Determinants of Physicians’ Radiation Safety Knowledge in Pediatric Imaging: The Role of ALARA Training and Institutional Protocols

Abstract

Background: International organizations have underscored the need to reduce radiation exposure through principles such as as low as reasonably achievable (ALARA), particularly in pediatric care. Objectives: This study aims to evaluate the level of knowledge and awareness of radiation safety among pediatricians and family physicians. Methods: This online cross-sectional study involved pediatricians and family physicians (aged ≥ 18 years, actively engaged in pediatric care) recruited through convenience sampling in Istanbul (May - August 2025). Knowledge was evaluated using an eight-item validated questionnaire scored as the percentage of correct responses. Statistical analyses included t-tests, analysis of variance, and multiple linear regression to identify factors associated with knowledge scores. Results: A total of 222 medical professionals participated in this study. Pediatricians exhibited markedly higher knowledge ratings than family physicians (74.1% vs 68.3%, P = 0.038). Physicians who had been practicing for less time (0 - 5 years) scored higher than those who had been practicing for 21 years or more (73.8% vs. 65.4%, P = 0.045). ALARA training was associated with a markedly higher knowledge score (76.3% vs 61.2%, P < 0.001). Multiple regression analysis revealed that ALARA training, institutional protocols, and computed tomography dose knowledge accounted for 42.6% of the variance in knowledge scores (R² = 0.426; adjusted R² = 0.401). Conclusions: Physicians exhibited moderate to high awareness of radiation safety in pediatric imaging; however, knowledge deficiencies persist, especially among family physicians and professionals without specialized ALARA training. Periodic education, institutional dose-reduction protocols, and compulsory radiation safety programs are advocated to help strengthen radiation-safe imaging practices and patient safety.