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Abstract Background: Growing concern about the increasing use of CT and its contribution to medical radiation exposure has driven improvements in CT hardware and software aimed at dose reduction. Understanding radiation effects and applying effective dose management strategies can enhance imaging practice and patient safety, this study explores how well radiographers in Northeastern Nigeria adhere to and apply CT dose management practices Material and methods: This cross-sectional study involved 110 radiographers who completed the questionnaire, while 44 were observed during routine CT practice. Descriptive statistics and Spearman’s correlation were used for analysis. Results: Overall adherence to recommended dose management practices was poor, with a mean adherence score of 45.2%. Fewer than half of the participants reported routine patient dose monitoring, awareness of diagnostic reference levels (DRLs), or regular review of dose reports. Practice scores were moderate (50.9%), reflecting partial use of optimization strategies such as automatic exposure control and patient size-based parameter adjustment. Direct observations revealed the absence of departmental DRLs and standard CT protocols across all facilities, along with inconsistent use of key dose reduction tools. Experience was positively correlated with regular patient dose review, (ρ = .23, p = .014) and better parameter adjustment (ρ = .30, p = .001). Conclusion: Radiographers in Northeastern Nigeria demonstrate limited adherence and moderate practice of CT radiation dose management. Strengthening institutional frameworks, standard protocols, training, and multidisciplinary collaboration is essential to improve patient radiation safety and optimize CT practice.