I am in support of the Virginia Board of Physical Therapy's recent guidance on diagnostic imaging referrals.  

When dealing with musculoskeletal pain syndromes, Physical Therapists are professionally qualified to gather a thorough history and perform a detailed physical examination when deciding whether diagnostic imaging is needed.  

Physical Therapists are often the first healthcare provider to diagnosis tendonipathathies. Having the ability to request a musculoskeletal diagnostic ultrasound image can: have a significant impact on clinical outcomes; provide a cost-effective and low-risk alternative to advanced imaging such as MRI or CT scan; screen for urgent conditions - deep vein thrombosis, fracture, tendon rupture; and enhance patient-clinician engagement by meeting patient's expecations provding visual information of the problem.