Point-counterpoint: X-ray technology in chiropractic

Canadian chiropractors are going to court to retain the ability to use x-ray technology before and after chiropractic adjustments if necessary. Should Chiropractors Keep This Right?

On February 4, 2021, the College Board approved amendments to the Professional Conduct Handbook (PCH) Part 2, Part 15 and Appendix L related to diagnostic imaging. These changes state that “Routine or repeated X-rays used as a regular protocol during patient assessment and diagnosis are not clinically justified.” — Statement from the College of Chiropractors of British Columbia, “Amendments to the PCH (Professional Conduct Handbook): Routine and Repeat Imaging”, on the use of X-ray technology

We believe this will be used as a ‘template’ or ‘proof of concept’ to be initiated in other regions of Canada and will eventually find its way to other parts of the world. We have reached out to several of the vitalist, principled chiropractors in British Columbia to reinforce and support opposition to these ideas, with the ultimate goal of having these changes canceled and/or removed entirely.

— International Federation of Chiropractors & Organizations statement on the use of X-ray technology

X-ray before CMT makes sense according to all guidelines taught in school, R/O FX, tumor, post-injury, where to use CMT, etc. However, re-xray after CMT does not make sense. X-ray after CMT is usually a technique related procedure, Pettibon etc. This is NOT acceptable in the normal field of care. A re-xray is usually only done to follow FX healing or when a new injury has occurred. Most states in the US do not allow Chiros to treat FXs, and most insurance companies will not pay for X-rays if they are performed according to a specific technique protocol. This usually results in a peer review being requested. Allowing Canadian chiropractors to take x-rays for normal reasons should be allowed; However, the X-ray retake issue is an insurance issue, not a regulatory issue. If a chiropractor elects to have a repeat X-ray taken after CMT, this should be discussed with the patient according to the specific technique protocols used with the patient, and the patient should pay for these films.

—C.Gast, DC

Although spinal X-ray analysis is a fundamental diagnostic tool for several chiropractic techniques, the proposed changes eliminate the use of X-rays for anything beyond warning signs (fractures, etc.). The changes would severely limit a chiropractor’s ability to take x-rays when evaluating biomechanical alignment issues. They would also eliminate follow-up X-rays, which are often critical to evaluating and adjusting treatment.

— Canadians for Chiropractic Health Action Network Statement on Chiropractors Using X-Ray Technology

Simple answer is absolute. It’s a matter of parity. If other related professions are reimbursable, so should chiropractors. Sounds like a case of discrimination against chiropractic.

— South Florida Medical and Wellness Clinic

The Sherman College of Chiropractic takes an evidence-based approach to the use of radiography in spine imaging…Radiology can reveal conditions that require co-management or referral to another type of healthcare provider. X-ray examinations should only be performed when clinically indicated. The decision to X-ray a patient is based on medical history, examination findings, the best available external evidence, the chiropractor’s judgment, and the individual’s preferences and unique characteristics… Clinical judgment cannot be reduced to prescriptions… Sherman College of Chiropractic appreciates the Opportunity to comment on the PCH Amendments and strongly encourages CCBC to repeal PCH Amendments 15.1 and 15.2. Accreditation, risk management, standards of care, professional responsibility, ethics and accountability for patient outcomes are all adversely affected by these changes.

— Statement on the use of X-ray technology by chiropractic physicians, Sherman College of Chiropractic

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