Insights into Radiology Malpractice Cases in the United States from the National Practitioner Data Bank

Background Radiologists face substantial malpractice risk. Prior studies based on surveys or legal databases may not reflect national trends. National-scale analyses using objective data remain limited. Purpose To compare radiology malpractice claims with those from other specialties, identify predictors of higher indemnity payments, and assess temporal and regional litigation trends using the National Practitioner Data Bank. Materials and Methods This retrospective study analyzed all physician malpractice payments in the National Practitioner Data Bank from September 1990 to December 2024. Radiology malpractice cases across the United States were identified on the basis of coded allegations involving imaging errors. Comparative statistical analyses were performed across patient, malpractice case, physician, and U.S. state variables. Temporal and regional payment trends were assessed relative to radiologist employment and compensation. State-level analysis examined reform status at the time of each malpractice event, and multivariable logistic regression identified factors associated with higher payments. Results This study included 399 568 malpractice cases involving 229 276 physicians (mean age ± SD, 44 years ± 10.9, sex not reported). Diagnostic errors accounted for 71.3% of radiology claims versus 27.6% of claims in other specialties (P < .001). Radiology malpractice cases more often involved outpatient care (50.5% vs 20.6%; P < .001) and severe outcomes (64.2% vs 32.3%; P < .001). On multivariate analysis, severe patient outcome (odds ratio, 8.64; P < .001) and malpractice cases after 2010 (odds ratio, 2.23; P < .001) predicted higher indemnity payments. The presence of noneconomic damage reform laws and insurer-paid claims were associated with lower payments (both P < .05). Recent cases (2010-2025) versus earlier cases (1990-2010) had higher payments (mean ± standard error, $344 197 ± 12 802 vs $184 000 ± 9873; P < .001) and fewer filings from states with noneconomic damages reform (P < .001) and joint liability reform (P = .007). Conclusion Radiology malpractice cases, compared with other specialties, more frequently involved diagnostic errors, severe patient outcomes, outpatient settings, and higher indemnity payments, and these trends increased over time and varied by state legal environment. © RSNA, 2026.