Radioprotection 2025, 60( 3), 242 – 249 © I. Harbaj et al., Published by EDP Sciences 2025 https:// doi. org / 10.1051 / radiopro / 2024048
Available online at: www. radioprotection. org
ARTICLE
Evaluation of knowledge, attitudes, and practices regarding the justification of radiological examinations among general practitioners in Morocco
I. Harbaj 1,*, A. Kharchaf 1, E. m. Chakir 1 and S. Harbaj 2
1 Materials and Subatomic Physics Laboratory, Faculty of sciences, Ibn Tofail University, Kenitra, Morocco. 2 Radiotherapy Department, National Institute of Oncology, Faculty of Medicine & Pharmacy, Mohammed V University, Rabat, Morocco.
Received: 4 September 2024 / Accepted: 24 November 2024
Abstract – This cross-sectional study aimed to evaluate Moroccan general practitioners’ knowledge, attitudes, and practices regarding the justification of radiological exams and to identify the factors influencing these practices. A total of 367 general practitioners completed a 44-item questionnaire. Data analysis used independent t-tests, ANOVAs, Pearson correlations, and multiple regressions. The mean scores for knowledge, attitudes, and practices were 6.41 ± 1.36 out of 12, 3.79 ± 0.42 out of 5, and 3.38 ± 0.42 out of 5, respectively. Practice scores varied statistically significantly by gender( p = 0.004), age( p = 0.000), work experience( p = 0.000), workplace( p = 0.010), and training( p = 0.011). Unexpectedly, physicians who had not received radiation protection training outperformed those who had. There were significant positive correlations between scores for knowledge and attitudes( r = 0.566, p < 0.001), knowledge and practices( r = 0.547, p < 0.001), and attitudes and practices( r = 0.517, p < 0.001). The factors influencing justifying radiological examinations were knowledge, attitudes, gender, and age. The study revealed insufficient knowledge and practice despite a positive attitude towards the rationale for radiological examinations. These results underline the need to reevaluate and improve existing training programs. We recommend focusing on practical cases and real-life clinical scenarios while developing ongoing training and support tools tailored to the local context.
Keywords: Justification / general practitioners / knowledge / attitudes / practices
1 Introduction
Medical imaging has advanced significantly in recent decades, and it is now a crucial tool for diagnosing and treating a wide range of pathologies. Technological advances, particularly in X-rays and computed tomography( CT), have significantly increased diagnostic accuracy, enhancing care quality. However, this development has resulted in a considerable rise in patient exposure to ionizing radiation. From 2009 to 2018, 4.2 billion radiographic exams were conducted annually globally, including diagnostic, interventional, and nuclear medicine radiography. Notably, CT scans, which account for only 9.6 % of all radiological examinations, contribute 61.6 % of the total collective dose due to their higher exposure level. CT exams have increased by 82 %, reaching an annual volume of over 400 million, demonstrating the rising relevance of this modality in medical imaging( UNSCEAR, 2022).
* Corresponding author: ilham. harbaj @ uit. ac. ma
To address these challenges, medical practitioners must understand radiation protection principles and the radiation doses corresponding to the different types of imaging. The principle of justification is fundamental, requiring a convincing demonstration that any radiation exposure results in a significant diagnostic or therapeutic benefit that outweighs the potential risks( ICRP, 2007). This notion is particularly pertinent in the context of CT scans, which add considerably to total radiation exposure. Strict adherence to justification criteria is critical not just for reducing radiation exposure but also for optimizing the use of healthcare resources.
This development raises serious concerns about the potential health effects of increased radiation exposure, particularly radiation-induced cancers( Nahangi and Chaparian, 2015; Karimizarchi and Chaparian, 2017). Although most studies on the overuse of imaging tests focus on expensive, high-dose radiation procedures like CT scanning, it is critical not to ignore the possible negative consequences of low-dose examinations( Bonnici, 2021). Around the world, rising concern focuses on inadequate compliance with justification requirements for radiological exams( Lehnert and Bree, 2010;
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