Background: The use of radiation in healthcare plays an important role in the diagnosis and treatment of injuries and diseases. However, there are associated health risks from exposure to radiation. For this reason, good practices have been developed following the recommendations from the International Commission on Radiation Protection (ICRP) to safeguard patients, personnel, and members of the public from unnecessary exposure to radiation. Objective: The purpose of this review is, therefore, to identify and offer solutions to challenges in radiation protection in Zambian healthcare. Methods: A literature search was undertaken in four databases: ScienceDirect, CINAHL, Google Scholar and PubMed/MEDLINE, and manual searches of radiography/radiation protection journals to have an in-depth understanding of the challenges of radiation protection in Zambia. This was supplemented with searches of radiation protection and Ministry of Health of Zambia websites. Results: The main challenges identified include the use of old and obsolete X-ray machines, a shortage of medical physicists and radiologists, limited personal radiation protective equipment, non-availability of a radiation protection course, limited data on patient radiation doses, non-availability of diagnostic reference levels (DRLs), unjustified radiological examinations, non-availability of imaging referral guidelines, and a lack of clinical audits and research on radiation protection. Conclusion: It is vital to increase the number of medical physicists, and train radiographers and radiography technologists in radiation protection to help medical physicists in conducting quality assurance (QA) and other specialised radiation protection related tasks