Pediatric Musculoskeletal Imaging Guidelines

Covers advanced imaging (MRI, CT, nuclear medicine, ultrasound) for specified pediatric musculoskeletal indications — e.g., suspected occult/stress or complex fractures (pre-op planning, nonunion), infection/osteomyelitis, tumors/soft‑tissue and bone lesions, DDH per criteria, CRMO, JIA and persistent limping — and excludes routine advanced imaging for benign superficial masses (ganglion, sebaceous cyst, hematoma, subcutaneous lipoma), acute compartment syndrome, many overuse conditions (e.g., Osgood‑Schlatter), and any imaging unlikely to change management. Key requirements: a documented pertinent clinical evaluation (detailed history, physical exam, appropriate labs) and usually recent plain radiographs (or ultrasound when indicated) before advanced imaging, clear documentation that imaging will affect immediate management, modality‑specific alternatives when MRI is contraindicated, limits on repeat studies and GBCA use, and specified documentation (entire‑bone x‑rays for lesions, mass characteristics and surgical/oncology consult, follow‑up radiographs for limp, anesthesia planning for pediatric MRI).