New Case Law Could Put Radiologists on Hook for Imaging-Order Appropriateness

Why It Matters

The decision could shift liability onto radiologists, prompting tighter oversight of imaging orders and reshaping risk management in radiology practices.

Key Takeaways

• Ohio appellate court allowed ACR Appropriateness Criteria in malpractice trial
• Radiologists may face liability for ordering inappropriate imaging studies
• Auto‑protocolling workflows could increase legal exposure without radiologist review
• Growing imaging volume and radiologist shortage challenge full order review
• Case highlights need for clearer standards on radiologist responsibility

Pulse Analysis

The Ohio appellate ruling in Kelley v. Horton is the first known instance where a court admitted the American College of Radiology’s Appropriateness Criteria as evidentiary support in a malpractice case. While the judgment ultimately exonerated the defendants, the mere acceptance of the criteria signals a potential shift in how courts may define the standard of care for imaging. Legal scholars note that the decision does not yet establish the guidelines as binding law, but it opens the door for future plaintiffs to argue that radiologists should have applied the criteria before performing a study.

For radiology departments, the ruling raises operational and liability concerns. Many practices have adopted auto‑protocolling systems—leveraging technologists, artificial intelligence, or predefined protocols—to manage soaring imaging volumes amid a nationwide radiologist shortage. If courts begin to view adherence to the Appropriateness Criteria as a duty, radiologists could face exposure for scans ordered by referring physicians that they did not personally review. This tension may force providers to re‑evaluate workflow automation, invest in decision‑support tools, or allocate more radiologist time to order verification, potentially increasing costs and affecting throughput.

The broader industry impact hinges on how quickly legal precedents evolve and whether professional societies codify clearer responsibilities. Hospitals and imaging groups may seek contractual protections, such as explicit clauses limiting radiologist liability for orders deemed appropriate by referring clinicians. Meanwhile, the American College of Radiology could strengthen its guidelines, offering more granular recommendations to reduce ambiguity. Ultimately, the case underscores the need for a balanced approach that safeguards patient safety without overburdening radiologists already stretched thin by demand.