DOE Ends ALARA Standard: What It Means for Healthcare Workers in Interventional Fluoroscopy

On January 12, 2026, Department of Energy Secretary Chris Wright issued a directive that ended the DOE's use of the "As Low As Reasonably Achievable" (ALARA) principle- a cornerstone of radiation protection that has guided nuclear regulation for decades. For those of us who work in interventional fluoroscopy, this news raises important questions about what it means for radiation safety in healthcare settings.

The short answer: the directive doesn't directly change the rules in your cath lab or IR suite. But the longer answer is more nuanced, and worth understanding.

What is ALARA, and Why Does It Matter?

ALARA stands for "As Low As Reasonably Achievable." It's a radiation protection philosophy based on the principle that even low doses of radiation carry some risk, so exposures should be minimized using all achievable measures- considering time, distance, and shielding.

For those of us in interventional medicine, ALARA isn't just a regulatory checkbox. It's the framework that drives us to reduce fluoroscopy time, step back from the table when possible, use proper shielding, and continuously look for ways to lower dose without compromising patient care. It's why we track dosimetry, invest in protective equipment, and train our teams on radiation safety best practices.

What Did the DOE Actually Do?

Secretary Wright's directive removes ALARA from DOE's regulatory framework. The DOE oversees nuclear weapons facilities, national laboratories, and major cleanup sites like Hanford in Washington state- not hospitals or medical facilities.

Proponents of the change argue that ALARA has led to excessive costs at sites like Hanford, where billions of dollars are being spent to achieve radiation reductions that, critics say, provide minimal real-world safety benefits. The administration frames this as eliminating regulatory burden to accelerate nuclear projects and reduce taxpayer costs.

Does This Affect Hospital Workers?

Not directly- at least not yet.

Radiation safety in hospitals is regulated by a different set of agencies: the Nuclear Regulatory Commission (NRC) for radioactive materials and nuclear medicine, the FDA for x-ray and fluoroscopy equipment standards, state health departments that adopt and enforce radiation safety regulations, and OSHA for general occupational safety.

The NRC's definition of ALARA remains in effect. State regulations- which govern most hospital radiation safety programs- still incorporate ALARA. Your institution's radiation safety program, dosimetry monitoring, and protective equipment requirements haven't changed because of this DOE directive.

Why ORSIF Is Paying Attention

While the immediate regulatory impact on hospitals is minimal, we're concerned about several indirect effects:

Precedent-setting: When one major federal agency abandons a foundational safety principle, it can create pressure on other agencies to follow. The NRC, FDA, and state regulators will be watching.

Cultural shift: This directive signals a federal philosophy that radiation protection may be "overblown." That message can trickle down to institutional attitudes, budget decisions, and training priorities.

International influence: The DOE provides staff and training for the International Atomic Energy Agency. Changes to U.S. standards can affect global radiation protection norms.

Scientific direction: The justification for this change relies partly on challenging the Linear No-Threshold (LNT) model, the principle that any radiation exposure carries some risk. If LNT comes under broader regulatory attack, it could reshape how all radiation safety standards are evaluated.

What You Can Do

1. Stay informed. Follow developments as the DOE works on replacement standards and watch for any ripple effects on NRC or state regulations.

2. Maintain your safety culture. Don't let policy changes dictate your commitment to protecting yourself and your team. Continue practicing time, distance, and shielding principles.

3. Engage with your professional societies. Organizations like ACC, SCAI, SIR, and HRS have a voice in radiation safety policy. Make sure they're hearing from their members.

4. Join ORSIF. Our community is dedicated to advocating for the safety of healthcare professionals in interventional fluoroscopy. Together, we can ensure that those who care for others are not put at unnecessary risk.

The Bottom Line

The DOE's decision to abandon ALARA is significant, even if it doesn't immediately change the rules in your fluoroscopy lab. It's a reminder that the regulatory landscape can shift, and that safety-minded professionals need to stay vigilant and engaged.

At ORSIF, we believe that patient safety and healthcare worker safety must be held to the same standard. Protecting those who heal is essential to the integrity and sustainability of modern medicine. We'll continue to monitor this situation and advocate for evidence-based protections for our community.

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