ORSIF

ADMINISTRATIVE SAFETY TOOLKIT

A Comprehensive Guide for Radiation Safety in Interventional Fluoroscopy
Health Impact: ICs vs General Population
Sources: SCAI 2023 Survey, Goldstein et al., ACC Workforce Reports 2023–2024, Radioprotection Journal 2025
24M+
Fluoroscopy procedures annually
IAEA, 2023
$88.7M
Annual economic impact
ORSIF Economic Study
7.5×
US eye lens limit vs. international
ICRP vs NRC comparison
This toolkit provides regulatory guidance, protection strategies, and compliance checklists to build an effective radiation safety program — reducing liability, improving staff retention, and protecting your interventional team.
Dose Limits Comparison
Category OSHA29 CFR 1910.1096 NRC10 CFR Part 20 ICRPRecommendations Gap
Whole Body 5 rem/yr (1.25/qtr) 5 rem/yr (50 mSv) 20 mSv/yr avg (5 yrs) 2.5×
Eye Lens 1.25 rem/qtr (~50 mSv) 15 rem/yr (150 mSv) 20 mSv/yr avg (5 yrs) 7.5×
Extremities 18.75 rem/qtr 50 rem/yr (500 mSv) 500 mSv/yr —
Last Update 1971 1991 Ongoing (2011, Pub. 118) 50+ yrs outdated
7.5×
NRC: 150 mSv/yr US Limit ICRP: 20 mSv/yr International Standard
The US allows eye lens doses 7.5× higher than ICRP recommendations.
OSHA last updated: 1971
What This Means for Your Facility
Liability Risk: The 7.5× gap exposes facilities to future regulatory tightening and litigation. Adopting ICRP standards positions you ahead of the curve.
Staff Retention: 41% of cardiologists considered quitting; projected shortage of 8,650 by 2037. Strong safety programs are a competitive advantage.
Economic Impact: $88.7M annual cost from occupational injuries. Investing in protection reduces workers’ comp costs and lost productivity.
Regulatory Trend: Arizona’s 2026 laws (SB 1118, 1120, 1121) signal a national trend toward stricter requirements.
© 2026 ORSIF — Occupational Radiation Safety in Interventional Fluoroscopy  |  orsif.org  |  Page 1 of 3
ORSIF Administrative Safety Toolkit
Regulatory Hierarchy
FEDERAL Sets minimum standards OSHA · NRC · FDA · CDC STATE Can add stricter rules 37 Agreement States FACILITY Implements & enforces RSO · RSC · Joint Comm.
Regulatory Framework
Federal Agencies
  • OSHA — 29 CFR 1910.1096: Workplace limits. Not updated since 1971.
  • NRC — 10 CFR Part 20: Dose limits and ALARA. Agreement States regulate healthcare.
  • FDA — 21 CFR 1000–1050: Equipment standards, not worker exposure.
  • CDC / NIOSH — Research and recommendations (non-regulatory).
  • EPA — Federal Guidance Reports for dose conversion factors.
State & Facility
  • CRCPD — Model state regulations. 37 Agreement States regulate independently.
  • 50 State Programs — License, inspect, enforce. Requirements vary widely.
  • Arizona (2026) — First fluoroscopy worker protection laws (SB 1118, 1120, 1121).
  • Joint Commission — Accreditation evaluates safety programs. Affects CMS reimbursement.
Key Safety Roles
R

Radiation Safety Officer

10 CFR 35.50
  • Oversees facility radiation protection program
  • Reviews dose reports, investigates overexposures
  • Conducts equipment surveys and area monitoring
  • Ensures proper dosimetry use by all workers
  • Authorized to stop procedures if safety compromised

Medical Physicist

CAMPEP Accredited
  • Annual equipment surveys and calibration
  • Shielding design for procedure rooms
  • Evaluates dose reduction technologies
  • Reviews imaging protocols for ALARA optimization
  • Must be board-certified (ABR, ABMP, or equivalent)

Radiation Safety Committee

10 CFR 35.24
  • Reviews and approves radiation safety policies
  • Evaluates dose trends and investigates incidents
  • Includes RSO, authorized users, nursing, management
  • Approves new uses of radiation-producing equipment
  • Required for broad-scope NRC licenses; meets quarterly
PPE & Equipment Guide
EquipmentWeightProtectionKey Note
Lead Aprons10–25 lbs0.25–0.5mm Pb59.8% report injuries
Thyroid Shield~1 lb0.5mm PbOften overlooked
Leaded Glasses~0.5 lb0.75mm Pb7.5× eye lens gap
Lead Gloves~2 lbs/pair0.5mm PbReduces dexterity
Lead Cap~1 lb0.5mm Pb85% left-side tumors
Facility Shielding
Ceiling-Mounted Shields — Leaded-glass barriers between scatter and operator
Table-Mounted Shields — Lead curtains blocking scatter from below
Mobile Barriers — Rolling leaded partitions for flexible configurations
Room Shielding — Lead-lined walls, doors, windows per NCRP guidelines
Emerging Solutions
Zero-Gravity Systems — Mechanical arms supporting apron weight
Robotic-Assisted PCI — Shielded cockpit (e.g., Corindus CorPath GRX)
Lightweight Composites — Bismuth/tungsten at 30–50% less weight
Real-Time Dosimetry — Immediate dose-rate feedback during procedures
CAP GLASSES THYROID APRON GLOVES Full PPE required in cath lab
ALARA: As Low As Reasonably Achievable
TTIME
  • Pulsed fluoro instead of continuous (50–80% dose reduction)
  • Last-image-hold to review without additional exposure
  • Plan procedures to minimize fluoroscopy time
  • Collimation to reduce irradiated field size
  • Track and display fluoro time during procedures
DDISTANCE
  • Inverse Square Law: 2× distance = 75% dose reduction
  • Stand on image receptor side when possible
  • Extension tools for catheter manipulation
  • Step back during cine runs
  • X-ray tube under table, receptor above
SSHIELDING
  • Always use ceiling-mounted shields when available
  • Table-mounted lead curtains properly positioned
  • Wear all assigned PPE consistently
  • Leaded glasses with adequate side shielding
  • Check PPE for cracks/damage at least annually
Inverse Square Law
X 100% 1 ft 25% 2 ft 6.25% 4 ft
Scatter Radiation — Optimal Position
Patient X-ray tube Receptor ✓ Operator here Stand on the receptor side to minimize scatter exposure
© 2026 ORSIF  |  orsif.org  |  Page 2 of 3
ORSIF Administrative Safety Toolkit
Your Rights as a Radiation Worker
Dosimetry Records
10 CFR 19.13; 29 CFR 1910.1096(o)
Written report of your radiation exposure at least annually, and upon termination.
Radiation Safety Training
10 CFR 19.12; 29 CFR 1910.1096(i)
Instruction on hazards, protective measures, and regulations before working with radiation.
Personal Protective Equipment
29 CFR 1910.132; 10 CFR 20.1902
Employer must provide PPE at no cost and maintain it in good condition.
Retaliation Protection
Section 211 ERA; 29 CFR 1910.1096
Cannot be fired, demoted, or discriminated against for reporting safety concerns.
Pregnancy Accommodation
10 CFR 20.1208; NRC Reg Guide 8.13
Voluntary declaration triggers 0.5 rem (5 mSv) total dose limit for the pregnancy.
Report Unsafe Conditions
OSHA §11(c); NRC 10 CFR 30.7
File complaints with OSHA or NRC without fear of retaliation.
Reporting: Escalation Path
1 Document the Concern Dates, locations, witnesses, dosimetry data 2 Report to RSO Internal first — most issues resolve here 3 Escalate to RSC Radiation Safety Committee review If unresolved ↓ 4 Contact State Program File complaint with state radiation control 5 File Federal Complaints OSHA (osha.gov) or NRC (nrc.gov) 6 Seek Legal Support Union rep or employment attorney INTERNAL EXTERNAL
Key Takeaway: Retaliation Is Illegal
Federal law (Section 211 ERA & OSHA Section 11(c)) prohibits retaliation against workers who report safety concerns. Employees can file complaints with OSHA within 30 days of adverse action.
OSHA Complaints
1-800-321-OSHA (6742)
osha.gov/workers/file-complaint
NRC Allegations
1-800-695-7403
nrc.gov/about-nrc/regulatory/allegations
Find Your State
State radiation control directory
crcpd.org/mpage/StateContactDirector
Best Practices Checklist
Facility Setup
Ceiling-mounted shields installed and functional in all fluoroscopy rooms
Table-mounted lead curtains properly positioned
Real-time dosimetry available for all cath lab staff
PPE inventory maintained and inspected annually
Lighter-weight or suspended PPE alternatives available
Daily Practice
All staff wear assigned dosimetry badges correctly
Pulsed fluoroscopy used as default (not continuous)
Last-image-hold used to reduce unnecessary exposure
Collimation applied to minimize irradiated field
Staff stand on image receptor side when possible
Training & Compliance
Annual radiation safety training completed for all staff
ALARA principles reviewed and reinforced regularly
Dose reports reviewed and distributed at least quarterly
Pregnancy declaration policy posted and explained
RSO contact information posted in all fluoroscopy rooms
Resources & Tools

ORSIF

ORSIF FAQs — 206 Q&As
faqs.orsif.org
US Guidelines — State-by-state
orsif-us-guidelines.vercel.app
International Guidelines
orsif-guidelines-international.vercel.app
Economic Study — $88.7M calculator
orsif-economic-study.vercel.app
Research Library — 555+ articles
orsif.org/library
Join ORSIF (free)
orsif.org

Government

OSHA Ionizing Radiation
osha.gov/ionizing-radiation
NRC 10 CFR Part 20
nrc.gov/reading-rm/doc-collections/cfr/part020/
CDC / NIOSH
cdc.gov/niosh/
CRCPD State Directory
crcpd.org/mpage/StateContactDirector
FDA Radiation Products
fda.gov/radiation-emitting-products

Professional

SCAI — Angiography & Interventions
scai.org
SIR — Interventional Radiology
sirweb.org
ACC — College of Cardiology
acc.org
HPS — Health Physics Society
hps.org
AAPM — Physicists in Medicine
aapm.org
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orsif-admin-toolkit.vercel.app

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© 2026 ORSIF — Occupational Radiation Safety in Interventional Fluoroscopy  |  orsif.org  |  Page 3 of 3
This toolkit is for educational purposes. It does not constitute legal or medical advice. Consult your facility’s RSO and applicable regulations for specific compliance requirements.