Wednesday, July 8, 2015

Wisdom Wednesday: X-ray Imaging

Imaging studies are an integral aspect of practice. However, they are not to be used as a screening tool with the possible exception of trauma. Today, most hospitals do not x-ray the spine of automobile accident victims, unless there is evidence of fracture on physical examination.

The best example of using x-ray as a screening procedure is the traditional chest x-ray taken whenever you are admitted to the hospital. There is no good reason to do so, it’s just convention. Chest x-rays are the most difficult x-rays to read. Statistically, the damage we cause through ionizing radiation far out weights the diagnostic value of the routine chest x-ray. However, reduced lung sounds, rales, chest pain and other exam findings may warrant a chest x-ray.

In the 1970’s, when I was in Chiropractic College, we were taught to x-ray every new patient. I started out doing just that. However, my first new patient that was an infant challenged my thinking. I did not x-ray that little baby and began to use discernment rather than just following the rule.

This was reinforced by my postgraduate studies in radiology. Radiologist are taught that the need for x-ray is based on history and physical examination. Was there trauma? Are there symptoms of pathology that might be revealed on x-ray? Are some of the orthopedic and neurological tests indicative of the need for x-ray? Can this patient be adjusted safely without the aid of an x-ray?

The more I used these analytical tools, the less often I took x-rays. Eventually, I sold my x-ray equipment. Now, when I feel x-rays are needed, I send the patient to a local radiologist who will take digital films of very high quality and give me an interpretation of their findings, at a very reasonable fee. It’s always nice to have another physician, with somewhat different training and experience, give you their findings to augment your own.

Digital x-ray dramatically reduces the ionizing radiation to the patient while improving film quality. Although the initial cost of the equipment may be prohibitive for individual physicians, most clinics now utilize digital x-ray. The images can be send to the physician’s office via the internet. Many hospitals now provide direct access to their imaging files to area physicians.

There are many chiropractic techniques that require x-ray for structural analysis. Those techniques also re-x-ray at prescribed intervals to evaluate the response to treatment. Honestly, with the exception of scoliosis evaluation, I do not believe x-ray is a viable tool for structural analysis of the spine.

In my opinion, chiropractors should take x-rays when their evaluation leads them to believe that pathology of the spine exists. That pathology (osteoporosis, cancer, Paget’s disease) may make spinal manipulation unsafe and/or may require referral to another physician for further evaluation and/or treatment.

The Bottom Line:
X-ray is a valuable tool when used properly, but not a screening tool to be used indiscriminately. When your physician recommends x-rays, please ask for the justification for the study prior to allowing yourself to be exposed to ionizing radiation.

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