This article examines the vital role of diagnostic radiography in modern medicine, exploring how radiologists and radiographers contribute to patient care, the nuances of their responsibilities, and the implications of missteps that can lead to medical-legal cases.

Diagnostic radiography has evolved exponentially since the discovery of the “X-ray” by Wilhelm Röntgen, on 8th November 1895.

Today, radiography is one of the most effective and versatile tools to diagnose injury or pathology, monitor disease and track recovery.

The known risks of X-rays are routinely mitigated to ensure that the benefits of any imaging procedure outweigh potential harm.

However, radiography imaging is never entirely free from risk.

Failure to meet expected standards and expectations for patient care and safety can lead to litigation.

Civil court proceedings for medical negligence, where a breach of duty is found to have resulted in avoidable harm to patient during a clinical imaging procedure can include, for example: –

In short, Radiologists are specialist doctors trained to interpret radiology images across a wide range of imaging technologies. They also undertake a range of interventions and image guided treatments.

Diagnostic Radiographers in contrast, are qualified (typically via BSc Honours degree or equivalent) and HCPC registered allied healthcare professionals, who use a range of imaging technologies to help diagnose, monitor and treat disease.

Some diagnostic radiographers will undergo further qualification and training in advanced practice such as the reporting of radiography images, computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), nuclear medicine (NMR).

Therapeutic Radiographers are qualified in the planning, administration and aftercare of radiotherapy treatment for patients, most of whom have cancer.

The provision of expert opinion in relation to medical imaging procedures has traditionally fallen to the Radiology profession, as doctors who commonly provide extensive interpretation of radiology images (reporting) and interventional procedures.

However, the evolution of Advanced Practice in Radiography to include areas such as the image interpretation, ultrasound reporting and even procedures such as CT-guided Colonoscopy have led to role expansion for radiographers as expert witnesses to assist the Courts and fitness to practice tribunals.

As a high-level guide, diagnostic radiographers are generally responsible for all practical elements of imaging procedures.

The following are core competencies of a qualified diagnostic radiographer, as outlined by the UK regulatory body, The Health and Care Professions Council (HCPC) which cover such areas as:

The type of claim and experience of the radiographer will determine their suitability to provide expert opinion on a particular case.

The following are case examples, to serve as a guide.

Synopsis: ❝The claimant was referred to [X] NHS Trust for a Computed Tomography Pulmonary Angiogram (CTPA) which required the insertion of a cannula and intravenous injection of contrast media (dye). The claimant advised that she had thin veins and was concerned it would not work, the radiographer advised that it would be fine. The radiographer did not warn the claimant of any risk associated with the CT contrast dye or the risk of extravasation (leakage). During the injection the claimant suffered serious extravasation injury causing nerve damage with permanent loss of full function of her arm. It is the claimant’s position that had she known of the risk of permanent and debilitating injury, she would not have continued with the procedure.❞

Comment: This case relates to the underlying issue of informed consent (which is a requirement to proceed with any invasive imaging procedure) and CT imaging practice.

A diagnostic radiographer with expertise in Computed Tomography (CT) practice and the intravenous administration of contrast media is the most appropriate individual to provide opinion in this case.

Synopsis: ❝Our client was diagnosed with Myeloma, which made her bones brittle. She required a chest x-ray. From the precognition of our client, the radiographer forced plates down her back which resulted in pain and a fractured spine and sternum.
With reference to the Hunter v Hanley case, was the radiographer negligent?❞

Comment: This case requires expert opinion with specific regard to the practice and alleged actions of the radiographer during the procedure and would be appropriate for an expert radiographer to receive instruction and provide opinion in relation to Hunter v Hanley test for ‘reasonable care’.

It would not typically be appropriate for a radiographer to comment or provide opinion on the causation of the fractures, without clinical qualification and expertise in cancerous disease (Oncology) and mechanism of skeletal injury (Orthopaedics).

Synopsis: ❝The claimant required the MRI following a Transient Ischaemic Attack (TIA) i.e. a Stroke. This case relates to the alleged misdiagnosis of a foreign metal artifact resulting in a Magnetic Resonance Imaging (MRI) scan not being undertaken. We require an expert to respond to the allegations in the letter of claim and to provide an alternative as to what imaging should have been performed in place of the MRI as based on current evidence and practice❞

Comment: There are two elements to this case that require opinion:
a) the accuracy of the diagnosis of a foreign metal artefact and;
b) the most appropriate alternative to an MRI procedure in the investigation of TIA.

Part a) requires expertise in the reporting of radiology imaging of the area identified as the potential site of the foreign metal artifact and Part b) requires expertise in cross sectional imaging of the brain. While there are radiographers who have expertise in the reporting of X-ray imaging and the reporting of cross-sectional imaging of the brain, is unlikely (but not impossible) for any individual radiographer to have expertise in both these areas.

For this reason, an expert neuro Radiologist is recommended for this case.

Synopsis: An alleged missed diagnosis of a mass in a patient’s lung. The patient had a shoulder X-ray performed and the image was reported by a reporting radiographer trained in Musculoskeletal imaging interpretation. We require an assessment and expert opinion on: ❝Would a reasonable body of reporting radiographers correctly identify the mass in the lung?❞

Comment: This case would be appropriate for both a suitably qualified and experienced reporting radiographer with demonstrable expertise in the reporting of musculoskeletal (MSK) images OR a Radiologist specialising in MSK imaging. 

Synopsis: ❝I am instructed to investigate a potential medical negligence claim for a client relating to a delay in diagnosis and treatment of a tubal ectopic pregnancy at around 4-6 weeks. She was under the care of [X] NHS Trust at the time.❞

Comment: This case would be suitable for a qualified and experienced sonographer with a specialist interest in Obstetrics and Gynaecological ultrasound imaging.

Further Information: While it can be challenging to determine whether to approach a radiographer or radiologist to receive instruct for a case, there is help available. The Society & College of Radiographers (SCoR) holds a national register of expert radiographers across a range of specialties and can provide advice and guidance on suitability and availability. Contact SCoR via Contact us | SoR for further information (Referencing the Radiography Expert Witness register).

As an expert witness, I offer a free 15-minute consultation or email to provide advice and guidance as to the suitability of a case expert.

If you are a radiographer and interested in becoming an expert witness, further information can be found here: The Role of the expert witness: a guide for clinical imaging and therapeutic practitioners.

Emily Faircloth is a HCPC-registered diagnostic radiographer with 25+ years’ NHS experience.

She specialises in diagnostic imaging, mental health, and crisis care.

Emily is an expert witness providing written reports and testimony for Civil Court Proceedings including:

• Anaphylactic or adverse reaction to / extravasation of intravenously administered contrast media during Computed Tomography (CT) procedure.
• Injuries sustained or exacerbation of existing injury during a CT or radiography procedure.
• Fitness to Practice (Health and Care Professionals Council – diagnostic radiography).

To request her CV or for any medico-legal matters she can be reached at emilyfaircloth@inneg.co.uk