Survey finds high self-reported radiation safety compliance in Saudi radiology departments

Radiology departments in Saudi Arabia operate under two overlapping regulatory frameworks: the Central Board for Accreditation of Healthcare Institutions (CBAHI), which accredits healthcare institutions against broad quality standards, and the Nuclear and Radiological Regulatory Commission (NRRC), which enforces radiation-specific safety requirements. A cross-sectional survey published in BMC Health Services Research has now examined how staff in Riyadh Health Cluster Three navigate this dual oversight, measuring self-reported compliance with radiation safety practices, the barriers they encounter, and their views on whether the two systems fit together coherently.

The study, conducted by Dalal Munays Al-Qahtani and Salah Alshagrawi, used a structured electronic questionnaire distributed to radiology, safety, and quality personnel within the cluster. The researchers analyzed 261 valid responses, applying descriptive statistics, one-way ANOVA, and multiple regression analysis to the quantitative data, while open-ended answers were examined thematically. The headline finding was encouraging: overall self-reported compliance with radiation safety practices was high, with a mean score of 22.87 plus or minus 2.86 out of a possible 25.

Beneath that aggregate figure, performance varied by domain. Equipment maintenance and quality assurance documentation recorded the highest self-reported compliance, at 4.74 plus or minus 0.60, suggesting that the technical backbone of radiation safety is well embedded in participating departments. Personal protective equipment use scored comparatively lower, at 4.30 plus or minus 0.94, indicating that day-to-day protective habits among staff lag behind the more formalized maintenance and documentation routines.

The regression analysis identified two factors significantly associated with higher compliance scores. Familiarity with CBAHI standards showed the strongest relationship (beta = 0.32, p < 0.001), followed by perceived adequacy of radiation safety training (beta = 0.20, p = 0.003). In practical terms, staff who knew the accreditation framework well and felt their training was sufficient reported safer practices, pointing to knowledge and education as levers for improvement rather than equipment or infrastructure alone.

When asked what hindered implementation, participants could select more than one barrier. Lack of staff awareness dominated, chosen by 81.6 percent of respondents, followed by workload pressures at 28.0 percent and insufficient managerial support at 25.7 percent. The overwhelming prominence of awareness gaps, despite generally high compliance scores, suggests that even experienced personnel may not fully grasp the requirements they are expected to meet, a mismatch the authors link to the need for stronger role-specific training.

The qualitative responses added a distinctly administrative dimension to the problem. Participants highlighted documentation duplication and administrative burden arising from overlapping CBAHI and NRRC requirements, describing how parallel reporting obligations consume time without necessarily improving safety. They also strongly supported greater regulatory harmonization between the two bodies, a sentiment the researchers treat as central to making compliance sustainable rather than episodic.

The authors conclude that self-reported radiation safety compliance among the participating radiology personnel was generally high but was accompanied by organizational and administrative challenges related to dual regulatory oversight. They propose improved harmonization between CBAHI and NRRC standards, stronger role-specific training, and streamlined documentation processes as measures that may support more durable radiation safety practices across Saudi radiology departments.

Several caveats deserve emphasis. The survey captured self-reported compliance rather than independently verified performance, so scores may reflect optimism as much as actual practice. The sample was drawn from a single health cluster in Riyadh, limiting how far the findings generalize to other regions or facility types. As a cross-sectional design, the study can identify associations, such as the link between CBAHI familiarity and compliance, but cannot establish cause and effect. Even so, the work offers regulators a concrete evidence base for aligning two frameworks that, in the eyes of the staff who must satisfy both, currently ask for much of the same paperwork twice.

Subject of Research: Radiation safety compliance and regulatory harmonization in Saudi radiology departments

Article Title: Assessing compliance and perceived regulatory compatibility between CBAHI standards and NRRC radiation safety requirements in Saudi radiology departments: a cross-sectional survey

Article References: Al-Qahtani, D. M., & Alshagrawi, S. (2026). Assessing compliance and perceived regulatory compatibility between CBAHI standards and NRRC radiation safety requirements in Saudi radiology departments: a cross-sectional survey. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15752-z

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15752-z

Keywords: radiation safety, radiology, CBAHI, NRRC, Saudi Arabia, healthcare accreditation, regulatory harmonization, cross-sectional survey, quality assurance, health services research, Assessing, compliance