1. A system for knowledge-based image computer aided detection comprising: a memory device storing a plurality of instructions embodying: a text interpretation system configured to receive an electronic patient record and output outputting an assertion relevant for the electronic patient record; an annotation/detection system configured to detect anatomical and functional structures in input images and interact with the text interpretation system to receive the assertion and output annotated images based on the input images; and an imaging decision support system configured to receive the annotated images and output classifications of annotated structures in the annotated images; wherein the annotation/detection system detects anatomical and functional structures in input images guided at least in part by the assertion; and a processor for receiving the electronic patient record and executing the plurality of instructions.