The purpose of this document is to assist facilities that possess
radiation-emitting equipment in establishing diagnostic x-ray safety procedures
as required by the Iowa Radiation Machines and Radioactive Materials Rules. It
should be noted that these are only guidelines and each facility must establish
specific procedures consistent with its own method of operation. The objective
of these safety procedures is to minimize radiation exposure to the patients,
staff, and general public and to produce the best x-ray image possible with
minimal radiation exposure.
- Except for patients who cannot be moved out of the room, only the staff
and ancillary personnel required for the medical procedure or training shall
be in the room during the radiographic exposure. Other than the patient
- All individuals shall be positioned such that the useful beam will
strike no part of the body unless protected by 0.5 millimeter lead
- Staff and ancillary personnel shall be protected from the direct scatter
radiation by protective aprons or whole body protective barriers of not
less than 0.25 millimeter lead equivalent.
- Human patients who cannot be removed from the room shall be protected
from the direct scatter radiation by whole body protective barriers of
0.25 millimeter lead equivalent or shall be so positioned that the nearest
portion of the body is at least 2 meters from both the tube head and the
nearest edge of the image receptor.
- Gonad shielding of not less than 0.50 millimeter lead equivalent shall be
used for human patients, who have not passed the reproductive age, during
radiographic procedures in which the gonads are in the useful beam, except
for cases in which this would interfere with the diagnostic procedure.
- Individuals shall not be exposed to the useful beam except for healing
arts purposes and unless such exposure has been authorized by a licensed
practitioner of the healing arts or a licensed registered nurse who is
registered as an advanced registered nurse practitioner pursuant. This
provision specifically prohibits deliberate exposure for the following
- Exposure of an individual for training, demonstration, or other
non-healing arts purposes; and
- Exposure of an individual for the purpose of healing arts screening
except as authorized by a Bureau approved healing arts screening program.
- When a patient or film must be provided with auxiliary support during a
- Mechanical holding devices shall be used when the technique permits. The
written safety procedures shall list individual projections where holding
devices cannot be utilized;
- Shall indicate the requirements for selecting a holder and the procedure
that the holder shall follow;
- The human holder shall be protected as stated in A.2. above;
- No individual shall be used routinely to hold film or patients; and
- In those cases where the human patient must hold the film, except during
intraoral examinations, any portion of the body other than the area of
clinical interest struck by the useful beam shall be protected by not less
than 0.5 millimeter lead equivalent material.
- Each facility shall have leaded aprons and gloves available in
sufficient numbers to provide protection to all personnel who are involved
with X-ray operations and who are otherwise not shielded.
- Procedures and auxiliary equipment designed to minimize patient and
personnel exposure commensurate with the needed diagnostic information shall
- The speed of film or screen and film combinations shall be the fastest
speed consistent with the diagnostic objective of the examinations. Film
cassettes without intensifying screens shall not be used for any routine
diagnostic radiological imaging, with the exception of veterinary
radiography and standard film packets for intra-oral use in dental
- The radiation exposure to the patient shall be the minimum exposure
required to produce images of good diagnostic quality.
- Portable or mobile X-ray equipment shall be used only for examinations
where it is impractical to transfer the patient(s) to a stationary X-ray
- X-ray systems other than fluoroscopic, intraoral, and CT shall not be
utilized in procedures where the source to human patient distance is less
than 30 centimeters.
- If grids are used between the patient and the image receptor to decrease
scatter to the film and improve contrast, the grid shall:
- Be positioned properly, i.e., tube side facing the correct direction and
the grid centered to the central ray;
- If of the focused type, be at the proper focal distance for the SIDs
- All operators and other staff shall be instructed to remain in a
specified protected area during exposures.
- Determine if a woman is of childbearing age or might be pregnant. If
pregnancy exists or may exist, establish whether the responsible doctor is
aware of this fact and still consents to the examination at this time.
- The registrant shall control the occupational dose to individual adults,
except for planned special exposures to the following dose limits:
- An annual limit, which is the more limiting of:
The total effective dose equivalent being equal to 5 rem (0.05 Sv); or
the sum of the deep dose equivalent and the committed dose equivalent to any
individual organ or tissue other than the lens of the eye being equal to 50
rem (0.5 Sv).
- The annual limits to the lens of the eye, to the skin, and to the
extremities which are:
An eye dose equivalent of 15 rem (0.15 Sv) and a shallow dose equivalent
of 50 rem (0.5 Sv) to the skin or to any extremity.
- Each registrant shall monitor occupational exposure to radiation and shall
supply and require the use of individual monitoring devices by:
- Adults likely to receive, in 1 year from sources external to the body, a
dose in excess of 10 percent of the limits listed above, and
- Minors and declared pregnant women likely to receive, in 1 year from
sources external to the body, a dose in excess of 10 percent of any of the
applicable limits for occupational workers, and
- Individuals entering a high or very high radiation area.
- Individuals working with medical fluoroscopic equipment.
- Each licensee or registrant shall ensure that individuals who are required
to monitor occupational doses wear individual monitoring devices as follows:
- An individual monitoring device used for monitoring the dose to the
whole body shall be worn at the unshielded portion of the whole body
likely to receive the highest exposure. When a protective apron is worn,
the location of the individual monitoring device is typically at the neck
- An individual monitoring device used for monitoring the dose to an
embryo/fetus of a declared pregnant woman shall be located at the waist
under any protective apron being worn by the woman;
- An individual monitoring device used for monitoring the eye dose
equivalent shall be located at the neck (collar), outside any protective
apron being worn by the monitored individual, or at an unshielded location
closer to the eye;
- An individual monitoring device used for monitoring the dose to the
extremities shall be worn on the extremity likely to receive the highest
exposure. Each individual monitoring device shall be oriented to measure
the highest dose to the extremity being monitored.
- Fluoroscopic equipment shall be used only under the direct supervision of
a licensed practitioner.
- A technique chart shall be provided in the vicinity of the control panel
which specifies kVp, mA, and time for all examinations performed. These
factors should be typical for the specified part of the human body being
radiographed and established to they provide the best possible x-ray image
with the least radiation exposure. The chart should include the following:
- Patient's anatomical size versus technique factors to be utilized;
- Type and size of the film or film-screen combination to be used;
- Type and focal distance of the grid to be used, if any;
- Source to image receptor distance to be used, except for dental
- Type and location of placement of human patient shielding to be used (gonadal).