Madhya Pradesh HC Dismisses Radiographers' Challenge to Handheld X-Ray TB Screening Guidelines

The Indore Bench declined to interfere with Central TB Division guidelines and a state NHM order deploying handheld X-ray devices for community tuberculosis screening, rejecting safety and pay grievances raised by a registered radiographers' union.

Justice Jai Kumar Pillai, sitting singly at the Indore Bench of the High Court of Madhya Pradesh, dismissed a writ petition filed by Pragatisheel Radiographers Sangh Madhya Pradesh challenging guidelines issued by the Central TB Division and a consequential state-level order directing the deployment of ultraportable handheld X-ray (HHXray) devices for community tuberculosis screening. The court held that judicial review of a national public health welfare policy is highly circumscribed and that the petitioner had placed no formal material on record establishing actionable prejudice. The petition was reserved on 14 May 2026 and decided on 3 June 2026.

The Dispute Before the Court

The petitioner is a registered association of qualified government radiographers and X-ray technicians employed as permanent, regular, or contractual employees in government health facilities across Madhya Pradesh. Its members are trained in X-ray operation, radiation protection, and occupational safety.

Under the TB Mukt Bharat Abhiyan, the Government of India procured and deployed ultraportable HHXray devices — specifically the Model Mine 2.1 — across several states, including Madhya Pradesh, under the National Tuberculosis Elimination Programme for community-based Active Case Finding. The Central TB Division issued guidelines titled “Installation and Operational Guidance on Ultraportable Handheld X-Ray Device (HHXray) for Tuberculosis Screening in the Community” dated August 2023 (Annexure P-1).

Acting on those guidelines, the Mission Director, NHM-MP issued Order/Circular No. H/Vst. S.A./CH-279/25/3345 dated 10 November 2025 (Annexure P-2), directing Chief Medical and Health Officers (CMHOs) to immediately press the devices into service. The CMHOs of Districts Neemuch, Jhabua, and Barwani then issued district-level circulars (Annexure P-3) prescribing daily operational targets of 100 to 150 chest X-rays per radiographer.

The petitioner challenged all three tiers of direction — the Central guidelines, the state NHM order, and the district circulars — through a writ petition under Article 226 of the Constitution seeking a writ of mandamus to quash them.

Safety Conditions and Pay Grievances Raised

The petitioner placed before the court a set of factual claims about field conditions. Members are required to transport HHXray devices to remote villages and operate them in temporary camps set up in Panchayat Bhawans, school rooms, and Anganwadis — structures that lack lead-lined walls or protective enclosures. They are provided only partial lead aprons, without mandatory real-time radiologist oversight and without Thermoluminescent Dosimeter (TLD) badges.

The petitioner union conducted an informal experiment which it said showed that X-rays penetrated the provided lead aprons. It also pointed out that the Central guidelines themselves state that “the radiation hazard is almost zero/negligible as per the claim of the company,” arguing that this reliance on the manufacturer's own assertion, without independent scientific validation, renders the guidelines arbitrary.

On pay, the petitioner highlighted that radiographers in Madhya Pradesh receive only Rs. 50 per month as a radiation allowance — a rate unchanged for approximately 35 years — while counterparts in other states receive between Rs. 1,500 and Rs. 2,500 per month. The petitioner sought a direction to the State to revise and enhance this allowance.

The petition also invoked WHO guidelines cautioning against routine chest X-rays for asymptomatic populations, arguing that mass community screening camps impose an unnecessary radiation burden on the public.

Legal Grounds Pressed by the Petitioner

Counsel for the petitioner argued that compelling radiographers to conduct 100 to 150 daily X-ray exposures in unshielded field conditions, without TLD badges and full-body shielding, directly violates Rules 6, 7, and 15 of the Atomic Energy (Radiation Protection) Rules, 2004, and the AERB Safety Code AERB/SC/MED-2. The petition framed this as a violation of the fundamental right to a safe working environment under Article 21 of the Constitution.

The disparity in radiation allowance was challenged under Article 14 as arbitrary and discriminatory. The petitioner also sought a direction to the respondents to ensure strict compliance with Atomic Energy Regulatory Board (AERB) safety norms, including provision of TLD badges, and to undertake periodic medical monitoring and health surveillance of radiographers operating these devices.

Respondents' Defence

Counsel for the Union of India and the State authorities opposed the petition. The respondents characterised the challenge as an attempt to stall a welfare policy developed under the National Health Mission for the eradication of tuberculosis — a matter of larger public interest. They submitted that the order dated 10 November 2025 is a welfare policy for the eradication of TB and that the district-level circulars are merely administrative tools to implement it at the grassroots level.

The respondents contended that there is no manifest evidence on the record demonstrating how the policy adversely affects the petitioners in a legally cognisable manner. They further submitted that no condition in the applicable service rules restricts the State from assigning field duties or numerical targets to radiographers, and that in the absence of any such restriction, no writ of mandamus could issue.

How the Bench Reasoned

Justice Pillai began by reaffirming that the jurisdiction under Article 226 is an extraordinary and equitable jurisdiction, and that the scope of judicial review in matters pertaining to executive policy on public health and national welfare is highly circumscribed.

The court accepted the respondents' characterisation of the impugned order as a welfare policy explicitly designed for the eradication of TB in the broader public interest. It held that courts must exercise profound restraint when invited to review state policies pertaining to public health initiatives, and that the domain of framing and executing health screening targets rests exclusively with administrative authorities.

On the radiation safety grievances, the court observed that there is no manifest material in the record that definitively establishes how the deployment will affect the petitioners. It treated the informal experiment conducted by the association as incapable of substituting for formal administrative findings, and concluded that no actionable prejudice is manifest on the record.

On the service conditions argument, the court found that there is no condition in the service rules which restricts the State from deploying radiographers to field camps or assigning specific daily targets. In the absence of a statutory or service rule violation, it held that a writ of mandamus cannot be issued to interdict the administrative orders.

The court also addressed the prescription of 100 to 150 X-rays per day, holding that such operational targets are essential administrative tools to achieve the objectives of the TB Mukt Bharat Abhiyan and cannot be categorised as arbitrary merely because they impose demanding work schedules.

Taken together, the court concluded that the challenges mounted by the petitioner lack legal foundation and that relief cannot be granted under Article 226 to stall or modify a national public health welfare policy and its administrative implementation.

Order

The writ petition was dismissed as devoid of substance and merit. Pending applications, if any, were disposed of accordingly. No order as to costs was made.