A new analysis published Tuesday in Radiology explores some of the most common occurrences leading to imaging contrast agent-related lawsuits.
Failure to diagnose or treat anaphylactic reactions was the No. 1 reason a patient or their advocate filed suit, occurring in about 30% of cases. The findings are based on a review of two legal databases covering all 50 states and spanning back to the 1980s.
Out of 151 publicly available contrast-related malpractice lawsuits, 7% went to trial, with all decided in favor of the defense. Experts urged practices to pay close attention to this concern, with over 50 million diagnostic imaging exams conducted each year using contrast, including almost half of all CT scans.
“The high volumes of contrast-enhanced imaging studies raise medicolegal concerns for radiologists,” Amin Khan, MD, with the Department of Radiology and Biomedical Imaging at the Yale School of Medicine, and co-authors wrote Sept. 19 [1]. “Radiology ranks high in terms of medical provider specialties most likely to be implicated in a medical malpractice claim. Most radiologists appreciate the risks of liability for missed findings or lapses of communication. A less common but potentially overlooked area of liability is the use of contrast agents.”
For the study, researchers queried two online legal data repositories for the terms “contrast” and “radiology” or “radiologist,” stretching back to both databases’ inception. They screened the results to only include cases involving the practice area of healthcare law where there was at least one claim of medical negligence against a provider or institution.
Of 45 claims pertaining to anaphylactic reactions, 93% were because a provider failed to diagnose or treat a reaction. Inappropriate management of contrast media extravasation was the second most common medical complication in these cases at 27% (41/151). And alleged contrast agent-induced acute kidney injury came in third at 13% (19/151). Meanwhile, the year of the adverse event that led to the lawsuit was reported in 38% of instances, spanning from 1987 to 2020. Allegations of malpractice were made against 60 radiologists, seven internists, seven rad techs, five RNs, four neurosurgeons, four EM docs, and three cardiologists.
Khan et al. offered three takeaways from their analysis for practice leaders hoping to mitigate the risk of malpractice claims:
- Avoid liability by adhering to the standard of care: “Hospitals or institutions should have policies in writing describing how requests for contrast material are handled, with the expectations of the ordering physician, the radiologist and, where possible, the patients explicitly delineated in terms of attesting to allergic reaction histories, prior reactions, and the need for premedication.”
- AI has a role to play: “As electronic medical records become more integrated, artificial intelligence may offer opportunities to more extensively review medical records, including prior radiology reports.”
- Review radiologists’ degree of decision-making in selecting protocols: “While the goal of performing a study urgently where the benefits reportedly outweigh the risks is an admirable one, and there is certainly justification for flexibility in many cases, the option to exercise discretion can also place a radiologist in a difficult position.”
Read much more in the flagship journal of the Radiological Society of North America, including a corresponding editorial [2], at the links below.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.