Radiation Protection Culture in Healthcare: Evaluating Awareness, Training, and Regulatory Compliance

Abstract

Background: The clinical adoption of ionising radiation across diagnostic radiology, interventional cardiology, nuclear medicine, and image-guided surgical suites has transformed clinical medicine. However, the accompanying surge in occupational and secondary patient radiation doses demands an institutional evolution from basic procedural adherence to an integrated Radiation Protection Culture (RPC). Radiation safety encompasses more than passive adherence to dose thresholds; it requires a collective mindset, institutional values, human behaviour, structured pedagogy, and continuous regulatory oversight.

Objectives: This review synthesises empirical evidence evaluating radiation safety awareness, educational interventions, behavioural practices, dosimetric monitoring frameworks, and administrative compliance across clinical environments.

Methods: A narrative literature analysis was conducted across academic medical and safety databases, synthesising multi-centre cross-sectional surveys, prospective dosimetric trials, pedagogical intervention studies, quality-assurance audits, and occupational epidemiological evaluations.

Results: Despite widespread qualitative endorsement of the "As Low As Reasonably Achievable" (ALARA) principle, significant knowledge gaps persist across medical specialities. Non-radiology personnel—particularly orthopaedic surgeons, interventional cardiologists, Cath-lab nurses, and anaesthesia providers—consistently display lower awareness of radiation scatter biophysics, regulatory occupational dose limits, and tissue-weighting variables than certified medical radiologic technologists. This deficit directly impacts practice: eye lens dosimeters, thyroid shields, and structural protective barriers remain underused, correlating with an elevated prevalence of occupational radiation-induced subcapsular lens changes. Passive didactic training models show minimal long-term behavioural translation, whereas structured post-licensure workshops, digital multimedia modules, and clinical simulation models produce sustained reductions in staff dose exposure. Systemic barriers—including chronic staffing shortages, high patient turnaround pressures, unmonitored physical deterioration of personal protective equipment (PPE), and fragmented reporting frameworks—impede regulatory compliance.

Conclusions: Establishing a resilient RPC requires shifting from individualized fault-finding to systems-based institutional governance. Healthcare systems must institute mandatory multi-tier post-licensure credentialing, routine radioprotective equipment surveillance, multi-dosimeter monitoring policies, and visible executive leadership to ensure that patient diagnostic benefits do not come at the expense of staff safety.