HSE radiation inspections of chiropractic practices: summary of findings

Between October 2025 and March 2026, the Health and Safety Executive (HSE) radiation specialist team carried out a targeted inspection campaign of chiropractic practices using electrically generated X-ray equipment for diagnostic imaging. Seven inspectors visited 28 practices across Great Britain.

The GCC has agreed to work with the HSE to share the learning from the inspection campaign and bring down the rate of material breaches relating to the Ionising Radiations Regulations 2017 (IRR17). Below is a summary of what the inspectors found.

Key findings

Material breaches were identified at 61% of practices (17 of the 28 inspected). These related to non-compliance with IRR17 and the Management of Health and Safety at Work Regulations 1999. Across the campaign, 67 material breaches resulted in Notification of Contravention letters and a further 11 resulted in Improvement Notices.

Verbal advice was also given at 71% of practices (20 of 28), most commonly on the radiation risk assessment, co-operation between employers and the requirements for designated areas.

The most common breaches

• Regulation 19 - Additional requirements for designated areas (46% of practices): mostly relating to Regulation 19(6), with no suitable dose assessment (for example, personal dosimetry) for non-classified workers entering controlled areas.
• Regulation 20 - Monitoring of designated areas (36%): no area monitoring around the controlled area, or monitoring not carried out often enough. The HSE expects this annually for chiropractic clinics. It can be done with real-time dose-rate measurements or passive environmental dosemeters placed on the walls.
• Regulation 9 - Restriction of exposure (29%): commonly insufficient justification for a lack of shielding in doors and windows, no automatic warning light showing the status of the controlled area in the X-ray room, an emergency stop in an inappropriate location (for example, reached through the primary beam), and insufficient restriction of access to the X-ray equipment (for example, no key or code).
• Regulation 8 - Radiation risk assessment (29%): risk assessments that were not suitable and sufficient, because they did not fully consider all relevant aspects of paragraphs 70 and 71 of the IRR17 Approved Code of Practice.
• Regulation 11 - Maintenance and examination of engineering controls (21%): routine checks on safety controls, such as warning light function and emergency stop checks, were not carried out or not documented.
• Regulation 15 - Information, instruction and training (18%): insufficient radiation safety training records for staff, or no evidence of suitable refresher training at regular intervals.
• Regulation 16 - Co-operation between employers (14%): clinics without handover arrangements for service engineers. A handover arrangement makes clear who has control of the X-ray controlled area and whose written arrangements are being followed.

Good practice

Inspectors highlighted areas of good practice at some sites, including good local rules and good training records.

How this compares with 2019

The results were very similar to the previous HSE radiation inspection campaign of chiropractic practices in 2019, when material breaches were found at 63% of practices, compared with 61% in 2025/26. There was a notable increase in the rate of material breaches relating to IRR17 Regulations 19 and 20 in the most recent campaign.