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Home Dialysis Fistula Malfunction
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Hemodialysis access dysfunction suspected, lower extremity, abnormal hemodynamic indicator, initial imaging, guide IR therapy 3196477
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access dysfunction suspected, upper extremity, abnormal clinical indicator, initial imaging, guide IR therapy 3196474
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access dysfunction suspected, lower extremity, abnormal clinical indicator, initial imaging, guide IR therapy 3196476
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access dysfunction suspected, upper extremity, abnormal hemodynamic indicator, initial imaging, guide IR therapy 3196475
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Suspected dysfunction of the upper or lower extremity hemodialysis access (ie, arteriovenous fistula or graft) suggested by an abnormal clinical indicator or hemodynamic indicator (ie, reduction in dialysis vascular access blood flow rate or kinetics). Treatment and procedures. 3196479
Fluoroscopy fistulography hemodialysis access with intervention


Usually appropriate
US duplex Doppler hemodialysis access area of interest
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Surgical consultation


May be appropriate
Continued hemodialysis access use with surveillance


May be appropriate
Placement of a new tunneled dialysis catheter


May be appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Hemodialysis access thrombosis suspected, upper extremity, no pulse or thrill on physical exam, initial imaging, guide IR therapy 3196482
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access thrombosis suspected, lower extremity, no pulse or thrill on physical exam, initial imaging, guide IR therapy 3196481
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Suspected thrombosis of the upper or lower extremity hemodialysis access, marked by absent pulse and thrill on physical examination. Treatment and procedures. 3196484
Fluoroscopy fistulography hemodialysis access with intervention


Usually appropriate
Surgical consultation


Usually appropriate
Placement of a new tunneled dialysis catheter


May be appropriate
US duplex Doppler hemodialysis access area of interest
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
AVF, lower extremity, not mature 2 mos after created, initial imaging, guide IR therapy 3196486
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
Usually appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
AVF, upper extremity, not mature 2 mos after created, initial imaging, guide IR therapy 3196487
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Failure of an upper or lower extremity arteriovenous fistula to mature within 2 months after creation. Treatment and procedures. 3196489
Fluoroscopy fistulography hemodialysis access with intervention


Usually appropriate
Surgical consultation


Usually appropriate
US duplex Doppler hemodialysis access area of interest
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Placement of a new tunneled dialysis catheter


May be appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Hemodialysis access, lower extremity, ipsilateral extremity swelling, with or without venous collaterals, central venous stenosis suspected, initial imaging, guide IR therapy 3196492
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
Usually appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access, lower extremity, ipsilateral extremity swelling, with or without venous collaterals, central venous occlusion suspected, initial imaging, guide IR therapy 3196494
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
Usually appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access, upper extremity, ipsilateral extremity swelling, with or without venous collaterals, central venous stenosis suspected, initial imaging, guide IR therapy 3196491
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
Usually appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access, upper extremity, ipsilateral extremity swelling, with or without venous collaterals, central venous occlusion suspected, initial imaging, guide IR therapy 3196493
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
Usually appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Clinical suspicion of central venous stenosis or occlusion suggested by swelling (ie, soft tissue edema) of the extremity ipsilateral to the upper or lower extremity hemodialysis access, with or without the development of venous collaterals. Treatment and procedures. 3196496
Fluoroscopy fistulography hemodialysis access with intervention


Usually appropriate
Continued hemodialysis access use with surveillance


May be appropriate
US duplex Doppler hemodialysis access area of interest
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Placement of a new tunneled dialysis catheter


Usually not appropriate
Surgical consultation


Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Hemodialysis access cannulation site, upper extremity, deep infection, initial imaging, guide IR therapy 3196513
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
May be appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, upper extremity, ulceration, initial imaging, guide IR therapy 3196508
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
May be appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, lower extremity, deep infection, initial imaging, guide IR therapy 3196506
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, lower extremity, ulceration, initial imaging, guide IR therapy 3196501
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, lower extremity, superficial infection, initial imaging, guide IR therapy 3196505
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, lower extremity, spontaneous bleeding, initial imaging, guide IR therapy 3196503
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, lower extremity, abnormal skin changes, initial imaging, guide IR therapy 3196498
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, upper extremity, spontaneous bleeding, initial imaging, guide IR therapy 3196510
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
May be appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, lower extremity, eschar, initial imaging, guide IR therapy 3196502
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, lower extremity, marked skin thinning, initial imaging, guide IR therapy 3196500
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, upper extremity, superficial infection, initial imaging, guide IR therapy 3196512
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
May be appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, upper extremity, marked skin thinning, initial imaging, guide IR therapy 3196507
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
May be appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, upper extremity, abnormal skin changes, initial imaging, guide IR therapy 3196499
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
May be appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, upper extremity, pseudoaneurysm, initial imaging, guide IR therapy 3196511
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
May be appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, upper extremity, eschar, initial imaging, guide IR therapy 3196509
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
May be appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Hemodialysis access cannulation site, lower extremity, pseudoaneurysm, initial imaging, guide IR therapy 3196504
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Abnormal skin changes associated with the upper or lower extremity hemodialysis access cannulation site, including marked thinning, ulceration, eschar formation, spontaneous bleeding, pseudoaneurysm formation, superficial or deep infection. Treatment and procedures. 3196515
Surgical consultation


Usually appropriate
Placement of a new tunneled dialysis catheter


Usually appropriate
Fluoroscopy fistulography hemodialysis access with intervention


May be appropriate
Continued hemodialysis access use with surveillance


Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Vascular steal syndrome suspected, upper extremity, cardiac failure, initial imaging, guide IR therapy 3196519
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
May be appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Vascular steal syndrome suspected, lower extremity, ischemic symptoms, initial imaging, guide IR therapy 3196518
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Vascular steal syndrome suspected, upper extremity, ischemic symptoms, initial imaging, guide IR therapy options 3196520
Fluoroscopy fistulography hemodialysis access upper extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access upper extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CTA upper extremity with IV contrast
1-10 mSv
☢☢☢
May be appropriate
CTV upper extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV upper extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Vascular steal syndrome suspected, lower extremity, cardiac failure, initial imaging, guide IR therapy 3196517
Fluoroscopy fistulography hemodialysis access lower extremity
1-10 mSv
☢☢☢
Usually appropriate
US duplex Doppler hemodialysis access lower extremity
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CTA lower extremity with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CTV lower extremity with IV contrast
10-30 mSv
☢☢☢☢
Usually not appropriate
MRA lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV lower extremity without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Suspected vascular steal syndrome (upper or lower extremity), suggested by cardiac failure or ischemic symptoms. Treatment and procedures. 3196522
Surgical consultation


Usually appropriate
Continued hemodialysis access use with surveillance


May be appropriate
Fluoroscopy fistulography hemodialysis access with intervention


May be appropriate
Placement of a new tunneled dialysis catheter


May be appropriate
US duplex Doppler hemodialysis access area of interest
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
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