Hawaii Radiation Safety Rules for Fluoroscopy Teams

Please double-check this information. This is an ORSIF research summary, researched November 3, 2026. It is not comprehensive and not always accurate: rules change, and answers may be incomplete, out of date or wrong. It is education, not legal advice. Not yet reviewed by a regulatory expert. Confirm each requirement at the source linked beside the answer, with the state program and with your facility's radiation safety officer. How this was made

In brief

ORSIF's research identified the Hawaii Department of Health, Indoor and Radiological Health Branch (IRHB), Radiation Section as the agency that regulates X-ray and fluoroscopy equipment in Hawaii. Hawaii is not a U.S. Nuclear Regulatory Commission (NRC) Agreement State, so the NRC regulates radioactive materials there directly. The state still regulates X-ray machines.

Hawaii requires X-ray and fluoroscopy facilities to keep worker doses ALARA under the general standards subchapter (HAR 11-45, subchapter 4). The X-ray subchapter applies that subchapter to X-ray workers and adds its own minimization requirement. Hawaii is not an NRC Agreement State. 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. The rules are silent on thyroid shields, eyewear, apron inspection and badge placement. Radiographers need an American Registry of Radiologic Technologists (ARRT)-based state license. Exemptions include licensed medical practitioners in radiology and physician assistants, and it is unclear how they apply to non-radiologist physicians. The rule appears unamended since 11/12/1999.

ALARA for X-ray usersYesBoth Whole-body limit5 rems (0.05 Sv), or 50 mSv, per year total effective dose equivalent (TEDE) for adults. Eye-lens limit150 mSva year Apron inspectionNot found Alternatives to apronsIn part

The rules, question by question

Every answer names the rule it comes from. Open "Rule text and source" to read the citation, the source page and, where it could be matched, the exact wording.

Where the rules live

Which rules apply, and whether ALARA is among them.

Is Hawaii an NRC Agreement State?

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.

Rule text and source

Rule: NRC list of Agreement States, updated October 29, 2026; HAR §11-45-37
Source: nrc.gov
What it says: Sources of radiation licensed by the U.S. Nuclear Regulatory Commission are exempt from the requirements of this subchapter to the extent they are regulated by the U.S. Nuclear Regulatory Commission.
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Which rules cover X-ray and fluoroscopy equipment in Hawaii?

Yes

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 Conference of Radiation Control Program Directors (CRCPD) Suggested State Regulations.

Rule text and source

Rule: HAR ch. 11-45; subchapters 4 and 6
Source: health.hawaii.gov
What it says: 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.
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Does Hawaii require X-ray users to keep doses as low as reasonably achievable (ALARA)?

Yes

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.

Where ALARA lives in Hawaii: In a shared rule and in X-ray-specific language. 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. (HAR §§11-45-39(b), 11-45-116(a)(10)-(11), 11-45-129, 11-45-37)

Rule text and source

Rule: HAR §11-45-39(b); §11-45-2 ("Licensee" and "As low as is reasonably achievable" definitions); §11-45-116(a)(11)
Source: health.hawaii.gov
What it says: 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).
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Dose limits

The annual limits for workers, written in millisieverts (mSv). Ten mSv equal one rem.

What is the annual whole-body dose limit in Hawaii?

Yes

5 rems (0.05 Sv), or 50 mSv, per year TEDE for adults.

Rule text and source

Rule: HAR §11-45-40(a)
Source: health.hawaii.gov

Why this matters, in ORSIF's FAQs

What is the annual eye-lens dose limit in Hawaii?

Yes

15 rems (0.15 Sv), or 150 mSv, per year. No lower International Commission on Radiological Protection (ICRP)-style limit (such as 20 mSv) has been adopted.

Rule text and source

Rule: HAR §11-45-40(a)
Source: health.hawaii.gov
What it says: 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.
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

What is the annual limit for the skin, hands and feet in Hawaii?

Yes

50 rems (0.50 Sv), or 500 mSv, per year shallow dose to the skin or any extremity.

Rule text and source

Rule: HAR §11-45-40(a)
Source: health.hawaii.gov
What it says: 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.
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

What limit applies to a declared pregnant worker in Hawaii?

Yes

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.

Rule text and source

Rule: HAR §11-45-47(a)-(b)
Source: health.hawaii.gov
What it says: does not exceed 0.5 rem (five millisieverts).
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Dosimeters

When a worker must wear a dosimeter, and where.

When must a worker in Hawaii wear a dosimeter?

Yes

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.

Rule text and source

Rule: HAR §11-45-54(a)
Source: health.hawaii.gov
What it says: 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)
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Where must the dosimeter be worn in Hawaii when a protective apron is worn?

Not foundLess certain

not found. The rule has no collar or outside-the-apron placement rule, no two-badge method and no approved effective-dose method. It only requires that the assigned dose be for the part of the body receiving the highest exposure.

Rule text and source

Rule: HAR §11-45-40(c)(1)
Source: health.hawaii.gov
What it says: The assigned deep dose equivalent and shallow dose equivalent shall be for the portion of the body receiving the highest exposure
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Aprons and alternatives

Protective apparel, how it is checked, and whether other systems are addressed.

Must staff in Hawaii fluoroscopy rooms wear protective aprons or other apparel?

Yes

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.

Rule text and source

Rule: HAR §11-45-116(a)(6)(A)-(B), (a)(9)(F); §11-45-118(i)
Source: health.hawaii.gov
What it says: 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.
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Does Hawaii require protective aprons to be inspected?

Not foundLess certain

not found. No provision requires periodic inspection of protective apparel. The only periodic-inspection language covers film cassettes and intensifying screens.

Rule text and source

Source: health.hawaii.gov
What it says: Film cassettes and intensifying screens shall be inspected periodically
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Do the rules in Hawaii address engineered protection systems used in place of aprons?

In partCheck the source

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.

Rule text and source

Rule: HAR §11-45-116(a)(6)(B); §11-45-118(i)(2)
Source: health.hawaii.gov

About ALARA+

Who operates the equipment

Who may use fluoroscopy equipment and what training the rules ask for.

Who may operate fluoroscopy equipment in Hawaii?

UnclearLess certain

Radiography on humans requires a radiographer license from the Radiologic Technology Board, and interventional and cardiac interventional technology also requires that license. Exempt from licensing are licensed medical practitioners in radiology, practitioners of nuclear medicine, physician assistants, dentists, dental technicians and dental hygienists, and supervised students. Nurses and nurse practitioners are not on the exemption list. It is unclear whether non-radiologist physicians are covered by the radiology exemption.

Rule text and source

Rule: HRS §§466J-1, 466J-4, 466J-6; HAR §11-44-3(b); HAR §11-45-116(a)(2)-(3)
Source: law.justia.com
What it says: 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;
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

What training or credentials does Hawaii require to operate fluoroscopy equipment?

In partLess certain

Radiographers must be registered in good standing with the ARRT. Licenses renew every two years and require 24 continuing-education credits, or meeting ARRT continuing education (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.

Rule text and source

Rule: 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)
Source: data.capitol.hawaii.gov
What it says: 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.
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Also worth knowing

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.

What ORSIF could not confirm

Questions the research could not settle. If you know the answer, tell us.

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.

Who regulates, and where to read the rules

Double-check before you rely on this page

ORSIF compiled this page from the sources linked on it and did its best. It is not comprehensive and it is not always accurate. Rules change, a rule may have been missed or misread, and the sources themselves can be out of date. Treat this page as a starting point.

Where to check

The rule itself. Open "Rule text and source" under any answer, or read the sources listed below.
The state. Hawaii Department of Health. Program contacts in the CRCPD directory.
Your radiation safety officer. They know the federal, accreditation and facility requirements that apply at your site, which the state rules do not cover.

What may be missing here

3 of 14 answers on this page are "Not found" or "Unclear". That means ORSIF did not find the answer in the rules it reviewed, not that no rule exists.
5 answers carry a flag or a lower confidence ("Check the source" or "Less certain").
Researched November 3, 2026. Rules may have changed since.
Only the state's rules for X-ray and fluoroscopy equipment were reviewed.

Found something wrong or missing? Tell ORSIF.

Sources and terms

Terms used on this page

ALARA: As low as reasonably achievable: keep radiation doses as low as is reasonable, below the legal limits.
Agreement State: A state that has signed an agreement with the U.S. Nuclear Regulatory Commission to regulate certain radioactive materials itself.
mSv: Millisievert, a unit of radiation dose. Ten mSv equal one rem, the older unit some rules still use.
Dosimeter: A badge or device worn to measure a worker's radiation dose.
Lead equivalent: The thickness of lead (mm Pb) that would give the same protection as the material described.
NRC: U.S. Nuclear Regulatory Commission
ICRP: International Commission on Radiological Protection
TEDE: Total effective dose equivalent
ARRT: American Registry of Radiologic Technologists
CRCPD: Conference of Radiation Control Program Directors
CE: Continuing education

All 11 sources the research read

Found something out of date or wrong? Tell ORSIF. Corrections are checked against the rule text and the page is updated.