Associations between fear of medical imaging radiation, risk perception, and patient decisional conflict: evidence from variable-centered and person-centered analyses

Background Medical imaging examinations play an irreplaceable role in modern medical diagnosis; however, some patients experience decisional difficulties due to fear of radiation, potentially leading to examination delays or refusals that subsequently compromise timely disease diagnosis and treatment. The psychological mechanisms through which fear of medical imaging radiation influences patient decision-making processes remain unclear, and the heterogeneous characteristics of radiation fear manifestations across patient populations lack systematic investigation. Methods A cross-sectional survey design was employed, with 468 adult patients scheduled to undergo medical imaging examinations conveniently sampled from two tertiary Grade-A general hospitals in Sichuan Province, China, between July and August 2025. Data were collected using the Fear of Medical Imaging Radiation Scale, Risk Perception Scale, and Decisional Conflict Scale. Results Mediation analysis using the PROCESS macro showed that fear of medical imaging radiation was significantly and positively associated with decisional conflict. Risk perception showed a significant partial mediating role in the association between fear of radiation and decisional conflict. Latent profile analysis identified three radiation fear subtypes: a low radiation fear group, a moderate radiation fear group, and a high radiation fear group. Analysis of variance demonstrated significant differences among the three groups in both risk perception and decisional conflict, with patients in the high radiation fear group exhibiting significantly elevated levels of risk perception and decisional conflict compared with the other two groups. Conclusions Fear of medical imaging radiation indirectly exacerbates decisional conflict by elevating patients’ risk perception levels, and significant heterogeneity exists in radiation fear manifestations across patient populations. These findings provide evidence-based guidance for healthcare institutions to develop targeted patient education programs, risk communication strategies, and psychological support interventions. The results facilitate the identification of high-risk patient populations and implementation of differentiated clinical management strategies, ultimately advancing the realization of patient-centered imaging medicine service models.