Abstract Diagnostic imaging is an essential and indispensable part of medical diagnosis and treatment, and diagnostic errors or biases are also common in the department of radiology, sometimes even having a severe impact on the diagnosis and treatment of patients. There are various reasons for diagnostic errors or biases in imaging. In this review, we analyze and summarize the causes of diagnostic imaging errors and biases based on practical cases. We propose solutions for dealing with diagnostic imaging errors and reducing their probability, thereby helping radiologists in their clinical practice. Critical relevance statement Diagnostic errors or bias contribute to most medical errors in the radiology department. Solutions for dealing with diagnostic imaging errors are pivotal for patients. Key points • Diagnostic errors or bias contribute to most medical errors in radiology department. • Solutions for dealing with diagnostic imaging errors are pivotal for patients. • This review summarizes the causes of diagnostic errors and offers solutions to them. Graphical Abstract