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Key Points Question What are the patient perceptions and knowledge about ionizing radiation used for medical imaging? Findings In this survey study among 2866 patients undergoing radiological examinations in Italian hospitals, a substantial proportion of respondents perceived their medical radiation knowledge as inadequate and had misconceptions about basic aspects of radiation protection. Better knowledge was associated with receiving such information from medical staff and having a higher educational level. Meaning These findings suggest that interventions to improve patients’ knowledge about radiation protection risks would be beneficial, with communication from medical staff potentially playing a determinant role., Importance Although imaging has become a standard tool of modern medicine, its widespread use has been paralleled by an increasing cumulative radiation dose to patients despite technological advancements and campaigns calling for better awareness and minimization of unnecessary exposures. Objective To assess patients’ knowledge about medical radiation and related risks. Design, Setting, and Participants A survey study of hospitals in Italy was conducted; all patients in waiting rooms for medical imaging procedures before undergoing imaging examinations at 16 teaching and nonteaching hospitals were approached to take the survey. The survey was performed from June 1, 2019, to May 31, 2020. Main Outcomes and Measures Survey respondents’ basic knowledge of ionizing radiation levels and health risks, earlier imaging tests performed, and information and communication about radiation protection issues. Results Among 3039 patients invited to participate, the response rate was 94.3% (n = 2866). Participants included 1531 women (53.4%); mean (SD) age was 44.9 (17.3) years. Of the 2866 participants, 1529 (53.3%) were aware of the existence of natural sources of ionizing radiation. Mammography (1101 [38.4%]) and magnetic resonance imaging (1231 [43.0%]) were categorized as radiation-based imaging modalities. More than half of the 2866 patients (1579 [55.1%]; P = .03) did not know that chest computed tomography delivers a larger dose of radiation than chest radiography, and only 1499 (52.3%) knew that radiation can be emitted after nuclear medicine examinations (P = .004). A total of 667 patients (23.3%) believed that radiation risks were unrelated to age, 1273 (44.4%) deemed their knowledge about radiation risks inadequate, and 2305 (80.4%) preferred to be informed about radiation risks by medical staff. A better knowledge of radiation issues was associated with receiving information from health care professionals (odds ratio [OR], 1.71; 95% CI, 1.43-2.03; P, This survey study examines patients’ knowledge of radiation used in imaging procedures.