Texas X-Ray Regulations: Registration, Operators, and Inspections

If you own or operate an x-ray machine in Texas, the Texas x-ray regulations in Title 25 of the Texas Administrative Code, Chapter 289, require you to register the equipment with the Department of State Health Services (DSHS) within 30 days of first use, employ only state-certified operators, maintain prescribed shielding and dosimetry, run periodic equipment performance evaluations, and submit to DSHS inspections on a schedule set by machine type. Violations can carry administrative penalties of up to $10,000 per day, with each day counted as a separate offense.¹

The rules apply the moment you possess or operate a radiation-producing machine, whether that machine lives in a hospital radiology suite, a chiropractor’s exam room, a dental office, a veterinary clinic, or an industrial inspection site. Chapter 289 is organized by use: Section 289.226 covers registration, Section 289.227 governs machines used in the healing arts, Section 289.228 addresses industrial radiography, and Section 289.232 handles dental equipment.²

Registering an X-Ray Machine With DSHS

You have 30 days after first using a radiation machine to file for a certificate of registration. Each physical location needs its own RC Form 226-2, paired with a Business Information Form (RC Form 226-1). The application must identify the intended use category: healing arts (medical, chiropractic, podiatric), mobile services, healing arts screening, non-human use (including forensic and educational), or radiation machine services such as installation and repair.³ Categorization is not a formality. It determines which safety standards DSHS applies and how often inspectors show up.

A machine designated for human use cannot be used on animals, and vice versa, without written DSHS authorization. After registration, any change to your facility name, mailing or street address, use location, or Radiation Safety Officer must be reported to DSHS within 30 days.³

Radiation Safety Officer

Every registered facility must designate a Radiation Safety Officer (RSO). The RSO is the primary point of contact with DSHS and carries day-to-day responsibility for compliance, including establishing and reviewing operating and safety procedures at least annually, overseeing emergency protocols, and having the authority to shut down operations when conditions are unsafe.⁴⁵

Fees

Registration fees are paid every two years based on the expiration month on the certificate. When one registration covers more than one category of use, DSHS charges the higher of the applicable fees. The current dollar amounts live in the fee schedule under Section 289.204.⁶

Who Can Legally Operate the Equipment

Only individuals with state-recognized credentials can operate x-ray equipment on patients. The Texas Medical Board handles certification and divides operators into three tiers.⁷

A Medical Radiologic Technologist (MRT) holds the unrestricted license, built on a full degree program in radiologic technology, and may perform a broad range of diagnostic imaging. A Limited Medical Radiologic Technologist (LMRT) carries a restricted permit tied to a narrower set of procedures, with training programs that must be approved by the Texas Medical Board.⁸ The entry-level Non-Certified Technician (NCT) registry requires a 120-hour approved classroom program covering radiation safety (at least 22 hours), image production (24 hours), equipment operation (16 hours), and anatomy and radiologic procedures for specific body areas. All training hours must be live and in-person under an approved instructor.⁹

All three credentials require at least 24 hours of continuing education every 24 months, tracked by the biennial registration period rather than the calendar year. Operator certification documents must be kept on-site and available to inspectors.¹⁰

Shielding, Dosimetry, and Operator Protection

Safety requirements run from the walls of the room down to the badge on each worker’s collar.

Shielding

Facilities must install structural barriers (lead-lined drywall or specialized concrete) designed around the workload and output of the installed equipment, so radiation stays contained within the x-ray room. For personal protection, lead aprons, thyroid shields, and gloves must provide at least 0.25 mm of lead equivalence. During sterile fluoroscopy procedures where normal barriers cannot be used, protective aprons must provide 0.35 mm lead equivalence. Gonadal shielding for patients, used when the reproductive organs are in or within 5 centimeters of the beam, must provide 0.5 mm lead equivalence, except where it would interfere with the diagnostic procedure.¹¹

Every protective device must be inspected annually for holes, cracks, and tears, visually, by touch, or through x-ray imaging. Defective equipment must be replaced or pulled from service until repaired.¹¹

Dosimetry

Registrants must supply individual monitoring devices and require their use by any adult worker likely to receive more than 10% of the annual occupational dose limit in a year, any minor likely to exceed a deep dose equivalent of 0.1 rem in a year, any declared pregnant worker likely to exceed 0.1 rem during the pregnancy, and anyone entering a high or very high radiation area. Each dosimeter is assigned to a single individual. For whole-body monitoring, the device is typically worn at the collar when a protective apron is in use, and a declared pregnant worker who wears a second dosimeter wears it at the waist, under the apron.¹²

Positioning and Signage

During any exposure, the operator must stand at least six feet from the radiation source or stay behind shielding of at least 0.25 mm lead equivalence. When a patient or image receptor needs to be held in place, mechanical restraints must be used whenever the exam allows. A person should never do the holding if a device can. Radiation areas must be posted with appropriate signage under Section 289.231, though registrants who maintain continuous surveillance and access control during operation can qualify for an exemption.¹¹

Occupational Dose Limits

Federal OSHA standards set the floor under 29 CFR 1910.1096. The quarterly whole-body limit is 1.25 rem. Hands, forearms, feet, and ankles are permitted up to 18.75 rem per quarter, and the skin of the whole body up to 7.5 rem per quarter. An employer may allow a quarterly whole-body dose up to 3 rem if the worker’s cumulative lifetime dose stays within 5(N-18) rem, where N is the worker’s age. Workers under 18 are limited to 10% of the standard quarterly limits.¹³

Texas layers on monitoring and recordkeeping obligations through Sections 289.231 and 289.202. In practical terms, Texas facilities must satisfy both the federal exposure limits and the state’s own control and documentation requirements.

Equipment Performance Evaluations and Quality Assurance

Compliant equipment at install is not the same as compliant equipment three years in. Texas requires periodic equipment performance evaluations (EPEs) on a schedule set by machine type:¹¹

CT and fluoroscopy systems: annually, not to exceed 14 months from the prior evaluation
General radiographic equipment: every two years
Podiatric x-ray machines: every four years

An EPE must also be performed within 30 days of initial installation, reinstallation, or repair of any component that could affect radiation output, such as the timer, tube, or power supply. Measurement instruments used in these evaluations must be calibrated with traceability to a national standard, with calibration renewed within 24 months.¹⁴

Facilities using digital imaging systems must follow the quality assurance protocol established by the equipment manufacturer, or develop their own if none exists, covering spatial resolution, noise, artifacts, and contrast. Test images must be acquired with each image receptor at least every three months and compared with previous results. Any machine or component that fails a quality test must begin correction or repair within 30 days.¹⁴

How Often DSHS Inspects, and What Inspectors Check

DSHS inspection intervals are tied to equipment type:¹⁵

CT, fluoroscopy, and therapy machines: every 2 years
General-purpose x-ray: every 3 years
Dental and podiatry: every 4 years
Industrial, service companies, and veterinary: every 5 years

During an inspection the DSHS representative reviews maintenance logs, operator certifications, equipment calibration records, and written safety procedures. The inspector tests machines to confirm that radiation output matches control settings and that safety interlocks work. The facility receives a formal inspection report; where violations are identified, the registrant gets a notice of violation and must submit a written response describing corrective actions.¹⁵

A dental office with only intraoral units may not see an inspector for four years. The quality assurance, dosimetry, and recordkeeping obligations still apply every day in between. Gaps in documentation are the most common findings when inspectors arrive, and they are entirely preventable.

Penalties for Violations

Under both Texas Health and Safety Code Chapter 401 and Section 289.205, each violation can carry a penalty of up to $10,000 per day, with each day the violation continues counted as a separate offense.¹⁶

DSHS calculates administrative penalties from a base amount scaled by severity. Licensees, registrants, and certified industrial radiographers start at a base of $5,000 per violation. Unlicensed or unregistered persons start at $10,000. The actual penalty applies the base at a percentage keyed to severity:¹

Severity Level I: 100% of base, for the most serious violations, including those creating immediate safety hazards
Severity Level II: 80% of base, for significant violations with substantial safety implications
Severity Level III: 50% of base, for moderate violations
Severity Level IV: 15% of base, for lower-level infractions
Severity Level V: 5% of base, for minor violations such as recordkeeping errors

For a registered facility, a Severity Level I violation starts at $5,000 and a Level V at $250. For an unregistered operator, the base doubles, so even a Level III violation starts at $5,000. Operating without a certificate puts you in the higher base category automatically, which is why the 30-day registration window matters.

Dental X-Ray Facilities

Dental practices operate under a dedicated set of rules in Section 289.232 rather than the general healing arts rules in Section 289.227. There is one important exception. When dental machines sit inside a facility that also operates other healing arts equipment, those dental machines inherit the shorter inspection cycle and the more frequent EPE intervals that apply to the medical equipment.¹⁷

Dental facilities using digital imaging sensors must run quality assurance tests at least quarterly against previous baselines, and the dosimetry calibration standard (traceable to a national standard, recalibrated within 24 months) applies here too.¹⁴ A standalone dental office uses relatively low-energy equipment, but the recordkeeping and quality control obligations remain detailed.

Prohibited Uses

Texas bars any use of a radiation machine that exposes individuals to the useful beam for training, demonstration, or other non-diagnostic purposes. A human-designated machine cannot be used on animals, and an animal-designated machine cannot be used on humans, without written DSHS authorization. Human research involving radiation machines requires a separate authorization track under Section 289.226.³

1
Texas Department of State Health Services. 25 TAC 289.205 Hearing and Enforcement Procedures
2
Texas Administrative Code. Texas Administrative Code Chapter 289 – Radiation Control
3
Texas Department of State Health Services. 25 TAC 289.226 Registration of Radiation Machine Use and Services
4
Texas Department of State Health Services. Radiation Safety Officer Form
5
Legal Information Institute. Texas Administrative Code 30-336.208 – Radiation Safety Officer
6
Legal Information Institute. Texas Administrative Code 25-289.204 – Fees for Certificates of Registration, Radioactive Material Licenses, Emergency Planning and Implementation, and Other Regulatory Services
7
Texas Medical Board. Medical Radiologic Technologist
8
Texas Medical Board. Non-Certified Technician and Limited Medical Radiological Technician Training Programs
9
Legal Information Institute. Texas Administrative Code 22-186.26 – Education Standards for Non-Certified Technician
10
Texas Medical Board. Continuing Education Requirements for Medical Radiologic Technologists
11
Texas Department of State Health Services. 25 TAC 289.227 Use of Radiation Machines in the Healing Arts
12
Texas Department of State Health Services. 25 TAC 289.231 General Provisions and Standards for Protection Against Radiation from Radiation Machines
13
Occupational Safety and Health Administration. Ionizing Radiation – Standards
14
Texas Department of State Health Services. 25 TAC 289.232 Radiation Control Regulations for Dental Radiation Machines
15
Texas Department of State Health Services. Inspections of X-Ray Machines
16
State of Texas. Texas Health and Safety Code 401.384
17
Legal Information Institute. Texas Administrative Code 25-289.227 – Use of Radiation Machines in the Healing Arts