Maryland 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 It is not comprehensive and not always accurate: rules change, and answers may be incomplete, out of date or wrong.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 Radiological Health Program (RHP), Air and Radiation Administration, Maryland Department of the Environment (MDE) as the agency that regulates X-ray and fluoroscopy equipment in Maryland. Maryland is a U.S. Nuclear Regulatory Commission (NRC) Agreement State: it has signed an agreement with the NRC to regulate certain radioactive materials itself.

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. 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. Only licensed practitioners or radiological technologists may energize fluoroscopy, with 4 hours of initial training and 1 hour every 2 years.

ALARA for X-ray usersYesBoth Whole-body limitTotal effective dose equivalent of 0.05 Sv (5 rem), which is 50 mSv per year. Eye-lens limit150 mSva year Apron inspectionNot found Alternatives to apronsNot found

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 Maryland an NRC Agreement State?

Yes

Yes. Maryland is not on the NRC list of non-Agreement States, and the NRC reviewed Supplement 35 for compatibility on 8 August 2025.

Rule text and source

Rule: NRC list of Agreement States, updated October 29, 2026; NRC letter, "Maryland Final Regulations to RATS ID 2023-1" (ML25198A160)
Source: nrc.gov
nrc.gov
What it says: We have determined that the regulations, as adopted, meet the compatibility and health and safety categories established in the Office of Nuclear Material Safety and Safeguards (NMSS) Procedure SA-200
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 Maryland?

YesCheck the source

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.

Rule text and source

Rule: COMAR 26.12.01.01; Parts D and F
Source: mde.maryland.gov

Why this matters, in ORSIF's FAQs

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

Yes

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.

Where ALARA lives in Maryland: In a shared rule and in X-ray-specific language. 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. (§D.101(a)-(b), (e); §F.3(a)(1)(x)-(xi) (Supp. 35 numbering))

Rule text and source

Rule: Regs. for Control of Ionizing Radiation §D.101(a), (e); §D.2 (page D4, Supp. 22)
Source: mde.maryland.gov
What it says: 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).
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 Maryland?

Yes

Total effective dose equivalent of 0.05 Sv (5 rem), which is 50 mSv per year.

Rule text and source

Rule: §D.201(a)(i)-(ii), §D.207, §D.208 (pages D4-D5, D12)
Source: mde.maryland.gov

Why this matters, in ORSIF's FAQs

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

Yes

0.15 Sv (15 rem), which is 150 mSv per year. No lower International Commission on Radiological Protection (ICRP)-style limit has been adopted.

Rule text and source

Rule: §D.201(a)(i)-(ii), §D.207, §D.208 (pages D4-D5, D12)
Source: mde.maryland.gov
What it says: (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.
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 Maryland?

Yes

0.5 Sv (50 rem), which is 500 mSv shallow-dose equivalent to the skin of the whole body or any extremity.

Rule text and source

Rule: §D.201(a)(i)-(ii), §D.207, §D.208 (pages D4-D5, D12)
Source: mde.maryland.gov
What it says: (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.
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 Maryland?

Yes

5 mSv (0.5 rem) to the embryo/fetus of a declared pregnant woman over the whole pregnancy. A footnote cites the National Council on Radiation Protection and Measurements (NCRP) Report 91 recommendation of no more than 0.5 mSv in any one month.

Rule text and source

Rule: §D.208
Source: mde.maryland.gov

Why this matters, in ORSIF's FAQs

Dosimeters

When a worker must wear a dosimeter, and where.

When must a worker in Maryland wear a dosimeter?

Yes

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.

Rule text and source

Rule: §D.502(a)(i)-(iv) (page D16, Supp. 30)
Source: mde.maryland.gov
What it says: 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;
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 Maryland when a protective apron is worn?

Yes

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).

Rule text and source

Rule: §F.3(a)(1)(xi)(a)(1) (Supp. 35, page F12); §D.209(a)-(c) (pages D13-D13-1, Supp. 22)
Source: nrc.gov
What it says: 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.
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 Maryland fluoroscopy rooms wear protective aprons or other apparel?

In partLess certain

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.

Rule text and source

Rule: §F.5(i)(1)-(3) (Supp. 35, page F22-5); deleted §F.3(a)(1)(viii)-(x)
Source: nrc.gov
What it says: remove Sections F.3(a)(1)(viii), F.3(a)(1)(ix), and F.3(a)(1)(x), on page F11;
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Does Maryland require protective aprons to be inspected?

Not foundLess certain

not found

Rule text and source

Source: mde.maryland.gov
What it says: "Protective apron" means an apron made of radiation absorbing materials used to reduce radiation exposure.
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

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

UnclearLess certain

Not addressed by name. F.5(i)(2)(ii) requires at least 0.25 mm lead-equivalent material "including, but not limited to" drapes, bucky-slot covers or curtains, and no longer mentions aprons. Whether a given engineered system qualifies is not settled.

Rule text and source

Rule: §F.5(i)(2)(ii) (Supp. 35)
Source: nrc.gov
What it says: 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.
This quote was matched word for word to the source page.

About ALARA+

Who operates the equipment

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

Who may operate fluoroscopy equipment in Maryland?

In part

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.

Rule text and source

Rule: §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)
Source: mde.maryland.gov
What it says: 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.
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

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

Yes

At least 4 hours of training before clinical use, plus at least 1 hour of in-service or continuing medical education (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.

Rule text and source

Rule: §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)
Source: mde.maryland.gov
What it says: 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
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Changes on the way, and recent ones

Rules, bills and guidance the research found from 2025 and 2026, with the ones that touch fluoroscopy teams first.

Adopted ruleSupplement 35 to COMAR 26.12.01.01
Adopted; effective; NRC found compatible 8 August 2025 (Sep 15, 2025)
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)).
Source: mgaleg.maryland.gov
BillCh. 214 of 2026 (SB 915; companion HB 1047)
Approved 28 April 2026; effective 1 October 2026 (Oct 1, 2026)
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.
Source: mgaleg.maryland.gov
OtherCOMAR 26.12.03 fee update
Listed in MDE regulations in development
Fee update for the Radiological Health Program; it is the only item on the list, and nothing is pending for COMAR 26.12.01.
Source: mde.maryland.gov

Also worth knowing

§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.

What ORSIF could not confirm

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

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.

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. Radiological Health Program (RHP). 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

2 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.
4 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
NCRP: National Council on Radiation Protection and Measurements
CME: Continuing medical education

All 17 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.