North Carolina: radiation safety rules for fluoroscopy teams

Yes. North Carolina is on the NRC's list of Agreement States, updated October 29, 2026.

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 The old state rules.1602-.1649 were repealed effective October 1, 2023.

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 State guidance (Rev. 11/17/16) also tells registrants to describe their ALARA procedures, though it cites the old repealed rule numbers.

Where ALARA lives in North Carolina: In a shared rule and in X-ray-specific language. 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. (10A NCAC 15.1601(b);.0603(a)(1)(I) (current older text))

5 rem (50 mSv) TEDE per year, via 10 CFR 20.1201 adopted through.1601(b)(8).

15 rem (150 mSv) per year; NC has not adopted a lower lens limit.

50 rem (500 mSv) per year for skin and extremities.

0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant worker over the whole pregnancy.

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)).

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 National Council on Radiation Protection and Measurements (NCRP) 122 or Webster) was found, so under 20.1201(c) deep-dose equivalent must be used unless the state agency approves a method.

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.

No inspection requirement found in the rules. Non-binding state guidance (Rev. 3/24/15) recommends checking aprons fluoroscopically at least once a year, "If possible."

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.

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.

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.