Is Texas an NRC Agreement State?
Yes
Yes. Texas signed its agreement on January 10, 1963, effective March 1, 1963; the NRC calls Texas the fifth Agreement State.
Texas: radiation safety rules for fluoroscopy teams
What Texas'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, with its weakest answers rechecked November 5, 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 It is not comprehensive and not always accurate: rules change, and answers may be incomplete, out of date or wrong.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 Texas Department of State Health Services (DSHS), Radiation Control Program as the agency that regulates X-ray and fluoroscopy equipment in Texas. Texas is a U.S. Nuclear Regulatory Commission (NRC) Agreement State: it has signed an agreement with the NRC to regulate certain radioactive materials itself.
Texas (DSHS Radiation Control Program, Agreement State since 1963) requires ALARA for X-ray registrants in a machine-only rule (25 TAC §289.231), separate from the materials rule (§289.202), and §289.227 also requires that operators keep their own dose ALARA during an exposure. Dose limits match federal: 50 mSv whole body, 150 mSv lens, 500 mSv skin/extremity, 5 mSv embryo/fetus. Fluoroscopy requires at least 0.25 mm Pb-equivalent shielding for the body except the head, neck and limbs, and drapes, self-supporting curtains or viewing shields count toward it, so engineered apron alternatives are partly addressed though not named; 0.35 mm aprons are required only when sterile fields or special procedures prevent those barriers, and aprons are inspected annually. Operation must be by or under a licensed practitioner, and the 8-hour fluoroscopically guided interventional (FGI) training rule is not enforced.
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.
Which rules cover X-ray and fluoroscopy equipment in Texas?
Yes
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.
Rule text and source
- Rule
- 25 TAC §289.231(a)-(b); §289.227
- Source
- dshs.texas.gov
dshs.texas.gov - What it says
this section applies to persons who receive, possess, use, or transfer radiation machines
This quote was matched word for word to a page the research read.
Does Texas require X-ray users to keep doses as low as reasonably achievable (ALARA)?
Yes
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))
Rule text and source
- Rule
- 25 TAC §289.231(l); §289.227(i)(10)
- Source
- dshs.texas.gov
- What it says
The registrant shall use, to the extent practical, procedures and engineering controls based upon sound radiation protection principles
This quote was matched word for word to a page the research read.
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 Texas?
Yes
5 rem (50 mSv) TEDE per year; minors 10% of adult limits.
Rule text and source
- Rule
- 25 TAC §289.231(m)(1)(A)-(D); §289.227(i)(3)
- Source
- dshs.texas.gov
- What it says
An annual limit shall be the TEDE being equal to 5 rems (0.05 Sv).
This quote was matched word for word to a page the research read.
What is the annual eye-lens dose limit in Texas?
Yes
15 rem (150 mSv) lens dose equivalent (LDE) per year; Texas has not adopted the International Commission on Radiological Protection (ICRP) 20 mSv limit.
Rule text and source
- Rule
- 25 TAC §289.231(m)(1)(A)-(D)
- Source
- dshs.texas.gov
- What it says
an LDE of 15 rems (0.15 Sv)
This quote was matched word for word to a page the research read.
What is the annual limit for the skin, hands and feet in Texas?
Yes
50 rem (500 mSv) shallow dose equivalent (SDE) per year to the skin of the whole body or any extremity.
Rule text and source
- Rule
- 25 TAC §289.231(m)(1)(B)(ii)
- Source
- law.cornell.edu
- What it says
(ii) an SDE of 50 rems (0.5 Sv) to the skin of the whole body, or to the skin of any extremity.
This quote was matched word for word to a page the research read.
What limit applies to a declared pregnant worker in Texas?
Yes
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.
Rule text and source
- Rule
- 25 TAC §289.231(m)(1)(D)
- Source
- law.cornell.edu
- What it says
(D) If a woman declares her pregnancy, the registrant shall ensure that the DE to an embryo/fetus during the entire pregnancy, due to occupational exposure of a declared pregnant woman, does not exceed 0.5 rem (5 mSv).
This quote was matched word for word to a page the research read.
Dosimeters
When a worker must wear a dosimeter, and where.
When must a worker in Texas wear a dosimeter?
Yes
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.
Rule text and source
- Rule
- 25 TAC §289.231(n)(1)-(2)
- Source
- dshs.texas.gov
- What it says
adults likely to receive, in 1 year from sources external to the body, a dose in excess of 10% of the limits
This quote was matched word for word to a page the research read.
Where must the dosimeter be worn in Texas when a protective apron is worn?
Yes
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.
Rule text and source
- Rule
- 25 TAC §289.231(m)(3)-(6); §289.231(q)(1)(B)-(E)
- Source
- dshs.texas.gov
- What it says
When a protective apron is worn, the location of the individual monitoring device is typically at the neck (collar).
This quote was matched word for word to a page the research read.
Aprons and alternatives
Protective apparel, how it is checked, and whether other systems are addressed.
Must staff in Texas fluoroscopy rooms wear protective aprons or other apparel?
Yes
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.
Rule text and source
- Rule
- 25 TAC §289.227(m)(8)(A)-(B); §289.227(i)(4)(A)
- Source
- dshs.texas.gov
- What it says
All persons, except the patient, in the room where fluoroscopy is performed shall wear protective aprons that provide a shielding equivalent of 0.35 mm of lead.
This quote was matched word for word to a page the research read.
Does Texas require protective aprons to be inspected?
Yes
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.
Rule text and source
- Rule
- 25 TAC §289.227(i)(4)(B)
- Source
- dshs.texas.gov
- What it says
Protective devices, including aprons, gloves, and shields shall be checked annually for defects such as holes, cracks, and tears.
This quote was matched word for word to a page the research read.
Do the rules in Texas address engineered protection systems used in place of aprons?
In part
Texas does not name engineered shielding systems, but it addresses them in part. In fluoroscopy, scattered radiation must pass through at least 0.25 mm of lead-equivalent material before reaching any part of a person's body except the head, neck and limbs, and that material can be drapes, self-supporting curtains or viewing shields as well as any apron. Everyone in the room except the patient must wear 0.35 mm lead-equivalent aprons only when sterile fields or special procedures prevent the use of those normal barriers.
Rule text and source
- Rule
- 25 TAC §289.227(m)(8)(A)
- Source
- law.cornell.edu
- What it says
The material may be, but is not limited to, drapes, self-supporting curtains, or viewing shields, in addition to any lead equivalency provided by a protective apron.
This quote was matched word for word to a page the research read.
Who operates the equipment
Who may use fluoroscopy equipment and what training the rules ask for.
Who may operate fluoroscopy equipment in Texas?
In partLess certain
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.
Rule text and source
- Rule
- 25 TAC §289.227(b)(1), (i)(5), (m)(9)(C)(i)(I); former 22 TAC §194.17 (repealed)
- Source
- dshs.texas.gov
- What it says
All usage of such machines under this section shall be made by or under the supervision of a practitioner of the healing arts.
This quote was matched word for word to a page the research read.
What training or credentials does Texas require to operate fluoroscopy equipment?
In partLess certain
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.
Rule text and source
- Rule
- 25 TAC §289.227(m)(9)(E); DSHS §289.227 Q&A
- Source
- dshs.texas.gov
dshs.texas.gov - What it says
shall complete a minimum of 8 hours of Category 1 CMEU in radiation safety awareness training prior to performing FGI procedures
This quote was matched word for word to a page the research read.
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 ruleTexas Medical Board repeal of Chapter 194 and move to Chapter 186
Chapter 194 repealed; date not confirmed
Technologist rules moved from 22 TAC ch. 194 to ch. 186.
3 other items the research logged (radiation therapy, industrial machines, fees and other subjects)
- Proposed ruleProposed amendment to §289.229 (radiation therapy machines)
Proposed in the Texas Register (Sep 18, 2026)
Would define "remote operation."
- Proposed ruleProposed amendment to §289.228 (industrial radiation machines)
Open for comment until November 23, 2026
The only rule listed on the DSHS proposed-rules page. No changes to §289.227 or §289.231 were found.
- OtherDSHS Sunset review
Under review
DSHS is under Sunset review.
Also worth knowing
- Every registrant doing FGI procedures needs a radiation protocol committee including a physician, a licensed medical physicist and the radiation safety officer (RSO), meeting at least every 14 months. It sets protocols and reference levels, and patient dose data (cumulative air kerma or DAP) must be recorded.
- Each operator must read the written operating and safety procedures at least once a year, with documentation.
- DSHS posts enforcement actions, including §289.227 penalties: https://www.dshs.texas.gov/sites/default/files/radiation/pdffiles/DiscEnfActions/newradiationdisciplinaryactions.pdf
- The 8-hour FGI training rule is on the books but not enforced (delayed, per FluoroSafety, since January 13, 2015).
- The §289.230 (mammography) revision is dated 06/06/25.
- Texas bills on apron alternatives were not searched.
What ORSIF could not confirm
Questions the research could not settle. If you know the answer, tell us.
- Current TMB technologist rules (22 TAC Chapter 186): who may run fluoroscopy (technologists, cardiovascular-category technologists, PAs, NPs, RNs), what supervision is needed, and any fluoroscopy, American Registry of Radiologic Technologists (ARRT) or continuing education (CE) requirements.
- §289.202 ALARA text, and whether DSHS would carry an NRC ALARA change over to §289.231.
- Whether the SOS official versions of §§289.227 and 289.231 match the DSHS PDFs.
- Whether the §289.231(m)(3) badge coefficients come from NCRP Report 122.
- Whether DSHS would accept an engineered shielding system under §289.227(m)(8)(A), or would require a variance or exemption.
- 2025-2026 Texas bills on apron alternatives or fluoroscopy operators (check https://capitol.texas.gov).
- Current enforcement status of the FGI training rule; the DSHS delay letter was unreadable.
Who regulates, and where to read the rules
- Texas Department of State Health Services (DSHS) program page
- Phone: (512) 834-6688
- Radiation Control Main
- Laws and Rules
- Program contacts in the CRCPD directory
Documents ORSIF has on file
Copies saved earlier. Rules change, so check the current text at the source.
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. Texas Department of State Health Services (DSHS), (512) 834-6688. 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
- 0 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.
- 2 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
- TEDE
- Total effective dose equivalent
- DDE
- Deep dose equivalent
- LDE
- Lens dose equivalent
- SDE
- Shallow dose equivalent
- EDE
- Effective dose equivalent
- ARRT
- American Registry of Radiologic Technologists
- FGI
- Fluoroscopically guided interventional
- RSO
- Radiation safety officer
- CME
- Continuing medical education
- CE
- Continuing education
All 16 sources the research read
- DSHS Radiation Control Program home
- DSHS Laws and Rules page
- 25 TAC §289.231 (DSHS PDF, December 2011)
- 25 TAC §289.231 (Cornell LII, secondary)
- 25 TAC §289.227 (DSHS PDF, May 2013)
- 25 TAC §289.227 (Cornell LII, secondary)
- DSHS §289.227 Q&A (search snippet only)
- DSHS Draft Rules page
- DSHS Proposed Rules page
- Texas Register, Sept. 18, 2026, Proposed Rules, Title 25
- NRC, Texas Agreement State page
- NRC agreement documents
- NRC agreement documents
- Cornell LII, 22 TAC ch. 194 (repealed)
- FluoroSafety (secondary, training delay)
- Medical Economics (secondary, old Chapter 194 summary)
Found something out of date or wrong? Tell ORSIF. Corrections are checked against the rule text and the page is updated.