Contemporary Risk Management for Radiologists

Navigating Malpractice: Guide for U.S. Radiologists

The majority of radiologists will face litigation in their careers, yet it remains an uncommon topic for training programs and educational conferences. The authors explore the landscape of radiology malpractice litigation to equip radiologists with essential knowledge before and in the event of a lawsuit. Radiologists should understand the four components necessary to be found liable for medical negligence: patient duty, breach of standard of care, injury, and proximate causality between the breach of standard of care and the injury. The authors introduce the mechanics of a lawsuit, common causes of lawsuits, and factors affecting risk. Many current radiologic norms and standards derive from legal precedent; examining these precedents and their effects on current practice through the context of prior litigated cases can help radiologists understand their evolving roles and responsibilities. Ultimately, 63% of malpractice claims are dismissed or dropped, 28% reach settlement agreements, and the remaining claims proceed to trial, where most result in defense wins. Radiologists should be familiar with common practices that may affect their legal risk, as well as potential misunderstandings regarding the discoverability of morbidity and mortality conferences, tumor boards, and other interdisciplinary conferences. Although litigation may not always be preventable, radiologists who understand the U.S. malpractice and medicolegal environment will be better positioned to mitigate unfavorable patient and legal outcomes. ©RSNA, 2025.

On-Site Evaluation and Improvement Strategies of Radiation Occupational Hazard Prevention and Control Effectiveness in Medical Institution Construction Projects

Objective

To evaluate the control effectiveness of medical institution construction projects, and to summarize and analyze the radiation protection management status and improvement strategies of relevant medical institutions.

Methods

A total of 40 medical institutions in our city were evaluated for control effectiveness through measures such as data research, on-site investigations, equipment quality testing, and radiation health protection inspections.

Results

The compliance rates of personnel configuration, verification of protective measures, and radiation protection management and emergency response were 95.0%, 67.5%, and 70.0%, respectively. Compared to earlier evaluation periods (eg, before the implementation of new DR performance testing standards, where compliance rates were below 60%), there has been a marked improvement in compliance with performance and protection testing, particularly after the introduction of updated evaluation criteria. The first-pass rates of performance testing for DSA, DR, CT, and dental equipment were 100%, 84.0%, 92.0%, and 100%, respectively. The first-pass rates of radiation protection inspection for related equipment rooms were 100%, 100%, 92.0%, and 100%, respectively. New DR performance testing standards introduced specialized testing items, such as dark noise, detector dose indication (DDI), and signal transmission characteristics (STP), which presented initial challenges due to the unavailability of pre-processing images in some manufacturers' products. Additionally, higher monitoring values were identified at doors, door gaps, and cable penetration points in equipment rooms. Regarding radiation protection management and emergency response, issues such as overly rigid emergency response plans, insufficient personal dose management, and inadequate occupational health examinations remain, requiring systematic adjustments.

Conclusion

At present, the awareness of radiation hazard prevention and control in medical institutions has been improved. Compared to earlier periods of testing and evaluation, there has been a significant improvement in the degree of compliance with performance and protection testing. Medical institutions have strengthened equipment annual inspections, quality control, and other management work, further enhancing the level of radiation protection management.

American College of Veterinary Radiology and European College of Veterinary Diagnostic Imaging consensus statement on imaging report foundations

Imaging reports are official medicolegal documents, detailing the conduct and interpretation of imaging studies in patient care. They serve as the primary means of communication for radiologists and significantly influence clinical decisions. This consensus statement, produced by a panel of the American College of Veterinary Radiology and European College of Veterinary Diagnostic Imaging board-certified veterinary radiologists through a modified Delphi method, addressed three key competency domains: basic patient care documentation, crafting meaningful reports, and ethical practice within legal boundaries. Meaningful reports move beyond documenting findings and providing impressions having qualities that foster effective communication for the betterment of patient care.

Teleradiology: good practice guide

Teleradiology is the electronic transmission of radiological images from one location to another with the main purpose of interpreting or consulting a diagnosis and must be subject to codes of conduct agreed upon by professional societies. The content of fourteen teleradiology best practice guidelines is analyzed. Their guiding principles are: the best interest and benefit of the patient, quality and safety standards homologous to the local radiology service, and use as a complement and support of the same. As legal obligations: guaranteeing rights by applying the principle of the patient's country of origin, establishing requirements in international teleradiology and civil liability insurance. Regarding the radiological process: integration with the local service process, guaranteeing the quality of images and reports, access to previous studies and reports and complying with the principles of radioprotection. Regarding professional requirements: compliance with the required registrations, licenses and qualifications, training and qualification of the radiologist and technician, prevention of fraudulent practices, respect for labor standards and remuneration of the radiologist. Subcontracting must be justified, managing the risk of commoditization. Compliance with the system's technical standards.

Acute aortic syndrome and radiology liability in Italy: Case reports and medico-legal considerations

The trend for medical malpractice claims has increased in recent years, both in the USA and in Europe. Although diagnostic radiology is not considered a high-risk field, malpractice claims in this area follow this general trend. The most common legal action taken against radiologists includes failure to diagnose, poor communication between physicians, failure to supervise technologists properly and improper procedures. Recently, the Italian Civil Supreme Court delivered a judgment (Cass. Civ., N.10158-18) regarding the liability of radiologists, stating that in radiological practice, a correct and timely execution of the diagnostic investigation is required. By contrast, the same judgment states that requesting further clinical consultations and/or the execution of in-depth diagnostic examinations are not within their duties. Considering this judgment, we report two cases of radiologist malpractice and related responsibility for negligent conduct regarding the diagnosis of thoracic aortic dissection and the prevention and management of acute aortic syndrome.

A practical system that enables physicians to respond expeditiously to significant unexpected findings (SUFs) in radiological reports

PURPOSE

To demonstrate effectiveness of our present radiological report check flowchart enabling physicians to respond to significant unexpected findings (SUFs), by comparing the response periods from the examination date to the action date on untreated SUFs between the previous and present versions of our flowchart.

METHODS

In the flowchart's previous version used February-October 2019, SUFs, which were notified by email, were audited every month. The physician received a phone call and was asked to act on the untreated SUF. In the flowchart's present version used from November 2019 to May 2020, SUFs were audited every 2 weeks. The physician and his/her chief were asked to return a written response to the untreated SUF. We evaluated the difference in the response periods between the previous and present versions of the flowchart.

RESULTS

With the previous flowchart's use, untreated SUFs were 43 of 229 SUFs (18.8%) with the present flowchart untreated SUFs were 22 of 130 SUFs (16.9%). All SUFs in both periods were eventually responded. The present flowchart (median/range, 25/11-70 days) significantly had shorter response periods than the previous flowchart (70/16-290 days) (p < 0.0001).

CONCLUSION

The present flowchart employing a shortened primary audit interval, a written response, and the department chief's intervention, helped reduce the response periods.