Download a PDF copy of Chiropractic diagnostic imaging fact sheet (78.5 KB,PDF).
The aim of this fact sheet is to help chiropractors to carry out chiropractic diagnostic imaging procedures in a safe and responsible manner, within the context of the Health Practitioner Regulation National Law1 and the Code of conduct.
Radiographic imaging (x-ray) is part of the suite of diagnostic procedures used by chiropractors, either in a chiropractic office or through referral.
Chiropractors receive training in radiology and radiography as part of their chiropractic education.
If you carry out your own radiography you must ensure that you meet your local state and territory requirements by:
Good practice includes:
You can use radiography to:
Radiographs should only be used if there is sufficient clinical justification in an evidence-based context. You must weigh the risk against the benefit in deciding to carry out any radiographic investigation.
‘Evidence-based context’ is the integration of the best available evidence with professional expertise to make decisions, in conjunction with patient preference, values and circumstances. Good practice includes clinical decision-making that is informed by evidence-based practice so that patients are empowered to make well-informed decisions.
This means that your decision to carry out radiography should be supported by:
Chiropractors must comply with the provisions of the Code of Practice for Radiation Protection in the Application of Ionizing Radiation by Chiropractors (2009) or any subsequent version as published by the Australian Radiation Protection and Nuclear Safety Agency (ARPANSA Code), and applicable Commonwealth, state or territory laws in relation to best practice (see www.arpansa.gov.au under Regulatory publications).
It is recommended that you note the following points from the ARPANSA Code:
In addition to the ARPANSA Code, we would like to clarify and reaffirm the following points:
You will make the ultimate judgement on the application of any radiation-based procedure in light of all the circumstances presented an evidence-based context.
You must comply with the Code of conduct, in particular:
To help determine if there is enough clinical reason to carry out a radiographic study on a patient, consider:
The ARPANSA webpage provides links to relevant Commonwealth, State and Territory regulators, which are good resources for information on radiography licences and other regulatory requirements.
Where advice or assistance is required from regulatory authorities, the ARPANSA Code provides contact details of relevant officers in the Commonwealth, State and Territory authorities (see www.arpansa.gov.au for up-to-date list).
The Australian Commission on Safety and Quality in Health Care has further information on the operation of the Diagnostic Imaging Accreditation Scheme for diagnostic imaging practices (see https://www.safetyandquality.gov.au/standards/diagnostic-imaging).
Jamie is a chiropractor practising in a multi-disciplinary clinic, along with other allied health
A new patient consulted with Jamie. The patient agreed to a clinical assessment and Jamie provided
the patient with an explanation of their examination findings and developed a treatment plan in
partnership with the patient.
The patient then asked Jamie to refer them for an x-ray of their lumbar spine to find out what is actually
causing their low back pain. Jamie knows that referring patients who have low back pain with no red
flags for radiography is not best practice. However, the patient continued to insist on having an x-ray.
Jamie recalled that the Chiropractic Board has a fact sheet for radiography, which prompts
chiropractors to consider five questions before using radiography in clinical practice. Jamie knows that
in accordance with the Code of conduct, it is their responsibility to minimise risk to patients (Principle 7)
and that working within the healthcare system requires effective and efficient use of healthcare
resources (Principles 6).
Jamie explained to the patient that x-rays for low back pain are not recommended as they provide little
diagnostic benefit. Jamie took time to discuss their clinical reasoning so that the patient can make an
informed decision based on the best available evidence.
Jamie told the patient that they are committed to working in partnership with them to achieve the best
possible outcome, which included supporting their right to seek a second opinion.
Although the patient had a strong initial view on being referred for x-ray imaging, the detailed
information provided by Jamie supported the patient to understand the benefits and harms involved with
The patient felt reassured that Jamie had offered to refer them to another allied health practitioner in the
practice for a second opinion if they wanted.
The patient and Jamie agreed to a brief trial of treatment and then to reassess the need for an x-ray
depending on the clinical outcome.