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X-Ray Policy

Our office's position on the use of x-rays is that we do not routinely use x-rays.

When I graduated in 1978 I did not have an x-ray machine in my office. For 10 years I would examine, provide care and if a patient did not respond in a few visits, I would refer them to an x-ray facility. Ten years into practice I took seminars on techniques utilizing x-rays that could help determine imbalances in spinal alignment and the biomechanics of coupling movement and by doing so be able to prescribe specific exercises and home traction to make corrections. I would then re-x-ray and look for changes in about 6 - 8 week intervals. Around the same time I took classes on impairment evaluations, based on the AMA's Impairment Evaluation standards, utilizing an inclinometer that would measure the alignment and ranges of motion. I found that I could make virtually the same determinations without taking x-rays. Our office then provides specific exercises, muscle and fascia care and chiropractic adjustments to give relief and make changes to improve function and most importantly decrease the likelihood of reoccurrences.

For the past 20 years I rarely use x-rays. Most conditions are irritations to muscles, tendons, joints and discs to the various levels of the spine. My profession's largest organization has begun to address the use of x-rays. The following is the new position the American Chiropractic Association has opened discussion about the use of x-rays:

By Christine Goertz, DC, PhD

The goal of the Choosing Wisely® campaign is to promote conversations between doctors and their patients about utilizing the most appropriate tests and treatments. The campaign is an initiative of the American Board of Internal Medicine Foundation and Consumer Reports. As part of the campaign, an organization creates an evidence-based list of 5 tests and/or procedures that may be common…but often should not be part of routine care. The program encourages an evidence-based approach to patient care and shared decision-making between doctors and patients. The American Chiropractic Association (ACA) joined the Choosing Wisely® campaign recently because these are principles that ACA strongly supports.

The first ACA Choosing Wisely® recommendation states: 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. This recommendation is not only on ACA’s Choosing Wisely® list; a similar item is also included on the lists of seven other organizations. This includes, among others, the American College of Emergency Physicians, the North American Spine Society and the American College of Physicians. It's also one of the performance measures established by the Centers for Medicare and Medicaid (CMS) under the MIPS Program. Thus, it is a widely accepted standard.

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I understand chiropractors that utilize x-rays on all their patients. We are trained to utilize them in Chiropractic school. We are educated to the degree that we can own and operate x-ray machines and we can interpret x-rays. We are also trained that x-rays damage cells of the body and we should be concerned with the amount of exposure a patient is receiving.

Robert Monokian, DC, DACBSP, FICC