Poor radiologic examination order indications are analogous to poor patient hand-offs and include performance of incorrect or incomplete examinations, overlooking patient-specific issues, general examination interpretations (not addressing clinical question), safety and compliance issues, billing delays, and rejections.2,5,6 Computerized physician order entry significantly and clinically improved the quality and information content of indications. Despite this improvement, 78% of orders continued to have inadequate, incomplete, or nonapplicable indications. We believe the required text fields and restricting ordering privileges to licensed health care providers directly contributed to improvements in order quality. However these free-text fields (implementation choice) failed to communicate adequate information. Implementation of discrete signs and symptoms, tracking health care provider ordering patterns, and educational programs targeted at improved documentation of patient indications should further improve order quality. In spite of these efforts, work-arounds are possible using any system; “gaming” order validation and appropriateness assessment systems is possible. With the pivotal role radiologic examinations play in health care decision making,1- 3 improving the quality of order indications for radiologic examinations should improve the quality of patient care.