Introduction

Occupational Safety and Health (OSH) is a multidisciplinary field focused on ensuring the safety and well-being of workers.¹ Its primary aim is to create and maintain a safe and healthy work environment through comprehensive health and safety programs.² Under common law, employers are legally obligated to prioritize the safety of their employees, with additional regulations often set by government bodies to enforce specific standards and tasks.³ OSH not only safeguards workers but also extends protection to coworkers, families, employers, and others who may be impacted by the working environment.⁴

A healthcare facility is dedicated to providing patient care through various services, including diagnosis, treatment, and preventive measures.⁵ Individuals employed within these facilities are recognized as healthcare workers (HCWs).⁶ Globally, healthcare facilities employ more than 59 million workers, according to the World Health Organization (WHO).^7,8 In the Kingdom of Saudi Arabia (KSA), the healthcare sector employs around 424,000 workers, comprising both Saudi citizens and expatriates.⁹ In healthcare settings, particularly hospitals, infection control is a critical aspect of patient care.¹⁰ Hospitals, while dedicated to treating diseases, also serve as environments where individuals with compromised health are more susceptible to infections.¹¹

For radiology workers, adhering to infection control policies is a fundamental professional responsibility, essential for ensuring the safety of patients, radiology technologists, and other healthcare team members.¹² The ongoing emergence of new diseases, the re-emergence of old ones, and the rise of hospital-acquired infections resistant to multiple drugs underscore the importance of these policies in preventing the spread of infections.¹³ In the field of radiology, occupational hazards are diverse and include biological, psychological, and physical risks.¹⁴ Among these, ionizing radiation stands out as a critical diagnostic tool in medical imaging, widely utilized across various therapeutic and diagnostic applications. While ionizing radiation plays a pivotal role in modern medicine, it is essential to balance its benefits with the associated risks.¹⁵ The hazardous effects of ionizing radiation on biological systems are well-documented, including its potential to cause irreversible damage.¹⁶ Exposure to ionizing radiation has been linked to an increased risk of cancer and can adversely affect various systems in the body, such as the gastrointestinal and central nervous systems, as well as the gonads.¹⁷ These effects may manifest in the individual exposed (somatic effects) or in future generations (genetic effects).¹⁸

The working conditions of HCWs are closely tied to the quality of care provided to patients. Factors such as psychosocial dynamics, shift schedules, work hours, team management, and organizational culture all play crucial roles in determining the health and safety of HCWs.^19–21 Contrary to the common perception that HCWs are resistant to illness, research reveals a different reality.^6,22–26 Ensuring the well-being of HCWs not only safeguards public health but also strengthens a workforce that constitutes 10 to 18% of a nation’s total workforce.^9,27 Despite efforts to reduce occupational risks, HCWs around the world still encounter various biological and non-biological hazards in their workplaces.^28,29

In Saudi Arabia, the Ministry of Health (MOH) established a standardized policy to ensure a safe and healthy environment across all public and private healthcare facilities. Each facility has developed its own vision, mission, and policies, aligned with the overarching guidelines set by the MOH.⁵ Regular evaluation of the occupational health risks encountered by healthcare workers is crucial for enhancing the nation’s public healthcare system.^20,27 This improvement can be realized by identifying the current prevalence of health hazards and the risk factors that healthcare workers face in their workplaces.^27,29 In 2018, Abdulmageed et al conducted research on 161 hCWs at a Hospital in Jeddah to identify the risk factors for biological hazards. Their findings revealed that 32.90% of the participants had experienced sharps injuries, with nurses being especially vulnerable due to factors like long work hours, rotating shifts, and heavy workloads.²⁵ A recent study involving 379 physicians and nurses across six hospitals in Makkah found that 67.8% had experienced work-related injuries.³⁰ A study conducted in select government hospitals in Saudi Arabia revealed that nurses, in particular, face an annual incidence of 3.2 needlestick injuries (NSIs) per 100 occupied beds.³¹ Similarly, recent research in a Medina region hospital reported that 32% of HCWs experience NSIs each year.³² Furthermore, in a study of 450 dental assistants from 40 private clinics in Jeddah, 63% reported experiencing NSIs but did not report them to authorities, with factors such as non-compliance with hepatitis B vaccination protocols, inadequate knowledge of infection control, and attending to 12 or fewer patients daily being significantly linked to a higher risk of NSIs.³³

The existing literature reveals a notable gap in research on occupational hazards specific to radiology technologists, both globally and in Saudi Arabia. While studies have generally addressed HCWs, they have largely overlooked the unique risks faced by radiology technologists, who are exposed to a distinct set of hazards, including radiation. This study seeks to address this gap by focusing exclusively on the occupational hazards encountered by radiology technologists in the study area, with the aim of providing insights that can inform safety protocols both locally and internationally. Our study hypothesizes that radiology technologists in Saudi Arabia are subjected to distinct occupational hazards that are currently underreported or underestimated. This forms the basis for our investigation and sets the stage for a deeper exploration of the associated health implications. The primary objective of this research is to identify and evaluate the key factors contributing to these hazards, thereby offering critical insights that have not been explored in previous studies. This focus not only highlights the significance of the issue but also underscores the necessity of addressing the occupational safety of radiology technologists. In Saudi Arabia, a Radiology Technologist is defined as a professional with a bachelor’s degree, which includes four years of undergraduate education and a one-year internship.^34–36

Materials and Methods

Participants and Procedure

A descriptive questionnaire study was carried out between January and February 2023, targeting radiology technologists employed in the medical imaging department at King Abdulaziz Medical City (KAMC) in Jeddah, a prominent tertiary hospital in Saudi Arabia. KAMC is a part of the Ministry of National Guard Health Affairs (MNG-HA), a government-funded health system established in 1983, renowned for its comprehensive healthcare services. The study invited all 75 radiology technologists working at KAMC to participate. Using the Raosoft^® Sample Size Calculator,^37,38 the recommended sample size was determined to be 63, considering a 5% margin of error and a 95% confidence level. The study focused exclusively on radiology technologists, excluding radiologists and nurses. Participants were recruited through non-probability convenience sampling via Email and WhatsApp invitations. The survey was administered online using Google Forms.

Study Measures

Radiology technologists were invited to complete a questionnaire that has been previously employed among radiographers. The questionnaire was initially developed based on a comprehensive review of relevant literature, with a particular focus on occupational hazards specific to radiology technologists. Notably, we referred to established research, such as Rajan et al’s study on radiographers’ perceptions of occupational hazards,³⁹ to align the questionnaire’s content with existing evidence in this domain and therefore enhance its relevance and content validity. Following its preliminary development and to ensure the instrument’s face validity, the questionnaire underwent a rigorous review process by a panel of experts, including three senior radiology practitioners with substantial expertise in radiological technology, along with the director of infection prevention and control and a consultant microbiologist with extensive experience in environmental and occupational health and safety. This expert review process guaranteed that the questionnaire was precisely tailored to our study’s demographic, was clear and concise, and maintained a focused and purposeful approach for accurately assessing occupational hazards in radiology settings. The questionnaire consistent use in previous research highlights its reliability in capturing similar constructs effectively across studies.^40,41

The questionnaire used to gather primary data was divided into two sections. Section “A” focused on the background information of the radiology technologists, while Section “B” addressed nine major causes of occupational hazards, each encompassing various subfactors. The second part of the questionnaire was structured using a five-point Likert scale, offering responses ranging from Strongly Agree to Strongly Disagree, with corresponding values of 5, 4, 3, 2, and 1. The perceptions of the radiology technologists were then quantified and categorized into three levels based on a 5-point Likert scale: 1–2 = Low, 3 = Moderate, and 4–5 = High.

Ethical Consideration

This research received approval from the local Institutional Review Board (IRB) under protocol number SP23J-137-08. Participation was entirely voluntary, with participants providing written informed consent prior to completing the questionnaire. The consent process was integrated into the Google Form questionnaire, where participants were asked to carefully read the consent form at the beginning and indicate their agreement by selecting an option before continuing. All responses were kept anonymous and confidential, adhering strictly to the principles outlined in the Declaration of Helsinki. The electronic survey application generated a password-protected Microsoft Excel file that excluded any identifying participant information.

Statistical Analyses

The statistical analyses were carried out in three distinct phases. Initially, a descriptive analysis was performed to outline demographic characteristics, including counts and percentages, and to compute the mean and standard deviation (SD) for the sample’s scores. Next, the Shapiro–Wilk test was utilized to evaluate the normality of the score distribution. Lastly, Mann–Whitney U and Kruskal–Wallis H nonparametric tests were employed to explore potential variations in weighted mean scores across occupational hazard dimensions based on demographic factors. All analyses were executed using SPSS version 24, with a significance level set at p < 0.05.

Results

Characteristics of the Participants

Table 1 summarizes the sociodemographic profile of the radiology technologists. Out of 75 contacted technologists, 63 responded, yielding a participation rate of 84%. The gender breakdown was 44.4% males (n = 28) and 55.6% females (n = 35). The majority of participants, 77.8% (n = 49), were between the ages of 20 and 30. Nearly half of the participants (46.1%, n = 29) had less than one year of experience, while 41.2% (n = 26) had three or more years of experience. A notable portion (41.3%, n = 26) specialized in radiography, mammography, and fluoroscopy, and 28.6% (n = 18) specialized in computed tomography (CT).

Table 1 Characteristics of the Participants

Factors Contributing to Occupational Hazards

Table 2 through 6 outline the primary causes and underlying factors contributing to occupational hazards. Figure 1 represents the overall mean of the key dimensions influencing occupational hazards. Workload, work shift, interruptions, and patient-related factors exhibited the highest mean scores (greater than 3.7), followed by radiology technologist-related factors (mean = 3.6) and organizational structure and policy (mean = 3.59). A rigid leadership style and unequal treatment of employees were identified as the leading organizational structure and policy-related factors linked to occupational hazards, with 68.3% (n = 43) of respondents agreeing or strongly agreeing (Table 2). Conversely, tasks such as bending and lifting heavy patients, along with frequent walking and climbing stairs to perform mobile X-rays, were recognized as the primary radiology technologist-related factors contributing to occupational hazards. These factors were agreed upon by 69.8% (n = 44) and 60.3% (n = 38) of respondents, respectively (Table 3).

Table 2 Causes of Occupational Hazards: Organizational Structure and Policy Factors

Table 3 Causes of Occupational Hazards: Radiology Technologists’ Specific Factors

Figure 1 Aggregate Mean of Main Dimensions Contributing to Occupational Hazards.

The fear of making errors during work processes and report preparation emerged as the top fear and safety-related factor associated with occupational hazards, with nearly half of the participants (49.2%, n = 31) expressing agreement or strong agreement. Furthermore, factors such as insufficient radiographers and support staff, poorly maintained equipment, and the unavailability of doctors were identified as the primary resource-related contributors to occupational hazards, with over 44% of participants agreeing or strongly agreeing (Table 4).

Table 4 Causes of Occupational Hazards: Fear and Safety, Resources Factors

Excessive workload, cited by 68.3% (n = 43) of participants, along with long working hours and the inability to leave duty on time (65.1%, n = 41), were the most prominent workload and shift-related factors contributing to occupational hazards. Additionally, cramped workspace and prolonged exposure to air conditioning, which increases susceptibility to infections, were identified as the key environment and hygiene-related factors, with more than half of the respondents agreeing or strongly agreeing (Table 5).

Table 5 Causes of Occupational Hazards: Workload & Work Shift, and Environment & Hygiene Factors

High levels of pressure from various sources, including the heavy involvement of outpatient departments and personal assistants in report-related tasks, as well as receiving conflicting instructions from multiple authorities, were identified as significant contributors to occupational hazards, with over 58% of respondents expressing agreement or strong agreement. Additionally, insufficient information on job-related occupational hazards and the absence of clear guidelines were highlighted as key communication and training issues, with more than half of the participants concurring. Furthermore, dealing with infectious patients, such as those with Tuberculosis or HIV, was noted as a major occupational risk by 76.2% (n = 48) of respondents, while managing emotionally unstable patients and their relatives was identified by 60.3% (n = 38) as a prominent patient-related factor contributing to these hazards (Table 6).

Table 6 Causes of Occupational Hazards: Interruption & Work Shift, Communication & Training, and Patient Factors

Workload, shift patterns, patient interactions, and interruptions emerged as the primary factors contributing to occupational hazards among radiology technologists (Figure 1). Interestingly, no statistically significant differences were observed in the weighted mean scores across occupational hazard dimensions when analyzed by demographic factors (Table 7).

Table 7 Inferential Analyses of Occupational Hazard Dimensions by Demographic Variables

Discussion

This study explored potential factors contributing to occupational hazards among radiology technologists at a major tertiary hospital in Jeddah, Saudi Arabia. The research findings suggest several noteworthy trends: First, workload, work shifts, interruptions, and patient-related factors appeared to play a more prominent role in contributing to occupational hazards compared to technologist-specific factors or organizational structure. Additionally, 68.3% of participants reported that a rigid leadership style and disparities in employee treatment might exacerbate occupational hazards within the organization. Over half of the respondents also indicated that insufficient staffing and a lack of adequate radiation protective devices could contribute to these hazards. Moreover, high workloads, extended working hours, and physically demanding tasks were perceived as significant risks by radiology technologists. Finally, frequent interaction with infectious or emotionally unstable patients, along with the fear of making errors, were identified as potential hazards related to patient interaction and safety concerns.

Public hospital staff often face significant challenges due to overwhelming workloads and insufficient staffing, especially in developing countries where health infrastructure is underdeveloped and resources are scarce.⁴² This environment leaves HCWs particularly vulnerable to various occupational hazards, with stress being a prevalent issue.⁴³ The demands of hospital jobs, characterized by high expectations and heavy workloads, frequently lead to job strain, physical exertion, and increased exposure to hazards, all of which contribute to the stress experienced by healthcare professionals.⁴⁴ In fact, the present study found that 68.3% of radiology technologists identified excessive workload and 52.4% identified inadequate staffing as significant contributors to these occupational hazards.

In this study, rigid leadership styles and unequal treatment of employees were identified as key organizational factors contributing to occupational hazards, with 68.3% of respondents agreeing or strongly agreeing with this observation. Hierarchical and inflexible leadership can cultivate a work environment marked by heightened stress, diminished autonomy, and poor communication—factors consistently linked to increased occupational risks.⁴⁵ Such leadership not only stifles employees’ ability to voice concerns but also creates a climate where strict adherence to protocols may overshadow personalized support for staff well-being.^46,47 In these settings, radiology technologists may feel powerless to advocate for safer working conditions or challenge policies that heighten their exposure to hazards, such as extended work hours or inadequate radiation safety measures. Moreover, the disparities in employee treatment identified in this study—particularly in salary, promotions, shift schedules, and recognition—reflect an organizational culture where inequality is prevalent. These disparities exacerbate stress and job dissatisfaction, both of which are well-established precursors to mental and physical health issues in healthcare environments.^48–51 Employees who perceive themselves as undervalued or unfairly treated are also more prone to burnout, a condition closely linked to compromised safety practices and an elevated risk of errors.^48,52

In the present study, 54% of radiology technologists identified the shortage of adequate radiation protective devices and lack of guidelines as a key resource and communication-related factors contributing to occupational hazards. This observation is consistent with previous research conducted among 60 radiographers in a multi-specialty hospital in Tirunelveli City, India, which also highlighted the insufficient availability of protective devices as a significant contributor to occupational risks in the field.³⁹ While the scarcity in the Tirunelveli study was attributed to financial constraints limiting access to essential safety equipment, the situation in the present study may reflect different underlying causes, such as administrative inefficiencies or gaps in policy implementation. Although financial barriers may not be as severe in Saudi hospitals, the shortage of protective devices continues to increase the risk of occupational exposure, underscoring the need for a more systematic approach to resource allocation and enforcement of safety protocols.

The results of the present study reveal that 76.2% of radiology technologists identified dealing with infectious patients, such as those with tuberculosis or HIV, as a primary cause of occupational hazards. These findings are consistent with other studies that highlight the risks associated with exposure to infectious patients.^39,53,54 The likelihood of infection following an incident involving contaminated blood depends on several factors, including the type of exposure, the amount of infectious material, the inoculum size, the host’s immune response, and the specific infectious agent involved.⁵⁴ Moreover, this aligns with research indicating that paramedics, due to their direct patient interactions, face increased vulnerability to occupational health hazards, particularly the risk of contracting hepatitis B in hospital departments where frequent contact with blood is common.⁵³

Occupational hazards in healthcare settings are often rooted in inadequate equipment, poor work environments, and improper posture.^39,55 Issues such as insufficient or outdated equipment, poorly designed work areas, and direct physical injuries, along with poor posture, contribute to these risks.^56,57 Physical hazards like inadequate lighting, excessive noise, and trauma, as well as biological risks from radiation and microorganisms, further exacerbate the situation. Additionally, prolonged sitting with a flexed or twisted back can lead to neck, lower back, and other musculoskeletal problems among HCWs.^56,58,59 The present study highlights that nearly half of radiology technologists identified inadequate workspace, outdated X-ray and scan machines, and malfunctioning equipment as significant contributors to occupational hazards. Furthermore, over 60% of respondents pointed to factors such as bending and lifting heavy patients, prolonged radiation exposure, and frequent walking and climbing stairs to perform mobile X-rays as major sources of these hazards.

Insufficient training and poorly designed environmental programs significantly contribute to occupational hazards.^60,61 Previous studies revealed a strong connection between organizational factors—such as the absence of safety training, a weak safety culture, and unsafe practices—and the incidence of work-related injuries among HCWs.^62,63 Notably, nearly half of the radiology technologists surveyed identified a lack of information about job-related hazards and insufficient training in critical areas like equipment handling, chemical use, report preparation, and patient interaction as major contributors to these risks.

Limitations

A key limitation of this study is the reliance on non-probability sampling, which may introduce selection bias and limit the generalizability of the findings. Additionally, the small population size reduces the statistical power of the study, potentially affecting the reliability of the results. Furthermore, the data were collected from a single hospital, which limits the ability to compare and generalize the findings across different healthcare settings, reducing the study’s external validity. Another important limitation of this study is the lack of a comparison group, such as other healthcare workers. Without this comparison, it is difficult to ascertain whether the identified occupational hazards are unique to radiology technologists or prevalent across other healthcare professions.

Implication of the Study

The findings of this study offer critical insights into the occupational hazards faced by radiology technologists and underscore the need for targeted interventions to enhance workplace safety. Given the identification of workload, inadequate staffing, and lack of proper safety equipment as primary contributors to these hazards, healthcare administrators should prioritize optimizing staffing levels, improving resource allocation, and ensuring the availability of necessary protective devices. Additionally, the significant role of rigid leadership and inequities in employee treatment suggests that fostering a more supportive and inclusive organizational culture could mitigate many of the risks associated with occupational hazards. Furthermore, the study’s emphasis on the need for better training and environmental safety programs highlights the importance of comprehensive safety education tailored to the specific challenges faced by radiology technologists. Addressing these issues through policy changes and targeted training initiatives could not only reduce the incidence of work-related injuries but also improve overall job satisfaction and performance among HCWs.

Additionally, the implications of this research extend beyond the immediate context of the study, calling for a broader examination of occupational hazards in healthcare settings in Saudi Arabia. Future research should consider a more extensive and diverse sample across multiple institutions to validate these findings and develop more generalized strategies for mitigating occupational risks in the healthcare industry. Finally, future research is encouraged to employ multivariate analysis techniques, such as multiple regression or factor analysis, to gain a deeper understanding of the interactions among demographic and occupational factors contributing to occupational hazards. Such methods could offer a more comprehensive perspective on the collective influence of multiple variables on hazard dimensions, enhancing the analytical depth of occupational health studies.

Conclusion

This study provides a comprehensive examination of the occupational hazards confronting radiology technologists at a leading tertiary hospital in Jeddah, Saudi Arabia. The findings reveal that the most significant contributors to these hazards are high workloads, work shifts, frequent interruptions, and patient-related factors, which collectively overshadow other elements like technologist-specific issues and organizational structure. A concerning 68.3% of participants identified rigid leadership styles and disparities in employee treatment as exacerbating factors, highlighting the critical impact of organizational dynamics on workplace safety. Additionally, the study uncovered that more than half of the respondents pointed to insufficient staffing and a lack of adequate radiation protective devices as key resource-related issues that heighten occupational risks. The demanding nature of the work, characterized by extended hours and physically taxing tasks, poses substantial challenges specific to radiology technologists. Moreover, the frequent interaction with infectious or emotionally unstable patients, alongside the constant pressure to avoid errors, further complicates the safety landscape for these professionals. In sum, this study highlights the urgent need for targeted interventions in staffing, resource allocation, and organizational culture to mitigate the occupational hazards faced by radiology technologists. The insights gained here serve as a foundation for developing strategies that prioritize the well-being and safety of HCWs in similar high-risk environments.