Errors of diagnosis are the most common cause of malpractice suits against radiologists, far exceeding the number of suits involving errors of communication or failure to recommend additional imaging, according to a study published online Nov. 30 in Radiology.

“There is a widespread perception that communication errors are a common cause of malpractice actions despite their relative infrequency in our data set,” wrote Jeremy S. Whang, MD, of the University of Medicine and Dentistry of New Jersey–New Jersey Medical School in Newark, and colleagues.

Data were collected from One-Call Medical network, which brokers CT and MRI services to settle workers’ compensation claims. Participating radiologists provide their malpractice history as part of the credentialing process, and Whang and colleagues used these histories to identify a total of 4,043 malpractices cases where a cause could be derived.

Results showed that error in diagnosis was the general cause in 14.83 claims per 1,000 person-years. Inadequate communication with patients or referrers was a cause of 0.40 and 0.71 claims per 1,000 person-years, respectively. Failure to recommend additional testing was also a rare cause at 0.41 claims per 1,000 person-years.

In the category of diagnosis errors, the most frequently missed diagnosis was breast cancer with 3.57 claims per 1,000 person-years. Non-spinal fractures, spinal fractures, lung cancer and vascular disease rounded out the remaining top five missed diagnoses.

“The specter of malpractice actions is a matter of continuous concern for radiologists. There is justification for this anxiety because suits against them are not rare nor are they declining in frequency,” wrote the authors, who cited data from the Physicians Insurers Association of America which showed that while radiologists comprise 3.6 percent of all U.S. physicians, they rank sixth among all specialists in the number of closed claims in which they were defendents.

Whang and colleagues noted that while the data, which featured claims dating back to the 1970s and 1980s, could not definitively identify the most recent trends in the distribution of malpractice suits, it has demonstrated an increasing responsibility for radiologists in the diagnosis of breast cancer. “The present data reflect the emergence of the nearly exclusive role of radiologists, as the interpreters of mammography and other imaging modalities, for the recognition of breast disease and the risks that such responsibility entails.”

For an in-depth look at a malpractice trial in action, please read "RSNA: Mock Trial Ends in a Split Jury."