Process analysis for strengthening radiation safety practices in operating theatre

Radiation safety in operating theatres is critical due to the growing use of radiation-emitting equipment in surgical specialties. While individual knowledge and compliance have been widely studied, limited research has focused on the systemic processes influencing radiation protection implementation. This study aimed to analyze radiation safety processes across healthcare roles to identify factors that facilitate or hinder effective protection. A cross-sectional survey was conducted among 212 healthcare professionals (116 technologists, 57 nurses, 26 surgeons, and 13 anesthesiologists) working in operating theatres with radiation-emitting equipment. The survey assessed process effectiveness in seven areas: safety checks, responsibility clarity, equipment accessibility, dosimeter use, communication, learning from incidents, and interdepartmental coordination. Statistical analysis included descriptive statistics, Kruskal-Wallis tests, and content analysis. Ethical approval was obtained, and the sample size was justified based on statistical power considerations. Significant variations in process effectiveness were found across roles, especially in equipment accessibility (p = 0.0039) and communication (p = 0.0201). Anesthesiologists reported higher effectiveness scores, while surgeons reported lower scores. Only 25 % of participants reported "always accessible" radiation protection equipment, and 30.7 % cited insufficient training as a major barrier. Team communication was the top enabler (44.8 %), while time pressure (28.8 %) and lack of awareness (29.2 %) were key barriers. Radiation safety in operating theatres is a systems issue requiring a focus on organizational processes, not just individual compliance. Addressing systemic factors, such as equipment accessibility and communication, is crucial for improving radiation safety. Radiation protection, Operation theatres, Safety, Saudi Arabia.