The prospect of expert system—Based cognitive support as a by-product of image acquisition and reporting

In order for computer-based decision-support tools to find routine use in the everyday practice of clinical radiology, further development of user interface and knowledge content are required. In an ideal interface, the interaction between the radiologist and the computer would be minimized and painlessly integrated into existing work patterns. In this article, we explore some of the ways that pre-existing computer interactions in the processes of image acquisition and reporting can be used to feed case information into an expert system and thereby allow users to acquire advice from it in an automatic fashion. We describe interface models that we have developed in the domains of mammography and obstetric ultrasound, and discuss interface and content-related questions that have arisen from informal evaluations of these systems. In particular, the need for clinical outcome-relevant decision support and training level-appropriate decision support are discussed in detail.