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Home Management of Vertebral Compression Fractures
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vertebral compression fracture on xray, lumbar, symptomatic, new, no malignancy, next imaging study 3195988
MRI cervical and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without 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
MRI thoracic and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT cervical and lumbar spine without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT thoracic and lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and lumbar spine
1-10 mSv
☢☢☢
May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic and lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI cervical and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		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 thoracic and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT cervical and lumbar spine with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic and lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography cervical and lumbar spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography thoracic and lumbar spine
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vertebral compression fracture on xray, cervical, symptomatic, new, no malignancy, next imaging study 3195986
MRI cervical and lumbar spine 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 		Usually appropriate
MRI cervical spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT cervical and lumbar spine without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
CT cervical spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and lumbar spine
1-10 mSv
☢☢☢
May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT neck
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI cervical and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical and lumbar spine without and with 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 spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI cervical spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT cervical and lumbar spine with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT cervical spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical spine without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography cervical and lumbar spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography cervical spine
10-30 mSv
☢☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vertebral compression fracture on xray, thoracic, symptomatic, new, no malignancy, next imaging study 3195987
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic and lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic and lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 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 complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic and lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography thoracic and lumbar spine
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT thoracic and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vertebral compression fracture on radiography, cervical, symptomatic, new, hx of malignancy, next imaging study 3195990
MRI cervical and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI cervical and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
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
MRI cervical spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI cervical spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT cervical and lumbar spine without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
CT cervical spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Image-guided biopsy cervical spine

Varies
Varies 		May be appropriate
MRI cervical and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI cervical spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and lumbar spine
1-10 mSv
☢☢☢
May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT neck
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography cervical and lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
CT myelography cervical spine
10-30 mSv
☢☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT cervical and lumbar spine with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT cervical spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical spine without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vertebral compression fracture on radiography, lumbar, symptomatic, new, hx of malignancy, next imaging study 3195992
MRI cervical and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI cervical and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		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
MRI thoracic and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT cervical and lumbar spine without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT thoracic and lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Image-guided biopsy lumbar spine

Varies
Varies 		May be appropriate
MRI cervical and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI thoracic and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and lumbar spine
1-10 mSv
☢☢☢
May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic and lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography cervical and lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
May be appropriate
CT myelography thoracic and lumbar spine
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT cervical and lumbar spine with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic and lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vertebral compression fracture on radiography, thoracic, symptomatic, new, hx of malignancy, next imaging study 3195991
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
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic and lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Image-guided biopsy thoracic spine

Varies
Varies 		May be appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI thoracic and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic and lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
CT myelography thoracic and lumbar spine
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT thoracic and lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Mid-back pain, new, hx of multiple vertebral compression fractures, initial imaging 3195999
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic and lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI thoracic and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic and lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic and lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography thoracic and lumbar spine
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT thoracic and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Neck pain, new, previously treated vertebral compression fracture, initial imaging 3195994
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI cervical spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT cervical spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI cervical spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT neck
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 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 spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT cervical spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical spine without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography cervical spine
10-30 mSv
☢☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Low back pain, new, previously treated vertebral compression fracture, initial imaging 3195996
MRI complete spine without 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
MRI thoracic and 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
CT thoracic and lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI thoracic and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic and lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic and 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
CT thoracic and lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		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
CT myelography thoracic and lumbar spine
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Low back pain, new, hx of multiple vertebral compression fractures, initial imaging 3195998
MRI complete spine without 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
MRI thoracic and 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
CT thoracic and lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI thoracic and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic and lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic and 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
CT thoracic and lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		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
CT myelography thoracic and lumbar spine
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Neck pain, new, hx of multiple vertebral compression fractures, initial imaging 3195997
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI cervical spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT cervical spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI cervical spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT neck
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 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 spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT cervical spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical spine without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography cervical spine
10-30 mSv
☢☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Mid-back pain, new, previously treated vertebral compression fracture, initial imaging 3195995
MRI cervical and thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic and lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
MRI cervical and thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI thoracic and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic and lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic and lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography thoracic and lumbar spine
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT thoracic and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vertebral compression fracture on radiography, cervical, asymptomatic, hx of malignancy, next imaging study 3196001
MRI cervical and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI cervical and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
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
MRI cervical spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI cervical spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT cervical and lumbar spine without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
CT cervical spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Image-guided biopsy cervical spine

Varies
Varies 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and lumbar spine
1-10 mSv
☢☢☢
May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT neck
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI cervical and lumbar spine with 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 spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT cervical and lumbar spine with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT cervical spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical spine without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography cervical and lumbar spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography cervical spine
10-30 mSv
☢☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vertebral compression fracture on radiography, lumbar, asymptomatic, hx of malignancy, next imaging study 3196003
MRI cervical and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI cervical and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
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
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		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 cervical and lumbar spine without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
CT lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Image-guided biopsy lumbar spine

Varies
Varies 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and lumbar spine
1-10 mSv
☢☢☢
May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI cervical and lumbar spine with 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 complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT cervical and lumbar spine with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography cervical and lumbar spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography lumbar spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vertebral compression fracture on radiography, thoracic, asymptomatic, hx of malignancy, next imaging study 3196002
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
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic and lumbar spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic and lumbar spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic and lumbar spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT cervical and thoracic spine without IV contrast
10-30 mSv
☢☢☢☢
Usually appropriate
CT complete spine without IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Image-guided biopsy thoracic spine

Varies
Varies 		May be appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT cervical and thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT complete spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic and lumbar spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI cervical and thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic and lumbar spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic and lumbar spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT cervical and thoracic spine with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT cervical and thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
CT complete spine with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT complete spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography cervical and thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT myelography thoracic and lumbar spine
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
Usually not appropriate
CT thoracic and lumbar spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT thoracic spine without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography complete spine
30-100 mSv
☢☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Asymptomatic, osteoporotic VCF. Initial treatment. 3196005
Medical management only


Usually appropriate
Percutaneous ablation spine


Usually not appropriate
Percutaneous vertebral augmentation


Usually not appropriate
Radiation oncology consultation


Usually not appropriate
Surgical consultation


Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Symptomatic osteoporotic VCF with bone marrow edema or intravertebral cleft. Initial treatment. 3196007
Medical management only


Usually appropriate
Percutaneous vertebral augmentation


Usually appropriate
Surgical consultation


May be appropriate
Percutaneous ablation spine


Usually not appropriate
Radiation oncology consultation


Usually not appropriate
Systemic radionuclide therapy


Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
New, symptomatic VCF. History of prior vertebroplasty or surgery. Initial treatment. 3196009
Medical management only


Usually appropriate
Percutaneous vertebral augmentation


Usually appropriate
Surgical consultation


May be appropriate
Percutaneous ablation spine


Usually not appropriate
Radiation oncology consultation


Usually not appropriate
Systemic radionuclide therapy


Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Benign VCF with worsening pain, or deformity, or pulmonary dysfunction. Initial treatment. 3196011
Percutaneous vertebral augmentation


Usually appropriate
Surgical consultation


Usually appropriate
Medical management only


May be appropriate
Percutaneous ablation spine


Usually not appropriate
Radiation oncology consultation


Usually not appropriate
Systemic radionuclide therapy


Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Pathological VCF with ongoing or increasing mechanical pain. Initial treatment. 3196013
Percutaneous ablation spine


Usually appropriate
Percutaneous vertebral augmentation


Usually appropriate
Radiation oncology consultation


Usually appropriate
Surgical consultation


Usually appropriate
Medical management only


May be appropriate
Systemic radionuclide therapy


May be appropriate
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