Amendments to the PCH: Routine and Repeat Imaging

On February 4, 2021, the College Board approved amendments to the Professional Conduct Handbook (PCH) Part 2, Part 15 and Appendix L regarding diagnostic imaging. These amendments state that “Routine or repeat X-rays used as a regular protocol during the evaluation and diagnosis of patients are not clinically justified.”

View the amendments to the PCH Part 2, Part 15 and Appendix L:

View the revised PCH in its entirety:

The College recognizes the importance of X-ray as a tool of which chiropractors are competent to apply and interpret, and supports the use of radiography by chiropractors where appropriate. The application of radiography is not without risk and therefore, must be carefully considered. Note the following amendments to Part 15 Diagnostic Imaging:

15.1   A chiropractor may

(a) apply X-rays to a patient, or

(b) issue an authorization or instruction for another person to apply X-rays to a patient, including X-rays for the purpose of computerized axial tomography,

only if the application of X-rays is indicated by a patient history or physical examination that identifies serious pathology or clinical reasons to suspect serious pathology.

15.2   Routine or repeat X-rays used as a regular protocol during the evaluation and diagnosis of patients are not clinically justified. This includes

(a) X-rays to screen for spinal anomalies or serious pathology in the absence of any clinical indication,

(b) X-rays to diagnose or re-assess spinal conditions in the absence of any clinical indication, and

(c) X-rays to conduct biomechanical analysis or listings to identify spinal dysfunction, whether called subluxation, fixation or by any other term.

In developing these policy amendments, the Board considered the research review of the clinical utility of routine spinal radiographs from Ontario Tech University’s rapid review that did not recommend the clinical routine use of radiographs for repeat evaluation of the structure and function of the spine, and the analysis of feedback from the September 2020 public consultation.

If you have any questions or concerns, please email

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