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Home Dizziness and Ataxia
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vertigo, episodic, brief, triggered by specific head movements, initial imaging 3196962
MRA head and neck with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT temporal bone with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vertigo, acute, persistent, normal neuro exam, HINTS exam, consistent with peripheral vertigo, initial imaging 3196964
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT temporal bone with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vertigo, acute, persistent, HINTS exam, consistent with central vertigo, initial imaging 3196966
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRA head and neck with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT temporal bone with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Vertigo, acute, persistent, abnormal neuro exam, initial imaging 3196967
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRA head and neck with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT temporal bone with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vertigo, chronic, recurrent, unilateral hearing loss, initial imaging 3196970
MRI head and internal auditory canal without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT temporal bone without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
MRI head and internal auditory canal without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT temporal bone with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vertigo, chronic, recurrent, tinnitus, initial imaging 3196969
MRI head and internal auditory canal without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT temporal bone without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
MRI head and internal auditory canal without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT temporal bone with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vertigo, chronic, recurrent, brainstem neuro deficits, initial imaging 3196972
MRA head and neck with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT temporal bone with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Cerebellar ataxia suspected, chronic disequilibrium, initial imaging 3196974
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT temporal bone with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Sensory or proprioceptive ataxia suspected, chronic equilibrium, initial imaging 3196976
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRA head and neck with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT temporal bone with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Dizziness, nonspecific, without vertigo, ataxia, or other neuro deficits, initial imaging 3196978
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and internal auditory canal without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT temporal bone with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT temporal bone without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
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