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Home Orbital Imaging and Vision Loss-Child
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Visual loss, traumatic, orbital injury suspected, initial imaging 3196980
CT orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually 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 without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head 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 orbits without and with 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 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
CTA head 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, acute, nontraumatic, no papilledema, initial imaging 3196982
MRI head and orbits without and with 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 		May be appropriate
MRI head and orbits 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
CT head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI complete spine without 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 and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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
CTA head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Nystagmus, isolated, initial imaging 3196984
MRI head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head and orbits 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
MRI orbits without and with 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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Visual acuity decreased due to developmental abnormality, unilateral, no leukocoria, initial imaging 3196992
MRI head and orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head 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 orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vision loss due to congenital abnormality, bilateral, no leukocoria, initial imaging 3196987
MRI head and orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head 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 orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Visual acuity decreased due to congenital abnormality, bilateral, no leukocoria, initial imaging 3196991
MRI head and orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head 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 orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vision loss due to developmental abnormality, unilateral, no leukocoria, initial imaging 3196989
MRI head and orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head 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 orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vision loss due to developmental abnormality, bilateral, no leukocoria, initial imaging 3196988
MRI head and orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head 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 orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Vision loss due to congenital abnormality, unilateral, no leukocoria, initial imaging 3196986
MRI head and orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head 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 orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Visual acuity decreased due to developmental abnormality, bilateral, no leukocoria, initial imaging 3196993
MRI head and orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head 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 orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Visual acuity decreased due to congenital abnormality, unilateral, no leukocoria, initial imaging 3196990
MRI head and orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head 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 orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 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, optic pathway tumor suspected, with or without hx of neurofibromatosis type 1, initial imaging 3196995
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head without and with 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)
Radiography orbit
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and orbits without 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 IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT head and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Signs of raised intracranial pressure, initial imaging 3196998
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
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 		May be appropriate
MRV head with 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 without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CTV head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA 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 and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Papilledema on ophthalmologic exam, initial imaging 3196997
MRI head and orbits without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head and orbits without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
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 		May be appropriate
MRV head with 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 without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CTV head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA 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 and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 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 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 with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Orbital infection suspected, initial imaging 3197001
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRI head without and with 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
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head without 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 IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		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
CT orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CTA head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CTV head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Periorbital infection suspected, initial imaging 3197000
CT orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually appropriate
MRI head without and with 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
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head without 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 IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRV head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		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
CT orbits without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CTA head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CTV head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Intraocular mass suspected, initial imaging 3197004
MRI head and orbits 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 head without and with 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 and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and orbits without 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
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without 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 without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CTA head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Leukocoria, initial imaging 3197003
MRI head and orbits 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 head without and with 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 and orbits with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT head with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT orbits 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
MRA head without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRA head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head and orbits without 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
CT head and orbits without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT head and orbits without 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 without and with IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
CTA head with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
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