Challenges for radiologists dealing with clinical decision support systems (CDSS) from a legal point of view

Excerpt

During the diagnostic process, radiological examinations are typically requested by clinical physicians. Radiologists check the imaging indication and then approve the examination or refuse it. In the case of examinations that use ionizing radiation (X-rays, computed tomography), based on European law, the so-called justifying indication has to be provided by authorized physicians, in most cases radiologists [ 1]. The advantages of each examination for the patient (possibility of a better diagnosis) are individually weighed against disadvantages (radiation exposure, possible induction of carcinomas). Regarding ultrasound, an examination without ionizing radiation, the disadvantages of an unnecessary examination are not of a medical nature (radiation exposure or damage to the patient), but rather economic ones (misallocation of resources). Occasional conflicts between the radiologist and the referring clinician are inevitable. This is a hot topic particularly in emergency departments, and during night shifts when time is essential, and the level of experience may not be the highest among both the ordering physicians and on-call radiologists as well. Guidelines, i.e., rule-based lists that assign justified examinations to certain symptoms, signs and suspected diagnoses, were created to help alleviate these conditions. …