Recent trends in emergency departments (EDs) imaging utilization reveal an increase which may lead to unnecessary healthcare costs, increased radiation exposure for patients, and potential delays in treatment. Several factors contribute to the use of imaging, with defensive medicine being one of the most prominent. Healthcare providers often order imaging as a safeguard against missing rare or low-probability diagnoses, or to mitigate the risk of malpractice. Other key drivers include the easy availability of imaging technologies and time constraints to examine patients. There is ongoing debate about whether efforts to address imaging variability should focus on individual physician behavior or implementing systemic changes, such as standardized imaging guidelines. We conducted a quality improvement retrospective 3-year study for ED encounters at Ronald Reagan UCLA Health Emergency Department and Nethercutt Emergency Department UCLA Health Santa Monica Medical Center. We are currently working towards collecting data across a 10-year period to gain a more comprehensive analysis given significant impacts of the COVID-19 pandemic.