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Home Preoperative and Postoperative Imaging for Bariatric Procedures
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Bariatric procedure, routine preprocedure planning 3199175
Fluoroscopy biphasic esophagram
1-10 mSv
☢☢☢
May be appropriate
Fluoroscopy single contrast esophagram
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
Fluoroscopy upper GI series
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
US abdomen
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Radiography abdomen
0.1-1mSv
☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Fluoroscopy small bowel follow-through
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRI abdomen without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI abdomen without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Bariatric procedure, routine immediate postprocedure evaluation 3199177
Fluoroscopy upper GI series
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
US abdomen
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Radiography abdomen
0.1-1mSv
☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Fluoroscopy biphasic esophagram
1-10 mSv
☢☢☢
Usually not appropriate
Fluoroscopy single contrast esophagram
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Fluoroscopy upper GI series with small bowel follow-through
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRI abdomen without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI abdomen without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Bariatric procedure, less-invasive, complication suspected, postprocedure evaluation 3199179
Fluoroscopy upper GI series
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
Radiography abdomen and pelvis
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
US abdomen
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Fluoroscopy biphasic esophagram
1-10 mSv
☢☢☢
Usually not appropriate
Fluoroscopy single contrast esophagram
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Fluoroscopy upper GI series with small bowel follow-through
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
MRI abdomen and pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI abdomen and pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Bariatric procedure, complication suspected, postprocedure evaluation 3199181
CT abdomen and pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
Fluoroscopy upper GI series
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		May be appropriate
CT abdomen and pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
US abdomen
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Fluoroscopy biphasic esophagram
1-10 mSv
☢☢☢
Usually not appropriate
Fluoroscopy single contrast esophagram
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Fluoroscopy upper GI series with small bowel follow-through
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Radiography abdomen and pelvis
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
MRI abdomen and pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI abdomen and pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT abdomen and pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		10-30 mSv [ped]
☢☢☢☢☢ 		Usually not appropriate
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