The fundamental error is failure of the provided history to match the type of examination requested. This type of error reduces the sensitivity and specificity of our interpretation, makes billing difficult or impossible, has substantial medico-legal and regulatory risks, and introduces lack of clarity about the nature of the clinical problem being evaluated. It is essential to provide a clear and concise history that relates directly to the examination requested. Examples include a CXR ordered with a history of "head pain", a history of "decreased pulses" for a foot x-ray, a history of "right arm pain" for a CXR, and a history of "dementia work-up" for a CXR. The association of the clinical symptom complex and the exam ordered is tenuous in all these cases, and probably incorrect in many of them. It is helpful to make it clear what the relationship is between the exam requested and the history so "guessing" and inappropriate examinations are minimized. Another common error is the "unnecessarily broad" or "imprecise" category. The basic error is that of "overkill", in which too much imaging is being ordered to get the job done. This increases expense and may make CPT-code based billing difficult. Examples include ordering an US of the entire abdomen with a history of "evaluate AAA", when an US of the aorta is the correct and less extensive exam to order. A similar error is to order an abdominal US with a history of "evaluate kidneys for hydro", when a renal US is the correct test to order. Please be careful to order only as much imaging as you require. Yet another example is when the right exam and body part are selected, but the wrong R & L modifiers are utilized. This would appear as a history of "left hip pain" associated with an order for a right hip x-ray. This introduces ambiguity about where the patient's symptoms are. Sometimes we end up asking the patient! Needless to say this introduces a high risk of imaging the wrong body part or not being able to bill for an exam since the "wrong" exam was ordered. In another variation the wrong exam modifier was selected such that the exam is difficult to perform or the exam ordered will not do the best job of imaging the patient. Examples include ordering a PA and lateral CXR for a patient in the MSCU on a ventilator (impossible to do) or ordering a "preop CXR" with a history of "LLL pneumonia". Lastly, there are cases in which the history does not describe the site of the patient's symptoms. Typically these are NM bone scans, with a history of "evaluate osteomyelitis", but no information was given as to WHERE the potential osteomyelitis was located. We end up asking the patient and/or calling the provider.