Australasian Faculty of Occupational and Environmental Medicine

Recommendations from the Australasian Faculty of Occupational and Environmental Medicine on low back imaging, opioids, time off work and asbestos exposure. The Australasian Faculty of Occupational & Environmental Medicine (AFOEM) is a Faculty of the Royal Australasian College of Physicians (RACP) that connects and represents Occupational and Environmental Medicine Fellows and trainees in Australia and New Zealand.

Do not request low back X-rays or other forms of low back imaging as part of a routine preplacement medical examination.

Date reviewed: 22 September 2017

The purpose of preplacement medical examinations should be to determine an individual’s ability to perform the job. However, such examinations are generally not recommended unless there is a reason for using them to assess some specific occupational risks. Even if a routine preplacement medical examination is justified, low back X-rays and other imaging are not useful preplacement tests to undertake because they have not been found to predict future injuries. These tests also result in unnecessary radiation exposure and age-related, asymptomatic, clinically unimportant findings may trigger further imaging evaluation and/or patient anxiety.

Supporting evidence
  • Gibson ES, Martin RH, Terry CW. Incidence of low back pain and pre-placement x-ray screening. J Occup Med 1980; 22(8):515-9.
  • Schaafsma FG, Mahmud N, Reneman MF, et al. Pre-employment examinations for preventing injury, disease and sick leave in workers. Cochrane Database Syst Rev 2016; 1: CD008881.
How this list was made How this list was made

The College worked with the President and EVOLVE Lead Fellow of AFOEM to compile and refine a list of nine recommendations regarding low-value clinical practices in occupational and environmental medicine. This initial list served as the basis for an online survey. Based on survey responses, each of the nine recommendations was assigned a score and ranked accordingly. Based on the ranking of the initial nine, and the review of newly suggested items, these five low-value practices and interventions were chosen.

Download AFOEM Recommendations