Radiation safety knowledge and practices among urologists in Saudi Arabia: A cross-sectional survey analysis

Fluoroscopy is an essential tool in urological procedures, but it poses significant radiation risks to both patients and healthcare professionals. Urologists require adequate radiation safety knowledge and practices to mitigate these risks. However, studies suggest knowledge gaps and suboptimal implementation of safety measures. This study aimed to assess level of radiation safety knowledge and practices among urologists in Saudi Arabia, and to identify factors associated with better understanding and compliance with safety guidelines, with overall goal of informing strategies to improve radiation safety practices and enhance patient and provider safety. A cross-sectional survey was conducted among urologists in Saudi Arabia during the 36th Saudi Urological Annual Conference in Riyadh (2025). A structured, self-administered questionnaire was used to assess knowledge of radiation physics, awareness of exposure risks, adherence to safety guidelines, use of protective equipment, and participation in training programs. Descriptive statistics and logistic regression analysis were performed to examine associations between demographic and professional factors and radiation safety practices. The study was conducted and reported following the STROBE guidelines for cross-sectional studies. A substantial 47.9% reported no formal radiation safety training, yet 90.4% believed structured training in residency programs is essential. While 78.1% recognized the risks of long-term fluoroscopy exposure, 69.9% did not use dosimeters, and 82.2% relied on automatic settings without dose monitoring. Alarmingly, 41.1% were unfamiliar with adjusting fluoroscopy machine settings. Furthermore, 72.6% lacked formal training on fluoroscopy use, and 46.6% never reviewed safety literature. Despite these shortcomings, 79.5% expressed a strong interest in further education on radiation safety. Non-Saudi urologists showed significantly higher radiation safety knowledge (AOR 5.29, 95% CI 1.34-20.97, P = .02) and practice (OR 4.49, 95% CI 1.50-13.44, P = .007). Fluoroscopy use of > 10 cases/week was also associated with higher knowledge (AOR 5.77, 95% CI 0.49-67.93, P = .06). Significant gaps exist in radiation safety knowledge and practices among urologists in Saudi Arabia. Non-Saudi nationality and higher fluoroscopy use were associated with better knowledge. Formal training programs are urgently needed to improve compliance and mitigate radiation risks.