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total MRI brains ordered from the department). The included studies made up~44% of total MRI ordering for the department and 73.8% of MRI brains ordered in total. Conclusions No studies performed in the absence of meeting RCPCH-Headsmart guidelines were found to have a spaceoccupying lesion indicating that these guidelines represent a sensitive decision support tool for intracranial mass albeit with low specificity. Given the limited availability of MRI brain in most departments use of this modality should be reserved for children who meet these criteria.