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Home Thoracic Back Pain
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Thoracic back pain, acute, no radiculopathy, no red flags, no prior management, initial imaging 3197559
Radiography thoracic spine
1-10 mSv
☢☢☢
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
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, acute, no myelopathy, no red flags, no prior management, initial imaging 3197560
Radiography thoracic spine
1-10 mSv
☢☢☢
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
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Thoracic back pain, subacute, no radiculopathy, no red flags, failed conservative management, initial imaging 3197565
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
(Disagreement)
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
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, chronic, no radiculopathy, no red flags, failed conservative management, initial imaging 3197563
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
(Disagreement)
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
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, chronic, no myelopathy, no red flags, failed conservative management, initial imaging 3197562
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
(Disagreement)
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
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, subacute, no myelopathy, no red flags, failed conservative management, initial imaging 3197564
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
(Disagreement)
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
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Thoracic back pain, myelopathy, initial imaging 3197567
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
MRI thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, radiculopathy, initial imaging 3197568
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
MRI thoracic spine without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Thoracic back pain, with or without radiculopathy, elderly, initial imaging 3197572
Radiography thoracic spine
1-10 mSv
☢☢☢
Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually 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
Bone scan with SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, with or without myelopathy, low-velocity trauma, initial imaging 3197574
Radiography thoracic spine
1-10 mSv
☢☢☢
Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually 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
Bone scan with SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, with or without myelopathy, elderly, initial imaging 3197576
Radiography thoracic spine
1-10 mSv
☢☢☢
Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually 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
Bone scan with SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, with or without radiculopathy, osteoporosis, initial imaging 3197571
Radiography thoracic spine
1-10 mSv
☢☢☢
Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually 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
Bone scan with SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, with or without radiculopathy, chronic steroid use, initial imaging 3197573
Radiography thoracic spine
1-10 mSv
☢☢☢
Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually 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
Bone scan with SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, with or without myelopathy, chronic steroid use, initial imaging 3197577
Radiography thoracic spine
1-10 mSv
☢☢☢
Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually 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
Bone scan with SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, with or without myelopathy, osteoporosis, initial imaging 3197575
Radiography thoracic spine
1-10 mSv
☢☢☢
Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually 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
Bone scan with SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Thoracic back pain, with or without radiculopathy, low-velocity trauma, initial imaging 3197570
Radiography thoracic spine
1-10 mSv
☢☢☢
Usually appropriate
MRI thoracic spine without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually 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
Bone scan with SPECT or SPECT/CT thoracic spine
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thoracic spine with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Thoracic back pain, with or without myelopathy, infection suspected, initial imaging 3197583
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
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without radiculopathy, immunosuppressed, initial imaging 3197581
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
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without radiculopathy, infection suspected, initial imaging 3197580
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
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without myelopathy, cancer suspected, initial imaging 3197582
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
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without myelopathy, immunosuppressed, initial imaging 3197584
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
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without radiculopathy, cancer suspected, initial imaging 3197579
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
Radiography thoracic spine
1-10 mSv
☢☢☢
May be appropriate
CT thoracic spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Thoracic back pain, with or without myelopathy, spinal deformity on radiography, next imaging study 3197590
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 spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without myelopathy, fracture on radiography, next imaging study 3197589
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 spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without radiculopathy, spinal deformity on radiography, next imaging study 3197587
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 spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without myelopathy, bone destruction on radiography, next imaging study 3197591
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 spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without radiculopathy, fracture on radiography, next imaging study 3197586
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 spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without radiculopathy, bone destruction on radiography, next imaging study 3197588
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 spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Thoracic back pain, with or without myelopathy, post thoracic spine surgery, follow-up imaging 3197594
Radiography thoracic spine
1-10 mSv
☢☢☢
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 spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
Thoracic back pain, with or without radiculopathy, post thoracic spine surgery, follow-up imaging 3197593
Radiography thoracic spine
1-10 mSv
☢☢☢
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 spine without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually appropriate
CT myelography thoracic spine
10-30 mSv
☢☢☢☢
May be appropriate
MRI thoracic spine with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan whole body
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Bone scan with SPECT or SPECT/CT thoracic spine
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 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
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