INTRODUCTION: Optimizing computed tomography (CT) parameters is crucial to minimize patient dose while maintaining diagnostic image quality. This study investigated the impact of practical education, specifically hands-on experience and clinical placements, on radiography students' knowledge of CT exposure parameters in Japan. METHODS: In 2023, a cross-sectional study was conducted among third- and fourth-year Kagoshima Medical Technology College radiography students. A validated 21-item questionnaire assessed their knowledge of CT exposure parameters, including tube voltage (kVp), milliampere-seconds (mAs), and pitch. Independent-sample t-tests were used to compare the mean knowledge scores between student groups. RESULTS: A total of 126 students participated. Fourth-year students (n = 60) demonstrated significantly higher knowledge of CT parameters than third-year students (n = 66) (t = -5.853, df = 121.279, p <
0.001). Among third-year students, females (n = 24) outperformed males (n = 42) on the knowledge questionnaire (t = -2.435, df = 54.992, p = 0.018). No significant gender-based differences were found in the fourth-year students' knowledge scores (t = 0.199, df = 51.199, p = 0.843). Additionally, no significant difference was observed between fourth-year students who participated in observation- and clerkship-based clinical training (t = 0.042, df = 49.298, p = 0.967). CONCLUSION: Practical education, including clinical placements and on-campus hands-on training, significantly improved radiography students' knowledge of CT exposure parameters. Incorporating practical training early in the curriculum and addressing gender-based differences in learning styles may be crucial for optimizing CT education and promoting radiation safety. Further research is warranted to explore how specific clinical activities and student participation during clinical placements influence knowledge acquisition. IMPLICATIONS FOR PRACTICE: Early integration of hands-on training and attention to learning styles can enhance radiography education, improving safety and competence in CT parameter management.