An often asked question when visiting a chiropractor or any health care provider: Do I need xrays? Do I need imaging? The American Chiropractic Association (ACA) recently released recommendations regarding this. It is a topic you may be faced with at any visit to a health care office and we hope to shed some light on it here.
First about our training, we do not support or argue against the scope of plain-film use endorsed by the ACA, “In the absence of red flags, do not obtain spinal imaging (X-rays) for patients with acute low-back pain during the six weeks after the onset of pain” and “Do not perform repeat spinal imaging to monitor patients’ progress.” We operate under logical clinical decision making. These decisions are not typically black and white, but contextual to clinical circumstances. We as clinicians train to navigate the “shades of gray” encountered in clinical practice related to the use of diagnostic imaging.
We carefully consider carefully costs in terms of ionizing radiation exposure, financial burden, and patient time related to diagnostic studies, including all modalities of clinical imaging. Imaging examinations should be clinically indicated and expected to provide clinically relevant information.
The ACA’s criteria overly simplify what are complex clinical decisions based on the patient’s history, clinical presentation, physical examination, and therapeutic intent. Their criteria are limited by the means to fit a structured plan, to consider fully the value of imaging studies to assess patient biomechanics, structure, and contra-indications related to chiropractic care.
Clinical decisions are best left to clinicians and their patients, guided by current best evidence (this evidence includes that provided by your case and care), clinical experience, and patient values.
Please stop by or call with questions on how this pertains to you!