Assessment of regulatory compliance in diagnostic X-ray facilities based on a radiation safety audit in Zanzibar

Regulatory compliance in radiation safety refers to adherence to national and international laws, standards, and guidelines that ensure the safe use of ionizing radiation to protect patients, workers, and the public from unnecessary exposure. This study evaluated regulatory compliance in radiation safety among 27 licensed diagnostic X-ray facilities in Zanzibar, where evidence on the implementation of radiation protection standards remains limited. The key variables assessed included safety training, personnel monitoring, safety infrastructure, documentation, and employee confidence in radiation safety practices.

A cross-sectional, descriptive design was employed. Data were collected from 81 participants through structured questionnaires, interviews, and observational audits. Quantitative analysis utilized Kendall's tau and Pearson's correlation to examine relationships between training frequencies, years of experience, and confidence in radiation safety knowledge, while qualitative findings provided contextual insights into observed practices.

Only 14.8% of facilities offered formal (structured) radiation safety training, and 11.1% of respondents reported high confidence in their knowledge. Training frequency showed a positive correlation with respondents' confidence (τ = 0.398, p = 0.035), whereas years of experience demonstrated a strong negative correlation (r = -0.736, p < 0.01). Observational data revealed limited use of radiation dosimeters, few appointed Radiation Safety Officers, and inconsistent shielding practices, despite a general awareness of the "As Low As Reasonably Achievable" (ALARA) principles and patient identification protocols.

Findings indicate significant weaknesses in radiation safety practices and regulatory enforcement in Zanzibar. Although general awareness exists, deficiencies in training, safety infrastructure, and inaccuracy persist. Strengthened training programs, institutional policy reform, and enhanced regulatory monitoring are essential to align with international safety standards and ensure optimal protection for patients and employees.