Risk Management for Radiologists

Risk management in radiology extends beyond the technical aspects of image interpretation. For radiologists, effective risk management includes a comprehensive approach that begins with thorough patient intake processes and extends through clear communication protocols, detailed documentation practices, and standardized reporting procedures. This article explores practices to help radiologists enhance patient safety and reduce the risk of medical liability.


Clinical history

“Radiologists are trained to look inside a person’s body, but they can also benefit from looking at the outside by putting into place a thorough intake process.” (1) Not having adequate information about a patient’s history or the context for which the imaging was ordered can lead to procedural errors or complications such as performing the wrong kind of imaging study.

It is good risk management practice for radiologists to ensure that with every procedure they obtain a patient history, know what they are looking for, request or suggest further testing if necessary, and — when needed — review the diagnosis with the ordering physician. 

As the American College of Radiology (ACR) states, “there is a reciprocal duty of information exchange . . . a request for imaging should include relevant clinical information, including pertinent signs and symptoms. In addition, including a specific question to be answered can be helpful. Such information helps tailor the most appropriate imaging study to the clinical scenario and enhances the clinical relevance of the report, thus promoting optimal patient care.” (2)

Diagnostic and imaging reports

In liability claims against radiologists, the quality and completeness of diagnostic imaging reports come under close scrutiny. Problem areas include:

• reports that lack important details about findings;
• reports that bury critical information in dense paragraphs where it can be overlooked;
• reports that fail to document the technical limitations of the study; and  
• reports that omit follow-up recommendations.

To manage these risks, the ACR states that reports “should address or answer any specific clinical questions. If there are factors that prevent answering the clinical question, these should be stated explicitly. Follow-up or additional diagnostic studies to clarify or confirm the impression should be suggested.” (2)

Adhere to established, standardized terminology. Clearly and accurately describe the findings using accepted, standardized terminology that the ordering physician will understand.

Communication best practices

Clear and timely communication is an essential best practice for radiologists. Critical findings must be communicated promptly and effectively to referring physicians.

Establish and follow clear protocols for communicating critical results. This may include prioritizing test results with such categories as “urgent,” “critical,” “action needed,” or “pending results.” A coding system may heighten awareness and trigger more timely communications or follow-up.

 Protocols may also include which methods of communication are required for different results. For example, a result categorized as “urgent” may require escalation with immediate action, such as attempting to contact the ordering physician directly by phone call, email, or text. 



The American College of Radiology Practice Guideline for Communication of Diagnostic Imaging Findings offers guidelines — not rules or requirements — for communicating results. 

According to the ACR, “in emergent or other non-routine clinical situations, the interpreting physician should expedite the delivery of a diagnostic imaging report (preliminary or final) in a manner that reasonably ensures timely receipt of the findings. This communication will usually be to the referring physician/health care provider or their designee.

When the referring physician/health care provider cannot be contacted expeditiously, it may be appropriate to convey results directly to the patient, depending upon the nature of the imaging findings.” (2)


Protocols for emergent/non-routine clinical scenarios should be clearly described in your practice’s policies and procedures. Protocols should also include how to appropriately document these communications.

Ensure proper handoff procedures between shifts. “Care transitions in radiology extend beyond the physical to include mental, verbal, and technological movements in care delivery between clinical staff, patients, and radiology departments. Handoffs in radiology occur each time there is a transfer of clinical information and a shift in decision-making responsibility, and this ensures the continuity of care through each transition.” (3) The outgoing radiologist should identify critical or complex cases, document ongoing physician communication, and note any technical issues before the handoff.

Good communication during handoff may be particularly critical for interventional radiologists. Inform the incoming radiologist of critical patients, complex cases, pending procedures, and any departmental issues such as equipment status or staffing concerns.

The handoff process should include verification steps, such as using checklists or work logs, to ensure critical information is provided to incoming radiologists or technologists. Review and update the handoff process, as needed, to help maintain its effectiveness and address any communication gaps or concerns.



Documentation

Accurate, complete, and contemporaneous documentation can be your best defense against a malpractice claim or board action. Incomplete or late documentation can compromise patient care, as other physicians will not have access to information needed for treatment decisions and continuity of care. Documentation recommendations for radiologists include the following.

Record any relevant patient history obtained, physical examination findings (when performed), and any counseling provided. Note any concerns reported by the patient.


Include all elements suggested in the ACR Practice Parameter for Communication of Diagnostic Imaging Findings, including:

• Demographics
• Relevant clinical information
• Procedures and materials
• Findings (using appropriate anatomic, pathologic, and radiologic terminology)
• Potential limitations
• Limiting factors
• Comparison with past relevant examinations
• Impression
• Follow-up or additional diagnostic studies suggested when recommended
• If applicable, any adverse event involving the patient during or after performance of the study (2)
• Maintain detailed documentation of all communications with ordering physicians.

Document all emergent or “non-routine” communications in the radiology report with the date, time, method of communication, and name of the person receiving the report. Documenting communication with other providers ensures the patient receives timely care and helps provide context for future studies.

Sources


1. Hille A. Top 5 unique risks for radiologists. Ultra Risk Advisors. Available at https://ultrariskadvisors.com/top-5-unique-risks-radiologists/ . Accessed January 13, 2025.

2. American College of Radiology. ACR Practice Parameter for Communication of Diagnostic Imaging Findings. Revised 2020. Available at https://www.acr.org/-/media/acr/files/practice-parameters/communicationdiag.pdf. Accessed January 9, 2025.

3. Burns J, et al. Handoffs in Radiology: Minimizing Communication Errors and Improving Care Transitions. Journal of the American College of Radiology. Volume 18, Issue 9, 1297–1309.

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