Home Chronic Hand and Wrist Pain
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Hand pain, chronic, initial imaging 3196863
Radiography hand
<0.1 mSv

Usually appropriate
US hand
0 mSv
O
0 mSv [ped]
O
May be appropriate
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
MR arthrography hand
0 mSv
O
0 mSv [ped]
O
Usually not 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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Wrist pain, chronic, initial imaging 3073965
Radiography wrist
<0.1 mSv

Usually appropriate
US wrist
0 mSv
O
0 mSv [ped]
O
May be appropriate
Radiographic arthrography wrist
<0.1 mSv

Usually not 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
MRI wrist without IV contrast
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Wrist pain, chronic, nonspecific arthritis findings on radiography, next imaging study 3196865
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually appropriate
MRI wrist without IV contrast
0 mSv
O
0 mSv [ped]
O
Usually appropriate
US wrist
0 mSv
O
0 mSv [ped]
O
May be appropriate
Radiography wrist additional views
<0.1 mSv

May be appropriate
CT arthrography wrist
<0.1 mSv

May be appropriate
CT wrist without IV contrast
<0.1 mSv

May be appropriate
Radiographic arthrography wrist
<0.1 mSv

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
Wrist pain, chronic, radiography normal, next imaging study 3081994
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually appropriate
MRI wrist without IV contrast
0 mSv
O
0 mSv [ped]
O
Usually appropriate
US wrist
0 mSv
O
0 mSv [ped]
O
May be appropriate
Radiography wrist additional views
<0.1 mSv

May be appropriate
CT arthrography wrist
<0.1 mSv

May be appropriate
CT wrist without IV contrast
<0.1 mSv

May be appropriate
Radiographic arthrography wrist
<0.1 mSv

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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Hand pain, chronic, radiography normal, next imaging study 3196867
MRI hand without IV contrast
0 mSv
O
0 mSv [ped]
O
Usually appropriate
US hand
0 mSv
O
0 mSv [ped]
O
May be appropriate
MRI hand without and with IV contrast
0 mSv
O
0 mSv [ped]
O
May be appropriate
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
MR arthrography hand
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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Hand pain, chronic, nonspecific arthritis findings on radiography, next imaging study 3073967
MRI hand without IV contrast
0 mSv
O
0 mSv [ped]
O
Usually appropriate
US hand
0 mSv
O
0 mSv [ped]
O
May be appropriate
MRI hand without and with IV contrast
0 mSv
O
0 mSv [ped]
O
May be appropriate
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
MR arthrography hand
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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Wrist pain, chronic, old scaphoid fracture on radiography, next imaging study, evaluate for malunion 3196871
MRI wrist without IV contrast
0 mSv
O
0 mSv [ped]
O
Usually appropriate
CT wrist without IV contrast
<0.1 mSv

Usually appropriate
MRI wrist without and with IV contrast
0 mSv
O
0 mSv [ped]
O
May be appropriate
US wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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
Wrist pain, chronic, old scaphoid fracture on radiography, next imaging study, evaluate for osteonecrosis 3196870
MRI wrist without IV contrast
0 mSv
O
0 mSv [ped]
O
Usually appropriate
CT wrist without IV contrast
<0.1 mSv

Usually appropriate
MRI wrist without and with IV contrast
0 mSv
O
0 mSv [ped]
O
May be appropriate
US wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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
Wrist pain, chronic, old scaphoid fracture on radiography, next imaging study, evaluate for post traumatic osteoarthritis 3196869
MRI wrist without IV contrast
0 mSv
O
0 mSv [ped]
O
Usually appropriate
CT wrist without IV contrast
<0.1 mSv

Usually appropriate
MRI wrist without and with IV contrast
0 mSv
O
0 mSv [ped]
O
May be appropriate
US wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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
Wrist pain, chronic, old scaphoid fracture on radiography, next imaging study, evaluate for nonunion 3082506
MRI wrist without IV contrast
0 mSv
O
0 mSv [ped]
O
Usually appropriate
CT wrist without IV contrast
<0.1 mSv

Usually appropriate
MRI wrist without and with IV contrast
0 mSv
O
0 mSv [ped]
O
May be appropriate
US wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Hand pain, chronic, carpal tunnel syndrome suspected, radiography indeterminate, next imaging study 3196873
US hand
0 mSv
O
0 mSv [ped]
O
May be appropriate
MRI hand without IV contrast
0 mSv
O
0 mSv [ped]
O
May be appropriate
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
Radiography wrist additional views
<0.1 mSv

Usually not appropriate
MR arthrography hand
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
MRI hand without and with 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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Wrist pain, chronic, carpal tunnel syndrome suspected, radiography indeterminate, next imaging study 3196875
US wrist
0 mSv
O
0 mSv [ped]
O
May be appropriate
MRI wrist without IV contrast
0 mSv
O
0 mSv [ped]
O
May be appropriate
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
Radiography wrist additional views
<0.1 mSv

Usually not 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 arthrography wrist
<0.1 mSv

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
Wrist pain, chronic, carpal tunnel syndrome suspected, radiography normal, next imaging study 3196874
US wrist
0 mSv
O
0 mSv [ped]
O
May be appropriate
MRI wrist without IV contrast
0 mSv
O
0 mSv [ped]
O
May be appropriate
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
Radiography wrist additional views
<0.1 mSv

Usually not 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 arthrography wrist
<0.1 mSv

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
Hand pain, chronic, carpal tunnel syndrome suspected, radiography normal, next imaging study 3128528
US hand
0 mSv
O
0 mSv [ped]
O
May be appropriate
MRI hand without IV contrast
0 mSv
O
0 mSv [ped]
O
May be appropriate
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
Radiography wrist additional views
<0.1 mSv

Usually not appropriate
MR arthrography hand
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
MRI hand without and with 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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Hand pain, chronic, tendon pathology suspected, nonspecific arthritis findings on radiography, next imaging study 3196884
US hand
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
MR arthrography hand
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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Hand pain, chronic, tendon injury suspected, radiography normal, next imaging study 3196877
US hand
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
MR arthrography hand
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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Hand pain, chronic, tenosynovitis suspected, radiography normal, next imaging study 3196882
US hand
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
MR arthrography hand
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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Hand pain, chronic, tendon pathology suspected, radiography normal, next imaging study 3196881
US hand
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
MR arthrography hand
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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Hand pain, chronic, tendon injury suspected, nonspecific arthritis findings on radiography, next imaging study 3196886
US hand
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
MR arthrography hand
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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Wrist pain, chronic, tenosynovitis suspected, radiography normal, next imaging study 3196879
US wrist
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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
Wrist pain, chronic, tendon pathology suspected, radiography normal, next imaging study 3196878
US wrist
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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
Wrist pain, chronic, tendon pathology suspected, nonspecific arthritis findings on radiography, next imaging study 3196883
US wrist
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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
Hand pain, chronic, tenosynovitis suspected, nonspecific arthritis findings on radiography, next imaging study 3196888
US hand
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography hand
<0.1 mSv

Usually not appropriate
MR arthrography hand
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
CT arthrography hand
0.1-1mSv
☢☢

Usually not appropriate
Bone scan hand
1-10 mSv
☢☢☢

Usually not appropriate
Wrist, chronic, tenosynovitis suspected, nonspecific arthritis findings on radiography, next imaging study 3196887
US wrist
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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
Wrist pain, chronic, tendon injury suspected, radiography normal, next imaging study 3196880
US wrist
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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
Wrist pain, chronic, tendon injury suspected, nonspecific arthritis findings on radiography, next imaging study 3196885
US wrist
0 mSv
O
0 mSv [ped]
O
Usually appropriate
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
Radiographic arthrography wrist
<0.1 mSv

Usually not appropriate
MR arthrography wrist
0 mSv
O
0 mSv [ped]
O
Usually not appropriate
CT arthrography wrist
<0.1 mSv

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