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Home Acute Shoulder Pain
Variants
Scenario Scenario ID Procedure Adult RRL Peds RRL Appropriateness Category
Shoulder pain, acute, any etiology, initial imaging 3198468
Radiography shoulder
<0.1 mSv
☢
Usually appropriate
US shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually not 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
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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
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
Shoulder pain, acute, occult fracture suspected, radiography negative, next imaging study 3198471
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT shoulder without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
US shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually not 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Shoulder pain, acute, occult fracture suspected, radiography indeterminate, next imaging study 3198470
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT shoulder without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
US shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually not 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
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
Shoulder pain, acute, clavicle fracture on radiography, next imaging study 3198473
CT shoulder without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
US shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually not 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Shoulder pain, acute, proximal humerus fracture on radiography, next imaging study 3198475
CT shoulder without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
US shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually not 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Shoulder pain, acute, scapular fracture on radiography, next imaging study 3198474
CT shoulder without IV contrast
1-10 mSv
☢☢☢
Usually appropriate
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
US shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually not 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
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
Shoulder pain, acute, hx or physical exam consistent with dislocation, radiography positive, next imaging study 3198482
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MR arthrography shoulder
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT shoulder without IV contrast
1-10 mSv
☢☢☢
May be appropriate
(Disagreement)
US 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Shoulder pain, acute, hx or physical exam consistent with dislocation, radiography negative, next imaging study 3198480
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MR arthrography shoulder
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT shoulder without IV contrast
1-10 mSv
☢☢☢
May be appropriate
(Disagreement)
US 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Shoulder pain, acute, hx or physical exam consistent with dislocation, radiography indeterminate, next imaging study 3198479
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MR arthrography shoulder
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT shoulder without IV contrast
1-10 mSv
☢☢☢
May be appropriate
(Disagreement)
US 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Shoulder pain, acute, hx or physical exam consistent with instability, radiography indeterminate, next imaging study 3198477
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MR arthrography shoulder
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT shoulder without IV contrast
1-10 mSv
☢☢☢
May be appropriate
(Disagreement)
US 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Shoulder pain, acute, hx or physical exam consistent with instability, radiography positive, next imaging study 3198481
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MR arthrography shoulder
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT shoulder without IV contrast
1-10 mSv
☢☢☢
May be appropriate
(Disagreement)
US 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Shoulder pain, acute, hx or physical exam consistent with instability, radiography negative, next imaging study 3198478
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MR arthrography shoulder
0 mSv
O 		0 mSv [ped]
O 		May be appropriate
(Disagreement)
CT shoulder without IV contrast
1-10 mSv
☢☢☢
May be appropriate
(Disagreement)
US 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
CT arthrography shoulder
10-30 mSv
☢☢☢☢
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
Shoulder pain, acute, physical exam consistent with labral tear, radiography indeterminate, next imaging study 3198484
MR arthrography shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually appropriate
US 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
CT shoulder without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Shoulder pain, acute, physical exam consistent with labral tear, radiography negative, next imaging study 3198485
MR arthrography shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually appropriate
US 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
CT shoulder without IV contrast
1-10 mSv
☢☢☢
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
Shoulder pain, acute, physical exam consistent with rotator cuff tear, radiography negative, next imaging study 3198488
US shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		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
CT shoulder without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT arthrography shoulder
10-30 mSv
☢☢☢☢
Usually not appropriate
FDG-PET/CT skull base to mid-thigh
10-30 mSv
☢☢☢☢ 		3-10 mSv [ped]
☢☢☢☢ 		Usually not appropriate
Shoulder pain, acute, physical exam consistent with rotator cuff tear, radiography indeterminate, next imaging study 3198487
US shoulder
0 mSv
O 		0 mSv [ped]
O 		Usually appropriate
MRI shoulder without IV contrast
0 mSv
O 		0 mSv [ped]
O 		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
CT shoulder without IV contrast
1-10 mSv
☢☢☢
Usually not appropriate
CT arthrography shoulder
10-30 mSv
☢☢☢☢
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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