County in 1983 [70], but only 4 years passed before a lawsuit was instituted claiming that it was used nappropriately. The lag time is clearly getting shorten. The mid 1 990s are witnessing emerging nadiologic developments such as positron emission tomography, computed radiography, digitalization of images, transmission of radiologic images through teleradiology, advances in CT such as helical scanning, refinements in sonography such as contrast agents, and continuing innovations in MR sequencing. As 1 994 ended, no malpractice lawsuit focusing on on alluding to these developments has yet been filed, but considering faster dissemination of medical knowledge and greater sophistication among plaintiffs’ attorneys, it is likely these cases will soon appear in the malpractice arena. Standards, Guidelines, and Parameters Over the past few years, a number of medical societies and government agencies have created and disseminated explicit clinical practice standards, guidelines, and parameters nelating to the quality and efficacy of a host of medical procedures. The American College of Radiology, as of the writing of this article, has issued 37 specific standards and has many more in the development stage [71]. The American Medical Association has promulgated its parameters [72], and the United States Agency for Healthcare Policy and Research has issued standards addressing “social, emotional, and physical needs of women undergoing mammography [73].” In addition to their stated goal of improving the quality of medical cane, these guidelines and standards will undoubtedly play an increasingly important role in the frequency and disposition of malpractice cases involving radiology in the coming years [74]. Conclusions The total number of medical malpractice lawsuits filed in Cook County, IL, has risen annually from 1975 through 1994, interrupted only by a precipitous drop in filings in 1986 due to tort reform measures passed by the state legislature. The proportion of suits related to radiology has remained relatively constant throughout this period, averaging 12%. The largest category of radiology-related litigation remains allegations of missed diagnoses. These account foran average of 42% of allradiology suits,but ifone considers only diagnostic radiologic lawsuits (deleting failure-to-order and radiation oncology cases), the missed-diagnosis category averages 59%. The greatest increase in missed-diagnosis cases is seen in breast cancer. Although claims of missed lung and GI lesions have remained relatively constant in the reporting period, claims alleging missed skeletal disease have fallen. Failure to order a radiologic examination is an increasing cause of malpractice litigation, accounting for 30% of all radiologic lawsuits filed since 1990. Allegations of injury due to failure to order mammography, CT, MR imaging, and angiography have shown the greatest rate of increase. Litigation parallels and is directly related to the development of nadiologic technology. Lawsuits involving myelognaphy have decreased, whereas those related to such imaging techniques as CT and MR imaging have increased. The lag time between the introduction of these new techniques and the appearance of litigation involving them is decreasing. Lawsuits filed because of complications sustained from radiologic procedures have shown a relative decrease oven the 20-year reporting period. The percentage of slip-and-fall cases and those related to radiation oncology have remained not significantly changed, accounting for 5% and 8%, respectively. Perhaps reflecting greaten sophistication and knowledge on the part of plaintiffs’ attorneys, the number of multipledefendant (shotgun) lawsuits has decreased, as has litigation claiming abortion or damage to the fetus resulting from exposure to diagnostic radiation. Radiologic malpractice in the future will be affected by several factors: new imaging techniques, such as positron emission tomography; innovations in processing of radiologic images, such as digital radiography, picture archiving and communication systems, and telenadiology; modifications in the certification process and institution of limited recertification by the American Board of Radiology; new standards published by the American College of Radiology, as well as clinical guidelines and parameters issued by other medical professional organizations; and economic considerations, related primarily to the growth of managed cane plans and capitation-payment-gatekeeping arrangements. Tort reform measures enacted by the Illinois state legislatune and signed into law by the governor on March 9, 199S, are likely to decrease malpractice litigation, as they did in 1 985, and possible future federal tort reform legislation will undoubtedly affect malpractice litigation nationally. Nevertheless, medical malpractice will undoubtedly continue to plague radiologists unabatedly for many years to come. ACKNOWLEDGMENTS The authors acknowledge with gratitude the assistance of Michael Capek in the preparation of the graphics for this article. REFERENCES 1 . Berlin L. Malpractice and radiologists. AJR 1980;135:587-591 2. Berlin L. Malpractice and radiologists, update 1986: an 11.5-year perspective. AJR 1986;147:1291-1298 3. Lander L. Defective medicine. New York: Farnar,Straus & Giroux, 1978:104 4. Brennan TA, Leape LL, Laird NM, et al. Incidence of