Recent studies have shown that most patients expect that an x-ray is necessary to determine why they have back pain. NCBIIn a 2001 study, two-thirds of patients expected to be sent for an X-ray after consulting a doctor, and almost half of those who didn’t consult expected to have one. PMCIn a 2022 study, 41.5% of participants agreed or strongly agreed that X-rays or scans are necessary for the best medical care for LBP, and 29.5% agreed that everyone with LBP should have spine imaging. BMJSystematic reviews of surveys and interviews suggest that about half of patients expect imaging because they believe it can help rule out a serious cause of the pain. The National Institutes of Health suggests that regular imaging of lower back pain is often unnecessary. Unneeded X-rays expose patients to radiation. A study from the Journal of Family Medicine shows that regular X-rays to evaluate lower back pain are often unneeded and a thorough evaluation is usually enough to develop a diagnosis. Practice patterns change and many health professions’ best practices suggest that taking an x-ray for lower back pain often does not correlate as well as a thorough evaluation. Higher-level imaging studies such as an MRI are also often not recommended unless a trial of treatment has failed to improve the problems within 2-4 weeks. There are instances where an x-ray is needed including an older patient with a history of chronic pain, previous surgery, trauma where a fracture is suspected or an illness is being considered that requires an x-ray. Many health professions now include taking fewer X-rays as part of their best practices initiatives to help doctors avoid procedures that are not beneficial to the health of the patient. Our practice takes fewer X-rays than it did 20 years ago as our practice patterns change with the latest research. While we often find many urgent care facilities continue to image everything, it is for the patient’s benefit that we follow our profession’s best practices initiatives. How do your doctors of chiropractic determine your need for an X-ray? During your initial visit to a chiropractor, a holistic thorough history of your current and past problems is followed by a holistic evaluation. There are times your chiropractor will suggest taking an x ray including Chronic problems that are not improving. Trauma. An older patient who the doctor suspects may have arthritic or degenerated joints Organic or other disease process is suspected and needs to be ruled out. An unknown reason for the pain after a thorough evaluation is performed. X-rays are never routinely ordered for an area of complaint unless there is a medical reason for doing so. As always, if we suspect a problem that requires medical attention, we will refer you to the appropriate provider so you can get the care you need.