Introduction: Unintended exposure of patients to ionizing radiation in healthcare settings represents a significant safety risk that can lead to deterministic and stochastic effects. Despite advances in radiological protection and the implementation of safety standards, adverse events remain frequent, mainly due to procedural errors, technical failures, or inappropriate use of diagnostic and therapeutic modalities. Purpose: This study aimed to investigate the causes of unintended patient exposure in healthcare, analyze them according to different radiological modalities, and compare their characteristics, with the goal of enhancing the safety culture, optimizing procedures, and reducing associated risks. Methods: A descriptive method and systematic literature review were employed. Data were collected from databases (Science Direct, SpringerLink, PubMed) and professional web sources, with the search limited to the period 2020 – 2025. Using a screening process, predefined inclusion and exclusion criteria, and relevance assessment, 28 sources were included in the final analysis. Results: The analysis revealed that procedural factors were predominant (e.g., use of inappropriate imaging protocols, incorrect patient identification, repeat imaging due to improper exposure settings), followed by technical factors (equipment malfunctions, software errors) and patient-related factors (non-cooperation during examination, high body mass index). By modality, interventional radiology showed frequent protocol deviations and prolonged exposures; computed tomography often involved incorrect protocol selection or exposure settings; radiotherapy errors included inappropriate treatment field/dose; and nuclear medicine incidents involved incorrect radionuclide dosing. Conventional radiography had the fewest cases, usually related to repeated imaging due to poor image quality. Discussion and Conclusion: The findings confirm that unintended exposure is predominantly caused by human error, often compounded by staffing shortages and time pressures. Technical improvements alone cannot eliminate errors without adequate training and systematic quality assurance. Implementing the ALARA principle, using diagnostic reference levels, and adhering to referral guidelines for radiological examinations could significantly reduce adverse event rates. Unintended patient exposure remains a key challenge in healthcare. Its reduction requires a comprehensive approach integrating technical improvements, protocol optimization, regular staff training, and strengthening of the safety culture. The results highlight the need for strict adverse event reporting, thorough cause analysis, and broader implementation of international recommendations into clinical practice.
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