/agreement-states/west-virginia" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "Yes. 64CSR23, the Radiological Health Rule, effective 1 July 2001. Section 6 sets general radiation protection standards and Section 7 covers the healing arts, with fluoroscopy at §7.7. A 2020 revision was withdrawn on 6 November 2020.", "citation": "64CSR23 §§1.4, 6, 7", "sourceUrls": [ "https://apps.sos.wv.gov/adlaw/csr/rule.aspx?rule=64-23", "https://apps.sos.wv.gov/adlaw/csr/readfile.aspx?DocId=55434&Format=PDF" ], "quote": "1.4. Effective Date. -- July 1, 2001.", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. §6.4.b requires ALARA for occupational and public doses for all registrants. §7.3.a.9 adds a duty to minimize personnel exposure.", "citation": "64CSR23 §6.1.a, §6.4.b; §7.3.a.9", "sourceUrls": [ "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-6" ], "quote": "The registrant shall use, to the extent practicable, procedures and engineering controls based upon sound radiation protection principles to achieve occupational doses and public doses that are as low as is reasonably achievable (ALARA).", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "50 mSv (5 rem) TEDE per year for adults. Minors are limited to 10% of adult limits.", "citation": "64CSR23 §6.5.a.1.A", "sourceUrls": [ "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-6" ], "quote": "An annual limit, which is the more limiting of: 6.5.a.1.A. The total effective dose equivalent being equal to five one-hundredths (0.05) Sv (five [5] Rem)", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "150 mSv (0.15 Sv) per year. No lower ICRP-style limit has been adopted.", "citation": "64CSR23 §6.5.a.2.A", "sourceUrls": [ "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-6" ], "quote": "6.5.a.2.A. An eye dose equivalent of fifteen one hundredths .15 Sv;", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "500 mSv (50 rem) shallow dose per year to the skin or any extremity.", "citation": "64CSR23 §6.5.a.2.B", "sourceUrls": [ "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-6" ], "quote": "6.5.a.2.B. A shallow dose equivalent of five-tenths (0.5) Sv (fifty [50] Rem) to the skin or to any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. If the fetus has already received more than 4.5 mSv when pregnancy is declared, a further 0.5 mSv is allowed.", "citation": "64CSR23 §6.12.a", "sourceUrls": [ "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-6" ], "quote": "The registrant shall ensure that the dose to an embryo or fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed five (5) mSv [five-tenths (0.5 Rem)].", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Adults likely to exceed 10% of a limit in a year must be monitored, as must minors and declared pregnant women likely to exceed 10% of their limits and anyone entering high or very high radiation areas. Everyone working with medical fluoroscopic equipment must be monitored, with no dose threshold.", "citation": "64CSR23 §6.17.a.2-a.5", "sourceUrls": [ "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-6" ], "quote": "6.17.a.2. Adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10 percent of the limits in Subdivision 6.5.a.; … 6.17.a.5. Individuals working with medical fluoroscopic equipment;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "The badge is worn at the collar outside the apron. A fetal badge goes at the waist under the apron and is required for a declared pregnant woman. With a single collar badge, the collar deep dose counts as effective dose, or collar × 0.3 if the reading exceeds 25% of the limit. The two-badge method uses 1.5 × waist (under apron) + 0.04 × collar (outside apron).", "citation": "64CSR23 §§6.5.c.2.A-C, 6.17.a.5.A-C, 6.18.a.1-a.4", "sourceUrls": [ "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-6" ], "quote": "multiplied by one and five-tenths (1.5) and the deep dose equivalent reported for the individual monitoring device located at the neck outside the protective apron multiplied by four one-hundredths (0.04).", "quoteMatchedToSource": true, "confidence": "high" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "yes", "answer": "Staff must be protected from scatter by aprons or whole-body barriers of at least 0.25 mm lead equivalent, and anyone who could be struck by the useful beam needs 0.5 mm. Facilities must keep enough aprons and gloves for all X-ray personnel. Fluoroscopy requires 0.25 mm above-table drapes or curtains in addition to the apron, with exemptions such as Table 64-23 S. Thyroid shields and eyewear are not required.", "citation": "64CSR23 §§7.3.a.5.A-B, 7.3.a.8.F, 7.7.h.1-3, Table 64-23 S", "sourceUrls": [ "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-7" ], "quote": "The x-ray operator, other staff, ancillary personnel, and other persons required for the medical procedure shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than twenty five one-hundredths (0.25) millimeter lead equivalent material;", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "West Virginia's X-ray rules do not require protective aprons, gloves or other protective apparel to be inspected periodically. Facilities must have enough leaded aprons and gloves for staff who are not otherwise shielded, but no inspection schedule or method is set.", "citation": "64CSR23 Section 7 (Use of X-Rays in the Healing Arts, incl. §7.3.a.5, §7.3.a.8.F, §7.3.a.12) and Section 6 (Standards for Protection Against Radiation)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-7" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rules do not mention engineered shielding systems by name. They do let staff be protected by either protective aprons or whole body protective barriers of at least 0.25 mm lead equivalent. During fluoroscopy, staff must also be either at least 120 cm from the center of the X-ray beam or shielded by at least 0.25 mm lead equivalent of drapes, curtains or similar shielding on top of the apron.", "citation": "64CSR23 §7.3.a.5.B", "sourceUrls": [ "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-7" ], "quote": "The x-ray operator, other staff, ancillary personnel, and other persons required for the medical procedure shall be protected from the direct scatter radiation by protective aprons or whole body protective barriers of not less than twenty five one-hundredths (0.25) millimeter lead equivalent material;", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Licensed radiologic technologists, whose scope includes noninterpretive fluoroscopy. Licensed practitioners (medicine, osteopathy, podiatry, chiropractic, dentistry), radiologists and residents are exempt from the license. PAs and NPs are not exempt. Radiologist assistant status is uncertain after HB 5458 (2026).", "citation": "W. Va. Code §§30-23-2, 30-23-4(j), 30-23-10, 30-23-12; 64CSR23 §7.1; 18CSR1 §1.1", "sourceUrls": [ "https://code.wvlegislature.gov/email/30-23/" ], "quote": "(4) A licensed practitioner, Radiologist or Radiology resident; (5) A person licensed as a Radiologist Assistant under the West Virginia Board of Medicine;", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "Technologists need an accredited program and the Board exam. From 1 July 2026, active national certification (ARRT, NMTCB, ARMRIT or ASPMA) is required to renew. All operators must be adequately instructed (Table 64-23 P). There is no fluoroscopy-specific permit or physician fluoroscopy training rule.", "citation": "W. Va. Code §30-23-9; 18CSR1 §§1.4, 7.1-7.3; 64CSR23 §7.3.a.2, Table 64-23 P", "sourceUrls": [ "https://wvrtboard.gov/Regulations/18-01" ], "quote": "Active licensees who do not maintain active national certification after July 1, 2026, are not in compliance with the Board's continuing education requirements and may not renew their license until compliance is met.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "HB 208 (2024) Radiation Control Act / Agreement State effort", "kind": "bill", "status": "Signed October 2024; NRC agreement still required, no draft application yet", "date": "2024-10", "dateISO": null, "summary": "Created W. Va. Code §16-27B to support an NRC agreement and directs the agency to keep rules compatible with federal programs.", "sourceUrls": [ "https://code.wvlegislature.gov/email/16-27B/" ] }, { "title": "18CSR1 technologist licensing rule", "kind": "adopted_rule", "status": "Filed 2 April 2026, effective 1 July 2026, sunset 1 August 2031", "date": "2026-07-01", "dateISO": "2026-07-01", "summary": "Requires active national certification for license renewal. Authorized by HB 4294 (2026).", "sourceUrls": [ "https://wvrtboard.gov/Regulations/18-01" ] }, { "title": "HB 5458 (2026)", "kind": "bill", "status": "Enacted; passed 9 March 2026, effective 7 June 2026", "date": "2026-03-09", "dateISO": "2026-03-09", "summary": "Repealed the radiologist assistant statute §30-3-7a.", "sourceUrls": [ "https://code.wvlegislature.gov/signed_bills/2026/2026-RS-HB5458-SUB%20ENR_signed.pdf" ] }, { "title": "Board of Medicine notice to repeal 11CSR9 (radiologist assistants)", "kind": "proposed_rule", "status": "Notice filed 30 June 2026; comments closed 30 July 2026; final status unknown", "date": "2026-06-30", "dateISO": "2026-06-30", "summary": "Repeal of the radiologist assistant rule following HB 5458.", "sourceUrls": [ "https://apps.sos.wv.gov/adlaw/csr/readfile.aspx?DocId=59179&Format=PDF" ] }, { "title": "SB 580 (2026)", "kind": "bill", "status": "Not enacted; passed Senate 26 February 2026; last action: H To House Government Organization 02/27/26", "date": "2026-02-27", "dateISO": "2026-02-27", "summary": "Would have rewritten §30-23, added PAs and APRNs to 'licensed practitioner', updated the technologist scope and moved RAs to the imaging Board.", "sourceUrls": [ "https://www.wvlegislature.gov/Bill_Status/bills_history.cfm?year=2026&sessiontype=RS&input=580" ] } ], "notable": [ "Every worker using medical fluoroscopic equipment must be badged regardless of expected dose (§6.17.a.5).", "Table 64-23 S automatically exempts angiograms and several interventional procedures from the above-table drape and curtain requirement (§7.7.h.3).", "Rooms where diagnostic X-ray is the only source are exempt from very-high-radiation-area access controls (§6.20.a), and diagnostic X-ray rooms need no caution signs (§6.28.e).", "Registrants must review their radiation protection program at least every 12 months (§6.4.c), and workers can request a dose summary when they leave a job (§6.41.c).", "The rule dates from 2001 and has no lens limit below 150 mSv.", "The 2024 Act states a policy of 'compatibility and equivalency' with federal standards (§16-27B-1)." ], "openQuestions": [ "Does the unretrieved 'Radiation Protection Program Guidelines' PDF address apron inspection, thyroid shields or eyewear? Ask the Radiological Health Program at (304) 352-5022.", "Does a commercial engineered shielding system count as a 'whole body protective barrier' under §7.3.a.5.B?", "Can PAs, APRNs and radiologist assistants operate fluoroscopy without a technologist license, and has the 11CSR9 repeal been finalized?", "When will West Virginia submit a draft Agreement State application, and will new rules keep X-ray protection standards in a shared Section 6?", "Cornell LII's copy of §6.15.a.1 has misplaced text; verify formal citations against the official SOS PDF.", "Watch the 2027 session for bills reviving SB 580's §30-23 rewrite." ], "sources": [ { "title": "WV SOS Code of State Rules 64-23 version list", "url": "https://apps.sos.wv.gov/adlaw/csr/rule.aspx?rule=64-23" }, { "title": "WV SOS 64-23 rule view", "url": "https://apps.sos.wv.gov/adlaw/csr/ruleview.aspx?document=2743" }, { "title": "WV SOS 64-23 final-file PDF", "url": "https://apps.sos.wv.gov/adlaw/csr/readfile.aspx?DocId=55434&Format=PDF" }, { "title": "WV SOS withdrawn 2020 revision of 64-23", "url": "https://apps.sos.wv.gov/adlaw/csr/ruleview.aspx?document=17260" }, { "title": "Cornell LII W. Va. Code R. §64-23-1", "url": "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-1" }, { "title": "Cornell LII W. Va. Code R. §64-23-6", "url": "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-6" }, { "title": "Cornell LII W. Va. Code R. §64-23-7", "url": "https://www.law.cornell.edu/regulations/west-virginia/W-Va-C-S-R-SS-64-23-7" }, { "title": "OEHS Radiological Health Program page", "url": "https://oehs.wvdhhr.org/rtia/radiological-health/" }, { "title": "NRC, West Virginia Non-Agreement State Information", "url": "https://www.nrc.gov/agreement-states/west-virginia" }, { "title": "NRC, West Virginia State Agreement Application Process", "url": "https://www.nrc.gov/agreement-states/west-virginia/West-Virginia-State-Agreement-Application-Process" }, { "title": "W. Va. Code Art. 16-27B (Radiation Control Act)", "url": "https://code.wvlegislature.gov/email/16-27B/" }, { "title": "W. Va. Code Art. 30-23 (Radiologic Technologists)", "url": "https://code.wvlegislature.gov/email/30-23/" }, { "title": "WV Medical Imaging & Radiation Therapy Technology Board, 18CSR1", "url": "https://wvrtboard.gov/Regulations/18-01" }, { "title": "HB 4294 (2026) bill page", "url": "https://bills.wvlegislature.gov/bill/history/2026/rs/HB4294/" }, { "title": "HB 4296 (2026) bill page", "url": "https://bills.wvlegislature.gov/bill/history/2026/rs/HB4296/" }, { "title": "SB 580 (2026) committee substitute text", "url": "https://www.wvlegislature.gov/Bill_Status/bills_text.cfm?billdoc=sb580+sub1.htm&yr=2026&sesstype=RS&billtype=B&houseorig=S&i=580" }, { "title": "SB 580 (2026) history", "url": "https://www.wvlegislature.gov/Bill_Status/bills_history.cfm?year=2026&sessiontype=RS&input=580" }, { "title": "Enrolled HB 5458 (2026)", "url": "https://code.wvlegislature.gov/signed_bills/2026/2026-RS-HB5458-SUB%20ENR_signed.pdf" }, { "title": "WV Board of Medicine notice to repeal 11CSR9", "url": "https://apps.sos.wv.gov/adlaw/csr/readfile.aspx?DocId=59179&Format=PDF" }, { "title": "Charleston Gazette-Mail, \"Bill letting WV regulate radioactive materials becomes law\"", "url": "https://www.wvgazettemail.com/news/legislative_session/justice-signs-bill-allowing-wv-to-regulate-radioactive-materials-into-law/article_78da802a-8ca7-11ef-ab2d-a7ffa298871e.html" } ] }, { "code": "WI", "name": "Wisconsin", "pageUrl": "https://orsif.org/guidelines/us/states/wisconsin", "regulator": { "name": "Wisconsin Department of Health Services (DHS), Division of Public Health, Radiation Protection Section", "url": "https://www.dhs.wisconsin.gov/radiation/xray/index.htm" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "" }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Wisconsin's ALARA requirement is in shared DHS 157.21, which covers X-ray registrants, and the X-ray chapter adds its own minimize-exposure language. Dose limits are 50 mSv whole body and 150 mSv lens; the lower 20 mSv lens limit has not been adopted. All fluoroscopy operators must wear a dosimeter, and the rule sets apron badge placement and dose formulas. Facilities must supply protective garments and X-ray them for defects every 2 years. The rules do not name engineered shielding systems, but staff may be protected by whole body protective barriers of at least 0.25 mm lead equivalent or by staying at least 2 meters away instead of wearing garments. Licensed practitioners or trained technologists under supervision may operate fluoroscopy. Pending CR 26-033 would rewrite the operator and supervision language.", "whereAlaraLives": { "category": "both", "explanation": "The ALARA requirement is in shared Subchapter III (DHS 157.21), which applies to licensees and registrants. The X-ray chapter separately requires procedures to minimize personnel exposure (DHS 157.74(2)(h)) without using the term ALARA. DHS 157.74(2)(i) cross-references the dose limits but not 157.21. Because 157.21 is shared, NRC-driven changes could reach X-ray registrants.", "citation": "DHS 157.21(2); DHS 157.74(2)(h)-(i)" }, "eyeLensLimitMsv": 150, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes. Wisconsin is an Agreement State; its agreement took effect August 11, 2003.", "citation": "NRC list of Agreement States, updated October 29, 2026; DHS Radiation Protection page", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.dhs.wisconsin.gov/radiation/index.htm" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "yes", "answer": "All radiation rules are in Wis. Admin. Code ch. DHS 157. General standards are in Subchapter III (DHS 157.20-157.33), X-ray rules are in Subchapter VIII (DHS 157.74-157.86), and fluoroscopy is in DHS 157.76. The official text was read only through excerpts and secondary copies. The DHS version note appears internally inconsistent.", "citation": "ch. DHS 157, Subch. III and VIII", "sourceUrls": [ "https://www.dhs.wisconsin.gov/radiation/index.htm", "https://www.law.cornell.edu/regulations/wisconsin/agency-department-of-health-services/DHS-110-199/chapter-DHS-157/subchapter-VIII" ], "quote": "Rules are specified in Wis. Admin. Code ch. DHS 157", "quoteMatchedToSource": true, "confidence": "high" }, "alara_required": { "question": "ALARA for X-ray users", "status": "yes", "answer": "Yes. DHS 157.21(2) applies to licensees and registrants, including X-ray facilities, and requires procedures and engineering controls that keep occupational doses ALARA. The radiation protection program must be reviewed at least every 13 months.", "citation": "DHS 157.21(2); DHS 157.03(27)", "sourceUrls": [ "https://docs.legis.wisconsin.gov/code/admin_code/dhs/110/157/iii/22/2" ], "quote": "to achieve occupational doses and doses to members of the public that are as low as is reasonably achievable.", "quoteMatchedToSource": true, "confidence": "high" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "0.05 Sv (5 rem) = 50 mSv per year total effective dose equivalent for adults.", "citation": "DHS 157.22(1)(a)1.a.", "sourceUrls": [ "https://docs.legis.wisconsin.gov/code/admin_code/dhs/110/157/iii/20" ], "quote": "a. The total effective dose equivalent being equal to 0.05 Sv (5 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "yes", "answer": "0.15 Sv (15 rem) = 150 mSv per year. Wisconsin has not adopted a lower lens limit, and the pending CR 26-033 draft does not appear to change it.", "citation": "DHS 157.22(1)(a)", "sourceUrls": [ "https://docs.legis.wisconsin.gov/code/admin_code/dhs/110/157/iii/20" ], "quote": "A lens dose equivalent of 0.15 Sv (15 rem).", "quoteMatchedToSource": true, "confidence": "high" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "0.5 Sv (50 rem) = 500 mSv per year to the skin of the whole body or any extremity.", "citation": "DHS 157.22(1)(a)2.b.", "sourceUrls": [ "https://docs.legis.wisconsin.gov/code/admin_code/dhs/110/157/iii/20" ], "quote": "b. A shallow dose equivalent of 0.5 Sv (50 rem) to the skin of the whole body or to the skin of any extremity.", "quoteMatchedToSource": true, "confidence": "high" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "yes", "answer": "5 mSv (500 mrem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy, with efforts to avoid large month-to-month variation.", "citation": "DHS 157.22(8)(a)", "sourceUrls": [ "https://www.mcw.edu/-/media/MCW/Departments/Radiation-Safety/Radiation-Protection-Legislation.pdf" ], "quote": "A licensee or registrant shall ensure that the dose equivalent to an embryo or fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 5 mSv (500 mrem).", "quoteMatchedToSource": true, "confidence": "high" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "A dosimeter is required for adults likely to exceed 10% of a limit, for minors and declared pregnant women above lower thresholds (1 mSv for a declared pregnant woman), for anyone entering a high radiation area, and for every individual operating medical fluoroscopic equipment regardless of projected dose. Dosimeters must be individually assigned and not shared. CR 26-033 would delete the badge-exchange language.", "citation": "DHS 157.25(2)(a)1.-5.", "sourceUrls": [ "https://docs.legis.wisconsin.gov/code/admin_code/dhs/110/157/III/25" ], "quote": "5. An individual operating medical fluoroscopic equipment.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "yes", "answer": "When an apron is worn, the badge goes at the neck (collar) outside the apron, with an optional second badge under the apron at the waist. Two-badge formula: HE = 1.5 HW + 0.04 HN. With one badge, the deep dose counts as the effective dose if exposure is under 25% of a limit; above 25%, it is the deep dose × 0.3. DHS may approve other methods. A ring badge is required for an unprotected hand in the beam unless clinically contraindicated.", "citation": "DHS 157.25(3)(b); DHS 157.22(1)(c)1.-2.", "sourceUrls": [ "https://www.mcw.edu/-/media/MCW/Departments/Radiation-Safety/Radiation-Protection-Legislation.pdf" ], "quote": "If a protective apron is worn, the individual monitoring device shall be located at the neck, which is the collar.", "quoteMatchedToSource": true, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "partial", "answer": "At least 0.5 mm lead equivalent is required for body parts in the useful beam. Others must be behind whole body protective barriers of at least 0.25 mm lead equivalent or stay at least 2 m away. Operators of C-arms at 0.2 mA or less are exempt from wearing an apron if they wear a dosimeter, which implies an apron requirement otherwise. Facilities must supply enough garments for personnel otherwise not shielded. There is no explicit thyroid-shield requirement for fluoroscopy, and no eyewear requirement was found.", "citation": "DHS 157.74(2)(d)1.-3., (g)3. and Note", "sourceUrls": [ "https://www.law.cornell.edu/regulations/wisconsin/Wis-Admin-Code-SS-DHS-157-74" ], "quote": "0.2 mA are exempt from the requirement to wear a leaded apron, provided the operator wears a personal dosimeter", "quoteMatchedToSource": true, "confidence": "high" }, "apron_inspection": { "question": "Apron inspection", "status": "yes", "answer": "Garments must be inspected fluoroscopically or radiographically at least every 2 years and replaced if defective. A visual inspection showing possible defects triggers a radiographic or fluoroscopic inspection.", "citation": "DHS 157.74(2)(g)4.-5.", "sourceUrls": [ "https://www.law.cornell.edu/regulations/wisconsin/Wis-Admin-Code-SS-DHS-157-74" ], "quote": "shall be fluoroscopically or radiographically inspected at least every 2 years for defects and replaced if defective.", "quoteMatchedToSource": true, "confidence": "high" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "partial", "answer": "The rules do not mention engineered shielding systems by name. They do let staff be protected from scatter radiation either by whole body protective barriers of at least 0.25 mm lead equivalent or by staying at least 2 meters from the X-ray tube and the patient being imaged. Protective garments are required for personnel who are otherwise not shielded.", "citation": "DHS 157.74(2)(d)2.", "sourceUrls": [ "https://docs.legis.wisconsin.gov/code/admin_code/dhs/110/157/viii/74/2/h/4/b" ], "quote": "All persons, including any patients who cannot be removed from the room, shall be protected from the direct scatter radiation by whole body protective barriers of not less than 0.25 millimeter lead equivalent material or shall be so positioned", "quoteMatchedToSource": true, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "A licensed practitioner or a radiologic technologist trained in fluoroscopy may operate. Technologists work under a licensed practitioner's supervision, and students need direct supervision. Diagnostic X-ray operators need a radiography license or LXMO permit, with statutory exemptions for physicians, PAs, chiropractors, dentists and dental staff, podiatrists, and supervised students. The LXMO scope does not include fluoroscopy. Nurse practitioners are not exempt; SB 281/AB 295 failed. 'Licensed practitioner' was not defined in the retrieved text.", "citation": "DHS 157.76(11)(a)-(c); DHS 157.74(2)(m); Wis. Stat. 462.02(2)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/wisconsin/Wis-Admin-Code-SS-DHS-157-76" ], "quote": "only a licensed practitioner or a radiologic technologist who is trained in the safe use of fluoroscopic x-ray systems is allowed to operate these systems.", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "yes", "answer": "Fluoroscopy operators must be ABR-certified or board eligible, or have completed training covering specified topics. No hours are specified and there is no state fluoroscopy permit. Radiographers need the ARRT exam or certification and 24 CE hours every two years; LXMO holders need 12 CE hours every two years. No annual training requirement was found.", "citation": "DHS 157.76(11)(e); RAD 2.03; RAD 5.01", "sourceUrls": [ "https://www.law.cornell.edu/regulations/wisconsin/Wis-Admin-Code-SS-DHS-157-76" ], "quote": "Is certified by the American Board of Radiology or board eligible.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "CR 26-033 (DHS 157 revision, Statement of Scope SS 069-24)", "kind": "proposed_rule", "status": "Sent to Rules Clearinghouse 6/22/26; public hearing 9/25/26; comments closed 10/2/26; scope expires 12/24/26; no later status found", "date": "9/25/26", "dateISO": "2026-09-25", "summary": "Would require fluoroscopy operators to be authorized under ch. 462 and specifically trained; technologists would work under direct supervision and students under personal supervision; 'leaded shielding' would become 'radiation protective garments and devices'; the badge-exchange language would be deleted. No ALARA or lens-limit changes found.", "sourceUrls": [ "https://www.dhs.wisconsin.gov/document/dhs-157-radiation-protection-requirements-proposed-rule-order.pdf" ] }, { "title": "CR 22-015", "kind": "adopted_rule", "status": "Effective 7/1/2023", "date": "7/1/2023", "dateISO": "2023-07-01", "summary": "Set program review at 13 months, amended parts of DHS 157.74 and 157.76, and repealed patient gonad shielding (DHS 157.74(2)(e)).", "sourceUrls": [ "https://www.dhs.wisconsin.gov/rules/dhs-157-radiation-protection-requirements-pro.pdf" ] }, { "title": "SB 281 / AB 295 (advanced practice nurse prescribers and radiography)", "kind": "bill", "status": "Failed to pass", "date": "3/23/2026", "dateISO": "2026-03-23", "summary": "Would have added advanced practice nurses to the radiographer licensing exemptions.", "sourceUrls": [ "https://docs.legis.wisconsin.gov/2025/proposals/sb281" ] } ], "notable": [ "Hospitals must have registered facilities inspected at least every 2 years and fix identified hazards within 30 days (DHS 157.74(5)).", "Typical and maximum air kerma must be measured annually (DHS 157.76(12)).", "Newer fluoroscopy units must display irradiation time and give an audible 5-minute signal (DHS 157.76(7)).", "A ring badge is required for unprotected hands in the beam.", "Radioactive-materials provisions must be kept compatible with NRC rules within three years of a federal change, which matters for the shared DHS 157.21.", "DHS issued an updated employee notice, P-45027, dated 10/2025." ], "openQuestions": [ "Confirm that DHS 157.25(2)(a)5., 157.25(3)(b) and 157.22(1)(c)2. are unchanged in the current official text.", "The DHS 157.03 definition of 'licensed practitioner' was not retrieved.", "Whether proposed DHS 157.76(11)(a) narrows out any group currently allowed (e.g., nurse practitioners); check the Clearinghouse report (https://docs.legis.wisconsin.gov/code/chr/active).", "CR 26-033 status after the 10/2/2026 comment deadline and before the scope expires 12/24/26.", "Whether DHS treats engineered shielding systems as 'whole body protective barriers'; ask DHSXray@dhs.wisconsin.gov.", "Whether the DHS 157.74(2)(d) room-presence rule applies to fluoroscopy.", "The source of the two-badge formula was not verified." ], "sources": [ { "title": "WI DHS, Radiation Protection", "url": "https://www.dhs.wisconsin.gov/radiation/index.htm" }, { "title": "WI DHS, X-Ray Facility Registrations, Surveys, and Inspections", "url": "https://www.dhs.wisconsin.gov/radiation/xray/index.htm" }, { "title": "WI DHS, X-Ray Device: Original", "url": "https://www.dhs.wisconsin.gov/regulations/medical/xray.htm" }, { "title": "WI DHS, Active Rulemaking Projects", "url": "https://www.dhs.wisconsin.gov/rules/active-rulemaking-projects.htm" }, { "title": "WI DHS, Proposed Order (DHS 157, CR 26-033 draft)", "url": "https://www.dhs.wisconsin.gov/document/dhs-157-radiation-protection-requirements-proposed-rule-order.pdf" }, { "title": "WI DHS, Proposed Order (CR 22-015 draft)", "url": "https://www.dhs.wisconsin.gov/rules/dhs-157-radiation-protection-requirements-pro.pdf" }, { "title": "WI DHS, Notice to Employees P-45027", "url": "https://www.dhs.wisconsin.gov/publications/p4/p45027.pdf" }, { "title": "Ch. DHS 157 (Register January 2018 No. 745), hosted by MCW", "url": "https://www.mcw.edu/-/media/MCW/Departments/Radiation-Safety/Radiation-Protection-Legislation.pdf" }, { "title": "Cornell LII, DHS 157.74", "url": "https://www.law.cornell.edu/regulations/wisconsin/Wis-Admin-Code-SS-DHS-157-74" }, { "title": "Cornell LII, DHS 157.76", "url": "https://www.law.cornell.edu/regulations/wisconsin/Wis-Admin-Code-SS-DHS-157-76" }, { "title": "Wisconsin Legislature, DHS 157 section pages", "url": "https://docs.legis.wisconsin.gov/code/admin_code/dhs/110/157" }, { "title": "Wis. Stat. ch. 462", "url": "https://docs.legis.wisconsin.gov/statutes/statutes/462.pdf" }, { "title": "RAD 2", "url": "https://docs.legis.wisconsin.gov/code/admin_code/rad/2/05" }, { "title": "RAD 3", "url": "https://docs.legis.wisconsin.gov/code/admin_code/rad/3" }, { "title": "RAD 5", "url": "https://docs.legis.wisconsin.gov/code/admin_code/rad/5" }, { "title": "DSPS Radiographer pages", "url": "https://dsps.wi.gov/Pages/Professions/RadiographerLicensed/Default.aspx" }, { "title": "2025 SB 281", "url": "https://docs.legis.wisconsin.gov/2025/proposals/sb281" }, { "title": "2025 AB 295", "url": "https://docs.legis.wisconsin.gov/2025/proposals/ab295" } ] }, { "code": "WY", "name": "Wyoming", "pageUrl": "https://orsif.org/guidelines/us/states/wyoming", "regulator": { "name": "No state agency regulates X-ray or fluoroscopy equipment; related bodies: Wyoming Office of Homeland Security Radiological Services Program (non-regulatory), Wyoming Board of Radiologic Technologist Examiners (operator licensing), Wyoming OSHA (Department of Workforce Services), Wyoming Department of Health (hospital licensure), Wyoming DEQ Uranium Recovery Program (Agreement State program, not X-ray)", "url": "https://hls.wyo.gov/programs/radiological-services" }, "nrcAgreementState": true, "review": { "status": "unreviewed", "by": "", "on": "", "note": "", "caveat": "The research for this state ended before every question was fully answered, so some answers may be incomplete." }, "researched": "2026-11-03", "rechecked": "2026-11-05", "summary": "Wyoming has no state program that registers, inspects or sets radiation-safety rules for X-ray or fluoroscopy machines; its only radiation office is a non-regulatory emergency-preparedness program in the Office of Homeland Security, and because Wyoming is an Agreement State only for uranium and thorium milling, the NRC regulates hospitals' radioactive materials directly. The only legal dose limits for fluoroscopy staff come from Wyoming OSHA's adoption of 29 CFR 1910.1096, which counts the lens of the eye inside the 1.25 rem (12.5 mSv) per quarter whole-body limit, sets no separate limit for a declared pregnant worker, and does not require keeping doses as low as reasonably achievable (ALARA). Wyoming rules do not require lead aprons, thyroid shields or protective eyewear, do not require apron inspection, say nothing about where to wear a badge with an apron, and do not address engineered alternatives to aprons. Licensed practitioners including PAs and APNs are exempt from operator licensing; technologists need a general license based on ARRT, NMTCB or CBRPA certification and may assist with fluoroscopy, though whether they may run it alone is not stated, and restricted-license holders may not perform fluoroscopy.", "whereAlaraLives": { "category": "none", "explanation": "No ALARA in Wyoming state law for X-ray and no unified state radiation-protection rule. Medical radioactive materials ALARA comes directly from NRC 10 CFR Part 20; X-ray worker protection rests on Wyoming OSHA's adoption of 29 CFR 1910.1096, which NRC compatibility does not govern; DEQ uranium recovery rules do not reach X-ray.", "citation": "NRC Wyoming page; OSHA Ch. 26 § 26-1" }, "eyeLensLimitMsv": 50, "answers": { "agreement_state": { "question": "Agreement State", "status": "yes", "answer": "Yes, but only for uranium and thorium milling facilities and 11e.(2) byproduct material (signed 2018-09-25, effective 2018-09-30); a 2026 amended agreement adds source material recovered from mineral processing. NRC Region IV directly licenses medical radioactive materials in Wyoming.", "citation": "NRC list of Agreement States, updated October 29, 2026; NRC, Wyoming: Agreement State Information", "sourceUrls": [ "https://www.nrc.gov/agreement-states", "https://www.nrc.gov/agreement-states/wyoming" ], "quote": "", "quoteMatchedToSource": false, "confidence": "high" }, "xray_rules": { "question": "Rules for X-ray and fluoroscopy", "status": "no", "answer": "No state X-ray or fluoroscopy rules and no state Standards for Protection Against Radiation rule for X-ray users. Wyoming OSHA adopts 29 CFR 1910.1096 (reportedly as in effect June 8, 2016, unconfirmed); operator rules are at W.S. 33-37-101 to -113 and Board rules at Wyo. Code R. agency 017 (filed 2022-09-15).", "citation": "Wyo. Code R. 053-0025-26 § 26-1 (version 3 per LII); W.S. 33-37-101 et seq.; Wyo. Code R. 017", "sourceUrls": [ "https://www.law.cornell.edu/regulations/wyoming/agency-053/subagency-0025/chapter-26/subpart-Z" ], "quote": "§ 26-1 - Incorporation by Reference, version 3", "quoteMatchedToSource": true, "confidence": "medium" }, "alara_required": { "question": "ALARA for X-ray users", "status": "no", "answer": "Wyoming has no state radiation rules for X-ray or fluoroscopy machines. The only binding worker radiation rule, the federal OSHA ionizing radiation standard adopted by Wyoming OSHA, sets quarterly dose limits but does not require keeping doses as low as reasonably achievable.", "citation": "29 CFR 1910.1096 (entire section), adopted by 053-26 Wyo. Code R. § 26-1(d)(i)", "sourceUrls": [ "https://www.law.cornell.edu/regulations/wyoming/Wyo-Code-R-agency-017-Subagency-0001-app-A" ], "quote": "demonstrates expertise in minimizing radiation exposure to the patient, self, and other members of the healthcare", "quoteMatchedToSource": true, "confidence": "medium" }, "whole_body_limit": { "question": "Whole-body dose limit", "status": "yes", "answer": "1.25 rem (12.5 mSv) per calendar quarter under 29 CFR 1910.1096 as adopted by Wyoming OSHA (values from a secondary UW summary).", "citation": "IV. Occupational Dose Limits, Table 1 (from 29 CFR 1910.1096)", "sourceUrls": [ "https://www.uwyo.edu/safety/radiation/docs/xray-safety-plan.pdf" ], "quote": "Dose to Whole Body: Head and trunk; active bloodforming organs; lens of eyes; or gonads", "quoteMatchedToSource": true, "confidence": "low" }, "lens_limit": { "question": "Eye-lens dose limit", "status": "no", "answer": "No separate lens limit; the lens of the eye falls inside the 1.25 rem (12.5 mSv) per quarter whole-body limit. No lens-specific limit adopted.", "citation": "IV. Occupational Dose Limits, Table 1 (from 29 CFR 1910.1096)", "sourceUrls": [ "https://www.uwyo.edu/safety/radiation/docs/xray-safety-plan.pdf" ], "quote": "Dose to Whole Body: Head and trunk; active bloodforming organs; lens of eyes; or gonads", "quoteMatchedToSource": true, "confidence": "low" }, "extremity_skin_limit": { "question": "Skin and extremity limit", "status": "yes", "answer": "Hands and forearms, feet and ankles: 18.75 rem (187.5 mSv) per quarter; skin of whole body: 7.5 rem (75 mSv) per quarter (secondary values).", "citation": "IV. Occupational Dose Limits, Table 1 (from 29 CFR 1910.1096)", "sourceUrls": [ "https://www.uwyo.edu/safety/radiation/docs/xray-safety-plan.pdf" ], "quote": "lens of eyes; or gonads Dose to Hands and forearms; feet and ankles Skin of whole body", "quoteMatchedToSource": true, "confidence": "low" }, "pregnant_worker_limit": { "question": "Declared pregnant worker limit", "status": "no", "answer": "Wyoming rules set no separate dose limit for the embryo or fetus of a declared pregnant worker using X-ray equipment. The federal OSHA standard Wyoming adopted has only quarterly limits for adults and a lower limit for workers under 18. The 0.5 rem (5 mSv) per pregnancy figure used at the University of Wyoming is university policy, not state law.", "citation": "29 CFR 1910.1096(b), adopted by 053-26 Wyo. Code R. § 26-1(d)(i)", "sourceUrls": [ "https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1096" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "monitoring_threshold": { "question": "When a dosimeter is required", "status": "yes", "answer": "Under 29 CFR 1910.1096(d)(2) (per UW summary), dosimeters are required for adults in a restricted area likely to exceed 25% of a quarterly limit, workers under 18 likely to exceed 5% of the adult limit, and anyone entering a high radiation area. No Wyoming-specific threshold found.", "citation": "III.B. Personnel Exposure Monitoring (Dosimetry)", "sourceUrls": [ "https://www.uwyo.edu/safety/radiation/docs/xray-safety-plan.pdf" ], "quote": "Each adult employee who enters a restricted area who is likely to receive a dose in any calendar quarter in excess of 25 percent of the applicable limits in Table 1;", "quoteMatchedToSource": true, "confidence": "medium" }, "apron_dosimeter_rules": { "question": "Dosimeter use with an apron", "status": "no", "answer": "Employers must provide radiation badges to workers likely to receive more than 25 percent of the quarterly limit, but Wyoming rules say nothing about where to wear a badge with a lead apron, two-badge methods, or how to estimate dose under an apron.", "citation": "29 CFR 1910.1096(d)(2) to (d)(3), adopted by 053-26 Wyo. Code R. § 26-1(d)(i)", "sourceUrls": [ "https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1096" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "protective_apparel": { "question": "Protective aprons and apparel", "status": "no", "answer": "Wyoming rules do not require fluoroscopy staff to wear lead aprons, thyroid shields or protective eyewear, and set no minimum lead equivalence.", "citation": "29 CFR 1910.1096 (entire section), adopted by 053-26 Wyo. Code R. § 26-1(d)(i)", "sourceUrls": [ "https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1096" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_inspection": { "question": "Apron inspection", "status": "no", "answer": "Wyoming rules do not require periodic inspection of lead aprons or other protective garments.", "citation": "29 CFR 1910.1096 (entire section), adopted by 053-26 Wyo. Code R. § 26-1(d)(i)", "sourceUrls": [ "https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1096" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "apron_alternatives": { "question": "Alternatives to aprons", "status": "no", "answer": "Wyoming rules do not address an engineered shielding system or other alternatives to personal protective garments.", "citation": "29 CFR 1910.1096 (entire section), adopted by 053-26 Wyo. Code R. § 26-1(d)(i)", "sourceUrls": [ "https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1096" ], "quote": "", "quoteMatchedToSource": false, "confidence": "medium" }, "who_may_operate": { "question": "Who may operate the equipment", "status": "partial", "answer": "Licensed practitioners (physicians, osteopaths, dentists, podiatrists, chiropractors, certified PAs, licensed APNs) are exempt from the licensing act. General-license technologists apply radiation under specific direction and may 'assist with fluoroscopy'; whether they may run fluoroscopy alone is not stated. Restricted-license technicians may not perform fluoroscopy. Students may operate under direct supervision.", "citation": "W.S. 33-37-102 (2025); Wyo. Code R. 017-3 § 3-2; 017-4 § 4-2", "sourceUrls": [ "https://law.justia.com/codes/wyoming/title-33/chapter-37/section-33-37-102/" ], "quote": "This act does not apply to: (i) Licensed practitioners as defined in W.S. 33-37-101(a)(iv)", "quoteMatchedToSource": true, "confidence": "medium" }, "operator_training": { "question": "Operator training", "status": "partial", "answer": "General license requires an approved radiologic technology program (JRCERT or other ARRT-recognized accreditor) and the ARRT, NMTCB or CBRPA registry exam; CE follows ARRT renewal standards. No fluoroscopy permit or fluoroscopy-specific training found, including for physicians, PAs or APRNs.", "citation": "Wyo. Code R. 017-3 § 3-4; 017-6 § 6-4", "sourceUrls": [ "https://regulations.justia.com/states/wyoming/agency-017/sub-agency-0001/chapter-6/section-6-4/" ], "quote": "General license holders shall earn continuing education hours based on the standards established for ARRT certification renewal.", "quoteMatchedToSource": true, "confidence": "high" } }, "changes": [ { "title": "Wyoming OSHA, General Industry 1910 Ch. 26 (Subpart Z) update, ARR25-089P", "kind": "proposed_rule", "status": "Notice of intent; OSHA Commission voted to adopt on 2025-09-12; final status and effect on 1910.1096 adoption date unknown", "date": "2025-09-12", "dateISO": "2025-09-12", "summary": "Update to Wyoming OSHA's Subpart Z chapter; unknown whether it changes the 2016 adoption date for 29 CFR 1910.1096.", "sourceUrls": [ "https://wyoleg.gov/arules/2012/rules/ARR25-089P.pdf" ] }, { "title": "2026 Amended State Agreement", "kind": "other", "status": "Listed on NRC page", "date": "", "dateISO": null, "summary": "Adds source material recovered from mineral processing (such as rare-earth extraction); no effect on X-ray.", "sourceUrls": [ "https://www.nrc.gov/agreement-states/wyoming" ] } ], "notable": [ "Wyoming is one of the few states with no state X-ray machine registration or inspection program for medical facilities; worker protection rests mainly on Wyoming OSHA (1910.1096) and operator licensing.", "Because physicians, PAs and APRNs are exempt from the licensing act, Wyoming law sets no fluoroscopy training requirement for those who most often run fluoroscopy in interventional labs.", "Equipment performance standards come from the federal FDA (21 CFR 1020), which UW cites.", "Dental X-ray inspections appear to be handled separately; 034-4 Wyo. Code R. § 4-5 'Radiograph Use' requires X-ray machine inspections, but the issuing board (agency 034) is unconfirmed.", "The HLS Radiological Services Program describes itself as 'not a regulatory program.'", "The research for Wyoming ended early, so some gaps remain." ], "openQuestions": [ "Confirm from the text of 29 CFR 1910.1096 the exact quarterly limits, any provision allowing higher quarterly doses and the monitoring threshold.", "Open the official Wyoming OSHA Ch. 26 § 26-1 text (agency 053, subagency 0025) to confirm the adopted version date of 1910.1096; check whether ARR25-089P has been finalized and what it changed.", "Confirm with the Wyoming Department of Health and HLS (Dillon Conner, 307-777-7197) that the state has no medical X-ray registration or inspection program, and whether any 2025-2026 bill proposes one or addresses apron alternatives.", "Ask the Board of Radiologic Technologist Examiners whether general licensees may operate fluoroscopy themselves or only 'assist.'", "Identify which board issues 034-4 § 4-5 and whether it reaches any medical fluoroscopy.", "Check whether Wyoming OSHA's PPE rules (29 CFR 1910 Subpart I) are applied to lead aprons in practice." ], "sources": [ { "title": "NRC, Wyoming: Agreement State Information (updated 2026-09-14)", "url": "https://www.nrc.gov/agreement-states/wyoming" }, { "title": "Wyoming Office of Homeland Security, Radiological Services", "url": "https://hls.wyo.gov/programs/radiological-services" }, { "title": "Wyoming Board of Radiologic Technologist Examiners, Rules and Regulations", "url": "https://radiology.wyo.gov/rules" }, { "title": "W.S. 33-37-101 (2025, Justia)", "url": "https://law.justia.com/codes/wyoming/title-33/chapter-37/section-33-37-101/" }, { "title": "W.S. 33-37-102 (2025, Justia)", "url": "https://law.justia.com/codes/wyoming/title-33/chapter-37/section-33-37-102/" }, { "title": "Wyo. Code R. 017 Ch. 1 § 1-3 (Justia)", "url": "https://regulations.justia.com/states/wyoming/agency-017/sub-agency-0001/chapter-1/section-1-3/" }, { "title": "Wyo. Code R. 017 Ch. 3 § 3-2 (Justia)", "url": "https://regulations.justia.com/states/wyoming/agency-017/sub-agency-0001/chapter-3/section-3-2/" }, { "title": "Wyo. Code R. 017 Ch. 3 § 3-4 (Justia)", "url": "https://regulations.justia.com/states/wyoming/agency-017/sub-agency-0001/chapter-3/section-3-4/" }, { "title": "Wyo. Code R. 017 Ch. 6 § 6-4 (Justia)", "url": "https://regulations.justia.com/states/wyoming/agency-017/sub-agency-0001/chapter-6/section-6-4/" }, { "title": "017-4 Wyo. Code R. § 4-2 (LII)", "url": "https://www.law.cornell.edu/regulations/wyoming/017-4-Wyo-Code-R-SS-4-2" }, { "title": "Wyo. Code R. 017 App. A, ARRT Standards of Ethics (LII, search result)", "url": "https://www.law.cornell.edu/regulations/wyoming/Wyo-Code-R-agency-017-Subagency-0001-app-A" }, { "title": "Wyoming OSHA General Industry Ch. 26, Subpart Z (LII, search result)", "url": "https://www.law.cornell.edu/regulations/wyoming/agency-053/subagency-0025/chapter-26/subpart-Z" }, { "title": "Notice of Intent ARR25-089P (search result)", "url": "https://wyoleg.gov/arules/2012/rules/ARR25-089P.pdf" }, { "title": "University of Wyoming X-ray Safety Plan (rev. Nov 2024; secondary)", "url": "https://www.uwyo.edu/safety/radiation/docs/xray-safety-plan.pdf" }, { "title": "OSHA, Ionizing Radiation Test Your Knowledge (search result)", "url": "https://www.osha.gov/ionizing-radiation/knowledge" }, { "title": "OSHA 29 CFR 1910.1096 (federal text)", "url": "https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1096" }, { "title": "Hospital licensure 048-12 § 12-11 (LII, search result)", "url": "https://www.law.cornell.edu/regulations/wyoming/agency-048/subagency-0061/chapter-12/048-12-Wyo-Code-R-SSSS-12-11" }, { "title": "034-4 Wyo. Code R. § 4-5 (LII, search result)", "url": "https://www.law.cornell.edu/regulations/wyoming/034-4-Wyo-Code-R-SS-4-5" }, { "title": "Cyclotron Info, Wyoming (secondary)", "url": "https://cyclotroninfo.com/legal/states/wy/" }, { "title": "Heartland Physics, Wyoming registration guide (secondary)", "url": "https://www.heartlandphysics.com/post/how-to-register-an-x-ray-machine-in-wyoming-a-simple-step-by-step-guide" } ] } ] }