Objective: To report the development and application of a pilot risk management tool for plain radiography and based on this, to determine whether plain radiographic examination increases the information that may direct or modify a chiropractic care plan. Setting: RMIT University chiropractic teaching clinics. Methods: Five hundred patient files dated between 2004 and 2005 were selected at random, reviewed and analysed using a risk management imaging guideline for plain radiography. Age, gender, percentage referred for radiography, radiological indications for plain radiography, patient status, radiographic anomaly (deviation from norm) identified on plain radiograph, and care plan modification were recorded. Results: Chiropractic care plan modification occurred for 20.4% of the 20.6% patients referred for plain radiography. The mean age for patient files assessed within the guidelines was 35.7 years and age range was 9.5 to 83 years and 51.2% of patients were female. The most common primary radiological indications for plain radiography were evidence of significant/acute trauma to cause fracture or instability (21.4%), chronic regional pain (21.3%) and patient aged greater than 50 years with chronic regional pain (16.5%). The most frequent conditions identified were degenerative joint disease (71.8%) and scoliosis (53.3%). Conclusion: The results suggest care planmodification occurred for a relatively small number of patients after referral for a plain radiographic examination although a high proportion of patients had anomalies. The most common indicator for referral for radiography was evidence of significant/acute trauma to cause fracture or instability and the most frequent anomaly wasdegenerative joint disease. Within this pilot environment the risk management tool for plain radiography has contributed to some understanding of the factors that influence not only referral for radiography but also modification of chiropractic care based on radiological findings.