Pediatric Musculoskeletal Imaging Guidelines

Advanced imaging (MRI preferred, with CT, ultrasound and nuclear medicine as alternatives) is considered medically appropriate for specified pediatric (≤18) musculoskeletal indications (fractures, growth‑plate injuries, DDH, infection, child abuse, tumors, JIA, CRMO, SCFE, etc.), while explicitly excluding routine imaging for ganglion/sebaceous cysts, hematomas, subcutaneous lipomas, Osgood‑Schlatter, acute compartment syndrome, and restricting hip ultrasound by age and routine JIA follow‑up MRI. Key requirements include a prior pertinent clinical evaluation (history, exam, labs) and basic imaging (plain x‑ray or ultrasound) before advanced studies unless guideline‑scheduled, documentation that imaging will affect management (including x‑ray results, justification for contrast or CT in place of MRI), and adherence to timing/repeat‑imaging rules (e.g., two negative x‑rays for bone scan consideration, specific intervals for stress‑fracture imaging) while minimizing repeat exams and GBCA exposure.