The results show that the proportion of patients in clinics with X-ray equipment who undergo an X-ray, ranges from 0 % to 39 %. The researchers also examined whether this variation could be explained by factors such as size of the clinic, geographic location, interdisciplinary collaboration, or the chiropractors’ age, gender, country of education, and experience. None of these factors were found to influence the use of X-ray.
National data provides new insights
The study is based on data from 2022 and includes 237 clinics and 657 chiropractors. Among clinics with their own X-ray facilities, an average of 9.5 % of patients underwent an X-ray examination. In the quarter of clinics with the highest usage, more than 21 % of patients were examined, and these clinics accounted for nearly half of all X-rays performed. Clinics without X-ray equipment referred only 1.1 % of patients through chiropractor codes, but since referrals to public hospitals are not included in the dataset, the actual usage is likely higher.
Background and trends
The use of X-rays in Danish chiropractic practice has declined in recent years, from 15 % in 2010 to 8 % in 2020. This reflects an international trend toward more restrictive imaging for back pain, as recommended in both national and international guidelines. However, the Danish guidelines have not been updated since 2013, and there are currently no valid updated national clinical guidelines for X-ray use in musculoskeletal pain.
Clinical significance
The study raises questions about consistency and evidence-based practice. The large variation in X-ray use, with no clear explanations, points to the need for updated guidelines, greater transparency in clinical decision-making, and further research into chiropractic practice.
Perspectives
The study shows that even in a relatively homogeneous healthcare system like the Danish healthcare system, there can be significant differences in clinical practice. These differences highlight the need to understand the underlying causes, and to ensure that imaging is used appropriately and in line with evidence. It should be noted that the results are based solely on X-ray examinations carried out in chiropractic practice and do not include referrals to hospitals and private clinics.
Rikke Krüger Jensen et. al. Variation in use of radiographs in chiropractic care: a cross-sectional study. Chiropractic & Manual Therapies 2025.
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