The ACR's appropriateness criteria are based on evidence from several thousand peer-reviewed articles.

"There's a lot that changes in imaging," Dreyer, who is also chair of the ACR Informatics Committee, told DOTmed News. "There are a lot of new studies and information that comes out and changes the decision-making process and makes some exams more appropriate in certain clinical circumstances. It's hard for general practitioners and specialists to keep track."

With the guidelines updated twice a year, and reviewed at least every two years, the ACR Select program is updated with a few clicks.

Dreyer said the in-house program ended up making financial sense. While the practice was decreasing the cost of what insurance companies had to pay for high-cost imaging by 12 percent, it was able to make that up by keeping the same patient volume.

The government has also taken notice. Systems using federally approved clinical decision support tools will be required by 2017. While the new law is not connected to the federal government's Meaningful Use incentive program, Cooke said the new law will likely lead to clinical decision support for radiology being integrated into the Meaningful Use program.

"What we foresee is the ability for platforms to access clinical decision support at point of order will become future certification criteria," Cooke said. "It would likely take some time, but it's a likely step given the SGR doc fix bill."

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