HHE Radiology and imaging supplement 2018 | Page 6

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, e