ACR logo

ACR AC Portal

Home Low Back Pain
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Low back pain, acute, no red flags, no prior management, initial imaging 3194291
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Low back pain, chronic, no red flags, no prior management, initial imaging 3194293
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Low back pain, subacute, no red flags, no prior management, initial imaging 3194294
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Low back pain, subacute, intervention candidate, persistent symptoms after 6 wks medical management, initial imaging 3194297
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Low back pain, chronic, intervention candidate, persistent symptoms after 6 wks medical management, initial imaging 3194296
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Low back pain, cauda equina syndrome suspected, initial imaging 3194299
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Low back pain, hx of prior lumbar surgery, progressive symptoms, initial imaging 3194301
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Low back pain, hx of prior lumbar surgery, new symptoms, initial imaging 3194302
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Low back pain, low velocity trauma, initial imaging 3194307
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Low back pain, elderly, initial imaging 3194305
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Low back pain, osteoporosis, initial imaging 3194306
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Low back pain, chronic steroid use, initial imaging 3194304
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Low pack pain, immunosuppression, initial imaging 3194309
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
(Disagreement)
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Low pack pain, spinal mets suspected, initial imaging 3194311
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
(Disagreement)
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Low pack pain, infection suspected, initial imaging 3194310
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Radiography lumbar spine
1-10 mSv
☢☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
(Disagreement)
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body with SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Discography and post-discography CT lumbar spine
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT whole body
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
© 2025