When Should a Chiropractor Refer for Imaging, and What Are the Rules?
In the UK, a chiropractor should refer for imaging when there is a clear clinical reason. Examples are a suspected fracture, nerve signs that are getting worse, or a history that does not fit the expected pattern. The referral must meet the UK IRMER regulations. Current guidance does not support routine or screening spinal x-rays without a clinical reason.
Key takeaways
- Under IRMER, every imaging referral must be clinically justified, not routine.
- The General Chiropractic Council (GCC) discourages serial or screening x-rays without a clear clinical reason.
- Red flags such as trauma, weakness that is getting worse or unexplained weight loss are strong reasons to image.
- Standing, weight-bearing imaging can show alignment problems that lying-down scans miss.
- Chiropractors can refer patients directly to private imaging services without going through the patient's doctor.
What are the UK rules for chiropractors ordering x-rays?
In the UK, all diagnostic imaging that uses ionising radiation is governed by the Ionising Radiation (Medical Exposure) Regulations, known as IRMER. These rules apply equally to chiropractors, GPs and hospital consultants. The core principle is justification. Every exposure must be expected to give a net benefit to the individual patient. The person referring must be able to explain why imaging is needed for that patient at that time.
In the UK, chiropractors registered with the General Chiropractic Council are recognised as legitimate referrers under IRMER. This means a GCC-registered chiropractor can request x-rays or other imaging directly, without going through a GP. But being allowed to refer does not mean every patient should be imaged. The legal and professional duty is to show that the clinical question cannot be answered by examination alone.
The practitioner who operates the equipment (the "operator") also has their own duty to check that the exposure is justified before going ahead. This two-step safeguard means the imaging provider can, and should, turn down a request that lacks clinical reasoning.
When is imaging clinically indicated for a chiropractic patient?
Imaging is clinically indicated when the history and examination raise a specific concern that cannot be settled without it. There is no single checklist. Well-recognised situations include the following.
Trauma, unexplained weight loss, a history of cancer, fever with spinal pain, or age over 50 with new back pain.
Muscle weakness that is getting worse, changes in reflexes, or altered sensation that suggest the nerves or spinal cord are involved.
A patient whose symptoms have not improved as expected after a reasonable course of care, which suggests an underlying structural cause.
When the clinical picture suggests a structural variant (such as scoliosis or spondylolisthesis) that could change your management plan.
Urgent red flags. If your patient comes in with sudden loss of bladder or bowel control, weakness in both legs, or saddle anaesthesia, do not image. Send them to the nearest emergency department at once, or advise them to call the local emergency number. These are possible signs of cauda equina syndrome.
Does the GCC allow routine spinal x-rays before treatment?
No. The UK General Chiropractic Council's guidance is clear. Routine or screening x-rays taken on every new patient, or at regular intervals to check progress, are not appropriate without a clinical reason for each individual exposure. This matches the wider IRMER principle: every dose of ionising radiation must be justified by an expected benefit that outweighs the risk.
The GCC does not ban x-rays. It discourages a blanket policy of imaging all patients as a screening step. The difference matters. If your examination raises a real question that imaging can answer, asking for an x-ray is entirely reasonable and responsible. If it does not, the request may not meet the IRMER justification threshold.
This also matters for informed consent. Patients should understand why imaging is being recommended for them in particular, not just that it is part of a standard protocol.
Why does standing imaging matter for chiropractic referrals?
Standing, weight-bearing imaging shows the skeleton under real load, exactly as the body works in daily life. When a patient lies down for a usual x-ray, CT or MRI, gravity is taken away. Muscles relax, the spine decompresses, and compensatory patterns disappear. The image may look reassuring, but it does not show how the patient really stands and moves.
For chiropractors, this difference is directly relevant. Your patients come to you standing. They report pain during movement and daily activities. A full spine x-ray taken standing captures the whole chain, from the base of the skull to the pelvis. It can show a leg-length difference, a pelvic tilt, or a compensatory curve that would flatten on a lying-down scan.
ScanAlign, low dose standing imaging, uses EOS technology to capture the full skeleton in a single standing exposure at about 90% less radiation than a standard x-ray, around ten times less. The image is taken in one pass. So the whole body is shown in proportion, and nothing is stitched together from separate views. You can read more about EOS scan safety and radiation.
How do chiropractors refer a patient for imaging at ScanAlign?
The process is simple. You do not need to go through the patient's doctor. If you are a GCC-registered chiropractor, you can refer directly.
Register as a referrer
Fill in a short form to register to refer patients. You only do this once, so we can check your registration and set up your account.
Submit a referral
When a patient needs imaging, refer a patient with a brief clinical summary and the question you need answered.
Patient attends
Your patient comes to 19 Harley Street, London, for a standing EOS scan. The scan itself takes only a few seconds.
Report shared
A specialist radiologist reports on the images. The report and images are shared with you and the patient. You can then discuss the findings together and plan next steps.
Want to discuss whether a patient is suitable for standing imaging? We are happy to talk through the clinical question before any referral is made.
Book a free video consultationWhen is MRI a better choice than x-ray for chiropractic patients?
EOS and x-ray are excellent at showing bones, joints and whole-body alignment. For questions about soft tissue, discs, nerves, or spinal cord compression, MRI is usually the better tool. The two work together. They do not compete.
When to choose MRI instead. If your clinical concern is a disc herniation, nerve root compression, ligament damage, or inflammatory disease, an MRI will answer the question better than any x-ray. ScanAlign does not offer MRI, but we are happy to advise on the most suitable imaging route for your patient.
Before a patient starts treatment, or changes the one they are on, a detailed diagnosis is worth having. Knowing whether the cause sits in the pelvis, the legs or the spine changes what will actually help.
Frequently asked questions
In the UK, GCC-registered chiropractors are recognised referrers under IRMER and can request x-rays. But each referral must be clinically justified for that individual patient. Current guidance does not support routine screening x-rays without a specific clinical reason.
No. As a registered chiropractor, you can refer directly to private imaging services like ScanAlign. You do not need to go through the patient's doctor. Still, it is good practice to keep their doctor informed if you are worried about a serious underlying condition.
IRMER requires you to give enough clinical information for the imaging operator and practitioner to judge whether the exposure is justified. This means a clear clinical question, the relevant history, and the reason examination alone is not enough.
The GCC discourages a blanket policy of imaging every new patient. Imaging should be requested only when there is a specific clinical reason that justifies the exposure for that person.
EOS delivers about 90% less radiation than a standard x-ray, around ten times less. This matters most when imaging larger areas, such as the full spine or full body, in a single pass.
When a patient lies down, gravity is taken away. The spine decompresses, muscles relax, and compensatory patterns disappear. A standing image captures the skeleton under real load, showing how the body really works. For chiropractors assessing alignment, this is often more useful clinically.
A brief clinical summary. It should cover the main complaint, relevant history, key examination findings, and the specific question you want imaging to answer. This helps the radiologist shape the report to your clinical needs.
Fill in the short registration form on our website. Once your GCC registration is checked, you can refer patients directly. You only need to do this once.
Yes. The specialist radiologist's report and the images are shared with both you and your patient. You can review the findings together and use them to guide your management plan.
Of course. If you are not sure whether standing imaging is right for a particular patient, or whether MRI might be more suitable, you can book a free video consultation to discuss the clinical question first.
Ready to refer a patient for standing imaging?
Register once, then refer patients directly for low-dose, weight-bearing EOS imaging at 19 Harley Street, London.
Book a free video consultationSources
- The Ionising Radiation (Medical Exposure) Regulations 2017 (IR(ME)R). UK Statutory Instruments 2017 No. 1322.
- General Chiropractic Council. Guidance on the use of X-rays in chiropractic practice. GCC, London.
- The Royal College of Radiologists. iRefer: Making the best use of clinical radiology. RCR, London.
Written by Abbas Dhami (Specialist Diagnostic Radiographer)
This page is general information and not a diagnosis.
ScanAlign is the trading name of CoreMed Solutions Ltd and operates under The Harley Street Hospital's CQC licence.