OBJECTIVE To assess the prevalence and characteristics of medical malpractice litigation involving radiology trainees. METHODS Using a LexisNexis legal database keyword search, we identified all state and federal lawsuits between 2009 and 2018 yielding formal appellate and lower court opinions (precedent setting "complex litigation") potentially involving physician trainees. Available judicial records were systematically reviewed to identify malpractice matters with material trainee involvement. Cases were categorized by criteria including specialty and location. Incidence rates were calculated for all specialties. Radiology lawsuits were characterized further. RESULTS Initial LexisNexis Boolean database search yielded 8,935 potentially relevant cases with 580 confirmed as malpractice materially involving physician trainees. Annual cases trended downward (high 70, low 37). Most originated in New York (195 of 580; 33.6%), Ohio (41; 7.1%), and Pennsylvania (34; 5.9%) and involved surgery (204; 35.2%), obstetrics and gynecology (114; 19.7%), and medicine (105; 18.1%). The case incidence rate for all trainees was 0.63 per 1,000 trainee years. Of 309 cases with known outcomes, defendant physicians prevailed in 238 (77.0%). Radiology trainees represented only 23 cases (4.0%), corresponding to an incidence rate ratio of 0.79 (confidence interval 0.52-1.20). Radiology litigation most frequently involved alleged missed diagnoses (14 of 23; 60.8%) and procedural complications (7; 30.4%). Defendant radiologists prevailed in 9 of the 13 cases with known outcomes (69.2%). CONCLUSIONS Complex medical malpractice litigation involving physician trainees is infrequent and decreasing over time. Lawsuits involving radiology trainees are uncommon, less likely than for many nonradiology trainees, and typically involve alleged missed diagnoses or procedural complications. Defendant radiologists usually prevail.