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Home Orbits, Vision, and Visual Loss
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Orbital trauma, visual defect, initial exam 3128556
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
CT orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
(Disagreement)
CTA head and neck with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		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 orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Exophthalmos, nontraumatic, initial exam 3131576
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
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
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Orbital asymmetry, nontraumatic, initial exam 3131575
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
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
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Enophthalmos, nontraumatic, initial exam 3131577
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
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
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Uveitis suspected, initial exam 3131579
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 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 orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Scleritis suspected, initial exam 3131580
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 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 orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Orbital cellulitis suspected, initial exam 3131578
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 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 orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Optic neuritis suspected, initial exam 3128559
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		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
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 orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		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
Vision loss, known etiology from exam or labs 3128560
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		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 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
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI orbits 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 orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		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
Visual loss, pre-chiasm symptoms, initial exam 3131583
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Visual loss, optic nerve symptoms, initial exam 3131582
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Visual loss, intraocular mass, initial exam 3131581
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Visual loss, chiasm symptoms, non-ischemic, initial exam 3131584
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
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRV head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRV head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
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
CTV head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Visual loss, post-chiasm symptoms, non-ischemic, initial exam 3131585
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
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRV head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRV head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
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
CTV head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Diplopia, initial exam 3131587
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Ophthalmoplegia, initial exam 3131586
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRA head and neck without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRA head and neck without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Arteriography cervicocerebral
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT orbits without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
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