Background: Radiology request form is a legal document that authorizes for imaging exams. Most of the imaging exams involve radiation exposure, which can cause detrimental effects if misused.  Despite international standards from the Royal College of Radiologists, anecdotal evidence suggests widespread incompleteness in Nigeria, but no national synthesis exists.

Objective: To systematically review the completeness and clinical adequacy of radiology request forms across Nigerian health institutions.

Methods: We searched PubMed, Scopus, Web of Science, AJOL, Google Scholar, and grey literature for institutional audits of radiology request forms in Nigeria. Two reviewers screened studies and extracted data on overall completeness and 12 field-specific items. Risk of bias was assessed using the Joanna Briggs Institute checklist. Due to heterogeneity, a Synthesis without Meta-analysis (SWiM) was performed, with vote-counting by geopolitical zone. Study pre-registered with PROSPERO: CRD420261433125.

Results: Fourteen cross-sectional audits (12,268 forms, 2009–2023) from all six geopolitical zones were included. Six studies were high quality, eight moderate. Median proportion of fully completed forms was 1.3% (range 0–24.8%). Patient name and examination requested were consistently documented. Safety-critical fields such as last menstrual period, previous imaging history, clinician telephone, patient address, and allergy history were systematically omitted.  No temporal improvement was observed over 14 years.

Conclusion: Radiology request forms in Nigeria are persistently incomplete and this violates international radiation protection standards and compromise patient safety. The problem is systemic and therefore, national implementation of a standardized minimum dataset with enforcement at radiology reception is urgently required to reduce avoidable radiation exposure and diagnostic error.

Keywords: radiology request forms, completeness, Nigeria, patient safety, radiation protection, systematic review, referral quality.