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Default Options to Decrease Unnecessary Imaging

Default Options to Decrease Unnecessary Imaging

Project status



Sonam Sharma, MD

David Guttman, MD, MTR

Joshua Jones, MD, MA

Justin Bekelman, MD

Innovation leads


National Cancer Institute

Department of Radiation Oncology, University of Pennsylvania


Each year in the United States, about 250,000 patients with advanced cancer receive palliative radiotherapy to help reduce pain, control bleeding, and improve quality of life. 

Daily imaging, which is often used for curative radiotherapy, is unnecessary for palliative radiotherapy, according to national guidelines. Unnecessary imaging can increase treatment time and expense for patients in distress. 


We introduced a default order in the electronic health record that called for no daily imaging for patients undergoing palliative radiotherapy. Physicians had the option to opt out of the default if they wished to select another imaging frequency.


Before the intervention, 68 percent of patients received daily imaging. After the intervention, this rate was reduced to 32 percent. The outcomes were similar across both university and community practices. 

Our findings suggest that simple nudges, such as setting default orders, can meaningfully reduce unnecessary care. This intervention has been implemented in all radiation oncology practices at Penn Medicine.