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X-ray and Advanced Imaging Policy Statement

Like many medical procedures, there are both risks and benefits of exposure to ionizing radiation. The benefits of X-rays are that they can be obtained quickly and are a relatively inexpensive way to rule out many serious problems and help your doctor identify the source of your problem.

The risk of X-ray is that radiation effects accumulate during a person?s lifetime, and can increase the risk of some serious health conditions, such as certain types of cancer . Due to the risk of accumulated exposure to radiation, X-ray should be limited to what is medically necessary. This policy is consistent with international standards of appropriate use of X-ray and exposure to ionizing radiation.

CT Scans also expose a patient to ionizing radiation, and therefore also should be utilized accordingly.

MRI Scans do not expose patients to ionizing radiation, but are relatively expensive and the cost-benefit ratio should be discussed with the patient when appropriate.

Chiropractors have extensive training in X-ray and other diagnostic imaging. In a typical accredited educational programme, such as the sample given in the “WHO Guidelines on Chiropractic Safety and Training”, a chiropractor will have 400 semester hours of course work in Radiology related subjects.

In view of all of these factors, The Association has set out basic guidelines for the appropriate use of diagnostic imaging, based on accepted evidence-based protocols.

If a patient has had recent X-rays or other diagnostic imaging within the last year without significant change in symptoms or additional traumatic injury, copies of these previous studies should be obtained in lieu of additional exposure.

Several factors are considered when ordering diagnostic imaging, including previous evaluation by other health professionals or previous care received for the same problem. Your chiropractor will weigh these and determine if studies are needed.

Some conditions where there would be medical justification for Xray or other diagnostic imaging would be as follows:

Clinical History

  • Age > 50
  • Significant trauma
  • Neuromotor deficits
  • Unexplained weight loss
  • Suspicion of AS
  • Drug/alcohol abuse
  • History of cancer
  • Corticosteroid use
  • Fever > 38 degree C
  • Diabetes / hypertension
  • Recent visit for same problem and not improved
  • Patients seeking compensation for back pain
  • History of surgery

Physical / Clinical Findings

  • Dermopathy
  • Cachexia
  • Deformity and immobility
  • Lymphadenopathy
  • Scars from surgeries or trauma
  • Motor and sensory deficit
  • Elevated ESR
  • Elevated acid or alkaline phosphatase
  • Positive Rheumatoid Factor
  • Positive HLA B27 Antigen
  • Serum gammopathy
  • Scoliosis
  • Inconsistent/equivocal biomechanical spinal examination findings
  • Evaluation of complex postural or biomechanical disorders
  • Limited examination due to pain

Repeat X-Rays

Re-X-ray of an area of chronic pain should be undertaken when there is substantial change in the character or pattern of pain, significant medical history, such as the diagnosis of cancer since the last films were made, when there has been new traumatic injury, or if the same type of treatment that managed a person?s pain in the past is now not effective.

The mechanical dysfunction of the motion segments of the spine and the related reflex neurological effects that chiropractors treat, is a functional entity, and is not visible on an X-ray. Loss of normal joint motion and change of muscular stability and function without any suspected bone pathology are not generally appropriate indications for taking x-rays, neither is it appropriate to re-X-ray to evaluate post-treatment progress if the patient is making good symptomatic progress, and especially if the patient is no longer symptomatic.

Some progressive skeletal disorders or pathologies, such as moderate and severe degree of adolescent onset idiopathic scoliosis, require periodic re-examination, however, patients, particularly adolescents, with these conditions are encouraged to have/ continue concurrent care with an orthopaedic surgeon, and effort should be made to have repeat X-rays made by the same physician, clinic or hospital, for best comparison.