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Brazilian Journal of Clinical Medicine and Review

Special Issue: Health Research in Sub-Saharan Africa

Vol. 4 No. 1 (2026): January/December - 2026

Perception of Physicians' Knowledge Regarding Guidelines and Clinical Practice in Prescribing Diagnostic Imaging Exams at a Hospital in Luanda, Angola

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2026.4.1.bjcmr61
Submitted
January 29, 2026
Published
2026-03-09

Abstract

This study aimed to assess physicians' perceptions of their knowledge of guidelines and clinical practice in prescribing imaging exams. A cross-sectional study was conducted from October to December 2025 at the Military Hospital in Luanda, Angola. Data were collected through an online questionnaire, the link to which was shared in several WhatsApp groups of physicians. The chi-square or Fisher's exact test, univariate and multivariate logistic regression analyses were used. A p-value <0.05 was considered significant. A total of 109 physicians participated in the study, 53.2% were women, with a mean age of 35.8±7.7 years and 78.0% were resident physicians. Of those, 51.4% had never heard of the guidelines, and 60.6% had inadequate knowledge regarding questions about the exams that use ionizing radiation. Specifically, 33.9% and 19.3% incorrectly stating that computed tomography and radiography, respectively, do not use ionizing radiation, and 34.9% incorrectly stating that magnetic resonance imaging does use it, without significant differences between being a specialist or resident, or having specific training in prescribing imaging exams or in radiation protection. A major investment in training and awareness among physicians is necessary to avoid the indiscriminate and incorrect use of imaging exams, service overload, and increased healthcare costs.

References

  1. Ståhlbrandt H, Björnfot I, Cederlund T, Almén A. CT and MRI imaging in Sweden: retrospective appropriateness analysis of large referral samples. Insights Imaging. 2023;14:134. doi:10.1186/s13244-023-01483-w.
  2. Liao S, Mo Z, Zeng M, et al. Fast and low-dose medical imaging generation empowered by hybrid deep-learning and iterative reconstruction. Cell Rep Med. 2023;4(7):101119. doi:10.1016/j.xcrm.2023.101119.
  3. Jensen C, Liu X, Chandler A, Sun J, Morani A, Javadi S, et al. Image quality assessment of abdominal CT by use of new deep learning image reconstruction: initial experience. AJR Am J Roentgenol. 2020;215:50–57. doi:10.2214/AJR.19.22332.
  4. Greffier J, Hamard A, Pereira F, Barrau C, Pasquier H, Beregi JP. Image quality and dose reduction opportunity of deep learning image reconstruction algorithm for CT: a phantom study. Eur Radiol. 2020;30:3951–3959.
  5. Baker M, Younger C, Lyall D. A systematic review of medical risk disclosure techniques and its application to ionising radiation risk. Radiography. 2026;32(1):103212. doi:10.1016/j.radi.2025.103212.
  6. Dijk SW, Wollny C, Kroencke T, Hunink MGM. Sex differences in inappropriate imaging requests: insights from the Medical Imaging Decision And Support (MIDAS) study. Eur Radiol. 2025. doi:10.1007/s00330-025-12088-w.
  7. Alhussinan AR, Almutairi HF, Alanazi AM, Aowad S. Assessment of radiological practices: knowledge of irradiation, medical imaging prescriptions, and clinical imaging referral guidelines among physicians. J Popul Ther Clin Pharmacol. 2022;29:502–507.
  8. Bwanga O, Chanda E. Challenges in radiation protection in healthcare: a case of Zambia. EAS J Radiol Imaging Technol. 2020;2(1):7–14. doi:10.36349/EASJRIT.2020.v02i01.002.
  9. Gyan E, Subaar C, Edusei G, Nyarko L. Paediatric computed tomography diagnostic reference levels in Africa: a systematic review. J Med Radiat Sci. 2025;72:139–147. doi:10.1002/jmrs.824.
  10. Lee AMLMJ. Radiation safety awareness among medical interns: are EU guidelines being implemented? Ir J Med Sci. 2017;186(3):547–553. doi:10.1007/s11845-016-1530-7.
  11. Cohen JA. Knowledge of radiation legislation and guidelines amongst foundation doctors is inadequate for safe practice in the current era of radiology. Clin Radiol. 2019;74(6):418–420. doi:10.1016/j.crad.2019.01.020.
  12. Kawooya MG, Kisembo HN, Malumba R, Nsereko E. Effectiveness of clinical imaging guidelines to reduce inappropriate head computed tomography imaging: a case of Uganda. Egypt J Radiol Nucl Med. 2022;53:164. doi:10.1186/s43055-022-00833-w.
  13. Dean A, Sullivan K, Soe M. OpenEpi: Open Source Epidemiologic Statistics for Public Health. 2013.
  14. Johnson L, Burton C, Green C, Kitchen D, Liu Y, Moirano J, et al. ACR Appropriateness Criteria: Radiation Dose Assessment Introduction. 2023.
  15. Eysenbach G. Improving the quality of web surveys: the checklist for reporting results of internet e-surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34. doi:10.2196/jmir.6.3.e34.
  16. Ong’ayo L, Yoon H. Radiological justification criteria of pediatric computed tomography in Kenya. Health Phys. 2026;130(1):183–187. doi:10.1097/HP.0000000000002089.
  17. Moifo B, Tene U, Roger J, Tapouh M, Ngano OS, Youta JT, et al. Knowledge on irradiation, medical imaging prescriptions, and clinical imaging referral guidelines among physicians in a Sub-Saharan African country (Cameroon). Radiol Res Pract. 2017. doi:10.1155/2017/1245236.
  18. Dylla L, Krothapalli N, Tu L, Payabvash S, Burke J, Sheth K, et al. Trends in head CT use in US emergency department patients from 2007 to 2022: a nationwide analysis. Neurology. 2025;105(12):e214347. doi:10.1212/WNL.0000000000214347.
  19. Campanella F, Rossi L, Giroletti E, Micheletti P, Buzzi F, Villani S. Are physicians aware enough of patient radiation pro-tection? Results from a survey among physicians of Pavia District, Italy. BMC Health Serv Res. 2017;17:406. doi:10.1186/s12913-017-2358-1.
  20. Harbaj I, Kharchaf A, Chakir E, Harbaj S. Evaluation of knowledge, attitudes, and practices regarding the justification of radiological examinations among general practitioners in Morocco. Radioprotection. 2025;60(3):242–249. doi:10.1051/radiopro/2024048.
  21. Hoveidaei A, Heidari S, Rahimzadeh R, Hamidreza G. Medical radiation knowledge among medical doctors and students in Iran: a nationwide cross-sectional study. J Med Imaging Interv Radiol. 2025;5. doi:10.1007/s44326-025-00050-5.
  22. Mellis S, Zhang Y, Mcateer D. Awareness of radiation risks by medical students and referrers requesting radiological ex-aminations in the North of Scotland: an audit. BMC Med Educ. 2024;24:830. doi:10.1186/s12909-024-05461-8.
  23. Instituto Nacional de Estatística (INE Angola). Instituto Nacional de Estatística. Available from: https://www.ine.gov.ao.
  24. Angola. Ministério da Economia e Planeamento. Plano de Desenvolvimento Nacional 2023–2027. Available from: https://www.mep.gov.ao/assets/indicadores/angola2050/20231030(3)_layout_Final_Angola_PDN 2023-2027-1.
  25. Kisembo HN, Malumba R, Nassanga R, Ameda F, Salama DH, Kawooya MG. Effect of continuous medical education on awareness of clinical imaging guidelines among imaging referrers in Sub-Saharan Africa. Int J Med Imaging. 2023;11(1):6–11.
  26. Hobbs JB, Goldstein N, Lind KE, Elder D, Dodd GD III, Borgstede JP. Physician knowledge of radiation exposure and risk in medical imaging. J Am Coll Radiol. 2018;15(1):34–43. doi:10.1016/j.jacr.2017.08.034.
  27. INAARES. Resultados do processo de avaliação externa e acreditação do ensino superior dos cursos de medicina e outras ciências da saúde. Angola: MESCTI; 2024.