Radiology Errors
Radiologists play a critical role in diagnosing disease and injury. When imaging studies are misread, findings are not reported, or the wrong patient's images are reviewed, the resulting diagnostic delays can have serious — even fatal — consequences.
What Are Radiology Errors?
Radiology errors are mistakes in the interpretation, reporting, or handling of medical imaging studies — including X-rays, CT scans, MRIs, mammograms, ultrasounds, and PET scans. These errors can result in missed diagnoses, delayed treatment, unnecessary procedures, and worsened patient outcomes. Because imaging is central to the diagnosis of conditions ranging from cancer to fractures to strokes, radiology errors have far-reaching consequences across virtually every area of medicine.
Radiology errors fall into three primary categories. Perceptual errors occur when the radiologist fails to see an abnormality that is present on the image. Studies have shown that radiologists miss approximately 3-5% of clinically significant findings — and the rate can be higher for certain types of studies, such as chest X-rays, where missed lung nodules are a well-documented problem. Perceptual errors are influenced by factors such as image quality, the radiologist's fatigue and workload, the complexity of the anatomy, and whether the abnormality is in an expected or unexpected location.
Interpretive errors occur when the radiologist sees a finding but assigns it the wrong significance. For example, a radiologist might see a lung nodule but characterize it as benign when it is actually malignant, or might attribute a bone lesion to a prior injury when it is actually a tumor. These errors often involve a failure to recommend appropriate follow-up imaging or biopsy — a failure that can delay cancer diagnosis by months or years.
Communication errors occur when a significant finding is identified but not effectively communicated to the referring physician or the patient. The American College of Radiology (ACR) has established guidelines for communicating critical and unexpected findings, including direct verbal communication for urgent results. When a radiologist identifies a potentially life-threatening finding — such as a pulmonary embolism or aortic dissection — but merely includes it in a written report that may not be reviewed for hours or days, the delay in communication can have fatal consequences.
Systemic factors contribute to radiology errors. The increasing volume of imaging studies has created enormous workloads for radiologists, who may be expected to read hundreds of studies per day. This volume pressure, combined with frequent interruptions and the cognitive demands of sustained visual search, creates conditions ripe for error. Additionally, inadequate clinical information provided to the radiologist, poor image quality, and lack of comparison with prior studies all increase the risk of missed findings.
The rise of teleradiology — where images are transmitted electronically to off-site radiologists for interpretation — has introduced additional concerns. Overnight or weekend reads by remote radiologists who may lack access to prior imaging or clinical context, combined with the potential for image degradation during transmission, can increase error rates. Hospitals that outsource radiology interpretation have a responsibility to ensure that the quality of remote reads meets the same standard as on-site interpretation.
Common Examples of Radiology Errors
Misread Imaging Studies
Failing to identify abnormalities on X-rays, CT scans, MRIs, or mammograms, including lung nodules, brain bleeds, tumors, and subtle fractures that are visible on the images.
Failure to Report Critical Findings
Identifying a potentially life-threatening finding but failing to communicate it urgently to the referring physician, resulting in dangerous delays in treatment.
Missed Fractures
Overlooking fractures on X-rays, particularly subtle fractures of the scaphoid bone, vertebral compression fractures, stress fractures, and rib fractures that may be difficult to see but require treatment.
Delayed Cancer Diagnosis from Imaging
Missing early signs of cancer on mammograms, CT scans, or MRIs, or characterizing a malignant finding as benign, allowing the cancer to advance before it is eventually detected.
Wrong Patient Imaging
Reading images belonging to the wrong patient, which can result in one patient receiving an incorrect diagnosis while another patient's condition goes undetected.
Failure to Compare with Prior Studies
Not reviewing previous imaging to identify changes over time, such as a nodule that has grown or a fracture that has failed to heal, which can indicate a new or worsening condition.
Failure to Recommend Follow-Up
Identifying an indeterminate finding but failing to recommend appropriate follow-up imaging or biopsy, leaving a potentially malignant finding unmonitored.
Technical Errors
Poor image quality due to improper technique, patient positioning, or equipment malfunction that renders the study non-diagnostic but is not flagged for repeat imaging.
Key Questions an Attorney Would Investigate
Was the abnormality visible on the original imaging when reviewed retrospectively by an expert?
Did the radiologist have adequate clinical information to guide their interpretation?
Were prior imaging studies available and compared to the current study?
Was the radiologist's workload at the time of the read consistent with safe practice?
Were ACR guidelines for communicating critical findings followed?
Did the referring physician review and act on the radiology report in a timely manner?
Was the imaging performed using proper technique and equipment, producing diagnostic-quality images?
Was the correct patient's imaging reviewed and reported upon?
Watch: Understanding Radiology Errors
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