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Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Ankle trauma, up to 3 weeks after injury, no exclusionary criteria, unable to bear weight immediately after injury, initial imaging

3191900

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

Ankle trauma, up to 3 weeks after injury, no exclusionary criteria, unable to take 4 steps, initial imaging

3191902

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

Ankle trauma, up to 3 weeks after injury, no exclusionary criteria, point tenderness over malleolus or talus or calcaneus, initial imaging

3191901

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

Ankle trauma, up to 3 weeks after injury, no exclusionary criteria, Ottawa rules positive, initial imaging

3191903

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 trauma, Ottawa rules negative, no exclusionary criteria, initial imaging

3191899

US ankle

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

Radiography ankle

<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

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

Ankle trauma, no point tenderness over the malleoli or talus or calcaneus, able to walk, no exclusionary criteria, initial imaging

3191898

US ankle

0 mSv
O

0 mSv [ped]
O

Usually not appropriate

Radiography ankle

<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

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 trauma, neuropathy, initial imaging

3191909

Radiography ankle

<0.1 mSv
☢

<0.03 mSv [ped]
☢

Usually appropriate

CT ankle without IV contrast

<0.1 mSv
☢

0.03-0.3 mSv [ped]
☢☢

May be appropriate

US ankle

0 mSv
O

0 mSv [ped]
O

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

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

Bone scan ankle

1-10 mSv
☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

Ankle trauma, does not meet requirements for Ottawa rules evaluation, initial imaging

3191911

Radiography ankle

<0.1 mSv
☢

<0.03 mSv [ped]
☢

Usually appropriate

CT ankle without IV contrast

<0.1 mSv
☢

0.03-0.3 mSv [ped]
☢☢

May be appropriate

US ankle

0 mSv
O

0 mSv [ped]
O

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

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

Bone scan ankle

1-10 mSv
☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

Ankle trauma, altered sensorium or cannot communicate, initial imaging

3191910

Radiography ankle

<0.1 mSv
☢

<0.03 mSv [ped]
☢

Usually appropriate

CT ankle without IV contrast

<0.1 mSv
☢

0.03-0.3 mSv [ped]
☢☢

May be appropriate

US ankle

0 mSv
O

0 mSv [ped]
O

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

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

Bone scan ankle

1-10 mSv
☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

Ankle trauma, neurologic disorder lower leg, initial imaging

3191908

Radiography ankle

<0.1 mSv
☢

<0.03 mSv [ped]
☢

Usually appropriate

CT ankle without IV contrast

<0.1 mSv
☢

0.03-0.3 mSv [ped]
☢☢

May be appropriate

US ankle

0 mSv
O

0 mSv [ped]
O

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

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

Bone scan ankle

1-10 mSv
☢☢☢

3-10 mSv [ped]
☢☢☢☢

Usually not appropriate

Scenario

Scenario ID

Procedure

Adult RRL

Peds RRL

Appropriateness Category

Ankle trauma, continued pain >1wk and <3wks, no exclusionary criteria, radiography negative

3084087

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

Radiography ankle

<0.1 mSv
☢

<0.03 mSv [ped]
☢

May be appropriate

Radiography ankle stress views

<0.1 mSv
☢

<0.03 mSv [ped]
☢

May be 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

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

Ankle trauma, no exclusionary criteria, fracture on radiography, next imaging study

3191921

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

Radiography ankle Broden’s view

<0.1 mSv
☢

<0.03 mSv [ped]
☢

May be 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

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

Ankle trauma, no exclusionary criteria, osteochondral injury suspected on radiography, next imaging study

3191922

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

Radiography ankle Broden’s view

<0.1 mSv
☢

<0.03 mSv [ped]
☢

May be 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

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

Ankle trauma, osseous injury negative on radiography, alignment abnormality on radiography or physical exam, dislocation suspected, next imaging study

3191924

Radiography ankle stress views

<0.1 mSv
☢

<0.03 mSv [ped]
☢

Usually appropriate

Radiography leg

<0.1 mSv
☢

Usually appropriate

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

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

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

Ankle trauma, osseous injury negative on radiography, alignment abnormality on radiography or physical exam, syndesmotic injury suspected, next imaging study

3191923

Radiography ankle stress views

<0.1 mSv
☢

<0.03 mSv [ped]
☢

Usually appropriate

Radiography leg

<0.1 mSv
☢

Usually appropriate

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

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

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