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Home Osteonecrosis
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Osteonecrosis suspected, wrist, initial imaging 3195706
Radiography wrist
<0.1 mSv
☢
Usually appropriate
MRI wrist without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI wrist without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT wrist with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT wrist without and with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT wrist without IV contrast
<0.1 mSv
☢
Usually not appropriate
Bone scan wrist
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, shoulder, initial imaging 3195708
Radiography shoulder
<0.1 mSv
☢
Usually appropriate
MRI shoulder without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan shoulder
1-10 mSv
☢☢☢
Usually not appropriate
CT shoulder with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT shoulder without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT shoulder without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, foot, initial imaging 3195713
Radiography foot
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually appropriate
MRI foot without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI foot without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT foot with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT foot without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT foot without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan foot
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis suspected, ankle, initial imaging 3195703
Radiography ankle
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually appropriate
MRI ankle without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI ankle without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT ankle with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT ankle without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT ankle without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan ankle
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis suspected, elbow, initial imaging 3195705
Radiography elbow
<0.1 mSv
☢
Usually appropriate
MRI elbow without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI elbow without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT elbow with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT elbow without and with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT elbow without IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan elbow
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, humerus, initial imaging 3195710
Radiography humerus
<0.1 mSv
☢
Usually appropriate
MRI upper arm without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI upper arm without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan arm
1-10 mSv
☢☢☢
Usually not appropriate
CT upper arm with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT upper arm without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT upper arm without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, hip, initial imaging 3195715
Radiography hip
1-10 mSv
☢☢☢
Usually appropriate
MRI hip without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI hip without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan hip
1-10 mSv
☢☢☢
Usually not appropriate
CT hip with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT hip without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT hip without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, femur, initial imaging 3195714
Radiography femur
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually appropriate
MRI thigh without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI thigh without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT thigh with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT thigh without IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan femur
1-10 mSv
☢☢☢
Usually not appropriate
CT thigh without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, pelvis, initial imaging 3195702
Radiography pelvis
0.1-1mSv
☢☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually appropriate
MRI pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan pelvis
1-10 mSv
☢☢☢
Usually not appropriate
CT pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis suspected, tibia fibula, initial imaging 3195707
Radiography tibia and fibula
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually appropriate
MRI lower leg without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI lower leg without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT lower leg with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT lower leg without and with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT lower leg without IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan leg
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, forearm, initial imaging 3195712
Radiography radius and ulna
<0.1 mSv
☢
Usually appropriate
MRI forearm without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI forearm without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT forearm with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT forearm without and with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT forearm without IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan forearm
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, knee, initial imaging 3195709
Radiography knee
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually appropriate
MRI knee without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI knee without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT knee with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT knee without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT knee without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan knee
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, hand, initial imaging 3195711
Radiography hand
<0.1 mSv
☢
Usually appropriate
MRI hand without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI hand without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT hand with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT hand without and with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT hand without IV contrast
<0.1 mSv
☢
Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, chest, initial imaging 3195704
Radiography chest
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually appropriate
MRI chest without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI chest without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan chest
1-10 mSv
☢☢☢
Usually not appropriate
CT chest with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT chest without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT chest without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Osteonecrosis suspected, chest, radiography normal, next imaging study 3195717
MRI chest without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI chest without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT chest without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
Bone scan chest
1-10 mSv
☢☢☢
Usually not appropriate
CT chest with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT chest without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis suspected, femur, suspicious findings on radiography, next imaging study 3195734
MRI thigh without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thigh without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT thigh without IV contrast
0.1-1mSv
☢☢
May be appropriate
CT thigh with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan femur
1-10 mSv
☢☢☢
Usually not appropriate
CT thigh without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, foot, radiography normal, next imaging study 3195722
MRI foot without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI foot without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT foot without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
CT foot with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT foot without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan foot
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis suspected, forearm, suspicious findings on radiography, next imaging study 3195736
MRI forearm without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI forearm without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT forearm without IV contrast
0.1-1mSv
☢☢
May be appropriate
CT forearm with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT forearm without and with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan forearm
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, hand, radiography normal, next imaging study 3195724
MRI hand without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI hand without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT hand without IV contrast
<0.1 mSv
☢
May be appropriate
CT hand with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT hand without and with IV contrast
<0.1 mSv
☢
Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, tibia fibula, suspicious findings on radiography, next imaging study 3195741
MRI lower leg without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI lower leg without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT lower leg without IV contrast
0.1-1mSv
☢☢
May be appropriate
CT lower leg with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT lower leg without and with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan leg
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, wrist, radiography normal, next imaging study 3195729
MRI wrist without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI wrist without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT wrist without IV contrast
<0.1 mSv
☢
May be appropriate
CT wrist with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT wrist without and with IV contrast
<0.1 mSv
☢
Usually not appropriate
Bone scan wrist
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, hip, suspicious findings on radiography, next imaging study 3195743
MRI hip without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI hip without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT hip without IV contrast
1-10 mSv
☢☢☢
May be appropriate
Bone scan hip
1-10 mSv
☢☢☢
Usually not appropriate
CT hip with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT hip without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, pelvis, suspicious findings on radiography, next imaging study 3195731
MRI pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
Bone scan pelvis
1-10 mSv
☢☢☢
Usually not appropriate
CT pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis suspected, ankle, radiography normal, next imaging study 3195719
MRI ankle without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI ankle without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT ankle without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
CT ankle with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT ankle without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan ankle
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis suspected, elbow, suspicious findings on radiography, next imaging study 3195733
MRI elbow without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI elbow without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT elbow without IV contrast
0.1-1mSv
☢☢
May be appropriate
CT elbow with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT elbow without and with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan elbow
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, humerus, suspicious findings on radiography, next imaging study 3195738
MRI upper arm without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI upper arm without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT upper arm without IV contrast
1-10 mSv
☢☢☢
May be appropriate
Bone scan arm
1-10 mSv
☢☢☢
Usually not appropriate
CT upper arm with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT upper arm without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, knee, radiography normal, next imaging study 3195726
MRI knee without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI knee without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT knee without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
CT knee with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT knee without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan knee
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, shoulder, suspicious findings on radiography, next imaging study 3195740
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI shoulder without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT shoulder without IV contrast
1-10 mSv
☢☢☢
May be appropriate
Bone scan shoulder
1-10 mSv
☢☢☢
Usually not appropriate
CT shoulder with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT shoulder without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, tibia fibula, radiography normal, next imaging study 3195728
MRI lower leg without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI lower leg without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT lower leg without IV contrast
0.1-1mSv
☢☢
May be appropriate
CT lower leg with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT lower leg without and with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan leg
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, wrist, suspicious findings on radiography, next imaging study 3195742
MRI wrist without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI wrist without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT wrist without IV contrast
<0.1 mSv
☢
May be appropriate
CT wrist with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT wrist without and with IV contrast
<0.1 mSv
☢
Usually not appropriate
Bone scan wrist
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, chest, suspicious findings on radiography, next imaging study 3195730
MRI chest without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI chest without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT chest without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
Bone scan chest
1-10 mSv
☢☢☢
Usually not appropriate
CT chest with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT chest without and with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis suspected, femur, radiography normal, next imaging study 3195721
MRI thigh without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI thigh without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT thigh without IV contrast
0.1-1mSv
☢☢
May be appropriate
CT thigh with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan femur
1-10 mSv
☢☢☢
Usually not appropriate
CT thigh without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, foot, suspicious findings on radiography, next imaging study 3195735
MRI foot without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI foot without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT foot without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
CT foot with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT foot without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan foot
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis suspected, forearm, radiography normal, next imaging study 3195723
MRI forearm without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI forearm without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT forearm without IV contrast
0.1-1mSv
☢☢
May be appropriate
CT forearm with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT forearm without and with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan forearm
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, elbow, radiography normal, next imaging study 3195720
MRI elbow without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI elbow without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT elbow without IV contrast
0.1-1mSv
☢☢
May be appropriate
CT elbow with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT elbow without and with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan elbow
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, hand, suspicious findings on radiography, next imaging study 3195737
MRI hand without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI hand without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT hand without IV contrast
<0.1 mSv
☢
May be appropriate
CT hand with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT hand without and with IV contrast
<0.1 mSv
☢
Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, knee, suspicious findings on radiography, next imaging study 3195739
MRI knee without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI knee without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT knee without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
CT knee with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT knee without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan knee
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, humerus, radiography normal, next imaging study 3195725
MRI upper arm without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI upper arm without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT upper arm without IV contrast
1-10 mSv
☢☢☢
May be appropriate
Bone scan arm
1-10 mSv
☢☢☢
Usually not appropriate
CT upper arm with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT upper arm without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, hip, radiography normal, next imaging study 3195744
MRI hip without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI hip without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT hip without IV contrast
1-10 mSv
☢☢☢
May be appropriate
Bone scan hip
1-10 mSv
☢☢☢
Usually not appropriate
CT hip with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT hip without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, shoulder, radiography normal, next imaging study 3195727
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI shoulder without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT shoulder without IV contrast
1-10 mSv
☢☢☢
May be appropriate
Bone scan shoulder
1-10 mSv
☢☢☢
Usually not appropriate
CT shoulder with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT shoulder without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis suspected, pelvis, radiography normal, next imaging study 3195718
MRI pelvis without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI pelvis without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT pelvis without IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
Bone scan pelvis
1-10 mSv
☢☢☢
Usually not appropriate
CT pelvis with IV contrast
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
CT pelvis without and with IV contrast
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis suspected, ankle, suspicious findings on radiography, next imaging study 3195732
MRI ankle without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI ankle without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT ankle without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
CT ankle with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT ankle without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan ankle
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Osteonecrosis, ankle, articular collapse on radiography, surgery planned, next imaging study 3195750
MRI ankle without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT ankle without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually appropriate
MR arthrography ankle
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI ankle without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT ankle with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT ankle without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan ankle
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Osteonecrosis, shoulder, articular collapse on radiography, surgery planned, next imaging study 3195747
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT shoulder without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
MR arthrography shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI shoulder without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan shoulder
1-10 mSv
☢☢☢
Usually not appropriate
CT shoulder with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT shoulder without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis, elbow, articular collapse on radiography, surgery planned, next imaging study 3195749
MRI elbow without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT elbow without IV contrast
0.1-1mSv
☢☢
Usually appropriate
MR arthrography elbow
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI elbow without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT elbow with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
CT elbow without and with IV contrast
0.1-1mSv
☢☢
Usually not appropriate
Bone scan elbow
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis, hip, articular collapse on radiography, surgery planned, next imaging study 3195751
MRI hip without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT hip without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
MR arthrography hip
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI hip without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Bone scan hip
1-10 mSv
☢☢☢
Usually not appropriate
CT hip with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT hip without and with IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis, wrist, articular collapse on radiography, surgery planned, next imaging study 3195746
MRI wrist without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT wrist without IV contrast
<0.1 mSv
☢
Usually appropriate
MR arthrography wrist
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI wrist without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT wrist with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT wrist without and with IV contrast
<0.1 mSv
☢
Usually not appropriate
Bone scan wrist
1-10 mSv
☢☢☢
Usually not appropriate
Osteonecrosis, knee, articular collapse on radiography, surgery planned, next imaging study 3195748
MRI knee without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT knee without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually appropriate
MR arthrography knee
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI knee without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT knee with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT knee without and with IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
Bone scan knee
1-10 mSv
☢☢☢
Usually not appropriate
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