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Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, initial imaging

3196047

Digital breast tomosynthesis diagnostic

0.1-1mSv
☢☢

Usually appropriate

Mammography diagnostic

0.1-1mSv
☢☢

Usually appropriate

US breast

0 mSv
O

0 mSv [ped]
O

May be appropriate

Digital breast tomosynthesis screening

0.1-1mSv
☢☢

Usually not appropriate

Mammography screening

0.1-1mSv
☢☢

Usually not appropriate

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, mammo findings highly suggestive of malignancy, BI-RADS 5, next imaging study

3196050

US breast

0 mSv
O

0 mSv [ped]
O

Usually appropriate

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Breast mass, palpable, mammo findings suspicious, BI-RADS 4, next imaging study

3196049

US breast

0 mSv
O

0 mSv [ped]
O

Usually appropriate

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, diagnostic mammo, DBT and US findings probably benign, BI-RADS 3, next imaging study

3196052

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, mammo findings benign at site of palpable mass, BI-RADS 2, next imaging study

3196053

US breast

0 mSv
O

0 mSv [ped]
O

May be appropriate

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, mammo findings negative, BI-RADS 1, next imaging study

3196054

US breast

0 mSv
O

0 mSv [ped]
O

Usually appropriate

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, initial imaging

3196055

US breast

0 mSv
O

0 mSv [ped]
O

Usually appropriate

Digital breast tomosynthesis diagnostic

0.1-1mSv
☢☢

Usually not appropriate

Digital breast tomosynthesis screening

0.1-1mSv
☢☢

Usually not appropriate

Mammography diagnostic

0.1-1mSv
☢☢

Usually not appropriate

Mammography screening

0.1-1mSv
☢☢

Usually not appropriate

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, US findings highly suggestive of malignancy, BI-RADS 5, next imaging study

3196057

Digital breast tomosynthesis diagnostic

0.1-1mSv
☢☢

Usually appropriate

Mammography diagnostic

0.1-1mSv
☢☢

Usually appropriate

Image-guided core biopsy breast

Varies

Usually appropriate

Image-guided fine needle aspiration breast

Varies

May be appropriate
(Disagreement)

Digital breast tomosynthesis screening

0.1-1mSv
☢☢

Usually not appropriate

Mammography screening

0.1-1mSv
☢☢

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Breast mass, palpable, US findings suspicious of malignancy, BI-RADS 4, next imaging study

3196058

Digital breast tomosynthesis diagnostic

0.1-1mSv
☢☢

Usually appropriate

Mammography diagnostic

0.1-1mSv
☢☢

Usually appropriate

Image-guided core biopsy breast

Varies

Usually appropriate

Image-guided fine needle aspiration breast

Varies

May be appropriate
(Disagreement)

Digital breast tomosynthesis screening

0.1-1mSv
☢☢

Usually not appropriate

Mammography screening

0.1-1mSv
☢☢

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, US findings probably benign, BI-RADS 3, next imaging study

3196059

Digital breast tomosynthesis diagnostic

0.1-1mSv
☢☢

Usually not appropriate

Digital breast tomosynthesis screening

0.1-1mSv
☢☢

Usually not appropriate

Mammography diagnostic

0.1-1mSv
☢☢

Usually not appropriate

Mammography screening

0.1-1mSv
☢☢

Usually not appropriate

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, US findings benign, BI-RADS 2, next imaging study

3196060

Digital breast tomosynthesis diagnostic

0.1-1mSv
☢☢

Usually not appropriate

Digital breast tomosynthesis screening

0.1-1mSv
☢☢

Usually not appropriate

Mammography diagnostic

0.1-1mSv
☢☢

Usually not appropriate

Mammography screening

0.1-1mSv
☢☢

Usually not appropriate

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, US findings negative, BI-RADS 1, next imaging study

3196061

Digital breast tomosynthesis diagnostic

0.1-1mSv
☢☢

Usually not appropriate

Digital breast tomosynthesis screening

0.1-1mSv
☢☢

Usually not appropriate

Mammography diagnostic

0.1-1mSv
☢☢

Usually not appropriate

Mammography screening

0.1-1mSv
☢☢

Usually not appropriate

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Breast mass, palpable, initial imaging

3196062

US breast

0 mSv
O

0 mSv [ped]
O

Usually appropriate

Digital breast tomosynthesis diagnostic

0.1-1mSv
☢☢

Usually appropriate

Mammography diagnostic

0.1-1mSv
☢☢

Usually appropriate

Digital breast tomosynthesis screening

0.1-1mSv
☢☢

Usually not appropriate

Mammography screening

0.1-1mSv
☢☢

Usually not appropriate

Image-guided core biopsy breast

Varies

Usually not appropriate

Image-guided fine needle aspiration breast

Varies

Usually not appropriate

MRI breast without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

MRI breast without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

FDG-PET breast dedicated

1-10 mSv
☢☢☢

Usually not appropriate

Sestamibi MBI

1-10 mSv
☢☢☢

Usually not appropriate