The Clinical Decision Support Registry (CDSR) was launched in 2018 under the CMS Transforming Clinical Practice Initiative as an automated mean to participate in the ACR R-SCAN project. This served to test the feasibility of using clinical decision support data to help facility personnel identify areas of potential imaging overuse and guide collaborations to improve imaging appropriateness especially for some of the most frequently ordered exams.

Following an approximate 18-month test period, and based on feedback from testing facilities, the ACR moved to establish the Clinical Decision Support Registry as a more robust and comprehensive clinical quality registry integrated fully into the NRDR platform. Currently in pilot phase, the continued aim of the CDSR is to enable efficient review of image ordering data for the purpose of quality improvement and improved patient care.