The study took place within a tertiary healthcare setting affiliated with Shri JJT University in Rajasthan, India, and deliberately looked beyond the radiology department itself. The researchers recruited seventeen female nurses working in wards, intensive care units, emergency departments, and operation theatres, the places where imaging frequently comes to the patient rather than the other way around. Participants were selected through purposive sampling, a technique in which researchers intentionally choose people with direct experience of the phenomenon under investigation. Each nurse took part in a semi-structured, in-depth interview, a format that combines a prepared set of questions with the freedom to follow unexpected threads as they arise.

To make sense of the transcripts, the team used thematic analysis organized around the Knowledge, Attitudes, Practices framework, a long-standing model in health services research that separates what people know, how they feel about it, and what they actually do. Coding and theme development were performed manually rather than by software, and the researchers interpreted the data through an iterative process, moving back and forth between raw interview text and emerging categories until a stable set of themes crystallized. Five major themes ultimately surfaced, and together they sketch a profession that recognizes danger but has not been equipped to manage it.

The first theme was a limited understanding of radiation fundamentals. Participants showed confusion about the distinction between ionizing and non-ionizing radiation, a distinction that sits at the heart of the entire field. Ionizing radiation, the kind produced by X-ray tubes and emitted by radioactive materials, carries enough energy per photon to strip electrons from atoms, breaking chemical bonds in DNA and other biological molecules. Non-ionizing radiation, which includes radio waves, microwaves, and the magnetic fields used in MRI, lacks that energy and is governed by an entirely different risk profile. When nurses conflate the two, they may either worry needlessly about harmless exposures or, more dangerously, underestimate genuine ones. The interviews also revealed incomplete knowledge of imaging modalities, meaning many nurses could not reliably say which machines used ionizing radiation and which did not.

The second theme concerned inadequate awareness of radiation protection measures. Modern radiation protection rests on three canonical principles: time, distance, and shielding. Exposure accumulates with duration, so minimizing time near a source reduces dose; intensity falls off with the inverse square of distance, so stepping back even a meter or two dramatically cuts exposure; and lead aprons, thyroid collars, and leaded barriers attenuate the beam before it reaches tissue. The study found that although most nurses acknowledged that radiation exposure could be harmful, their detailed understanding of dose limits, the justification of procedures, and specific protection strategies was limited. Occupational dose limits, set by national and international bodies, define how much ionizing radiation a radiation worker may receive per year, and monitoring devices such as film badges or thermoluminescent dosimeters exist precisely to track that accumulation. Without knowing these thresholds or how monitoring works, nurses cannot judge whether their own exposure is being managed responsibly.

The third theme, inconsistent patient education practices, may be the most consequential for patient care. Nurses are often the clinicians patients ask first: Is this scan safe? Will it harm my baby? Why do I need another CT? Answering such questions well requires an accurate mental model of dose and risk, including the ability to explain that a single diagnostic X-ray delivers a small fraction of the dose associated with clearly demonstrated harm, while repeated high-dose imaging carries a cumulative consideration that clinicians weigh against diagnostic benefit. The interviews showed that patient education happened unevenly, depending on the individual nurse’s confidence and background rather than on a standardized, evidence-based approach. In a busy emergency department, an inconsistent answer is not merely a missed teaching moment; it can shape whether a patient consents to a necessary procedure or refuses one.

The fourth theme captured a keen recognition of occupational risks, particularly during pregnancy. This concern is well founded. A developing fetus is among the most radiosensitive tissues in the human body, and international guidance recommends that pregnant radiation workers declare their pregnancy so that dose monitoring and work assignments can be adjusted accordingly. The nurses in the study were clearly alert to this vulnerability, and their anxiety about working in radiation environments while pregnant emerged as a recurring thread in the interviews. Yet awareness of a risk without the technical knowledge to evaluate or mitigate it produces fear rather than safety, and the researchers noted that this recognition coexisted with the same knowledge gaps documented elsewhere in the data.

The fifth theme was, in some ways, the most hopeful: a strong and consistent desire for continuing education. Participants repeatedly expressed the need for additional training and called for improved radiation content within nursing curricula. This appetite matters because the study’s conclusions point in exactly that direction. The authors conclude that the findings indicate substantial gaps in radiation safety knowledge among nurses working in radiation-related clinical areas, and they recommend strengthening radiation protection education in undergraduate nursing programs alongside regular continuing professional development initiatives. The logic is straightforward: attitudes were largely favorable, and practices faltered mainly because knowledge was thin, so education is the highest-leverage intervention available.

The study’s design shapes how its findings should be read. With seventeen participants, all female, all drawn from a single tertiary center in one Indian state, and all interviewed rather than tested, this was a qualitative descriptive study, not a survey measuring the prevalence of misconceptions across a profession. Qualitative work of this kind cannot say what percentage of nurses misunderstand ionizing radiation; it can only illuminate how misunderstanding manifests, how it feels from the inside, and what structures produce it. What it loses in statistical generalizability it gains in depth, and the consistency of the five themes across interviews gives the findings weight. The research received no external funding, was approved by the Institutional Ethics Committee of Shri JJT University under approval number JJTU/R&D/DAL/027, and was conducted in accordance with the Declaration of Helsinki, with written informed consent obtained from all participants and no competing interests declared by the authors.

The broader context makes the study timely. Medical imaging has expanded enormously over recent decades, and CT in particular now accounts for a large share of the collective medical radiation dose delivered to populations. Meanwhile, the bedside nurse, not the radiologist or the radiographer, is frequently the constant presence when portable imaging reaches a critically ill patient, when a fluoroscopic procedure runs long in theatre, or when a frightened family wants answers at three in the morning. If the people occupying that position cannot distinguish an MRI from a CT or explain why a lead apron matters, the safety culture of an entire hospital acquires a quiet structural weakness. The study’s authors frame their work as evidence for curricular reform, and the interviews themselves supply the argument: nurses want to protect their patients and themselves, they already believe the hazard is real, and what stands between that belief and safe practice is training that nursing education has, so far, failed to deliver. Closing that gap, the researchers suggest, would improve safety practices, patient education, and occupational protection in equal measure, turning an anxious workforce into a knowledgeable one.

Subject of Research: Radiation safety knowledge, attitudes, and practices among nurses working in radiation-related hospital departments

Article Title: Radiation safety knowledge, attitudes, and practices among nurses working in radiology departments: a qualitative study

Article References: Radiation safety knowledge, attitudes, and practices among nurses working in radiology departments: a qualitative study. (n.d.). https://doi.org/10.1186/s12912-026-05467-1

Image Credits: AI Generated

DOI: 10.1186/s12912-026-05467-1

Keywords: radiation safety, nurses, radiology, ionizing radiation, radiation protection, qualitative research, nursing education, patient education, occupational safety, KAP framework, medical imaging, pregnancy