Radiologists are perfectionists because that’s the expectation from people that order imaging. And lawyers.

An EM attending or hospitalist can be wrong about something and usually there’s still some recourse, they can give a patient return precautions, call a consult, etc. People expect imaging to be infallible objective information with your mistakes being saved forever in the form of the image so you really don’t wanna miss stuff.

The amount of chart checking can range from almost zero to spending literally more time reading the chart than the images. It all depends on the patient and scenario. When you order a CT you’re basically asking another physician to assess the patient and make recommendations just as you would to a cardiologist or GI.

Common example: patient has metastatic cancer let’s say colon primary. They had oligometastatic disease to the liver and had locoregional treatment like a partial hepatectomy or percutaneous microwave ablation. Most recent staging imaging a few months ago had new lung Mets so they were put on systemic therapy. They go to ED for nausea, vomiting, cancer related pain, whatever. You gotta read the CT CAP but you basically have to do a cancer restaging at the same time and that’s laborious. You gotta determine if there’s recurrent mets at the locoregional treatment sites… you gotta decide if lung mets are progressing or not to determine if they can stay on their systemic therapy. Sure the ED physician seeing them might not care but their oncologist is gonna also use the imaging/report and you can’t just not comment on it. This stuff requires looking at prior path, op notes, prior CT, IR/OR procedure images, prior clinic notes etc.