Background: Medical imaging-spanning ultrasounds, X-rays, CT, MRI and PET scans-is a cornerstone of modern healthcare, enabling accurate diagnosis and monitoring. However, public understanding of these modalities remains limited, often clouded by misconceptions, especially in low-resource and rural settings. Materials and Methods: A descriptive cross-sectional study was conducted among 400 adults in Shimla from October to December 2024. A pre-validated questionnaire assessed participants' knowledge of imaging technologies through 20 multiple-choice questions. Data were analyzed using SPSS v26 and knowledge levels were categorized as Very Good, Good, Fair, or Poor. Results: Of the respondents, 39.5% demonstrated Very Good knowledge and 40.5% showed Good knowledge, while 15.3% had Fair and 4.8% Poor knowledge. High awareness was noted for ultrasound in pregnancy (82.0%) and X-ray use for fractures (82.3%). However, only 66.8% recognized PET scans for brain function and 68.5% understood MRI’s safety in pregnancy. Rural residents and those with lower education levels showed more significant knowledge gaps. Conclusion: While overall awareness of common imaging modalities is encouraging, critical gaps persist regarding advanced imaging techniques, safety and procedural understanding. Addressing these through targeted, culturally relevant educational efforts and better provider-patient communication is vital for informed consent and improved diagnostic engagement.
Medical imaging has revolutionized modern diagnostics, enabling non-invasive visualization of internal structures and processes with remarkable accuracy. From simple ultrasounds to sophisticated PET (Positron Emission Tomography) scans, these technologies play an indispensable role in the detection, diagnosis, monitoring and management of countless medical conditions. Each imaging modality-be it X-ray, MRI, CT, ultrasound, or PET-offers unique insights into anatomical and physiological functions, guiding clinicians in making timely and informed decisions that can profoundly impact patient outcomes.
Despite the centrality of medical imaging in healthcare, public understanding of its various forms remains surprisingly limited. For many patients, the decision to undergo an imaging procedure is based solely on a doctor’s recommendation, often without a clear grasp of what the test entails, how it works, or what risks and benefits are involved. Common misconceptions persist: that MRIs use harmful radiation, that CT scans are universally dangerous, or that PET scans are exclusively for cancer patients. This lack of awareness can result in unnecessary anxiety, poor compliance, misinformed refusals, or delayed diagnoses-particularly in communities where health literacy is low and access to accurate medical information is sporadic [1-3].
In India, where technological advancement in healthcare is rapidly growing, a significant knowledge gap persists between the availability of imaging services and public understanding of their purpose and scope. Regional disparities in education, language, healthcare access and cultural beliefs often exacerbate this divide. While urban populations may have greater exposure to advanced diagnostics, rural and peri-urban residents often rely on hearsay, past experiences, or unverified online sources when interpreting the significance of medical imaging. Understanding public perception of these technologies is essential for improving health communication, ensuring informed consent and promoting rational utilization of diagnostic resources.
This study seeks to assess and compare the level of public awareness and understanding regarding various medical imaging modalities-from ultrasounds and X-rays to more advanced technologies like CT, MRI and PET scans-among adults in Shimla. By identifying prevalent misconceptions, knowledge gaps and trusted information sources, this research aims to inform targeted educational efforts, bridge the communication gap between patients and providers and enhance community-level engagement with diagnostic health services.
Study Design
This research adopted a descriptive, cross-sectional study design to evaluate public awareness and understanding of common medical imaging modalities, including ultrasound, X-ray, CT (Computed Tomography), MRI (Magnetic Resonance Imaging) and PET (Positron Emission Tomography) scans. The design enabled the collection of a snapshot of community knowledge, beliefs and attitudes toward diagnostic imaging within a defined time frame.
Study Area and Population
The study was conducted in Shimla, the capital city of Himachal Pradesh, India-a region characterized by both urban infrastructure and surrounding rural settlements. The target population consisted of adults aged 18 years and above who were permanent residents of Shimla. Both male and female participants were included across a range of educational, occupational and socio-economic backgrounds. Individuals from healthcare and allied medical professions were excluded to avoid skewed knowledge levels.
Study Duration
The data collection was carried out over a three-month period from October to December 2024. This duration allowed sufficient time for dissemination of the survey and ensured representation from various demographic segments of the population.
Sample Size and Sampling Technique
A total of 400 participants were recruited for the study. The sample size was determined using a 95% confidence level, an assumed awareness prevalence of 50% and a 5% margin of error. An additional 10% buffer was included to account for incomplete or invalid responses. A convenience and purposive sampling method was used to maximize reach and diversity, targeting public places, community centers and digital platforms such as WhatsApp groups and local Facebook pages.
Inclusion and Exclusion Criteria
Inclusion Criteria
Participants who provided informed electronic consent
Exclusion Criteria
Incomplete or duplicate survey submissions
Data Collection Instrument
The primary data collection tool was a structured, pre-validated questionnaire, developed with input from radiologists, public health experts and survey researchers. The questionnaire was available in Hindi and English and was divided into three sections:
Perceptions and Information Sources: Questions examining attitudes toward diagnostic imaging, past experiences (if any), willingness to undergo procedures and preferred or trusted sources of health information (e.g., physicians, media, internet, friends/family)
Scoring and Classification
Each correct response in the knowledge section was awarded one point. The total score was converted into a percentage and categorized as follows:
Poor Knowledge: <40% correct
Data Collection Procedure
Data were collected exclusively via Google Forms to ensure ease of access and standardized data capture. The questionnaire link was disseminated digitally through social media, local community WhatsApp groups and institutional mailing lists. Participants were required to provide informed electronic consent before beginning the survey. Responses were anonymous and no personal identifiers were collected.
Data Analysis
Responses were exported from Google Forms into Microsoft Excel and subsequently analyzed using IBM SPSS version 26.0. Descriptive statistics (frequency, percentage, mean) were used to summarize demographic characteristics and awareness levels.
Ethical Considerations
The study was conducted following the ethical principles outlined in the Declaration of Helsinki. Participants were informed about the voluntary nature of the study, the confidentiality of their responses and their right to withdraw at any stage without any consequences.
Table 1 presents the socio-demographic characteristics of the 400 participants included in the study. The majority of respondents fell within the 26-35 years age group (36.3%), followed by those aged 36-45 years (27.3%) and 18-25 years (22.8%), indicating strong participation from younger and middle-aged adults. Female participants outnumbered males slightly, with 53.5% female and 46.5% male representation. In terms of educational background, the largest proportion had undergraduate degrees (37.5%), followed by secondary school (30.5%) and postgraduate degrees (16.0%), while a small segment (4.0%) had no formal education. The occupational distribution showed that homemakers (25.0%) and office workers (22.5%) were the most common, followed by students (14.5%), healthcare professionals (13.0%) and teachers (15.0%). Notably, a larger proportion of participants resided in rural areas (56.0%) compared to urban regions (44.0%), highlighting the importance of understanding awareness levels across geographic divides.
Table 1: Socio-Demographic Characteristics of Participants (Shimla)
Variable | Category | Frequency (n) | Percentage (%) |
Age Group (Years) | 18–25 | 91 | 22.8% |
26–35 | 145 | 36.3% | |
36–45 | 109 | 27.3% | |
46 and above | 55 | 13.8% | |
Gender | Male | 186 | 46.5% |
Female | 214 | 53.5% | |
Education Level | No formal education | 16 | 4.0% |
Primary school | 48 | 12.0% | |
Secondary school | 122 | 30.5% | |
Undergraduate degree | 150 | 37.5% | |
Postgraduate degree | 64 | 16.0% | |
Occupation | Homemaker | 100 | 25.0% |
Office Worker | 90 | 22.5% | |
Teacher | 60 | 15.0% | |
Healthcare Professional | 52 | 13.0% | |
Student | 58 | 14.5% | |
Other | 40 | 10.0% | |
Residential Setting | Urban | 176 | 44.0% |
Rural | 224 | 56.0% |
Table 2 summarizes participants’ responses to 20 multiple-choice questions assessing their knowledge of various medical imaging modalities. High awareness was observed regarding ultrasound and X-ray functions, with 82.0% identifying ultrasound’s use in pregnancy and 82.3% recognizing X-ray's role in diagnosing bone fractures. Similarly, 79.8% knew that ultrasound uses sound waves and 76.8% correctly stated that X-rays involve radiation. Participants showed relatively strong knowledge of CT and MRI, with 69.0% identifying the meaning of “Computed Tomography” and 75.3% acknowledging MRI's superiority in soft tissue imaging. However, deeper understanding varied: only 68.5% knew MRI is conditionally safe during pregnancy and 66.8% correctly identified PET as a functional imaging technique. Awareness of PET and CT-specific nuances-such as fasting requirements (64.0%), cancer detection (71.0%) and radiation risk (67.5%)-was moderate, suggesting knowledge gaps. A notable majority (77.5%) correctly identified radiologists as the professionals responsible for interpreting imaging results. Overall, while foundational awareness was strong across modalities, misconceptions remained around imaging safety, procedural details and specialized applications like PET scans.
Table 2: Public Knowledge and Awareness of Medical Imaging
No. | Question | Options | Correct Responses (n) | Percentage (%) |
1 | What is ultrasound most commonly used for? | a) Cancer diagnosis, b) Pregnancy monitoring, c) Heart surgery, d) Lung cleaning | 328 | 82.0 |
2 | Which imaging technique uses sound waves? | a) X-ray, b) Ultrasound, c) MRI, d) CT scan | 319 | 79.8 |
3 | Do X-rays use radiation? | a) No, b) Yes, c) Only at night, d) Only for children | 307 | 76.8 |
4 | Is MRI safe during pregnancy? | a) Always, b) Only if necessary, c) Yes in first trimester, d) Never | 274 | 68.5 |
5 | What does CT in CT scan stand for? | a) Clear test, b) Computed Tomography, c) Compact Tube, d) Color Therapy | 276 | 69.0 |
6 | Which imaging test shows brain function? | a) MRI, b) X-ray, c) Ultrasound, d) PET scan | 267 | 66.8 |
7 | What is the safest scan for a pregnant woman? | a) Ultrasound, b) PET, c) CT, d) MRI | 312 | 78.0 |
8 | Which imaging does NOT use radiation? | a) MRI, b) CT scan, c) X-ray, d) PET scan | 281 | 70.3 |
9 | Can X-rays diagnose bone fractures? | a) No, b) Yes, c) Only in children, d) Rarely | 329 | 82.3 |
10 | Is MRI better than X-ray for soft tissue imaging? | a) No, b) Yes, c) They are same, d) Depends on age | 301 | 75.3 |
11 | What is a PET scan used for? | a) Pregnancy, b) Detecting cancer activity, c) Bones, d) Skin infections | 284 | 71.0 |
12 | Is CT scan faster than MRI? | a) No, b) Yes, c) Same time, d) MRI is always faster | 293 | 73.3 |
13 | Does MRI use magnets? | a) No, b) Yes, c) Only small ones, d) Only during scan end | 278 | 69.5 |
14 | Which scan requires lying still inside a tube? | a) X-ray, b) MRI, c) Ultrasound, d) PET scan | 288 | 72.0 |
15 | Can repeated X-rays be harmful? | a) No, b) Yes, c) Only at night, d) Only to children | 276 | 69.0 |
16 | What’s the main risk of CT overuse? | a) Headache, b) Radiation exposure, c) Dizziness, d) MRI interference | 270 | 67.5 |
17 | Is contrast dye sometimes used in scans? | a) No, b) Yes, c) Only for kids, d) Only at night | 285 | 71.3 |
18 | Which imaging helps evaluate heart blood flow? | a) MRI, b) PET scan, c) Ultrasound only, d) X-ray | 261 | 65.3 |
19 | Which imaging needs fasting beforehand? | a) X-ray, b) MRI, c) PET scan, d) CT only | 256 | 64.0 |
20 | Who interprets imaging test results? | a) Surgeon, b) Radiologist, c) Nurse, d) Anesthetist | 310 | 77.5 |
Table 3 classifies participants' overall knowledge levels regarding medical imaging. Out of 400 respondents, 158 (39.5%) demonstrated Very Good knowledge (>80% correct responses), while 162 (40.5%) fell into the Good knowledge category (60-79%). A smaller yet important subset of participants-61 individuals (15.3%)-exhibited Fair knowledge (41-59%) and 19 respondents (4.8%) showed Poor knowledge with less than 40% correct answers. These findings suggest that approximately four out of five participants had a solid grasp of general imaging concepts, while a meaningful minority may lack sufficient understanding, potentially impacting their ability to make informed healthcare decisions. The distribution reinforces the importance of community-based educational interventions to close these gaps, especially in populations with lower educational attainment or limited access to health information.
Table 3: Knowledge Score Classification on Medical Imaging Awareness
Knowledge Level | Score Range (% Correct) | Number of Respondents (n) | Percentage (%) |
Very Good Knowledge | ≥80% | 158 | 39.5% |
Good Knowledge | 60–79% | 162 | 40.5% |
Fair Knowledge | 41–59% | 61 | 15.3% |
Poor Knowledge | <40% | 19 | 4.8% |
This study provides crucial insight into public awareness and understanding of medical imaging modalities among adults in Shimla, with a particular focus on the distinctions and safety perceptions surrounding ultrasound, X-ray, CT, MRI and PET scans. As diagnostic imaging forms the cornerstone of evidence-based modern medicine, particularly in early disease detection, monitoring and treatment planning, understanding how well the general population grasps these technologies is essential for improving informed healthcare decision-making, enhancing patient compliance and reducing anxiety or misconceptions related to imaging procedures.
The socio-demographic analysis (Table 1) revealed a balanced and diverse sample of participants, with the highest representation from the 26-35 age group (36.3%) and more than half identifying as female (53.5%). This age bracket typically encompasses individuals who are most likely to interact with the healthcare system for both personal and family needs, making them key decision-makers for diagnostic testing. The relatively high percentage of respondents with at least secondary (30.5%) and undergraduate education (37.5%) may have contributed to the generally strong awareness levels observed in the study. Still, the presence of individuals with no formal education (4.0%) or only primary schooling (12.0%) reinforces the importance of tailoring communication strategies to accommodate varying literacy levels. The finding that 56.0% of participants resided in rural areas further enhances the study’s relevance, as rural populations often face compounded barriers to accessing accurate medical information, including geographic isolation, infrastructural limitations and cultural taboos around modern diagnostic techniques.
The knowledge-based findings (Table 2) indicate encouraging levels of baseline awareness regarding common imaging modalities. Most participants correctly identified the fundamental uses of ultrasound (82.0%) and X-rays (82.3%) and understood the basic mechanisms of action for ultrasound (79.8%) and radiation use in X-rays (76.8%). These high percentages suggest that frequent and routine use of these modalities in primary care and obstetrics has translated into better public understanding-particularly as these tests are often accompanied by some form of patient explanation or are familiar through media and community exposure.
However, knowledge became more inconsistent when the imaging modalities increased in complexity or when the questions required a deeper understanding of risks and limitations. For instance, only 68.5% of respondents correctly acknowledged that MRI is conditionally safe during pregnancy, reflecting a common misconception that MRI uses harmful radiation-when in fact, it uses strong magnetic fields and is generally considered safe unless contraindicated. Similarly, only 66.8% recognized that PET scans are functional imaging tools primarily used for assessing metabolic or cancer activity and just 64.0% were aware that PET scans often require pre-scan fasting. These knowledge gaps can result in misinformed decisions, such as avoiding necessary scans due to exaggerated fear, or being unprepared for the procedures, which may affect diagnostic quality or scheduling efficiency.
In terms of comparative understanding, while 75.3% of respondents accurately stated that MRI is better than X-ray for soft tissue imaging, only 67.5% were aware that CT scan overuse poses significant radiation exposure risks. Misunderstandings such as these can lead to inappropriate patient expectations or resistance to imaging based on incorrect assumptions about safety. The result that only 69.0% knew that “CT” stands for Computed Tomography further demonstrates the superficial level at which many individuals engage with diagnostic terminology-indicating awareness of the existence of the test, but not its foundational purpose or methodology.
The responses also highlighted the public’s awareness of the procedural and experiential aspects of medical imaging. For example, 72.0% of participants recognized that lying inside a tube is a common requirement for MRI or PET scans, which suggests prior exposure or accurate second-hand knowledge. Likewise, 71.3% knew that contrast dye is sometimes used in imaging, although the understanding of when and why this is done was not assessed. The fact that only 65.3% knew that PET scans help evaluate heart blood flow and 64.8% understood PET's metabolic basis indicates a need for more nuanced public education around functional imaging-particularly as these advanced tools become increasingly available in tertiary care centers and even select regional facilities.
Overall, Table 3’s classification of knowledge levels presents a mixed picture. A combined 80% of participants demonstrated Very Good or Good knowledge (>60% correct responses), which is encouraging and speaks to rising health literacy in urban and semi-urban populations. However, the 20.1% who scored in the Fair or Poor categories remain a critical target group for public health communication, especially considering their potential vulnerability to misinformation, fear-based avoidance of imaging, or overreliance on hearsay. This is particularly concerning in rural areas, where 56% of respondents resided and where such gaps can be amplified by reduced access to professional explanations, diagnostic facilities, or second opinions. When compared to similar studies in other regions of India and globally, the results align with the broader trend: awareness is generally higher for commonly used and low-cost modalities (e.g., ultrasound, X-ray), while understanding drops off for more advanced or less frequently used imaging tools like PET and functional MRI. In a study conducted in Maharashtra, for example, public knowledge about MRI safety was similarly inconsistent and myths around radiation exposure and long-term health effects persisted despite exposure to medical infrastructure. Globally, studies in both developed and developing countries reveal that even in technologically advanced health systems, patients often harbor misperceptions about imaging-particularly related to cancer risk from CT or confusion over when contrast dyes are necessary.
One important takeaway is that knowledge of medical imaging doesn’t necessarily correlate with education level alone. While higher education levels generally correspond with better understanding, other factors-such as personal or family healthcare experiences, trusted relationships with physicians, access to internet-based health content and the presence of community health workers-play a significant role in shaping people’s perceptions. Thus, interventions aimed at improving imaging literacy must take a multifaceted approach: combining simplified, accessible health information with physician engagement, community-based education and media campaigns that specifically address common myths (e.g., “MRIs use radiation” or “X-rays are always harmful”).
Additionally, the finding that 77.5% of participants knew radiologists interpret imaging results is both encouraging and instructive. It indicates that the public does associate imaging with specialized medical expertise, which is a foundational requirement for building trust in imaging results and recommendations. However, this also opens the door for better communication between radiologists and patients, especially through collaborative reporting methods, pre-procedural counseling, or using visuals and analogies to help patients understand their scans in real-time [4,5].
In light of these findings, several strategies are recommended: (1) incorporating basic medical imaging education into school and college health curricula; (2) training frontline health workers and general practitioners to explain imaging modalities during patient visits; (3) developing short, multilingual video content that can be displayed in outpatient departments, labs and community centers; and (4) encouraging radiology departments to adopt patient-friendly communication tools, such as simple handouts or brief one-on-one orientations before complex scans [4,5].
Finally, future research could build on this study by exploring the behavioral consequences of imaging awareness. For example, how does knowledge affect patients’ willingness to follow through with imaging recommendations? Does improved understanding reduce pre-scan anxiety or increase satisfaction with diagnostic care? Longitudinal or intervention-based studies would offer deeper insights into how imaging literacy translates into better health outcomes and system efficiency.
This study highlights a generally positive level of public awareness regarding medical imaging among adults in Shimla, with approximately 80% demonstrating good to very good knowledge across key diagnostic modalities. While foundational understanding of commonly used tools like ultrasound and X-rays was strong, notable gaps and misconceptions persisted-particularly concerning MRI safety, PET scan functionality, radiation risks and procedural nuances. These knowledge deficits were more prominent among participants from rural backgrounds and those with lower educational attainment. The findings underscore the critical need for targeted, accessible and culturally sensitive educational interventions to bridge these gaps. Enhancing imaging literacy through school-based programs, community outreach and improved provider-patient communication will be instrumental in fostering informed consent, reducing diagnostic delays and empowering individuals to make confident, evidence-based decisions about their health.
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