Adherence and Barriers to Effective CT Dose Management Among Radiographers in Northeastern Nigeria: A Multicentre Study

Abstract

Computed Tomography (CT) accounts for a substantial proportion of medical radiation exposure globally. Although the International Commission on Radiological Protection (ICRP) recommends structured dose management strategies, including the use of Diagnostic Reference Levels (DRLs) and dose monitoring systems, implementation remains inconsistent in many low-resource settings, with limited evidence from northeastern Nigeria. This study assessed adherence to recommended CT dose management practices and identify challenges to the effective implementation among radiographers in northeastern Nigeria. A cross-sectional study was conducted among radiographers working in public and private facilities with functional CT scanners across selected northeastern states. Data was collected using a validated questionnaire and structured observational checklist (S-CVI/Ave of 0.87), (Cronbach’s α = 0.724). Descriptive statistics and the Mann–Whitney U test was used for data analysis. A total of 110 radiographers participated (64.5% male; mean experience 6.21 ± 4.39 years). Only 36.7% reported active patient dose monitoring, 38.2% acknowledged established DRLs, and 30.9% regularly reviewed dose reports. Protocol selection based on clinical indication was observed in only 4.5% of cases. Patient dose tracking was absent in 90.9% of observed examinations. Major barriers included lack of training (75.5%), limited awareness (62.7%), time constraints (40.0%), equipment limitations (38.2%), and resistance to change (30.9%). CT dose optimization in northeastern Nigeria remains suboptimal and requires structured training, institutional reform, and mandatory dose monitoring frameworks to align practice with international standards.