Professional Conduct Handbook

The College of Chiropractors of BC publishes a Professional Conduct Handbook (PCH) applicable to all registrants of the College. Registrants are responsible for being familiar with the content in the PCH. The public will also find information regarding commonly asked questions. The PCH is revised periodically by the regulator as required.

Recent Amendments

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.

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

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:

Amendments to the PCH: Routine and Repeat 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.

15.3 Before applying X-rays and before issuing an authorization or instruction for another person to apply X-rays under section 4(1)(f) of the Chiropractors Regulation, a chiropractor must

a) document the clinical indication for X-rays in the patient’s clinical record,

b) determine whether existing imaging that would remove the need to apply X-rays can be obtained within a clinically reasonable time, and

c) give due consideration to the particular risk X-rays present to

(i) patients under 19 years old, and

(ii) the reproductive capacity of female patients.

15.4 When a chiropractor applies X-rays for diagnostic or imaging purposes, he or she must

a) create a report describing what was imaged and the findings from that imaging,

b) retain in a form that complies with s. 72 of the Bylaws a copy of the report created under paragraph (a) and copies of all imaging from the application of the X-rays, and

c) advise the patient of the findings from the imaging.

15.5 A chiropractor must make an appropriate referral if there are findings outside the scope of practice for chiropractic in

a) imaging from X-rays that he or she has applied, or

b) imaging or reports produced further to instructions or authorizations
he or she has issued under section 4(1)(f) of the Chiropractors Regulation.

15.6 A chiropractor must document in the clinical record all action taken and referrals made further to section 15.5. See Appendix “L” for additional information.

15.7 A chiropractor who owns or operates radiograph equipment must comply with all radiation safety requirements, including section 83(1) of the Bylaws and the Radiographic Equipment Ownership Guide for CCBC Registrants.


If you have any questions or concerns, contact the Deputy Registrar.