The easy way.

Daily imaging for alignment during straightforward palliative radiation is usually excessive, adding both time and expense to a patient’s care without clear benefit. On the other hand, it’s what we’re used to. This pragmatic randomized trial from U Penn asked if a default order without daily image guidance would influence physician behavior. In other words, ordering physicians would have to actively opt-out of default less frequent imaging with the extra effort of specifying daily image guidance. Subjects included 21 rad oncs from academic and community practices delivering nearly 1200 palliative treatment courses. The proportion of these courses utilizing daily imaging was carved in half between the 4-month period pre-default ordering (68%) to the 4-month period post-default ordering (32%). TBL: Placing the appropriate order should be the easy thing to do. | Sharma, JAMA Oncol 2019