Texas: radiation safety rules for fluoroscopy teams

Yes. Texas signed its agreement on January 10, 1963, effective March 1, 1963; the NRC calls Texas the fifth Agreement State.

25 TAC §289.231 (machine-only standards for protection, last amended effective Dec 29, 2011), §289.227 (healing arts X-ray and fluoroscopy, effective May 1, 2013), and §289.226 (registration). Radioactive materials fall under the separate §289.202.

Yes. Machine registrants must use procedures and engineering controls to keep occupational and public doses ALARA, and the operator's position during an exposure must keep the operator's dose ALARA.

Where ALARA lives in Texas: In X-ray-specific rules. ALARA appears in §289.231(l), a rule limited to radiation machines, and in §289.227(i)(10), the operator-position requirement. Radioactive materials have the separate §289.202, so an NRC-driven change there would not automatically change §289.231. §289.202 itself was not read. (25 TAC §289.231(b)(2); §289.231(l); §289.227(i)(10))

5 rem (50 mSv) TEDE per year; minors 10% of adult limits.

15 rem (150 mSv) lens dose equivalent (LDE) per year; Texas has not adopted the International Commission on Radiological Protection (ICRP) 20 mSv limit.

50 rem (500 mSv) shallow dose equivalent (SDE) per year to the skin of the whole body or any extremity.

0.5 rem (5 mSv) to the embryo/fetus of a declared pregnant worker over the whole pregnancy. Large swings above a uniform monthly rate are to be avoided, citing National Council on Radiation Protection and Measurements (NCRP) Report 91's 0.5 mSv/month guidance.

Dosimeters are required for adults likely to exceed 10% of a limit per year; minors likely to exceed 1 mSv deep dose equivalent (DDE), 1.5 mSv LDE or 5 mSv SDE; declared pregnant workers likely to exceed 1 mSv DDE over the pregnancy; and anyone entering a high or very high radiation area. Operators of only minimal-threat machines are exempt.

The badge is typically worn at the collar outside the apron and the fetal badge at the waist under the apron. Effective dose equivalent (EDE) for fluoroscopy with an apron: one collar badge counts as the reported reading, or reading × 0.3 if it exceeds 25% of the limit; with two badges, 1.5 × waist badge plus 0.04 × collar badge. The rule does not name NCRP 122 as the source.

The fluoroscopy system must shield the body (except head, neck and extremities) with at least 0.25 mm lead-equivalent material. Where sterile fields or special procedures prohibit normal barriers, everyone in the room except the patient must wear 0.35 mm lead-equivalent aprons. Protective devices generally must be at least 0.25 mm lead-equivalent. No thyroid shield or eyewear requirement was found.

Yes. Aprons, gloves and shields must be checked annually by sight, touch or X-ray imaging. Defective items must be replaced or removed from service, and each check must be recorded.

Not specifically addressed. The required built-in 0.25 mm shielding may be met by drapes, curtains or viewing shields, and aprons are mandatory only when sterile fields or special procedures prevent such barriers. The rules do not say whether an engineered system would suffice without aprons.

Use must be by or under supervision of a Texas-licensed physician, chiropractor or podiatrist, and operators must meet Occupations Code ch. 601 credentialing. FGI procedures are limited to radiologists, radiation oncologists, physicians and their ch. 601 delegates. Technologist, PA and nurse scope under the new TMB Chapter 186 was not verified.

Non-radiologist physicians and their delegates must complete 8 hours of Category 1 continuing medical education (CME) in radiation safety plus 1 hour of hands-on training before FGI procedures, but DSHS has delayed enforcement indefinitely. Technologist certification goes through the TMB under ch. 601; details were not verified.