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Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Brain tumor primary, screening, genetic risk factors 3198608
MRI head 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 without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MR spectroscopy head without 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 IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI functional (fMRI) head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head perfusion with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head perfusion without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without IV contrast with DTI
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 head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
DOTATATE PET/CT brain
1-10 mSv
☢☢☢
Usually not appropriate
DOTATATE PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
FDG-PET/CT brain
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Fluciclovine PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Fluciclovine PET/CT brain
10-30 mSv
☢☢☢☢
Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Brain tumor metastatic, screening, extracranial malignancy 3198610
MRI head 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 without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MR spectroscopy head without 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 IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI functional (fMRI) head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head perfusion with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head perfusion without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without IV contrast with DTI
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 head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
DOTATATE PET/CT brain
1-10 mSv
☢☢☢
Usually not appropriate
DOTATATE PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
FDG-PET/CT brain
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Fluciclovine PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Fluciclovine PET/CT brain
10-30 mSv
☢☢☢☢
Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Brain tumor on prior imaging, intra-axial suspected, pretreatment evaluation 3198612
MRI head perfusion 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 		Usually appropriate
MR spectroscopy head without 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 functional (fMRI) head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head perfusion 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 head without IV contrast with DTI
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Fluciclovine PET/MRI brain
1-10 mSv
☢☢☢
May be appropriate
Fluciclovine PET/CT brain
10-30 mSv
☢☢☢☢
May be appropriate
MRI complete spine with 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 head 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 head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
DOTATATE PET/CT brain
1-10 mSv
☢☢☢
Usually not appropriate
DOTATATE PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
FDG-PET/CT brain
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Brain tumor on prior imaging, extra-axial suspected, pretreatment evaluation 3198614
MRI head 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 functional (fMRI) head 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
DOTATATE PET/CT brain
1-10 mSv
☢☢☢
May be appropriate
DOTATATE PET/MRI brain
1-10 mSv
☢☢☢
May be appropriate
MR spectroscopy head without 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 IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head perfusion with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head perfusion without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without IV contrast with DTI
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 head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
FDG-PET/CT brain
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Fluciclovine PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Fluciclovine PET/CT brain
10-30 mSv
☢☢☢☢
Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Brain tumor, treated, surveillance 3198616
MRI head perfusion 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 		Usually appropriate
MRI complete spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
MRI head perfusion 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
(Disagreement)
MR spectroscopy head without 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 IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI functional (fMRI) head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head without IV contrast with DTI
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 head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
DOTATATE PET/CT brain
1-10 mSv
☢☢☢
Usually not appropriate
DOTATATE PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
FDG-PET/CT brain
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
FDG-PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Fluciclovine PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Fluciclovine PET/CT brain
10-30 mSv
☢☢☢☢
Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Brain tumor, treated, new lesion on surveillance, next imaging study 3198618
MRI head perfusion with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head perfusion 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
MR spectroscopy head 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 head without IV contrast with DTI
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
DOTATATE PET/CT brain
1-10 mSv
☢☢☢
May be appropriate
DOTATATE PET/MRI brain
1-10 mSv
☢☢☢
May be appropriate
FDG-PET/CT brain
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/MRI brain
1-10 mSv
☢☢☢
May be 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 complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI functional (fMRI) head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head 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 head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Fluciclovine PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Fluciclovine PET/CT brain
10-30 mSv
☢☢☢☢
Usually not appropriate
Brain tumor, treated, enlarging lesion on surveillance, next imaging study 3198619
MRI head perfusion with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI head perfusion 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
MR spectroscopy head 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 head without IV contrast with DTI
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
DOTATATE PET/CT brain
1-10 mSv
☢☢☢
May be appropriate
DOTATATE PET/MRI brain
1-10 mSv
☢☢☢
May be appropriate
FDG-PET/CT brain
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
FDG-PET/MRI brain
1-10 mSv
☢☢☢
May be 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 complete spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI functional (fMRI) head without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI head 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 head without IV contrast
1-10 mSv
☢☢☢ 		0.3-3 mSv [ped]
☢☢☢ 		Usually not appropriate
Fluciclovine PET/MRI brain
1-10 mSv
☢☢☢
Usually not appropriate
Fluciclovine PET/CT brain
10-30 mSv
☢☢☢☢
Usually not appropriate
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