Missouri 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 It is not comprehensive and not always accurate: rules change, and answers may be incomplete, out of date or wrong.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 Missouri Radiation Control Program (MRCP), Section for Health Standards and Licensure, Missouri Department of Health and Senior Services (DHSS) as the agency that regulates X-ray and fluoroscopy equipment in Missouri. Missouri 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.

Missouri's X-ray rules (19 CSR 20-10, 1964, unamended) contain no ALARA wording; the closest is a 1963 statute barring "unnecessary radiation." Missouri is not an NRC Agreement State. The rules use old-style dose limits: 5 rems (50 mSv) a year for the whole body, with the lens of the eye included. There is no embryo/fetus limit. Aprons, apron inspections, thyroid shields and eyewear are not required; the only fluoroscopy shielding rule is a dose-rate cap at the fluoroscopist's position. There is no state operator license or training requirement, except for mammography.

ALARA for X-ray usersNoNone found Whole-body limit5 rems (50 mSv) per year and 3 rems (30 mSv) per quarter for the whole body. Eye-lens limit50 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 Missouri an NRC Agreement State?

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.

Rule text and source

Rule: NRC list of Agreement States, updated October 29, 2026; 19 CSR 20-10.020(1)(E)
Source: nrc.gov
sos.mo.gov
What it says: (E) The use of radioactive sources licensed by the United States Nuclear Regulatory Commission to installations in Missouri; and
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 Missouri?

Yes

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.

Rule text and source

Rule: 19 CSR 20-10.010-.200
Source: sos.mo.gov
What it says: Original rule filed Nov. 9, 1964, effective Dec. 9, 1964.
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

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

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.

Where ALARA lives in Missouri: No ALARA requirement found for X-ray users. 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. (19 CSR 20-10 (whole chapter); RSMo 192.430)

Rule text and source

Rule: RSMo 192.430 (statute, effective 28 Aug 1963); 19 CSR 20-10 (no ALARA provision)
Source: revisor.mo.gov
What it says: 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.
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 Missouri?

Yes

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.

Rule text and source

Rule: 19 CSR 20-10.040(1), Table I, (1)(A)-(C), (3)
Source: sos.mo.gov
What it says: During any calendar quarter, the maximum dose of three (3) rems, listed in Column B of Table I, is not exceeded;
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

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

In part

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 International Commission on Radiological Protection (ICRP) limit.

Rule text and source

Rule: 19 CSR 20-10.040(1), Table I
Source: sos.mo.gov
What it says: Whole body, head and trunk, major portion of the bone marrow, gonads or lens of eye.
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 Missouri?

Yes

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.

Rule text and source

Rule: 19 CSR 20-10.040(1), Table I
Source: sos.mo.gov

Why this matters, in ORSIF's FAQs

What limit applies to a declared pregnant worker in Missouri?

Not found

not found. There is no embryo/fetus or declared pregnant worker limit; the words "pregnant," "embryo" and "fetus" do not appear in the rules.

Rule text and source

Rule: 19 CSR 20-10.040
Source: sos.mo.gov

Why this matters, in ORSIF's FAQs

Dosimeters

When a worker must wear a dosimeter, and where.

When must a worker in Missouri wear a dosimeter?

Yes

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.

Rule text and source

Rule: 19 CSR 20-10.050(1), (3), (4)
Source: sos.mo.gov
What it says: 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.
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 Missouri when a protective apron is worn?

Not found

not found. There is no badge location, two-badge method or effective-dose method. Aprons are only considered when deciding whether monitoring is needed.

Rule text and source

Rule: 19 CSR 20-10.050(3)
Source: sos.mo.gov
What it says: taking into consideration the use of protective gloves, aprons or other radiation-limiting devices.
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 Missouri fluoroscopy rooms wear protective aprons or other apparel?

In part

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 National Council on Radiation Protection and Measurements (NCRP) recommendations.

Rule text and source

Rule: 19 CSR 20-10.130(2)
Source: sos.mo.gov
What it says: 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
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

Does Missouri require protective aprons to be inspected?

Not found

not found. Apron inspection is not addressed in 19 CSR 20-10. Facilities with fluoroscopy get an annual Qualified Expert survey (Class A), but it is unclear whether that survey covers aprons.

Rule text and source

Rule: 19 CSR 20-10.050(1) (survey duty); MRCP Qualified Expert FAQ (policy)
Source: health.mo.gov
What it says: 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;
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

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

Not found

not found. The rules are silent. An MRCP FAQ allows written requests for an equivalent "alternative standard," but that relates to inspection classification, not protective apparel.

Rule text and source

Rule: 19 CSR 20-10 (silent); MRCP Qualified Expert FAQ
Source: health.mo.gov
What it says: each facility is also afforded an opportunity to request in writing that an alternative standard be applied, one that provides an equivalency of public health protection for the operator, patient, and general members of the public.
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 Missouri?

No state limit on who may operate fluoroscopy, and no X-ray operator license exists. Exceptions: mammography requires American Registry of Radiologic Technologists (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.

Rule text and source

Rule: MRCP guidance "Requirements for X-ray Operators in Missouri"; MRCP guidance on physician orders (last revised Aug 2015)
Source: health.mo.gov
What it says: 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.
This quote was matched word for word to the source page.

Why this matters, in ORSIF's FAQs

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

No statewide fluoroscopy training requirement exists, and standards are largely left to each facility. Mammography is the exception.

Rule text and source

Rule: MRCP guidance "Requirements for X-ray Operators in Missouri"
Source: health.mo.gov
What it says: setting the standards for training and experience is largely left up to the individual facility
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.

OtherJoint Task Force on Radiologic Technologist Licensure
Created by 2019 law; was to report by January 15, 2020
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.
Source: revisor.mo.gov

Also worth knowing

Missouri has no Occupational Safety and Health Administration (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.

What ORSIF could not confirm

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

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.

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. Missouri Radiation Control Program (MRCP). 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

4 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.
0 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
ARRT: American Registry of Radiologic Technologists
OSHA: Occupational Safety and Health Administration

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.