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Background The Royal College of Radiologists' (RCR) iRefer guidelines are an established evidence-based clinical decision support tool intended to optimise diagnostic imaging referrals, reduce unnecessary radiation exposure, and improve radiology workflow efficiency. In Ireland, imaging referrals also carry statutory weight: Statutory Instrument (S.I.) No. 256 of 2018 places defined duties on referrers regarding the justification of medical exposures, and Health Service Executive (HSE) guidance requires referrers to have access to iRefer or an equivalent decision support tool. Awareness and use of iRefer among non-consultant hospital doctors (NCHDs) in smaller, high-turnover hospital settings are poorly described. Aim To evaluate awareness, utilisation, and accessibility of the iRefer guidelines among NCHDs in a Model 3 hospital and to identify the systemic, technological, and cultural barriers preventing routine use. Methods A sequential explanatory mixed-methods design was employed. Phase 1 comprised an in-person, anonymous cross-sectional audit questionnaire developed by the authors for this study, administered to NCHDs to assess awareness, decision-making sources, and guideline