Chest radiography: an underappreciated source of litigation exposure in emergency radiology

Chest radiographs are the most frequently performed imaging examination yet remain vulnerable to interpretive errors, particularly in the high-volume emergency radiology setting. This analysis reviewed published cases in a legal database involving chest radiograph interpretation to highlight recurring medicolegal themes and their implications for emergency radiology practice. While published legal opinions cannot estimate malpractice incidence, they provide valuable insight into potentially modifiable sources of diagnostic error.

A retrospective review of the LEXIS/NEXIS legal database identified publishedopinions from July 1, 2021, to July 14, 2026 involving chest radiograph interpretation. Manually reviewed cases in which chest radiograph interpretation contributed meaningfully to the litigation were analyzed thematically. Medicare Physician Fee Schedule reimbursement and work relative value unit (RVU) data were reviewed for economic context.

Fifty-four published cases met inclusion criteria. The most frequent themes involvedfailure to diagnose cancers/masses/tumors (n = 16, 29.6%), cardiovascular abnormalities (13.0%), infection (13.0%), trauma (11.1%), and misplaced lines/tubes(11.1%). Although published opinions represent only a subset of malpractice claims,they demonstrated recurring patterns of perceptual and communication-related error within a high examination volume practice environment characterized by lowreimbursement and RVU assignment.

Published judicial opinions, though representing only a fraction of claims, illustrate preventable errors in a high-volume modality relevant to emergency radiologists.Findings support continued emphasis on structured search patterns, comparison with prior examinations, effective communication, and, where available, adjunctive AI-assistanceas a second reader to help mitigate risk.