Nearly 35 percent of all the imaging costs for 2068 orthopedic patient encounters in Pennsylvania were ordered for defensive purposes, according to a new study presented at the 2011 Annual Meeting of the American Academy of Orthopaedic Surgeons in San Diego. For many years, some physicians have ordered specific diagnostic procedures that are of little or no benefit to a patient, largely to protect themselves from a lawsuit. Until now, however, efforts to measure defensive medicine practices have been limited primarily to surveys that ask physicians whether they practice defensive medicine. “This is the first study we know of that looked at the actual practice decisions of physicians regarding defensive imaging in real time, prospectively done,” said Dr. John Flynn, associate chief of orthopedic surgery at Children’s Hospital of Philadelphia.