With the broad usage of X-ray, the protection of staff is becoming of high importance. The complexity of medical procedures creates the need for education and training in radiation safety especially during procedures as well as for the wearing of protective gears or tools to help prevent the risks associated with radiation [1] .

Ionizing Radiation (IR) is a non-invasive procedure being used to diagnose diseases, guide surgical procedures and it helps the treating physicians to assess and plan their therapeutic interventions through the use of different modalities such as X-ray, CT Scan and Mammography.

Wong et al. in their study assessing the knowledge and practice of radiological imaging among local physicians, radiologists and interns, reported that the perception was unsatisfactory and could imply a tendency to misuse radiation which could have deleterious effects [2] .

Willoughby et al. in a study carried out in England also revealed that participants have an estimated lifetime risk of cancer associated with radiological tests and had evaluated the underestimation of risk of procedures under radiation especially in the primary care [3] .

The populations most affected by Ionizing Radiation during procedures are the staff, the patients, and the general public. The doses are easily measured by Dosimetry mainly for the staff and the general public but for patients, it is not realistically possible to measure the dose directly [4] . The practice of untrained clinicians in radiological safety or Radiobiology uncovered the potential for injury. Thus, patient education on radiological safety can lead to protection from injury and future risk of cancer [5] .

Specialists such as cardiologists, vascular surgeons, gastroenterologists, etc., are aware of the risks of the ionizing radiation specifically when performing an intravascular surgery. During such a procedure, both the specialists and the patients are at risk of ionizing radiation hence, monitoring the exposure is of high necessity [6] .

Some medical procedures demand higher doses of radiation that are determined by various parameters on patient doses. The staff usage of Dosimetry has helped in determining the level of the exposure. A Previous study by Miller et al. showed [7] significant clinical radiation dose to the patient during most procedures.

Although several parallel studies have been published, there is a paucity of literature in this area of research in the Kingdom of Saudi Arabia, in particular Najran province where health education among the populace is rather low. However, there are a few studies in the rest of Arab nations. One of such studies showed that only 6.1% of the respondents were able to identify the As Low As Reasonably Achievable (ALARA) principle and as much as 98.2% did not know that there was no safe dose limit according to international recommendations. [8] .

The aim of the study was to assess patients’ knowledge and attitude of ionizing radiation among patients.

This was a cross-sectional study design, which involved three hundred seventy-five (375) consecutive patients attending the Medical Diagnostic Imaging (DMI) Department at King Khalid Hospital in Najran Province, Kingdom of Saudi Arabia for ionization radiological procedures. Ethical approval was obtained from the College of Public Health and Health Informatics Ethics Committee Ethics King Khalid Hospital, Najran. Written informed consent was obtained from each study participant prior to enrolment after duly explaining the objectives of the study.

The study was conducted over a period of 4 months at the Medical Imaging Department of King Khalid Hospital (500 beds capacity) in Najran, which is situated at the southern part of the Kingdom of Saudi Arabia. Najran province has a population of about (350,000) with an annual birth rate of (7500).

A Self-administered survey questionnaire that aims to assess the patients’ knowledge and attitudes toward the risks of radiation was developed. The questionnaires were written both in Arabic and English languages (Appendix 1). Responses were recorded based on 5 items in the Likert scale: “Strongly disagree, Disagree, Neutral, Agree and Strongly agree” and were randomly distributed by the Picture Archiving and Communication System (PACS).

The sample size was calculated based on one month patients’ visits that equal (6500) patients with marginal error (5%), confidence interval level (95%), and respondent distribution (50%). The required sample size was 363. In order to account for attrition, this was increased by 12 to give a total sample of 375. The questionnaires were randomly selected using the randomization table for the Radiology reception at King Khalid Hospital. A self-addressed envelope with number was included to facilitate the easy return of the paper copy while a dedicated address was available for the return of the questionnaire for those who chose to complete it.

The validity of research questionnaire was determined by conceptual approach which was based on literature review reference. The questionnaires were tested prior to the study on fifty patients so as to help standardize for readability, reliability and validity, in order to gain an adequate set of questions to capture what the research has intended to capture. The questionnaires were administered by the surveyor face to face and individually with a small group of participants (10% of the sample size) to help determine the accuracy, the language and the legibility of the survey. Thirty-three of the participants were approached in order to adjust the questionnaires according to their comments.

The data was analysed using the Statistical Package for Social Sciences (SPSS) version 22.0. Descriptive statistical analysis was performed to examine the frequencies and percentages of questionnaire responses on knowledge and attitudes about the radiation.

The study had a 100% response rate. Table 1 shows the distribution of study participants according to socio-demographic information. A total of 375 patients, 221 (58.9%) males and 154 (41.1%) females who required Ionizing Radiation procedures participated in the study after meeting the inclusion criteria. There were more male participants constituting about two-thirds of the study sample. The patients’ ages ranged from 17 - 82 years with a total mean of 29.58 ± 10.09 years. The modal age group was the young adults with a total number of 191 participants, constituting 51.1% of the study sample. There was however, no