ACR AC Portal

Home Imaging of Suspected Intracranial Hypotension

Variants

Documents

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Headache, orthostatic, intracranial hypotension suspected, no recent spinal intervention that could cause CSF leakage, initial imaging

3197429

MRI complete spine without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually appropriate

MRI complete spine 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

Usually appropriate

CT myelography complete spine

30-100 mSv
☢☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

May be appropriate

Radiographic myelography digital subtraction complete spine

10-30 mSv
☢☢☢☢

Usually not appropriate

MR myelography complete spine

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 head with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

CT head cisternography

1-10 mSv
☢☢☢

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

DTPA cisternography

1-10 mSv
☢☢☢

Usually not appropriate

CT complete spine with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without and with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography dynamic complete spine

30-100 mSv
☢☢☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Headache, orthostatic, within 72 hrs of spinal intervention that could cause CSF leakage, initial imaging

3197432

Radiographic myelography digital subtraction complete spine

10-30 mSv
☢☢☢☢

Usually not appropriate

MR myelography complete spine

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 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 head with 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 head without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

CT head cisternography

1-10 mSv
☢☢☢

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

DTPA cisternography

1-10 mSv
☢☢☢

Usually not appropriate

CT complete spine with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without and with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography complete spine

30-100 mSv
☢☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography dynamic complete spine

30-100 mSv
☢☢☢☢☢

Usually not appropriate

Headache, orthostatic, intracranial hypotension suspected, within 72 hrs of dural puncture that could cause CSF leakage, initial imaging

3197431

Radiographic myelography digital subtraction complete spine

10-30 mSv
☢☢☢☢

Usually not appropriate

MR myelography complete spine

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 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 head with 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 head without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

CT head cisternography

1-10 mSv
☢☢☢

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

DTPA cisternography

1-10 mSv
☢☢☢

Usually not appropriate

CT complete spine with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without and with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography complete spine

30-100 mSv
☢☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography dynamic complete spine

30-100 mSv
☢☢☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Headache, orthostatic, intracranial hypotension suspected, no improvement post 72 hrs of dural puncture that could cause CSF leakage, initial imaging

3197434

Radiographic myelography digital subtraction complete spine

10-30 mSv
☢☢☢☢

Usually not appropriate

MR myelography complete spine

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 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 head with 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 head without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

CT head cisternography

1-10 mSv
☢☢☢

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

DTPA cisternography

1-10 mSv
☢☢☢

Usually not appropriate

CT complete spine with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without and with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography complete spine

30-100 mSv
☢☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography dynamic complete spine

30-100 mSv
☢☢☢☢☢

Usually not appropriate

Headache, orthostatic, intracranial hypotension suspected, no improvement post 72 hrs of spinal intervention that could cause CSF leakage, initial imaging

3197435

Radiographic myelography digital subtraction complete spine

10-30 mSv
☢☢☢☢

Usually not appropriate

MR myelography complete spine

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 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 head with 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 head without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

CT head cisternography

1-10 mSv
☢☢☢

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

DTPA cisternography

1-10 mSv
☢☢☢

Usually not appropriate

CT complete spine with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without and with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography complete spine

30-100 mSv
☢☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography dynamic complete spine

30-100 mSv
☢☢☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Obtundation, intracranial hypotension suspected on initial brain imaging, next imaging study

3197437

MRI complete spine without and with IV contrast

0 mSv
O

0 mSv [ped]
O

Usually appropriate

MRI complete spine without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually appropriate

CT myelography complete spine

30-100 mSv
☢☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

May be appropriate

Radiographic myelography digital subtraction complete spine

10-30 mSv
☢☢☢☢

Usually not appropriate

MR myelography complete spine

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

DTPA cisternography

1-10 mSv
☢☢☢

Usually not appropriate

CT complete spine with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without and with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography dynamic complete spine

30-100 mSv
☢☢☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Headache, chronic, daily, intracranial hypotension suspected, initial imaging negative, hx and clinical exam suggesting CSF leakage, next imaging study

3197439

Radiographic myelography digital subtraction complete spine

10-30 mSv
☢☢☢☢

Usually appropriate

CT myelography dynamic complete spine

30-100 mSv
☢☢☢☢☢

Usually appropriate

MR myelography complete spine

0 mSv
O

0 mSv [ped]
O

May be appropriate

DTPA cisternography

1-10 mSv
☢☢☢

May be appropriate

CT head cisternography

1-10 mSv
☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Headache, rebound, post fibrin glue patch treatment, intracranial hypotension suspected, initial imaging

3197442

Radiographic myelography digital subtraction complete spine

10-30 mSv
☢☢☢☢

Usually not appropriate

MR myelography complete spine

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 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 head with 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 head without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

CT head cisternography

1-10 mSv
☢☢☢

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

DTPA cisternography

1-10 mSv
☢☢☢

Usually not appropriate

CT complete spine with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without and with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography complete spine

30-100 mSv
☢☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography dynamic complete spine

30-100 mSv
☢☢☢☢☢

Usually not appropriate

Headache, rebound, post epidural blood patch treatment, intracranial hypotension suspected, initial imaging

3197441

Radiographic myelography digital subtraction complete spine

10-30 mSv
☢☢☢☢

Usually not appropriate

MR myelography complete spine

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 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 head with 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 head without IV contrast

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

CT head cisternography

1-10 mSv
☢☢☢

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

DTPA cisternography

1-10 mSv
☢☢☢

Usually not appropriate

CT complete spine with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without and with IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT complete spine without IV contrast

10-30 mSv
☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography complete spine

30-100 mSv
☢☢☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

CT myelography dynamic complete spine

30-100 mSv
☢☢☢☢☢

Usually not appropriate