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Home Chronic Ankle Pain
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Ankle pain, initial exam 3073925
Radiography ankle
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually appropriate
US 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
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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Ankle pain, djd multi-site on radiography 3073924
Image-guided anesthetic injection ankle and hindfoot

Varies
Varies 		May be appropriate
MRI ankle and hindfoot without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
CT ankle and hindfoot without IV contrast
<0.1 mSv
☢
May be appropriate
US ankle and hindfoot
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Radiographic arthrography ankle and hindfoot
<0.1 mSv
☢
Usually not appropriate
MR arthrography ankle and hindfoot
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
MRI ankle and hindfoot without and with IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
CT ankle and hindfoot with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT ankle and hindfoot without and with IV contrast
<0.1 mSv
☢
Usually not appropriate
CT arthrography ankle and hindfoot
<0.1 mSv
☢
Usually not appropriate
Bone scan hindfoot/ankle
1-10 mSv
☢☢☢
Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Ankle pain, osteochondral lesion suspected, neg radiography 3073921
MRI ankle without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MR arthrography ankle
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 arthrography ankle
<0.1 mSv
☢
May be appropriate
Bone scan with SPECT or SPECT/CT ankle
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
US ankle
0 mSv
O 		0 mSv [ped]
O 		Usually not appropriate
Radiographic arthrography ankle
<0.1 mSv
☢
Usually not appropriate
Radiography ankle stress views
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not appropriate
Image-guided anesthetic injection ankle

Varies
Varies 		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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Ankle pain, tendon abnormality suspected, neg radiography 3073926
US ankle
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI ankle without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US-guided anesthetic injection ankle tendon sheath
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Fluoroscopy tenography ankle
<0.1 mSv
☢
Usually not appropriate
Radiographic arthrography ankle
<0.1 mSv
☢
Usually not appropriate
Radiography ankle stress views
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not 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
CT ankle without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		Usually not appropriate
CT arthrography ankle
<0.1 mSv
☢
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
Ankle pain, instability suspected, neg radiography 3073927
MR arthrography ankle
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI ankle without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US ankle
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Radiography ankle stress views
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		May be appropriate
CT arthrography ankle
<0.1 mSv
☢
May be appropriate
Radiographic arthrography ankle
<0.1 mSv
☢
Usually not appropriate
Image-guided anesthetic injection ankle

Varies
Varies 		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
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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Ankle pain, impingement syndrome suspected, neg radiography 3073922
MRI ankle without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US ankle
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Image-guided anesthetic injection ankle

Varies
Varies 		May be appropriate
(Disagreement)
MR arthrography ankle
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 arthrography ankle
<0.1 mSv
☢
May be appropriate
Radiographic arthrography ankle
<0.1 mSv
☢
Usually not appropriate
Radiography ankle stress views
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		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
3-phase bone scan with SPECT or SPECT/CT ankle
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Ankle pain, uncertain etiol, neg radiography 3073923
MRI ankle without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
US ankle
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
Image-guided anesthetic injection ankle

Varies
Varies 		May be appropriate
CT ankle without IV contrast
<0.1 mSv
☢ 		0.03-0.3 mSv [ped]
☢☢ 		May be appropriate
Bone scan with SPECT or SPECT/CT ankle
1-10 mSv
☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		May be appropriate
(Disagreement)
Radiographic arthrography ankle
<0.1 mSv
☢
Usually not appropriate
Radiography ankle stress views
<0.1 mSv
☢ 		<0.03 mSv [ped]
☢ 		Usually not 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
CT arthrography ankle
<0.1 mSv
☢
Usually not appropriate
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