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Medical Imaging and Radiologic Technology Risk Assessment: Patient Safety, Equipment and Data Controls

A worked example of how a hospital imaging department finds, scores and controls risks to patients, staff, equipment and image data, from dose and identification errors to contrast reactions, staffing and handover.

Updated November 2026 8 hazards assessed Review every 6 months Highest risk: Critical to High
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Executive summary

This assessment shows how a hospital radiology department can find, rate and control the risks that matter most to patients, staff, equipment and image data. Eight hazards were chosen because they arise in everyday imaging work, from radiation dose and identification errors to contrast reactions, staffing and handover. Wrong patient or wrong side errors carry the highest inherent score and are the first priority. Most hazards fall to Medium or Low once the added controls are in place, but identification errors and contrast reactions stay at High because the harm is severe and cannot be fully removed. The first actions are time out checks, dose reference levels, access reviews and a contrast screening checklist. Every score is a teaching example that illustrates method, not a measurement of any real service.

Focus area
Medical imaging and radiologic technology
Setting
Hospital radiology department providing diagnostic radiography, computed tomography and fluoroscopy with a shared picture archiving system
Method
Five by five likelihood and impact risk register with clinical governance review

Scope

This assessment covers a hospital radiology department, from referral and patient identification through examination, image storage, reporting handover and follow up. It considers risks to patients, staff, equipment, image data and service continuity. It does not replace local radiation protection, medical physics or clinical governance review. Jurisdiction, equipment vendor and staffing model are assumptions made for teaching.

Context

The department operates radiography, computed tomography and fluoroscopy rooms, with a shared picture archiving system and a radiology information system linked to the electronic record. Radiographers perform examinations, a radiologist reports images, and a medical physicist maintains dosimetry and calibration. Each risk is scored before controls to show its natural level, then again after existing controls and the additional controls that should be added. Scores are teaching examples, not measurements of any real service.

Objectives, assets and stakeholders

The objective is to deliver safe, accurate and timely imaging, limit radiation to what each examination needs, protect identifiable health data, and keep staff competent. The assets in scope are patients, imaging equipment, the picture archive and reporting system, medication and contrast stock, and the reputation of the department. Stakeholders include patients and families, referring clinicians, reporting radiologists, radiographers, medical physicists, the infection prevention and information governance teams, managers and regulators. Every risk has one owner role, and the clinical governance lead reviews the register with the service manager each quarter and reports significant changes to the clinical board.

Risk matrix: before and after controls

Each cell shows hazard numbers placed by likelihood and impact. Compare the two grids to see how controls move each hazard.

Before controls

Inherent risk

Risk before controls: rows are likelihood from almost certain to rare, columns are impact from insignificant to catastrophic. Cells list hazard numbers.
1
Insignificant		 2
Minor		 3
Moderate		 4
Major		 5
Catastrophic
5 Almost certain
4 Likely Likelihood 4, impact 3, score 12, high: H07 Likelihood 4, impact 4, score 16, high: H01 Likelihood 4, impact 5, score 20, critical: H02
3 Possible Likelihood 3, impact 3, score 9, medium: H08 Likelihood 3, impact 4, score 12, high: H03 Likelihood 3, impact 5, score 15, high: H04
2 Unlikely Likelihood 2, impact 4, score 8, medium: H05 Likelihood 2, impact 5, score 10, high: H06
1 Rare

After controls

Residual risk

Risk after controls: rows are likelihood from almost certain to rare, columns are impact from insignificant to catastrophic. Cells list hazard numbers.
1
Insignificant		 2
Minor		 3
Moderate		 4
Major		 5
Catastrophic
5 Almost certain
4 Likely
3 Possible
2 Unlikely Likelihood 2, impact 2, score 4, low: H08 Likelihood 2, impact 3, score 6, medium: H03 H07 Likelihood 2, impact 4, score 8, medium: H01 H04 H06 Likelihood 2, impact 5, score 10, high: H02
1 Rare Likelihood 1, impact 4, score 4, low: H05
  • Low 1 to 4
  • Medium 5 to 9
  • High 10 to 16
  • Critical 17 to 25

Hazard register

A summary first, then the detail for each hazard.

Summary of hazards with scores before and after controls
No.HazardBeforeAfterOwner
H01 Excess radiation dose to patients and staff 16 High 8 Medium Radiation protection supervisor
H02 Wrong patient or wrong examination performed 20 Critical 10 High Lead radiographer
H03 Imaging equipment failure or calibration drift 12 High 6 Medium Medical physicist
H04 Loss or unauthorised access to patient images and records 15 High 8 Medium Information governance lead
H05 Infection spread during contrast injection and procedures 8 Medium 4 Low Infection prevention lead
H06 Adverse reaction to contrast agents 10 High 8 Medium Clinical lead for radiology
H07 Staffing gaps and cover by staff without current competence 12 High 6 Medium Workforce manager
H08 Incomplete reports and missed handover of urgent findings 9 Medium 4 Low Radiology clinical governance lead
H01

Excess radiation dose to patients and staff

Safety Before 16 After 8

Exposure settings, repeat images or fluoroscopy time exceed the level needed for the diagnostic question, so patients and staff receive more radiation than necessary.

Who or what is affected: Patients, radiographers, pregnant staff and visitors

Causes

Protocols copied without adjustment, time pressure and limited dose feedback to staff.

Consequences

Avoidable radiation harm, complaints, retakes and loss of confidence in the service.

Existing controls

  • Exposure settings are protocol based for each examination type.
  • A medical physicist reviews dose records for each scanner each year.

Control gaps

Dose audit covers only a sample of scanners, and patient size is not always recorded.

Additional controls

  • Prevent: Set dose reference levels for common examinations and review any study that exceeds them.
  • Detect: Audit dose reports each month and flag repeated images or long fluoroscopy times.
Likelihood 4 x impact 4 before; 2 x 4 after Owner: Radiation protection supervisor Target: Within 60 days Early warning: Dose reports above the local reference level for the same examination on two or more days in a row.
H02

Wrong patient or wrong examination performed

Safety Before 20 After 10

Images are taken of the wrong body part, side or patient, or the wrong examination is booked from a referral, so results mislead the reporting clinician and treatment is delayed or harmful.

Who or what is affected: Patients, referring clinicians and reporting radiologists

Causes

Busy lists, similar patient names and requests that are unclear or incomplete.

Consequences

Repeat exposure, delayed diagnosis, wrong treatment and serious patient harm.

Existing controls

  • Two patient identifiers are checked before each examination.
  • Laterality markers are placed on the patient for side specific requests.

Control gaps

Checks rely on verbal confirmation, and the weekly review does not cover emergency lists.

Additional controls

  • Prevent: Require a time out check of name, examination and side against the request before the first image.
  • Detect: Review each week any image labelled with a wrong side or a repeated examination.
  • Respond: Recall affected patients promptly and notify the referrer when an error is found.
Likelihood 4 x impact 5 before; 2 x 5 after Owner: Lead radiographer Target: Within 30 days Early warning: Two or more wrong side or wrong patient events reported in one month in the same room.
H03

Imaging equipment failure or calibration drift

Operational Before 12 After 6

A scanner, generator or detector fails during a list, or its output drifts out of calibration, so images are poor, repeats increase and diagnoses are delayed.

Who or what is affected: Patients, radiographers, physicists and service planners

Causes

Ageing equipment, missed maintenance visits and heavy daily use.

Consequences

Lost list time, repeat examinations, patient transfers and delayed diagnosis.

Existing controls

  • Service contracts cover preventive maintenance for each scanner.
  • Daily quality control images are checked before the first patient.

Control gaps

The downtime plan has not been rehearsed, and some faults are fixed without recorded checks.

Additional controls

  • Prevent: Replace parts approaching end of life and schedule calibration against manufacturer guidance.
  • Respond: Keep a written downtime plan that reroutes urgent patients to a nearby service.
Likelihood 3 x impact 4 before; 2 x 3 after Owner: Medical physicist Target: Within 90 days Early warning: Daily quality control results outside tolerance on two consecutive days.
H04

Loss or unauthorised access to patient images and records

Technology and data Before 15 After 8

Image archives, reporting systems or shared drives are corrupted, lost or viewed by people without a clinical need, exposing identifiable health data and disrupting care.

Who or what is affected: Patients, clinicians, the information governance team and the public

Causes

Shared logins, unused accounts and remote viewing on personal devices.

Consequences

Privacy breach, reporting duties, loss of trust and delayed care.

Existing controls

  • Role based access limits who can open a patient record.
  • The archive is backed up each night to a separate location.

Control gaps

Access logs are not reviewed, and restore tests have not covered the full archive.

Additional controls

  • Prevent: Enable multi-factor sign in for remote access and disable accounts of leavers on their last day.
  • Detect: Review access logs each month for searches without a clinical link.
  • Recover: Test restoring a sample of images from backup every quarter.
Likelihood 3 x impact 5 before; 2 x 4 after Owner: Information governance lead Target: Within 45 days Early warning: A staff account searching records of patients not on its work list.
H05

Infection spread during contrast injection and procedures

Safety Before 8 After 4

Contaminated equipment, poor hand hygiene or shared injection materials spread infection between patients and staff during examinations that involve needles, catheters or close contact.

Who or what is affected: Patients, radiographers and cleaning staff

Causes

Rushed turnaround, shared trolleys and unclear cleaning responsibilities.

Consequences

Patient infection, staff sickness, room closure and reputational harm.

Existing controls

  • Single use injection materials are used for each patient.
  • Hand hygiene is audited each month in clinical areas.

Control gaps

Cleaning checks are visual only and do not record product or contact time.

Additional controls

  • Prevent: Clean and disinfect contact surfaces and equipment between each patient using agreed products.
  • Respond: Isolate and report any suspected transmission to the infection prevention team at once.
Likelihood 2 x impact 4 before; 1 x 4 after Owner: Infection prevention lead Target: Within 30 days Early warning: Two or more infections in patients seen in the same room within a short period.
H06

Adverse reaction to contrast agents

Safety Before 10 After 8

A patient reacts to iodinated or gadolinium based contrast because allergy, kidney function or medicines were not checked, or the reaction is not recognised and treated quickly.

Who or what is affected: Patients, radiographers and reporting clinicians

Causes

Incomplete screening history, urgent requests and staff unfamiliar with newer agents.

Consequences

Severe allergic reaction, kidney injury, emergency transfer and legal claims.

Existing controls

  • Allergy and kidney function are checked on the request before contrast is given.
  • The resuscitation trolley and emergency drugs are checked daily.

Control gaps

Screening answers are recorded in free text and are not checked against the medication list.

Additional controls

  • Prevent: Use a written screening checklist with a clinical decision point for high risk patients.
  • Respond: Practise a contrast reaction drill with the emergency team each year and record outcomes.
Likelihood 2 x impact 5 before; 2 x 4 after Owner: Clinical lead for radiology Target: Within 60 days Early warning: Contrast reactions recorded in one month above the agreed threshold for the department.
H07

Staffing gaps and cover by staff without current competence

People Before 12 After 6

Vacancies, sickness or unfamiliar staff on call leave examinations to be done by people without current competence, increasing errors and fatigue.

Who or what is affected: Patients, staff and the service rota planner

Causes

Recruitment delays, high sickness and reliance on overtime.

Consequences

Errors, fatigue, closed lists, burnout and loss of staff.

Existing controls

  • A rota is set a month ahead with named cover.
  • New staff are supervised until they sign off their competence.

Control gaps

Competence sign off is not repeated after a long absence.

Additional controls

  • Prevent: Keep a competence matrix and check it before assigning sensitive examinations.
  • Detect: Track overtime and sickness monthly and flag any rota below the minimum safe level.
  • Respond: Use a named bank list of trained cover and escalate to the service manager at once.
Likelihood 4 x impact 3 before; 2 x 3 after Owner: Workforce manager Target: Within 60 days Early warning: A shift starts with fewer staff than the minimum safe level on the rota.
H08

Incomplete reports and missed handover of urgent findings

Operational Before 9 After 4

An urgent or unexpected finding is not communicated, is reported late, or is buried in an incomplete report or handover, so the referring clinician acts without the key information.

Who or what is affected: Patients, referring clinicians and the reporting radiologist

Causes

Verbal handovers, high report volume and unclear ownership of follow up.

Consequences

Delayed treatment, harm to patients and incident reports.

Existing controls

  • Urgent findings are phoned to the referrer and noted in the record.
  • Reports are checked against a template before sign off.

Control gaps

Telephone calls are not logged with the time and the name of the recipient.

Additional controls

  • Prevent: Use a structured handover sheet for every list that records pending and urgent results.
  • Recover: Review missed or late reports each week and contact patients where needed.
Likelihood 3 x impact 3 before; 2 x 2 after Owner: Radiology clinical governance lead Target: Within 45 days Early warning: Urgent findings reported later than the agreed time after the image was viewed.

Rating method and evaluation

Each risk is rated on two five-point scales. Likelihood runs from Rare to Almost certain, and impact runs from Insignificant to Catastrophic. Multiplying the two gives a score from 1 to 25, which falls into one of four bands: Low from 1 to 4, Medium from 5 to 9, High from 10 to 16 and Critical from 17 to 25. Critical risks need immediate action and senior sign off, High risks need a dated plan reviewed by the service manager, Medium risks need routine controls with a named owner, and Low risks are accepted and watched. Inherent risk is the score before any controls. Residual risk is the score after existing and additional controls are in place, and it must never be higher than the inherent score. Impact includes physical harm to patients and staff, delayed diagnosis, privacy effects, cost and trust. A patient safety risk is never rated down only because harm has not yet happened. Radiographers, physicists and the patient safety team challenge the ratings at each review, and any indicator that reaches its threshold triggers a rating review.

Likelihood, impact and rating bands

Likelihood

  • 5 Almost certain: Expected to happen in most circumstances.
  • 4 Likely: Will probably happen in many circumstances.
  • 3 Possible: Could happen at some time.
  • 2 Unlikely: Not expected, but it could happen.
  • 1 Rare: Only in exceptional circumstances.

Impact

  • 1 Insignificant: No lasting effect. Handled within routine work.
  • 2 Minor: Small effect that is quickly corrected.
  • 3 Moderate: Noticeable effect that needs managed effort to correct.
  • 4 Major: Serious effect on people, delivery or reputation.
  • 5 Catastrophic: Severe or lasting effect that threatens the whole activity.

Bands (likelihood x impact)

  • Low (1 to 4): Accept and monitor.
  • Medium (5 to 9): Manage with routine controls.
  • High (10 to 16): Senior attention and a treatment plan.
  • Critical (17 to 25): Act first. Do not proceed until reduced.

Monitoring, escalation and review

Review this assessment every 6 months, and sooner when an indicator below reaches its threshold.

Early-warning indicators and escalation thresholds
Indicator to watchEscalate when
Wrong side or wrong patient events reported in the department each month.Escalate to the lead radiographer at once, and to the clinical lead for radiology if two events occur in one month.
Dose reports above the local reference level for the same examination.Escalate to the radiation protection supervisor when a study exceeds the level, and to the clinical lead if the pattern repeats for a week.
Daily quality control results outside tolerance.Escalate to the medical physicist on the first result out of tolerance, and take the scanner out of clinical use until cleared.
Accounts accessing records without a clinical link in the access log.Escalate to the information governance lead within one working day, and to the data protection officer if a breach is confirmed.
Shifts starting below the minimum safe staffing level.Escalate to the service manager before the shift starts, and to the clinical director if the gap cannot be covered.

Contingency arrangements

If a serious event occurs, such as a wrong patient exposure, a severe contrast reaction or a loss of image data, the lead radiographer pauses the list, secures the patient and calls the emergency team. The clinical lead informs the referrer and the service manager, and the incident is reported through the local system the same day. The medical physicist isolates affected equipment, and the information governance lead preserves logs and restores images from the latest tested backup. Patients are offered clear information and follow up, and staff are supported through debriefing.

Prioritized action plan

  1. Confirm wrong patient and wrong side time out checks at every examination, owner lead radiographer, within 30 days.
  2. Set dose reference levels and start monthly dose audits, owner radiation protection supervisor, within 60 days.
  3. Remove unused accounts and enable multi-factor sign in for remote access, owner information governance lead, within 45 days.
  4. Create a contrast screening checklist and an annual reaction drill, owner clinical lead for radiology, within 60 days.
  5. Rehearse the scanner downtime plan and track calibration results, owner medical physicist, within 90 days.

Conclusion

Safe imaging depends on a few steady habits: checking identity and side before every exposure, keeping doses to the level each question needs, testing equipment and backups on schedule, controlling access to images and making sure competent people are on every list. The highest scores sit with identification errors, contrast reactions and data exposure, and each has actions that bring the residual score down. Treat the register as a living record, review it on the stated cycle, and seek specialist clinical, physics and legal advice for any real patient, dose, device or privacy decision.

Assumptions and limitations

Assumptions

  • Jurisdiction is not specified, so regulatory duties are described in general terms and must be checked locally.
  • Staff are registered professionals who have completed core training, and equipment is maintained under a service contract.
  • Patients are referred by clinicians and identified with at least two identifiers at the point of examination.

Limitations

  • The scores are examples for learning and do not describe any real department or patient population.
  • Radiation dose, contrast and equipment rules change over time and differ by setting, so specialist review is needed.
  • This educational content is not medical, physics or legal advice and does not replace a formal site-specific assessment.

Related frameworks to study

  • Hierarchy of controls
  • ALARA principle for radiation dose
  • Structured incident reporting and root cause analysis
  • Structured clinical handover tools
  • Medical device lifecycle management

Healthcare Risk Assessment

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For Learning Reference Only: This assessment demonstrates how risk assessment principles are applied in a practical setting, providing a useful reference for learning and understanding. Actual assessments may be adapted to suit specific site conditions and circumstances.

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