The purpose of this study was to assess chiropractic interns' knowledge and adherence to radiographic clinical practice guidelines (CPGs) and compare their clinical decisions to previous surveys of established practitioners in Canada and Australia.


A clinical decision-making survey was administered to 88 interns. The survey contained clinical scenarios and vignettes with inquiries regarding indications for radiographic referral, the likelihood of referral, and the application of CPGs.


Forty-four percent (43.75%) of the interns were aware of CPGs, 38.75% were unsure, and 17.5% were not aware. When asked specific questions about the appropriateness of diagnostic imaging, the interns' responses were similar to those of practitioners in Canada and Australia. When interns evaluated a clinical vignette, there was lower compliance with CPGs.


The interns' clinical decisions regarding the use of diagnostic radiography did not significantly differ from those of practitioners who were surveyed in other related studies. Interns were inconsistent in applying their decision making in clinical cases. Notwithstanding the similarities with practitioners, some deviation from the guidelines indicates the need for further intern education to improve the implementation of CPGs for optimal cost-effective and clinically appropriate care.

This content is only available as a PDF.

Author notes

David N. Taylor (corresponding author) is a professor in the Clinical Sciences Department at Texas Chiropractic College (5912 Spencer Hwy, Pasadena, TX 77505; dtaylor@txchiro.edu). Cheryl Hawk is a professor in the Research Department at Texas Chiropractic College (5912 Spencer Hwy, Pasadena, TX 77505; chawk@txchiro.edu). This article was received November 26, 2021; revised December 10, 2021, February 18, 2022, and May 25, 2022; and accepted July 16, 2022.

Concept development: CH. Design: CH, DNT. Supervision: CH. Data collection/processing: DNT. Analysis/interpretation: CH, DNT. Literature search: DNT. Writing: DNT. Critical review: DNT, CH.