portions thereof. Although radiologists are usually not alleged negligent in these cases, nonetheless, the radiologists’ professional liability insurance carriers bear the costs of defense and of any ensuing compensation. Table 1 and Figure 2 show that slipand-fall cases have accounted for 4-7%, with an average of 5%, of all radiology-related cases annually throughout the 20- year span ofthis study. A modest yearly decrease has occurred for the past 10 years, but no particular trends have been seen for the specific types of allegations. Radiation Oncology Cases Table 1 and Figure 2 reveal a decreasing frequency of lawsuits claiming patient injury resulting from radiation oncology treatment. The proportion of radiation oncology suits was as high as 17% in the first 5 years of the reporting period, but it has 1eveled off since 1982 to 3%. The significantly higher number of suits filed priorto 1982 was related to allegations thatthyroid car- cinoma in adulthood developed from tonsillar radiation administered during childhood. Plaintiffs were not successful in this litigation, and no similar lawsuits were filed subsequent to 1984. Except for these, the complaints in radiation oncology suits relate generally to complications of radiation treatment; several isolated cases claimed that either radiation treatment was performed without appropriate indication or that it was withheld for inappropriate reasons. The percentage of therapeutic nadiologic lawsuits remains low, and no noteworthy trends have emerged. Complications The proportion of nadiologic malpractice cases alleging corn- plications resulting from radiologic examinations or procedures has remained in the 12-20% range over the entire reporting period, and, as can be seen in Table 1 and Figure 2, the percentage has actually gone down over the past 8 years. The largest subgroup of complications remains those related to angiographic procedures, which account for just under 40% of the total (Table 2). Other complications include those related to TABLE 2: Radiology-Related Malpractice Lawsuits, Cook County, IL, 1975-1994: Complications of Radiology 5-Yr Period Myelography Fetal Abortion/Abnormality Due to Radiation Angiography Barium Studies Contrast Injections (Intravenous Urography, CT) 1975-1979 12 2 27 6 7 1980-1984 17 24 66 9 24 1985-1989 16 5 24 9 17 1990-1994 6 4 22 6 12 Downloaded from www.ajronline.org by 2600:1700:3c30:a3d0:f906:a606:b80b:7d98 on 07/20/22 from IP address 2600:1700:3c30:a3d0:f906:a606:b80b:7d98. Copyright ARRS. For personal use only; all rights reserved 784 BERLIN AND BERLIN AJR:165, October 1995 contrast media reactions (17%), GI studies (8%), myelography (14%), and a number of other miscellaneous procedures. There has been a noteworthy change in the rate of occur- nence of one type of malpractice suit, the allegation that abontion on fetal anomalies were caused by exposure to diagnostic radiation. These cases numbered only two during the 5-year period from 1975 to 1 979 but nose to 24 from 1980 to 1984. From 1985 to 1991 only nine similar suits were filed, and none has occurred in Cook County since 1991. Miscellaneous Cases Malpractice allegations that do not fall into the categories mentioned have been classified as miscellaneous. The percentage of miscellaneous cases was as high as 12% prior to 1990 but has fallen to an approximate average of 4% over the pastS years (Table 1 , Figure 2). The largest single cause ofthe miscellaneous cases, accounting for two thirds of them, are those in which radiologists are named as one of multiple defendants, where the involvement of the radiologist is either nonexistent or marginal at best (Table 3). Radiologists are frequently dismissed from these cases before their final disposition. The number of these multiple-defendant on shotgun cases nose sharply until mid 1985, then dropped dramatically, a phenomenon clearly related to the tort reform measures enacted in Illinois. In a rush to file malpractice cases before the effective date of those mea- sunes, plaintiffs’ attorneys submitted claims without complete investigation, often resulting in the inclusion of radiologists withoutjustification. Since 1985, no more than five of these multipledefendant cases have been filed in any single year. The second most common allegation in the miscellaneous category relates to a breakdown in communication between the radiologist and the attending physicians, causing delayed on inaccurate reporting on loss of reports. Although Levinson [14] reported that up to 80% of all malpractice cases made reference to communication problems, lawsuits dealing with this issue were few in Cook County, numbering only four in the first 5-year block, rising to 11 in the second 5-year block, and peaking at 15 from 1985 to 1989, but falling to only three from 1990 to 1994. Although informed consent is frequently debated among radiologists in the context of risk management, failure to inform was alleged in only two radiologic malpractice cases before 1 979, and in none since. Of major controversy in the radiologic community in the past few years has been the use of nonionic and ionic contrast media and legal implications arising from differences in their safety and frequency of reactions [15]; however, to date no cases in Cook County have