# Knowledge, attitudes, and practices of healthcare professionals toward radiation safety in Kazakhstan: a cross-sectional study

## TL;DR

This study examines how healthcare professionals in Kazakhstan use medical imaging and finds that many order unnecessary scans, suggesting a need for better training and practices.

## Contribution

The study identifies demographic and practice-based factors linked to unnecessary CT scans and highlights gaps in radiation safety knowledge among clinicians in Kazakhstan.

## Key findings

- Clinicians aged <34 years and those with <5 years of experience request more CT scans per month.
- 24.6% of clinicians reported ordering CT scans without clear clinical indications.
- 38% rarely review prior imaging studies before ordering new scans.

## Abstract

Clinicians’ overutilization of medical imaging increases patients’ exposure to ionizing radiation (IR). Assessing clinicians’ knowledge, decision-making, and potential for unnecessary imaging is therefore essential. This study aimed to investigate the knowledge, attitudes, and practices of healthcare professionals in Kazakhstan regarding imaging procedures involving IR.

A cross-sectional questionnaire-based study was conducted between June 2024 and May 2025 to assess healthcare professionals’ knowledge, attitudes, and practices regarding medical imaging involving IR. A thirty-item questionnaire was used, including a knowledge section scored on a scale of 0–10, with higher scores indicating greater knowledge of ionizing radiation and imaging safety. Group comparisons were performed using independent t-tests or one-way ANOVA for continuous variables and chi-square tests for categorical variables. Multivariable linear regression was used to examine predictors of CT scan requests per month (treated as a continuous count variable), with a p-value ≤0.05 considered statistically significant.

Of 250 distributed questionnaires, 218 were completed (response rate: 87.2%). Nearly two-thirds (68.8%) of respondents were female, with a mean age of 29.5 ± 6.9 years, representing diverse medical specialties. The mean knowledge score was 50.5 ± 5.9, and did not differ by gender or geographic location (independent t-test, p > 0.05). However, clinicians aged >35 years and those working in public hospitals had significantly higher knowledge (one-way ANOVA, p = 0.010; independent t-test, p = 0.048). In multivariable linear regression, clinicians aged <34 years (β = 0.401; 95% CI: 0.202–0.300; p ≤ 0.05), those with <5 years of experience (β = 0.338; 95% CI: 0.311–0.403; p ≤ 0.05), and clinicians in high-volume urban settings (β = 0.455; 95% CI: −0.281 to 0.391; p ≤ 0.05) were associated with a higher number of CT requests per month. Notably, 24.6% reported ordering CT scans without clear clinical indications, influenced by workload pressures, patient expectations, fear of malpractice, and the need to expedite diagnostics. Additionally, 38% rarely reviewed prior imaging studies before ordering CT scans.

There is an observed gap in clinicians’ knowledge and imaging practices. These findings highlight the need for targeted educational interventions, improved access to prior imaging records, and organizational strategies to optimize medical imaging practices and reduce unnecessary patient exposure to ionizing radiation. However, these results should be interpreted with caution due to the cross-sectional study design, convenience sampling, and reliance on self-reported data.