{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,6]],"date-time":"2026-11-06T21:59:47Z","timestamp":1794002387006,"version":"4.8.0"},"reference-count":33,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Med Imag Rad Onc"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      High volumes of low\u2010value imaging represent a growing challenge for healthcare systems, contributing to unnecessary radiation exposure, increased costs, clinician burnout and environmental impact through CO\n                      <jats:sub>2<\/jats:sub>\n                      emissions. Electronic Clinical Decision Support (eCDS) systems have emerged as a strategy to improve imaging appropriateness and reduce overutilisation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective observational study with pre\u2010 and post\u2010implementation analysis evaluated the impact of an eCDS system (MedCurrent OrderWise) implemented in the emergency department (ED) of a quaternary hospital in Australia. Data were collected from 1 July 2024 to 30 June 2025 via the hospital data warehouse and vendor software administration application. Metrics included imaging request volumes, appropriateness scores (high, medium, low), order modifications and CT utilisation rates (examinations per 100 ED presentations). Analysis was descriptive, using absolute counts, percentages and rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Across the 12\u2010month period, 75.3% of imaging requests were classified as high or medium appropriateness, indicating broad adherence to guidelines. Approximately 7% of orders were modified following eCDS prompts, reflecting meaningful improvements in appropriateness within a high\u2010volume ED setting. CT utilisation decreased by 9.1% compared with the pre\u2010eCDS period, suggesting a shift towards more selective imaging requests without restricting clinical autonomy. Educational engagement preceding implementation likely contributed to early reductions. Applying published emission estimates, this decline equated to an approximate reduction of 4744\u2009kg of CO\n                      <jats:sub>2<\/jats:sub>\n                      over 12\u2009months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Integration of eCDS into clinical workflows was associated with improved imaging appropriateness, reduced low\u2010value CT utilisation and potential environmental benefit. Sustained impact likely depends on clinician engagement, education and broader cultural change.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1754-9485.70097","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T05:35:21Z","timestamp":1775799321000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Improving Imaging Appropriateness in the Emergency Department: Radiology Clinical Decision Support in a Quaternary Care Centre\u2014A Retrospective Observational Study"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0352-4112","authenticated-orcid":false,"given":"Bruno","family":"Di Muzio","sequence":"first","affiliation":[{"name":"Department of Radiology The Alfred  Melbourne Australia"},{"name":"Department of Surgery, School of Clinical Sciences at Monash Health Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben","family":"Morgan","sequence":"additional","affiliation":[{"name":"Department of Radiology The Alfred  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rika","family":"Darmaputri","sequence":"additional","affiliation":[{"name":"Department of Radiology The Alfred  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Woo","sequence":"additional","affiliation":[{"name":"Medical Services The Alfred  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Perry","sequence":"additional","affiliation":[{"name":"Department of Radiology The Alfred  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Jarema","sequence":"additional","affiliation":[{"name":"Department of Radiology The Alfred  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philippa","family":"Hawkings","sequence":"additional","affiliation":[{"name":"Medical Services The Alfred  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1443-557X","authenticated-orcid":false,"given":"Peter","family":"Cameron","sequence":"additional","affiliation":[{"name":"Emergency and Trauma Centre The Alfred  Melbourne Australia"},{"name":"Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Radiology The Alfred  Melbourne Australia"},{"name":"Department of Neuroscience, School of Translational Medicine Monash University  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330\u2010023\u201010136\u2010x"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.carj.2018.10.004"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2022.06.001"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare9111557"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330\u2010021\u201008479\u20104"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq\u20102020\u2010001076"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.0505"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k2387"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2023.10.046"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzy248"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.250325"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.250070"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2022.100459"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10278\u2010021\u201000433\u20106"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13244\u2010023\u201001567\u20107"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.7326\/M14\u20102600"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.19.21511"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2018.03.045"},{"key":"e_1_2_13_20_1","unstructured":"The Royal College of Radiologists \u201ciRefer: Making the best use of clinical radiology 2024:40511 \u201d(2024) https:\/\/www.irefer.org.uk\/using\u2010guidelines."},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2021.03.021"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.27853"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0213373"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2025.105966"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102017\u2010019535"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2018.05.005"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1093\/JAMIA\/OCX106"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamia\/ocac029"},{"key":"e_1_2_13_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00247\u2010018\u20104322\u20106"},{"key":"e_1_2_13_30_1","first-page":"102","article-title":"Effects of Electronic Decision Support on High\u2010Tech Diagnostic Imaging Orders and Patients","volume":"16","author":"Solberg L. I.","year":"2010","journal-title":"American Journal of Managed Care"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.19.21386"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00330\u2010024\u201010938\u20107"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2023.05.023"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13195"}],"container-title":["Journal of Medical Imaging and Radiation Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1754-9485.70097","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/1754-9485.70097","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1754-9485.70097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T05:35:23Z","timestamp":1775799323000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1754-9485.70097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":33,"alternative-id":["10.1111\/1754-9485.70097"],"URL":"https:\/\/doi.org\/10.1111\/1754-9485.70097","archive":["Portico"],"relation":{},"ISSN":["1754-9477","1754-9485"],"issn-type":[{"value":"1754-9477","type":"print"},{"value":"1754-9485","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]},"assertion":[{"value":"2025-12-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-26","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-04-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"1754-9485.70097"}}