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Background: Patients and accompanying persons may be exposed to ionising radiation during radiological examinations, so adequate knowledge and safe practices are needed to limit avoidable exposure. This study assessed patients’ knowledge, awareness and experiences of radiation safety at the Federal University Teaching Hospital, Owerri (FUTHO) and Lifeway Medical Diagnostics Centre (LMDC), Owerri, Nigeria. Methods: A descriptive cross-sectional survey was conducted among 100 respondents (50 per centre) using a structured, self-administered questionnaire. Data were analysed with descriptive statistics, Pearson’s chi-square test and the independent-samples t-test at a 0.05 significance level. Results: Only 42.0% of respondents identified ordinary X-ray as involving ionising radiation, 22.0% identified CT, and 30.0% did not know the difference between imaging procedures. Overall, 42.0% knew of the cancer risk from repeated or high-dose exposure. Radiation warning signs were noticed by 56.0%, but only 45.0% correctly understood the red light outside the X-ray room. Among 56 females aged 18–55 years, 33.9% knew that X-ray or CT exposure could harm an unborn baby and 42.9% said nobody asked about pregnancy. Only 37.0% received a proper explanation and 45.0% received a protective cover. Respondents nevertheless agreed that their safety was adequately considered (mean 3.54 ± 0.89). The two centres did not differ significantly in most indicators (p > 0.05); the exception was perceived long-term risk from repeated examinations (p = 0.032). Conclusion: Important gaps exist in patients’ understanding of radiation risks, warning signs, pregnancy-related safety and pre-examination communication. Radiographer-led explanations, clearer signage, routine pregnancy enquiry and patient-education materials are recommended.