[Liability claims in radiology: an 8-year follow-up and future projections]

The analysis of the liability claims filed by Italian radiologists over the past 8 years allows us to evaluate past trends and predict the future evolution of litigation in radiology.

The assurance claims of Italian radiologists over the 1993-2000 period were anonymously evaluated. A total number of 422 claims were classified according to the cause as due to: 1) missed diagnoses; 2) complications; 3) failure to order further radiological examinations; 4) iatrogenic lesions due to radiation therapy; 5) slip-and-fall injuries; 6) miscellaneous cases. The data were analysed using descriptive statistics and curve estimation, i.e. selection of the regression models which best fit the observed data.

Claims showed a linear increase from 1993 to 2000; however exponential increase could not be ruled out. The incidence risk-rate of claims rose over 45 per thousand persons/year. Misdiagnosis represented the first and most important claim category (>60% of total). Missed bone and joint abnormalities accounted for the greatest percentage of cases (37.8%). Missed abnormalities on breast and chest radiographs were the following most common diagnostic errors (25.2% and 15.0%, respectively). Within this class of claims, missed malignant lesions of the breast showed the greatest increase in number. Claims alleging complications resulting from radiological examinations or procedures were 13% of all cases. These complications mostly occurred following administration of i.v. contrast medium, or due to interventional procedures, or barium edema. Slip-and-fall accounted for 6% of cases. A few cases (0.7%) resulted from failure of the radiologist to order further diagnostic examinations. Finally, in roughly 12% of all cases, the radiologists were named as one of multiple defendants, together with medical doctors or other clinicians, in cases of patient's death.

The risk of being sued for Italian radiologists is now comparable to that radiologists in the United States. Strict adherence to radiological standards will probably not be sufficient to reduce the risk of being sued. Special legislative measures may be required to obviate litigation.