I. Harbaj et al.: Radioprotection 2025, 60( 3), 242 – 249 247
the development of future educational programs focused on improving radiological examination justification practices among general practitioners.
The results indicate a moderate level of comprehension regarding the rationale of radiological exams, with a mean score of 6.41 ± 1.36 out of 12 points. This result is consistent with previous studies that indicated insufficient knowledge and underestimated the radiation doses and hazards associated with conventional diagnostic imaging procedures( Kada, 2010; Willoughby et al., 2013; Moifo et al., 2014; Semghouli et al., 2017; Bwanga, 2019; Tahiri et al., 2022; Amaoui et al., 2023). Similarly, a Norwegian study also showed that medical students had similar shortcomings, with an average score of 3.91 out of 11 points, underscoring the urgent need to improve radiation protection training in medical curricula( Kada, 2017).
The mean attitude score for justifying radiological testing was 3.79 ± 0.42 out of 5, indicating a high level. This result is consistent with a comparable study, which demonstrated that 74.6 % of prescribing physicians had a favorable attitude toward the rationale of radiological tests( Bwanga, 2019).
The practice of justifying radiological exams received a moderate rating( 3.38 ± 0.42 out of 5). This conclusion is similar to earlier studies that have revealed deficiencies in physicians’ practices. For example, only 12 % of CT scan prescribers inform their patients about the hazards caused by radiation exposure( Amaoui et al., 2023), that general medical interns do not systematically discuss radiological risks with their patients( Willoughby et al., 2013) and that only 10 % of doctors use CT examination guidelines( Semghouli et al., 2017). However, another study found that more than half of prescribers( 61.3 %) accurately follow procedures for justifying radiological exams( Bwanga, 2019).
The findings also revealed that females outperformed males in attitudes and practices, but there was no significant difference in knowledge. Women’ s meticulous approach to clinical decisionmaking and more compassionate communication with patients may have contributed to this outcome. Furthermore, older doctors and those with ten or more years of experience performed better in all three domains, highlighting the value of professional experience. Additionally, doctors working in private practice exhibited better knowledge, attitudes, and practices.
Regarding radiation protection training, 89.1 % of participants reported having received formal instruction— a finding that stands in stark contrast to previous studies where only 28 % and 35 % of participants had received training in radiology and radiation protection, respectively( Willoughby et al., 2013; Bwanga, 2019). A recent study in Morocco highlighted this disparity, revealing that only 20 % of clinicians had undergone radiation protection training( Amaoui et al., 2023). Interestingly, our study revealed an unexpected pattern: practitioners without formal training achieved higher scores across all three domains( knowledge, attitudes, and practices) than those with initial radiation protection training. This finding contradicts the results of similar studies( Kada, 2010; Yuan et al., 2024; El Fahssi et al., 2024), which demonstrated that formal training typically enhances knowledge and promotes practices aligned with radiation protection standards.
Our analysis suggests that older and more experienced practitioners have developed effective ways to compensate for their lack of initial training. They employ various learning strategies, including self-directed study, peer-to-peer knowledge exchange, and learning through extensive hands-on experience in clinical situations where radiation protection is crucial.
Furthermore, the ineffective nature of radiation protection training during medical studies in Morocco may explain this result. The training sessions, which occur in the early semesters( Amaoui et al., 2023), focus too much on theoretical concepts and fail to provide practical applications that align with field requirements. 86.9 % of participants supported this finding, considering their training insufficient. Another limiting factor is the lack of continuing education among all study participants. Ongoing training would have allowed practitioners to update their knowledge of technological advances and new radiation protection guidelines. As a result, untrained practitioners have developed solid radiation protection skills through practical experience and self-learning, matching or surpassing the impact of formal training, which often proves too theoretical or poorly suited to field needs.
Moreover, our study revealed significant positive correlations between general practitioners’ knowledge, attitudes, and practices regarding the justification of radiological examinations. Physicians with a better understanding of justification principles generally adopt more favorable attitudes and appropriate practices. This result underscores the importance of enhancing knowledge and improving attitudes to foster practices that comply with radiation protection standards. A coherent educational strategy, combining robust theoretical training with contextualized practical training, is essential to optimize the quality and safety of radiological care. However, this observation contrasts with another study, which found no significant association between knowledge, attitudes, and practices related to the justification of radiological examinations( Bwanga, 2019).
Finally, the multiple regression analysis identified several factors influencing justification practices. Knowledge of participants, along with their gender, age, and attitudes, emerged as significant predictors. The model explained 42.8 % of the total variance in observed practices. In contrast, professional experience and workplace location had no significant effect. Despite untrained practitioners achieving higher scores, the analysis did not identify radiation protection training as a determinant predictor of justification practices.
These findings highlight the need to revise foundational radiation protection training programs and implement mandatory targeted continuous education to regularly update physicians’ knowledge in line with current clinical requirements. Future studies should use qualitative methodologies, such as interviews or focus groups, to better understand practitioners’ sources of knowledge and their perceptions of the usefulness of existing training programs. These efforts will help address the gaps identified in this study and align training outcomes with tangible enhancements in clinical practices.