College of Chiropractic Intern’s Clinic Handbook

9.1 Guidelines for Performing Radiological Examinations

A radiological examination is performed to help identify or rule out clinically suspected abnormalities, including biomechanical alterations and pathology. Occasionally, as with a full-spine study for scoliosis, the examination may serve as a baseline for anticipated follow-up. The radiological examination should be based upon findings from a thorough history and physical examination.

  1. Examples of findings that may indicate the necessity for a radiological study include:
    • Biomechanical alterations or dysfunction
    • History of significant trauma
    • History of malignancy
    • History of fever or other findings suggesting active inflammation/infection
    • Night pain
    • Severe focal pain
    • Findings that may indicate a systemic disease with musculoskeletal manifestations
    • Clinically apparent scoliosis, especially in a skeletally immature patient
    • Patient over 40 years old, especially with no previous films of the area of interest
    • Evidence of visceral involvement
    • Abnormal laboratory findings
    • Clinician's intuition/suspicion for radiographically demonstrable abnormality that may significantly alter diagnostic or therapeutic approach.
  2. Examinations should be chosen based on the careful analysis of projected risks vs. benefits of the study. Radiological studies should always provide maximum information at the minimum radiation dose to the patient. The following questions should be answered:
    • Does the patient have a health problem requiring a radiological examination?
    • Could the examination provide essential information that may significantly alter case management?
    • Does the iatrogenic hazard of the study outweigh the benefits of the procedure?
    • Could another examination or imaging procedure be warranted?
  3. Generally, a minimum of two opposing views at 90 degrees to each other are required to adequately image a body region. Partial or incomplete studies are a liability and are unacceptable. Interns will receive no credit for incomplete studies. Appropriate shielding and filtration should be used whenever indicated, unless this will interfere with the purpose of the study.
  4. The patient should always be clearly informed of the need and purpose for the radiological examination. Interns should discuss with their faculty clinician who will be informing the patient of the need and purpose of the examination, and whether or not there are contraindications to the procedure. Most offices have a form to be signed by female patients indicating that they are not pregnant.
  5. The patient's privacy is to be guarded at all times. No unnecessary personnel and no other patients should be in the area of the radiology suite at the time of the examination.