Table 1 Secondary outcome questions

New patients^a

X-ray's of the lumbar spine are indicated when a patient is nonresponsive to 4 weeks of conservative treatment for low back pain

Patients with the clinical suspicion of a traumatic injury

Routine x-rays of the lumbar spine are recommended prior to initiating spinal manipulative therapy (adjustments)^a

Patients with the clinical suspicion of a red flag pathology (ie. tumour, infection, osteoporotic fracture etc.)

X-ray's of the lumbar spine are indicated to perform radiographic biomechanical analysis to assess spinal misalignments (subluxations) and to obtain spinal listings or other biomechanical information which are used to direct treatment^a

Patients with the clinical suspicion of an inflammatory arthridity (ie. ankylosing spondylitis, rheumatoid arthritis etc.)

There is a role for the use of lumbar spine x-rays in the evaluation of patients with acute low back pain (less than one month duration), even in the absence of red flags for serious disease^a

Patients with the clinical suspicion of a biomechanical pathology (ie. osteoarthritis, nontraumatic spondylolisthesis etc.)^a

There is a role for the use of lumbar spine x-rays in the evaluation of patients with chronic low back pain (greater than three months duration), even in the absence of red flags for serious disease

Biomechanical analysis of the lumbar spine (spinal listings, spinal curve measurement etc.)^a

There is a role for full spinal x-rays in chiropractic practice (other than for patients with scoliosis)

Screening for subclinical contraindications to treatment (ie. congenital anomalies, unsuspected pathology etc.)^a

There is overutilisation of plain film x-rays in chiropractic practice in our community

Patients without low back pain as a component of a full spine x-ray series^a

There is a role for x-rays of the lumbar spine when there are neurological signs associated with low back pain^a

Patient reassurance or at patient request

X-rays of the lumbar spine are useful in the diagnostic work up of patients with sciatica^a

X-rays of the lumbar spine are useful in the diagnostic work up of patients with suspected pathology

X-rays of the lumbar spine are useful to confirm the diagnosis and to direct appropriate treatment of low back pain^a

There is a role for the use of x-rays as a screening tool to find contraindications to manipulation in patients with low back pain^a

I am likely to refer low back pain patients for x-rays of the lumbar spine because patients often expect me to do so