Clinicians are responsible for the ordering of x-rays. Nearly all patients who are to receive manipulative therapy should have x-rays of the area to be treated.

Patients with any of the following clinical findings should have x-rays of the area indicated by the History and Physical Examination:

1. Age over 50 years.
2. trauma.
3. Significant neurological deficit.
4. Positive orthopedic findings.
5. Unexplained weight loss.
6. Suspicion of inflammatory joint disease.
7. Suspicion of pathological cause of spinal or peripheral joint fixation.
8. Drug or alcohol abuse.
9. Familial history of Cancer.
10. Temperature = 37.8 C (100 F) or greater.
11. Prolonged use of Corticosteroids.
12. Recent visit for same problem and not improved.
13. Patients seeking compensation.
14. Spinal instability.
15. Osteoporosis, History of, Suspicion of.
16. Longstanding history of pain.
17. Weight bearing pain. (and  6-24 month olds, avoiding weight bearing after trauma.)

If a patient presents with any of the above clinical findings, and the clinician decides x-rays are not indicated, reasons for the decision must be noted in the patient's file on the summary form. Patients presenting with visceral complaints should have the benefit of a clinician consultation with a Radiologist to determine whether a radiological examination would be of benefit.

Patients with the following indications may be excluded from
routine x-rays:

1.Menstruation females falling within the "10 day rule", without significant trauma.
2. Pregnant females without significant trauma.
3.Children under 18 without one of the listed clinical findings or significant trauma.