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Don't perform neuroimaging (CT or MRI) for patients with stable headaches that meet criteria for migraine. Setting: recurrent headaches meeting migraine criteria, stable pattern, normal neurological examination, no red flags Why: Neuroimaging in stable migraine without red flags almost never reveals significant pathology and drives incidentalomas and cost. Consider instead: clinical diagnosis; image only for red flags (thunderclap onset, new/progressive deficit, immunosuppression, age >50 new headache) Source: American College of Radiology (Choosing Wisely, US, 2012).

Don't order knee MRI as the first study for an acute knee injury; obtain weight-bearing radiographs first and reserve MRI for a suspicious exam or negative radiographs with continued suspicion of internal derangement. Setting: acute knee injury (within ~1-2 days) where the exam does NOT suggest significant internal derangement or fracture — no effusion/haemarthrosis, negative ligamentous and meniscal special tests (e.g., Lachman, anterior drawer negative), able to bear weight, no Ottawa Knee Rule positive findings — and radiographs have not yet been obtained. An order for knee MRI on day 1 in this low-suspicion setting is low-value. Why: Day-1 MRI for an acute knee with a benign exam rarely changes early management, yields incidental findings, and strains access; radiographs are first-line and MRI adds value chiefly after negative radiographs or with a significant effusion / positive exam. Consider instead: apply the Ottawa Knee Rule and obtain weight-bearing radiographs first; manage conservatively with short-interval reassessment; reserve MRI for negative radiographs with continued suspicion of occult fracture / internal derangement, or a significant effusion or positive ligament exam Source: American College of Radiology (Choosing Wisely, US, 2019).

Don't obtain advanced spinal imaging (MRI or CT) when there are no red flags and no localizing neurological indication. Setting: limb or regional pain being evaluated for a possible spinal cause, with NO focal or progressive neurological deficit, NO neurogenic claudication or radiculopathy, NO saddle anaesthesia or bowel/bladder dysfunction, and NO other red flags (major trauma, cancer history, unexplained weight loss, fever/infection, IV drug use, immunosuppression); a plausible non-spinal cause has already been evaluated (e.g., normal venous Doppler, specialist review advising no intervention). An order for whole-spine or multi-region 'screening' MRI in this setting is low-value. Why: Absent red flags or a localizing neurological indication, advanced spinal imaging does not improve outcomes and yields incidental/degenerative findings that drive low-value downstream care; whole-spine 'screening' compounds this by imaging asymptomatic regions with no pre-test indication. Consider instead: if a spinal cause is genuinely suspected, image only the symptomatic region guided by a localizing exam finding rather than screening the whole spine; otherwise continue conservative management and reassess, escalating only if a red flag or focal deficit emerges Source: American College of Radiology (Choosing Wisely, US, 2021).