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Referral for Imaging is a clinical decision within a shared decision making framework.

Step One: A Cogent Argument for Imaging
1. What is suspected and if this is found how it will alter management of my condition
2. Patient Consent

General Reasons for Imaging in MSK Conditions

Suspected Pathology
Trauma Significant Enough to Likely Cause a Fracture
Chronic Steroid Use
Particular Symptoms with Neck Movement e.g. ligament laxity
Sustained and unexplained raised temperature above 38 degrees celcius
Sustained and unresponsive hyperreflexia
Suspected spinal anomalies
Suspected active inflammatory arthropathy
Scoliosis progression associated with onset of pain change

Specific MSK Reasons

Symptoms remain unresponsive to Chiropractic Care after 4 weeks (Royal College of Chiropractors) and 6 weeks (IRMER Regulations) of Chiropractic Care Management
Inconsistent (strange) and or persistent paradoxical bio-mechanical findings
Limited evaluation due to pain, where a person with likely mechanical pain does not prefer a trial of treatment.

Reasons that do not need x-rays to be taken. 

Acute Low Back Pain with or without neurological signs
To analyse alignment (e.g. Gonstead and Biophysics Chiropractic Techniques)
Screening for pathology or a contraindication screen
Recent films have already been taken (ALARA principle)

NB. Females of childbearing age that have any chance of being pregnant should not be imaged using ionising radiation techniques.

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