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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.
Chiropractors undertaking their own radiography must ensure that they meet their local state and territory requirements by:
Chiropractors can use radiography for several purposes following the identification of various history and examination findings. These include:
Radiographs should only be obtained if there is sufficient clinical justification in an evidence based context. Practitioners must weigh the risk against the benefit in deciding to undertake any radiographic investigation.
An ‘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.
This means that a chiropractor’s decision to undertake radiography should be supported by:
Chiropractors must comply with the provisions of the Code of practice for radiation protection and the application of ionizing radiation by chiropractors (2009) (ARPANSA Code) (or any subsequent version as published by the Australian Radiation Protection and Nuclear Safety Agency), and applicable commonwealth, state or territory laws in relation to best practice (see the Publications section on the APRANSA website).
This is in addition to their obligations under the Health Practitioner Regulation National Law, as in force in each state and territory (National Law).
The ARPANSA Code relates to the end exposure to radiation and therefore applies to both the decision to obtain radiographic imaging and the taking of radiographic images. The aim of the guidelines is to ensure that the radiation dose received by a chiropractic patient is as low as possible.
This means that radiographic imaging must only be undertaken when the benefits outweigh the harms, and that it is administered at the lowest dose possible.
Therefore, before a procedure involving exposure of an individual to ionising radiation is approved or commenced, the indications for it must be clinically justified in an evidence based context by the chiropractor.
The process for determining whether there is enough clinical reason to undertake a radiographic study on a patient can be simplified into asking the following five questions.
A number of good quality studies and papers have been undertaken on the clinical utility of radiography in chiropractic practice. Some useful references include: