Background: Current guidelines recommend imaging (CT and/or PET) to evaluate treatment response and detect residual disease after nonsurgical management of head and neck cancers squamous cell cancers (HNSCC). To objectively evaluate the utility of these diagnostic tests, we reviewed our institutional cohort to better understand the value of these interventions compared to routine history and physical examination (PE). Methods: After IRB approval, we retrospectively reviewed an institutional cohort of 160 HNC patients who underwent definitive radiation +/- chemotherapy from 2003 - 2014. All patients had post-treatment history, PE, and imaging data, including a 4-month PET scan. The sensitivity, specificity, negative-predictive and positive-predictive values were calculated, along with Kaplan-Meier survival analyses for each symptom, PE, and imaging finding. Results: PE and symptoms had higher specificity than imaging but had lower sensitivity (see table). While imaging had good sensitivity and NPV, excess false positives led to poor specificity and PPV. When PE and symptoms were evaluated together, performance was similar to CT and PET. On KM analysis, all PE/symptom factors and PET response correlated with outcome, while baseline CT did not. There were no early interventions resulting from baseline CT scans. Conclusions: In an era of value-based care, a renewed emphasis on patient symptoms and PE findings may allow for improved resource utilization and cost of care. These are strong predictors of residual disease in the immediate post-treatment setting, suggesting a need to reevaluate current imaging paradigms, particularly the utility of post-treatment CT scans.