x_ray_kent_2017.doc

The Journal of the Canadian Chiropractic Association, 2005

Radiography has been part of chiropractic diagnostics since shortly after its discovery in 1895, the same year D.D. Palmer discovered chiropractic. In fact, it was B.J. Palmer who brought x-ray to chiropractic in 1910. 1 This is what led to a very interesting and rich chiropractic history of technique innovators with their varied radiographic biomechanical analysis systems. Many different x-ray analysis systems are used today in clinical practice and research as well as taught in the chiropractic colleges around the world. In fact, use of radiography for structural data is an integral component to the practice of chiropractic. 2,3 With the recent concerns about the profession's future (i.e. to remain a separate entity or be incorporated into mainstream medicine), 4 there has been pressure to restrict the use of radiography in clinical practice. 5-10 In fact, recent proposed guidelines suggest that except for ruling out "red flags" (i.e. serious medical conditions such as cancer, infection etc…) no radiographic imaging should be taken for treatment management of patients presenting with uncomplicated low back pain. 11-15 To no surprise, the current practice trend is much higher than this. 15-18 This commentary is written to present to the profession, and specifically to the advocates of continued restrictive use of radiography in clinical practice and research (i.e. DACBRs), that at low doses of ionizing ra

Health and History, 2016

Chiropractic fi rst adopted the X-ray in 1910 for the purpose of demonstrating tiny misalignments of spinal bones, theorised to cause all disease, which they called chiropractic subluxations. This paper explores the apparent contradiction and resultant controversy of a system of natural healing adopting a medical technology. It centres on the actions of B.J. Palmer, the fi rst chiropractor to use X-rays. It also clarifi es details of Palmer's decision to incorporate the technology and interprets the change in the sociological context of boundary work. The continuing use of the subluxation paradigm for radiography by chiropractors has had a lingering effect on the profession, a metaphorical hangover of vitalism that is not consistent with modern healthcare practice. As a result of this confl ict, arguments within the profession on the use of X-rays contribute to the continuing schism between evidencebased and subluxation-based chiropractors.

Chiropractic & Manual Therapies

Introduction: When indicated by signs or symptoms of potentially serious underlying pathology (red flags), chiropractors can use radiographs to inform their diagnosis. In the absence of red flags, the clinical utility of routine or repeat radiographs to assess the structure and function of the spine is controversial. Objectives: To determine the diagnostic and therapeutic utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. Investigate whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. The research objectives required that we determine the validity, diagnostic accuracy and reliability of radiographs for the structural and functional evaluation of the spine. Evidence review: We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from inception to November 25, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (cross-sectional, case-control, cohort, randomized controlled trials, diagnostic and reliability) were critically appraised. Studies of acceptable quality were included in our synthesis. The lead author extracted data and a second reviewer independently validated the data extraction. We conducted a qualitative synthesis of the evidence. Findings: We identified 959 citations, screened 176 full text articles and critically appraised 23. No relevant studies assessed the clinical utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. No studies investigated whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. Nine low risk of bias studies investigated the validity (n = 2) and reliability (n = 8) of routine or repeat radiographs. These studies provide no evidence of clinical utility. Conclusion: We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.

Journal of Manipulative and Physiological Therapeutics, 2008

Objective: This study describes instruction provided at chiropractic schools worldwide on the use of spine radiography and compares instruction with evidence-based guidelines for low back pain. Methods: Individuals responsible for radiology instruction at accredited chiropractic schools throughout the world were contacted and invited to participate in a Web-based survey. The survey included questions on the role of conventional radiography in chiropractic practice and instruction given to students for its use in patients with acute low back pain. Results: Of the 33 chiropractic schools identified worldwide, 32 (97%) participated in the survey. Consistent with the guidelines, 25 (78%) respondents disagreed that "routine radiography should be used prior to spinal manipulative therapy," 29 (91%) disagreed that there "was a role for full spine radiography for assessing patients with low back pain," and 29 (91%) disagreed that "oblique views should be part of a standard radiographic series for low back pain." However, only 14 (44%) respondents concurred with the guidelines and disagreed with the statement that there "is a role for radiography in acute low back pain in the absence of 'red flags' for serious disease." Conclusions: This survey suggests that many aspects of radiology instruction provided by accredited chiropractic schools appear to be evidence based. However, there appears to be a disparity between some schools and existing evidence with respect to the role of radiography for patients with acute low back pain without "red flags" for serious disease. This may contribute to chiropractic overutilization of radiography for low back pain. (J Manipulative Physiol Ther 2008;31:412-418) Key Indexing Terms: Public health; Chiropractic M ore than 90 000 chiropractors practice internationally, and this number is expected to grow to 150 000 by the year 2010. 1 Most practicing chiropractors are graduates of one of approximately 30

Journal of Clinical Medicine

Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4301 surveys were completed, of which 3641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model. Survey responses show that 73.3% of respondents utilize PROTS in practice and 26.7% refer patients out for PROTS. ...

2018

The use of diagnostic x-ray is controversial in chiropractic, due to different groups in the profession holding conflicting opinions on its main utility. This thesis is a historical study of the effects the x-ray has had on the practice of chiropractic from its introduction in 1910 until the present day. It examines the influence of the founders of the profession, other prominent chiropractors, medical and chiropractic professional associations, as well as the role of the state in defining the paradigms for diagnostic imaging. The study adopts a biomedical perspective which prioritises the use of historical evidence in contextualising epistemologies of healthcare methods. In doing so it questions traditional chiropractic depictions of health and disease, which have not changed significantly since the profession’s inception. Historically, chiropractic has been divided along traditional/biomedical lines, and the exacerbating effect of the adoption of x-ray technology on the schism in ...

Journal of Chiropractic Medicine, 2006

Objective: To determine if there is a greater yield of pathological findings identified on MRI scans of patients referred by chiropractors as compared to those referred by allopathic providers. Methods: MRI reports authored by medical radiologists from two independent MRI centers in the Denver metropolitan area were analyzed retrospectively for pathological data related to the spinal regions studied. A pathological report data sheet was used to record pathological findings in 22 different categories. A total of 150 reports from each provider group were reviewed. Results: Of the 22 pathological conditions studied, a statistically significant difference between doctor of chiropractic and medical doctor referrers was identified in 4 categories: central spinal canal stenosis, lateral stenosis, facet arthrosis, and negative report. The most common primary diagnoses given for MRI referral were low back pain/sciatica, neck pain, and extremity pain. Seventy-four percent of the reports evaluated were performed on patients referred with a diagnosis of pain. In 3 of the 22 categories (14%), the medical doctors had a statistically higher pathological yield than the chiropractors. However, in 4 of the 22 categories (18%), the chiropractors had a statistically higher pathological yield. In 18 of the 22 categories (82%), there was no statistical difference between the two provider groups. Conclusion: The data presented in this study suggests chiropractic and medical providers are compeer at ordering MRI for suspected pathological findings.

BACKGROUND: Plain film radiography is the most common imaging technique requested by chiropractors to assist in the management of patients with musculoskeletal complaints. There is a paucity literature indicating that chiropractors’ interpretive radiographic skills are consistently able to achieve the same outcome given a particular set of radiographs. An important indication for the use of radiography in chiropractic is to exclude any possible contraindications to spinal manipulative therapy (SMT) that could cause serious injury to a patient if it is left unmodified or excluded as a treatment option. OBJECTIVES: The study aimed to investigate the inter- and intra-examiner reliability of chiropractor’s diagnosis on cervical spine radiographs. Additionally, the effect of clinical history added to the radiographs was assessed. METHODS: Inter- and intra-examiner evaluations occurred on two consecutive readings of 30 radiographs by six qualified chiropractors. No clinical history was gi...

Chiropractic & Manual Therapies

Background: It is known that not all chiropractors follow mainstream guidelines on the use of diagnostic ionising radiation. Various reasons have been discussed in the literature, including using radiography to screen for congenital anomalies, to perform postural analysis, to search for contraindications to spinal manipulation, and to document chiropractic subluxations, i.e., tiny anatomical displacements of vertebrae thought to affect nerves and health. The visualisation of subluxations was the reason chiropractic first adopted the x-ray in 1910. There has never been a study of the influence of this historical paradigm of radiography on the practices of chiropractic radiologists (DACBRs or Diplomates of the American Chiropractic College of Radiology). Methods: A survey was administered with a modified Dillman method using SurveyMonkey and supplemented by hard copies distributed at a professional conference. The target population was all active DACBRs. There were 34 items, which consisted of multiple choice and open-ended interrogatives on all three areas in which chiropractic radiologists work: education, clinical practice, and radiology practice. Results: The response rate was 38% (73 of 190 DACBRs). Respondents reported that the historical paradigm of radiography was found in all areas of practice, but not as a major aspect. The majority of respondents did not condone that historical paradigm, but many tolerated it, particularly from referring chiropractors. Radiographic subluxation analysis was reportedly perpetuated by private clinical practitioners as well as technique instructors and supervising clinicians in the teaching institutions. Conclusions: Within the chiropractic profession, there is a continuing belief in radiographically visible subluxations as a cause of suboptimal health. This situation is sustained in part due to the reticence of other chiropractors to report these practices to licensing and registration boards. Investigation into other structures supporting a vitalistic belief system over science in chiropractic is recommended. In addition, it may be useful to explore remunerative systems that move beyond the inherently conflicted fee-for-service model.

Australasian chiropractic & osteopathy : journal of the Chiropractic & Osteopathic College of Australasia, 2003

This article is the second in a series of articles dealing with risk management in the practise of chiropractic and osteopathy, prepared by the COCA Risk Management Subcommittee.Background: Radiographic examination carries risks that must be weighed against the possible benefits when determining patient care.Objective: The objective of this article is to propose guidelines for the use of imaging in chiropractic and osteopathic practice.Discussion: Plain film radiography, CT scan, magnetic resonance imaging (MRI) and other forms of imaging are available for use in chiropractic and osteopathic practice in Australia. The astute practitioner utilises these imaging procedures for clinical decision making in order to make an accurate diagnosis that will determine a patient's management. This article attempts to guide the practitioner in the proper use of these imaging procedures for different regions of the body.