The usual system for providing radiology services in a hospital is a contract
between the hospital and an individual physician or a practice group. The group
agrees to supervise technical personnel and to read and interpret all tests. The
hospital gives the group an exclusive contract to provide these services and
requires that all tests done in the hospital be done through the group. Patients
eventually receive a bill from the radiology group.
One source of liability for radiologists is improper supervision of nonphysician
technical personnel and equipment. Physicians are responsible for ensuring that
the personnel are adequately trained and doing their jobs properly. Patients
must be protected from falls and other simple injuries. The radiologists must
ensure that all equipment is functioning, that the tests are technically
adequate, and that patients are not exposed to excessive doses of radiation.
Radiologists must carry out special tests and invasive procedures safely and
accurately. Whenever there are invasive procedures, the radiologist should
review the patient’s history, do a physical examination as necessary to verify
critical information, and obtain informed consent for the procedure. For
example, if the attending physician has ordered an IVP and the patient is
dehydrated, the radiologist has a duty to cancel or postpone the test until the
patient is able to tolerate it. If the IVP was done by a technician without the
radiologist’s evaluating the patient, the radiologist is responsible, not the
attending physician. The attending physician would argue that determining the
patient’s fitness for the test at the scheduled time is the radiologist’s
Radiologists should interpret tests as completely as possible. There is an
unfortunate tendency to equivocate on reports as a way of avoiding
responsibility. Giving a report of “possible pneumonitis” instead of “right lower
lobe infiltrates consistent with bacterial pneumonia” does not provide the
attending physician with the benefit of the expert opinion that a radiologist is
expected to provide. Vague readings increase the consultant’s liability when
they mask serious conditions or substitute for an in-depth review of the film.
Radiologists have a duty to make sure attending physicians are informed
quickly of any serious or life-threatening conditions found on a test.
Technicians should routinely inform their supervising radiologists about any
serious results or results that are strange or unusual. Radiologists also must
ensure that the patient is informed of test results and their significance.
Usually this is done by alerting the attending physician, who in turn informs the
patient and recommends any necessary care. This generally discharges the
radiologist’s duty to inform the patient personally.