workload and yet to provide the greatest possible
value to the patients.
Contribution of a radiologist to a correct and
timely imaging report is key for the right
treatment decision. In our opinion, the first step
toward creating value for patients referred to the
radiology department starts with assuring the
appropriateness of the imaging examinations.
There are statistics showing that up to 20% of all
requests in Europe and up to 50% in the USA are
not appropriate. 2,3 In this regard, the radiologist
should play a pivotal role in providing the right
examination for the right clinical indications,
and, if necessary, to reject unnecessary or
redundant imaging requests. The reality, however,
is somewhat complex. In many situations,
especially in the case of outpatients, the
information coming with the request for the
radiological examination is minimal. A promising
technical support could be provided by the
clinical decision support (CDS) systems, which
ensure whether the modality requested to the
examination and patient condition is in line with
currently valid guidelines. CDS systems prove,
whether MRI or CT, with or without contrast
agent, is the most appropriate imaging modality
to answer the given clinical question. Preferably,
these systems should be fed with additional
information from the electronic health record
(EHR) of the patient (for example, renal function,
pregnancy, HIV status, diabetes). Beyond choosing
the right modality, an intelligent CDS system
should even be able to assign the appropriate
protocol, examination lane, dose, volume of
contrast, number of phases, and additional
The main challenge the field of
radiology is facing nowadays is to
handle an ever-increasing workload
and yet to provide the greatest
possible value to the patients
sequences in MRI, to help adequately address the
medical question. In other words, CDS should
help tailor and personalise examination protocols.
Dose management of imaging examinations
involving radiation exposure goes hand in hand
with the appropriateness check, which is a part of
the radiologist’s and medical physicist’s
responsibility. When implemented adequately,
CDS systems will increase productivity, reduce
unnecessary examinations and save resources.
The radiologists will benefit from time saved to
engage more on patient care, whether it is
appropriate reporting, communication of
diagnosis or follow-up of treatment results. In
order to harmonise imaging appropriateness
criteria throughout European countries, the
European Society of Radiology (ESR) has launched
a computer-based CDS tool called ESR iGuide. This
tool provides a core standard system, with
guidelines adaptable to local (national and
institutional) situations. 4
Picture archiving communications systems
(PACS) have revolutionised radiology in every
sense. The downside of computerisation is,
however, reduced in-person consultation between
the treating clinicians and the radiology
departments. In general, images are analysed and
annotated in the PACS; radiology reports are then
created mostly as a narrative text and deposited
in the EHR or sent to the referring physician in a
hard copy. According to a recent study, one third
of radiologists’ recommendations contained in
written reports are ignored or even not
documented in the patient medical record by the
referring physician. 5 One approach to address this
issue is the improvement of radiology reports by
structuring and standardising. The solution is to
be expected from IT development. Similar to a
checklist, structured reports have a template with
standardised content and standardised language.
According to recent studies, structured radiology
reports are more complete and have more
relevant content. 6,7 Moreover, improved linguistic
quality of structured repo