Ionizing radiation is widely used in industry, energy, and medicine. The global number of monitored workers is approximately 24 million, while in the Russian Federation it stands at about 250,000, with the medical sector representing the largest employer. The study aims to compare approaches to regulating occupational exposure, evaluating the specific features of dose restrictions for different worker categories, medical surveillance, and the list of occupational diseases of radiation etiology. A comparison of the regulatory documents of the Russian Federation, the EU, the USA, the IAEA and the ILO revealed a high level of conceptual harmonization: general principles of justification, optimization and dose limitation (standardization in Russian practice); recognition of the linear non-threshold model and the principle of optimization of ALARA, the need for individual dosimetric control, workplace monitoring and medical supervision of employees. At the same time, significant differences remain in the classification of exposure situations and groups/categories of personnel, dose limits (especially for the lens of the eye and fetus) and reference levels, regulation of natural radiation, organization of medical supervision, and approaches to classifying occupational diseases of radiation origin. The systems considered show differing balances between strict regulatory mandates and risk-oriented flexibility. The Russian model prioritizes uniformity and procedural formalization; the US model relies on a recommendatory approach delegating responsibility to the licensee; whereas the IAEA and EU documents provide framework requirements for national application. Particular attention should be paid to the harmonization of scientific positions regarding dose limits for tissue reactions; consideration of new evidence on risks to the cardiovascular system; improvement of radiation monitoring technologies; regulation of exposure to natural radiation sources; optimization of radiological protection of medical personnel; and the development of guidelines for clinical practice based on a reliable evidence base.