RSNA2023 Leading Through Change
Daily Bulletin

Contrast Agents, Liability and Lawsuits – What Radiologists Need to Know

Tuesday, Nov. 28, 2023

By Nick Klenske

Contrast media are a key tool in the radiology toolbox. In fact, an estimated 50 million CT scans with contrast are performed in the U.S. every year.

While radiologists are generally aware of the risks associated with contrast agents, many fail to understand the extent of the legal liability that can follow when things go wrong.



“Radiology ranks high in terms of specialties implicated in medical malpractice claims,” said Jonathan Mezrich, MD, JD, MBA, LLM, associate professor of radiology and biomedical imaging at Yale School of Medicine in New Haven, CT. “While most radiologists understand the risks of liability for missed findings or lapses of communication, liability for the use of contrast agents in imaging procedures may be underappreciated.”

Just how big of a liability are we talking about? According to Dr. Mezrich, it’s not insignificant.

“Judgments and settlements often stem well into the millions,” he said.

Contrast-Related Injuries Can Result in Judgement Awards

During a Monday RSNA session, Dr. Mezrich presented the results of a recent Radiology study on the legal risks inherent in contrast utilization. The study analyzed data from two major legal databases regarding published cases stemming from contrast related injuries.

Of the 151 cases identified, 45 of these lawsuits involved anaphylaxis, 41 related to contrast extravasation issues, 19 involved acute kidney issues, eight involved bowel injury, six involved development of aspiration pneumonia, 18 involved neurological complications, and four related to failure to order appropriate studies, with the remaining 10 categorized as miscellaneous/other.

“Failure to diagnose or treat anaphylactic reactions promptly, monitor contrast agent administration or refer patients for urgent contrast media extravasation treatment were frequent allegations in medical malpractice lawsuits for contrast-related imaging procedures,” Dr. Mezrich said.

The majority of these lawsuits went to trial, with the others being resolved by settlement or arbitration. The remainder were either dismissed or their outcome was unknown.

In terms of costs, the study showed that plaintiffs won 26.4% of cases that went to trial, with an average judgment award of $2.9 million.

“While most of the settled cases were settled for an undisclosed or confidential amount, the average published settlement amount was approximately $1 million,” Dr. Mezrich said.

Mitigating the Risk

As Dr. Mezrich noted, these figures are not insignificant.

“Radiologists cannot afford to ignore the legal risks associated with contrast media and, more importantly, they need to take steps to mitigate their exposure,” he said.

A good place to start is to adhere to published hospital policies and standards of care.

“Deviation from the standard of care is a strong indication of negligence, and failure to comply with one’s own hospital policies is generally a bad position to take in front of a jury,” Dr. Mezrich said.

Furthermore, policies that limit a radiologist’s discretion to bypass safeguards may be helpful in certain settings. Likewise, bolstering education and the use of up-to-date technology with respect to managing contrast reactions and anaphylaxis can go a long way in reducing liability. 

Where possible, Dr. Mezrich also recommends incorporating AI into the process of reviewing patient medical records for allergies, the need for premedication, prior reactions and other risk factors.

“AI can decrease liability due to its ability to rapidly mine information regarding allergies and prior reactions from multiple components of the electronic medical record in real time,” he concluded.

Access the presentation, “Contrast Administration as a Source of Liability: Legal Database Analysis,” (M6-SSNPM01-5) on demand at