Time, shielding and distance are the pillars of radiation protection in the X-ray examination room. The team at Flinders Medical Centre have been working for many years exploring all aspects of radiation dose reduction to both the staff and the patient in the angiography and interventional radiology suite. During these investigations it has been noted that significant dose reductions were possible when image utility is considered as the driver of imaging protocols ahead of image quality. Among other findings, it is noted that long procedure times do not necessarily equal high radiation dose and the balance of exposure from fluoroscopy versus acquisition during an interventional procedure is significantly shifted. The comparison of image quality versus image utility in medical Imaging is unconventional, however a powerful argument is presented and supported by the evidence. These findings challenge the conventional thinking of time, shielding and distance as the basis of radiation protection.