Audit Toolkit – X-ray Referral


This dual-purpose audit aims to assess whether the requirements of referral for x-rays are being met and that subsequent films are being reported. In addition, the audit will be used to assess what skeletal regions are being examined in order to target resources and training appropriately.


The referral criteria for the justification of imaging within the chiropractic context are those of the European Union document “Radiation Protection 118 – Referral Guidelines for Imaging”. They require a least one of 15 criteria to be met. IR(ME)R 2000 stipulates a number of requirements for the practitioner and the referrer (which in this setting is the same person). Signing the referral acknowledges these duties. Once films have been taken, the practitioner/referrer has a duty to ensure that a report is written (and signed). Local rules require a second practitioner to review and sign this report.

Patient consent is a legal requirement of all medical procedures. A further declaration for females of childbearing age acknowledging the dangers of x-ray examination in pregnancy is used to address IR(ME)R 2000 legislation.

How to undertake the audit

Round 1: The x-ray records of all patients who had been x-rayed within the clinic over a six-month period (your may decide to increase or reduce this period) are examined and reviewed. Findings are recorded using the excel checklist provided here (right click and ‘save target as’). Determine levels of compliance (i.e. the frequency with which each factor was considered) and reflect on your findings. Write a report to share with colleagues and decide upon and introduce changes in practice as required.

Round 2: Repeat after a similar period has elapsed (e.g. 6 months) recording your findings in sheet 2 in the excel checklist and review findings.

You may decide to undertake further rounds.

An example of the findings of this audit will follow here.


1. Radiation Protection 118 – Referral Guidelines for Imaging

2. IR(ME)R 2000