In the Australia Northern Territory (NT), the health service and especially Royal Darwin Hospital (RDH) faces many unique and special challenges related to the diversity of its population and its remoteness. The NT population is vast and varied, both culturally and geographically, and there are long distances between communities. Represented among the many cultures present in the NT are Anglo-Saxon, Mediterranean, Middle Eastern and African, and Aboriginal people. The Aboriginal population spans many different cultural beliefs and languages, depending on their geographic location. One initiative to address such health service challenges was the introduction of a permit system to enable doctors to perform limited numbers of X-rays in the NT's remote and rural communities. Implemented by the Radiographer Registration Board of the NT, this initiative allows for people in remote areas to be diagnosed and treated in their home community. It also prevents the unnecessary medical evacuation of patients to RDH, particularly when no abnormality is detected on initial imaging. The strategy greatly reduces social, emotional and economic costs. This article addresses the process involved in modernising and updating a vital aspect of the program, the 1981 Radiographic Procedures Manual, provided to doctors as a reference while studying in Darwin and for use on return to their communities. The revision process included consultation with senior radiology staff, previously trained doctors and senior academics. Associated issues and challenges are discussed, as are the results of questionnaires about doctors' satisfaction with the manual. The unique health issues present in the NT demand unique solutions to minimise the social, cultural and financial impact of health care on those involved.