What Tennessee's rules say about ALARA (as low as reasonably achievable), dose limits in millisieverts (mSv), dosimeters, aprons and training for the people who work in fluoroscopy labs.
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 It is not comprehensive and not always accurate: rules change, and answers may be incomplete, out of date or wrong.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
ORSIF's research identified the Tennessee Department of Environment and Conservation (TDEC), Division of Radiological Health (DRH) as the agency that regulates X-ray and fluoroscopy equipment in Tennessee. Tennessee is a U.S. Nuclear Regulatory Commission (NRC) Agreement State: it has signed an agreement with the NRC to regulate certain radioactive materials itself.
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. An NRC-driven change could therefore 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. The radiation rules require operators only to be instructed and competent. Board of Medical Examiners certification applies only to physicians' offices, and no license for hospital fluoroscopy operators was found. The official PDFs could not be opened; rules were read via Cornell LII and indexed excerpts.
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.
Which rules apply, and whether ALARA is among them.
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.
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.
0400-20-05 Standards for Protection Against Radiation (Transferred from 1200-02-05 which was repealed) 0400-20-06 Use of X-Ray ApparatusThis quote was matched word for word to the source page.
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.
Where ALARA lives in Tennessee: Only in a rule shared with radioactive materials. 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. (0400-20-05-.40; 0400-20-06-.04(8))
Using ALARA the licensee or registrant shall make efforts to avoid substantial variation above a uniform monthly exposure rate to a declared pregnant woman.This quote was matched word for word to the source page.
The annual limits for workers, written in millisieverts (mSv). Ten mSv equal one rem.
5 rem (50 mSv) per year total effective dose equivalent; minors are limited to 10% of adult limits.
15 rem (150 mSv) per year; no lower limit adopted. Rule unchanged since 5/22/2012.
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.This quote was matched word for word to the source page.
50 rem (500 mSv) per year shallow-dose equivalent to the skin of the whole body or any extremity.
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.This quote was matched word for word to the source page.
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.
Using ALARA the licensee or registrant shall make efforts to avoid substantial variation above a uniform monthly exposure rate to a declared pregnant woman.This quote was matched word for word to the source page.
When a worker must wear a dosimeter, and where.
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.
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;This quote was matched word for word to the source page.
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.
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.This quote was matched word for word to the source page.
Protective apparel, how it is checked, and whether other systems are addressed.
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.
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.This quote was matched word for word to the source page.
not found
The effectiveness of protective equipment shall not be impaired.This quote was matched word for word to the source page.
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.
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).This quote was matched word for word to the source page.
Who may use fluoroscopy equipment and what training the rules ask for.
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.
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.This quote was matched word for word to the source page.
In physicians' offices, full certification requires American Registry of Radiologic Technologists (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.
Rules, bills and guidance the research found from 2025 and 2026, with the ones that touch fluoroscopy teams first.
Effective June 9, 2026
New fusion rules filed March 11, 2026; did not appear to change fluoroscopy provisions.
Effective (Mar 3, 2024)
Latest amendment to the medical X-ray rule.
Rulemaking hearing noticed (2025)
Supports nuclear and fusion deployment and creates a fusion fee mechanism; did not appear to change fluoroscopy provisions.
Board vote reported Nov 17, 2025 by a vendor blog; not verified
Amendment to X-ray supervision rules on contrast supervision; a related bill, HB 2113, is described.
Questions the research could not settle. If you know the answer, tell us.
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.
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