Lung Cancer Missed on an X-Ray Can You Sue?

Finding out that a chest X-ray from months or years ago showed signs of lung cancer, and that nobody caught it, is a particular kind of blow. It is not only the diagnosis.

It is knowing that time was lost: time that might have meant surgery instead of chemotherapy, or more years with the people you love.

This article explains why chest X-rays miss lung cancer more often than most patients would guess, where tumors tend to hide, and how New York law decides whether a miss was an unavoidable limit of the test or a lung cancer malpractice claim.

Why the Chest X-Ray Is Where Most Lung Cancers Are Missed

A chest X-ray flattens a three-dimensional chest into a single image. Ribs, the collarbones, the heart, blood vessels, and the spine all overlap the lungs.

A tumor can sit directly behind one of those structures and blend in.

That is a big reason missed lung cancer is so closely tied to X-rays rather than CT scans. A 2017 review of the medical literature on missed lung cancer reported that about 90% of presumed mistakes in lung cancer diagnosis involved chest radiographs, with only about 5% on CT.

The same review cited U.S. data showing that failure to diagnose lung cancer is the second most common reason radiologists are sued. Among radiologists who specialize in chest imaging, it accounted for 42.5% of malpractice suits.

Detailed research comes from Radiology. In one study, radiologists reviewed 40 lung cancers that had been visible on earlier X-rays at a point when they could still have been removed surgically.

The missed tumors had a median diameter of 1.9 centimeters, roughly three-quarters of an inch, which is not microscopic. Earlier work in the same journal put the average size of missed cancers at about 16 millimeters.

In other words, the tumors at the center of these cases are often large enough to see once someone knows where to look. Whether they should have been seen the first time is a separate question, and it is the one these cases turn on.

Where Tumors Hide on a Chest X-Ray

Radiologists are trained to check certain “blind zones” with extra care because overlapping anatomy makes them easy to miss:

• The lung apex, at the very top of the chest, where the collarbone and first ribs cross. In the Radiology study above, 72% of missed cancers were in the upper lobes, and the collarbone covered 22% of them.

• The hilum, the central area where the airways and blood vessels enter each lung. Its normal shape varies so much between people that a tumor there can look like ordinary anatomy.

• Behind the heart, where the lower lobes sit in the heart’s shadow on a front-facing view.

• Below the diaphragm line, where the curved bottom of the lungs dips behind the abdomen on the image.

Tumors at the top of the lung, including Pancoast tumors, can also cause shoulder pain or nerve symptoms long before anyone suspects the lung.

Our page on lung cancer signs and symptoms describes how these apical tumors present.

Visible in Hindsight vs. Should Have Been Seen

This distinction decides most of these cases. Almost every lung cancer is easier to spot once you know it is there.

Defense lawyers call that hindsight bias, and they are right that it is real. Looking back at an old film with the answer in hand is not the same as reading it cold.

So the question an expert has to answer is not “can I see it now?” It is “would a reasonably careful radiologist, reading this film the first time with the information available then, have identified it or recommended more imaging?” Experts look at factors like these:

• Size and contrast. How large and dense was the shadow, and how clearly did it stand out from the tissue around it?

• Location. Was the shadow in a blind zone, or in open lung where it should have been obvious?

• Prior films. Were earlier X-rays available, and did they show the shadow growing?

• Clinical history. Did the order mention a smoking history, a cough that wouldn’t clear, coughing up blood, or weight loss that should have raised the radiologist’s level of alert?

• Report language. Did the radiologist describe something “indeterminate” without recommending a CT scan to sort it out?

When a shadow is reasonably clear, was present on more than one film, or was noted but never followed with a recommendation for CT, the case moves from “unfortunate limit of the test” toward a departure from the standard of care.

An X-ray that raises any suspicion is supposed to lead to a CT scan, which shows the chest in slices without overlapping structures.

Our page on how lung cancer is diagnosed walks through that next step. The same limitation is why yearly low-dose CT, not X-ray, is the recommended tool for lung cancer screening in higher-risk adults.

Who Can Be Responsible

The radiologist who read the film is the obvious starting point. Responsibility can also extend to others:

• The ordering physician, if the report noted an abnormality or recommended a CT and no one acted on it or told the patient

• The hospital or imaging center, if reports were routed to the wrong place or there was no system to track recommended follow-up imaging

When the radiologist did flag a finding and the breakdown came afterward, the case looks more like the follow-up failures covered in our article on when a missed pulmonary nodule becomes malpractice.

New York Deadlines

Under the amended CPLR 214-a, a claim for a negligent failure to diagnose cancer generally must be filed within two years and six months of the later of two dates:

• When you knew or reasonably should have known of the mistake and the harm it caused, or

• Your last continuous treatment for the condition

There is an outer limit of seven years from the missed reading. The amendment reaches back to negligent acts on or after July 31, 2015. A short revival window for claims that had recently expired closed in 2018.

If the X-ray was read at a public hospital, a notice of claim generally must be served within 90 days. The lawsuit itself must generally be filed within one year and 90 days of the event, a much shorter clock than for private providers.

When a missed diagnosis has led to a death, the family’s claims follow separate deadlines, explained in our article on wrongful death after a missed lung cancer diagnosis.

Talk With a New York Cancer Lawyer

Porter Law Group represents patients and families across New York, with offices in Albany, Buffalo, New York City, Rochester, and Syracuse.

Our New York cancer lawyers work with board-certified radiologists who review the original films, compare them with later imaging, and give a straight answer about whether the tumor should have been caught.

Call 833-888-LATE, email info@porterlawteam.com, or request a free case evaluation.

Attorney advertising. This article provides general information and is not legal or medical advice. Prior results do not guarantee a similar outcome. Filing deadlines depend on the facts of each case.

Frequently Asked Questions

How often is lung cancer missed on a chest X-ray?

More often than most patients expect. A review of the medical literature found that about 90% of presumed errors in lung cancer diagnosis involve chest X-rays rather than CT scans. Studies published in Radiology found missed tumors were often more than a centimeter and a half across, large enough to see once someone knew where to look.

Where on a chest X-ray is lung cancer most often missed?

Most missed cancers are in the upper lobes, especially near the top of the lung where the collarbone and first ribs overlap. Other common blind spots include the central hilum, the area behind the heart, and the lower lung near the diaphragm, where overlapping anatomy can hide a tumor.

What is “satisfaction of search” in radiology?

It is a recognized type of error in which a radiologist finds one abnormality, such as a rib fracture or fluid around the lung, and stops looking. A second, smaller finding on the same image, including an early lung tumor, can then go unreported. Careful, systematic review of the whole film is meant to prevent it.

Should an abnormal chest X-ray be followed by a CT scan?

Generally, yes. A chest X-ray flattens overlapping structures into one image, so any suspicious or indeterminate shadow is typically followed by a CT scan, which shows the lungs in cross-sectional slices. A report that describes an unclear finding without recommending further imaging can become a central issue in a malpractice case.

Does Lavern’s Law apply if my X-ray was misread before 2018?

Possibly. Lavern’s Law took effect January 31, 2018, but it applies to negligent acts on or after July 31, 2015. It does not revive claims that had already expired, other than through a short window that closed in 2018. The outer limit is seven years from the missed reading, so the exact dates matter.