Diagnostic errors and communication breakdowns are leading contributors to radiology malpractice claims, with nearly half of the cases examined involving serious permanent injury or patient death, according to a new analysis from The Doctors Company.

The medical professional liability insurer reviewed 735 closed malpractice claims involving radiologists from 2010 through 2025, finding that 75% involved diagnosis-related allegations, including failure to diagnose, incorrect diagnosis or delayed diagnosis.

Nearly half, 47%, of the claims involved high-severity injuries resulting in significant permanent harm or death. Indemnity payments were made in 42% of cases, with an average payment of approximately $456,000. Average gross expenses incurred were $76,000 per claim.

The findings appear in The Doctors Company's Malpractice Risk Review: Radiology Claims, a November 2026 report examining negligence allegations, contributing factors and strategies for reducing patient harm.

Clinical judgment errors were identified as contributing factors in 80% of radiology claims. These included misinterpretation of diagnostic imaging studies, an overly narrow diagnostic focus and failure or delay in ordering appropriate tests.

Communication breakdowns contributed to approximately 26% of claims, most frequently involving failures to exchange critical information between healthcare practitioners. Behavior-related factors, including patient failure to comply with recommended follow-up studies or treatment plans, were identified in approximately 20%.

Although clinical judgment errors were substantially more common, claims involving communication failures generated the highest average indemnity payments among the major contributing factors examined.

The average payment for claims involving communication breakdowns was $518,000, compared with $487,000 for clinical judgment errors and $444,000 for behavior-related factors. Claims involving documentation deficiencies averaged $511,000, while those involving technical skill deficiencies averaged $423,000.

Because individual claims could involve multiple contributing factors, the percentages exceeded 100% when combined.

Beyond diagnosis-related allegations, 13% of claims involved medical treatment, 5% involved patient safety and security, and 3% involved surgical treatment.

The analysis identified cognitive errors as a central contributor to missed or delayed diagnoses. Radiologists may overlook abnormalities because of diagnostic assumptions, distractions, visual fatigue or excessive workloads, according to the insurer.

The report distinguishes between interpretive errors, in which an identified abnormality is incorrectly characterized, and perceptual errors, in which an existing abnormality is overlooked entirely. Citing research on radiology diagnostic errors, The Doctors Company reported that perceptual errors account for 60% to 80% of such errors, compared with 15% to 28% for interpretive errors.

Faster reading rates, higher imaging volumes and studies interpreted near the end of a work shift were associated with increased perceptual errors.

The insurer recommended standardized checklists for commonly missed diagnoses, consistent image-review patterns, reduced interruptions during complex studies and scheduling practices designed to minimize fatigue.

It also identified artificial intelligence detection systems as potentially useful tools for flagging abnormalities and recommended obtaining second interpretations when imaging findings are uncertain.

Communication failures represent another significant area of liability exposure, particularly when unexpected or potentially serious imaging findings are not promptly conveyed to the physician responsible for the patient's care.

The Doctors Company emphasized the importance of closed-loop communication, in which the radiologist delivers a significant finding, the receiving practitioner acknowledges the information and the sender verifies receipt.

The approach is consistent with the American College of Radiology's practice parameters for communicating diagnostic imaging findings, which recommend prompt notification of significant, unexpected findings that could adversely affect patient outcomes.

The insurer also recommended documenting nonroutine communications, including the date, time, method of communication and identity of the recipient.

An accompanying case study illustrates how diagnostic and communication failures can combine to produce a fatal outcome.

The case involved a patient admitted to a community hospital with chest pain who subsequently underwent angioplasty and stent placement at a regional medical center.

An initial chest x-ray was interpreted as unremarkable, although a subsequent expert review identified a visible lung nodule. A second x-ray performed the following day at the regional medical center revealed a suspected lung mass and recommended additional imaging to exclude malignancy.

However, the radiologist did not notify the treating cardiologist, and a system error prevented the report from appearing in the patient's medical chart. The cardiologist discharged the patient without learning of the abnormal finding.

Nearly a year later, the patient was diagnosed with inoperable lung cancer after imaging revealed lesions suspicious for metastases. The patient died approximately one month after the diagnosis.

An expert reviewing the case concluded that both the initial failure to identify the lung nodule and the subsequent failure to communicate the suspicious finding fell below the standard of care.

The case demonstrates how an imaging interpretation error, combined with deficiencies in communication and electronic reporting systems, can delay diagnosis even when an abnormality is subsequently identified.

The Doctors Company also highlighted the importance of patient education as radiology reports become increasingly accessible through electronic patient portals. Practices should use understandable language when explaining findings and recommended follow-up care to help ensure patients recognize the significance of abnormal results.

The insurer concluded that reducing radiology malpractice exposure requires coordinated attention to diagnostic decision-making, communication between practitioners and reliable systems for tracking and managing significant imaging findings.