Background Medical institutions are an important gateway to the Healthy China strategy, how to strengthen radiation safety management and protection in radiation diagnosis and treatment is a key area in the work of radiation health.

Objective By identifying, analyzing, and evaluating the risk factors and degree of danger in radiation safety management process, to propose strategies for reducing these risks.

Methods Using failure mode and effect analysis (FMEA), 11 experts were selected to develop radiation safety management strategies through questionnaire surveys and brainstorming. Risk factors were evaluated based on a failure risk index≥9.5 and risk priority number (RPN)＞80 as benchmarks, potential failure causes were analyzed to develop radiation safety management strategies.

Results The proposed risk factors in the radiation safety management process of medical institutions included 3 main risks, 7 sub-risks, and 32 risk items. Based on the failure risk index, 12 key links were proposed, and potential failure causes were analyzed by RPN for 10 risk links, and management strategies were proposed. The key links in the process of radiation safety management mainly included low compliance with radiation safety management by radiation workers, insufficient awareness of protection, occupational burnout induced by occupational stress, and improper disposal of radioactive waste. The proposed main strategies were radiation safety education and training by joint management departments and equipment supply departments, strengthening psychological intervention and radiation awareness of radiation workers, improving quality of radiation protection safety facilities and equipment, enhancing personal dosimeter wearing management and feedback, regulating patient movement after administration, and strengthening independent ventilation and filtration device management for radioactive waste.

Conclusion  A set of feasible and practical management strategies are proposed after analyzing main risk factors for radiation safety management in medical institutions. Targeted occupational health training should be carried out, occupational health monitoring and radiation protection should be strengthened, and the management of radiation sources and radioactive waste should be enhanced. This study provides suggestions and guidance for radiation safety management in medical institutions and has practical implications.