Radiology Errors and Missed Findings

Radiology is the branch of medicine most dependent on disciplined, systematic observation. A radiologist reviewing a chest CT does not just look for what the ordering physician suspects. The standard of care requires a thorough, methodical review of everything visible in the image — because the most important finding is often not the one anyone expected.

When a radiologist sees something significant and fails to report it clearly, or when a physician orders an imaging study and never acts on the report, a patient can go months or years without a diagnosis that was medically achievable far earlier. In cancer cases, in cardiovascular disease, in pulmonary conditions and abdominal emergencies, that delay can be the difference between a treatable condition and a fatal one.

At Lupetin & Unatin, we represent Pennsylvania patients who were harmed because a radiologist or physician failed to meet the standard of care in reviewing, reporting, or acting on imaging findings.

What Radiologists Are Required to Do

Radiologists are physicians. They are not technicians who produce images — they are specialists trained to interpret those images and communicate clinically relevant findings to the treating physician. The standard of care governing their work includes:

• A complete, systematic review of all structures visible in the imaging study — not just the area of clinical concern identified in the ordering physician’s request
• Clear, unambiguous reporting of all significant findings in the radiology report, with findings prioritized by clinical urgency
• Direct, immediate communication to the ordering physician when findings require urgent action — a standard sometimes called the “critical value” or “critical result” communication requirement
• Follow-up recommendations when findings require additional evaluation — specifying the type of follow-up study, the appropriate timeframe, and whether specialist consultation is warranted

The American College of Radiology (ACR) has published detailed practice guidelines governing each of these obligations. When a radiologist fails to meet these standards — by missing a visible finding, failing to communicate an urgent result, or burying a significant abnormality in the last sentence of a long report without flagging it — and a patient is harmed, that failure may constitute malpractice.

The Specific Problem of Incidental but Critical Findings

Among the most consequential radiology failures are those involving findings that were not the focus of the original study but that carried critical clinical significance. A cardiac CT ordered to evaluate the coronary arteries may reveal a lung mass. An abdominal MRI ordered for back pain may show a lesion in the liver. A neck ultrasound ordered to evaluate a lymph node may reveal a thyroid nodule meeting criteria for biopsy.

These findings are sometimes called “incidental” because they were not anticipated, but they are not unimportant. Medical guidelines specifically address the management of common incidental findings — and radiologists are trained to recognize them and report them with appropriate urgency.

When a radiologist notes an unexpected finding that meets criteria for follow-up but buries it in a report in a way that makes it easy for the ordering physician to overlook, that failure is not simply poor communication. It is a breach of the standard of care. Similarly, when a physician receives a radiology report containing a significant finding and takes no action, that physician has also breached the standard of care.

The Most Common Radiology Malpractice Failures We See

• Missed lung nodules or masses on chest CT or X-ray, leading to delayed lung cancer diagnosis
• Overlooked liver lesions on abdominal CT or ultrasound, leading to delayed liver cancer or metastatic disease diagnosis
• Unreported lymphadenopathy (enlarged lymph nodes) visible on imaging but not flagged, leading to delayed lymphoma diagnosis
• Missed pulmonary embolism on CT angiography, leading to preventable death
• Overlooked aortic aneurysm on abdominal imaging, leading to rupture
• Failure to communicate urgent or critical imaging findings to the ordering physician in a timely manner
• Misread or mischaracterized lesions on MRI or CT that were later proven to be malignant

The Ordering Physician’s Separate Obligation

Radiology malpractice cases do not always end with the radiologist. The ordering physician — the internist, emergency physician, hospitalist, or specialist who requested the imaging study — has an independent obligation to review the report and act on its findings.

This obligation is not satisfied by simply receiving the report in an electronic health record system. The standard of care requires that the physician actually review the report, understand its significance, communicate relevant findings to the patient, and ensure that recommended follow-up occurs. When a physician orders imaging and the report flags a significant finding, the failure to follow up on that finding is itself a departure from the standard of care — regardless of what the radiologist did or did not do.

In many of the most damaging delayed diagnosis cases we handle, the failure was not a single point of breakdown. The radiologist identified the finding but did not give it sufficient prominence. The ordering physician received the report but did not read it carefully. The patient was discharged without being told. No follow-up was scheduled. Three years later, a cancer that was visible and manageable has become metastatic.

How We Evaluate a Radiology Malpractice Case in Pennsylvania

When a potential client contacts us with a question about whether a missed or misread imaging finding contributed to a delayed or missed diagnosis, we typically begin by:

• Obtaining all imaging studies and radiology reports from the relevant time period
• Retaining an independent, board-certified radiologist to review the original images and assess what was visible, what should have been reported, and whether the radiologist’s report met the standard of care
• Reviewing all physician notes and communications to determine whether the ordering physician received and acted on the report
• Consulting with a specialist in the relevant disease area to assess the impact of the delay on the patient’s prognosis and treatment options

Pennsylvania’s statute of limitations for medical malpractice is generally two years from the date of the injury or from when it was discovered through reasonable diligence. In delayed diagnosis cases, the discovery rule may toll the limitations period from the date a patient learns — or should have learned — that an earlier diagnosis was possible. An attorney consultation is essential to understand how these rules apply to your situation.

About Lupetin & Unatin, LLC

Lupetin & Unatin is a boutique medical malpractice firm based in Pittsburgh, Pennsylvania. We represent patients and families harmed by radiology errors, missed diagnoses, and delayed cancer diagnosis throughout Pennsylvania. Our attorneys have been recognized by the American College of Trial Lawyers, Super Lawyers, and Best Lawyers in America. All cases are handled on a full contingency fee basis — no fee unless we win.