X-rays: Is seeing the only way to know?

There are so many myths about chiropractors I have a hard time finding a starting point.  Let’s address one of the more harmful myths in today’s column: x-rays.  I recently heard the proposition that “a thorough chiropractor is one who takes x-rays on every patient before he touches them.”  I actually hear some variation of this quite a bit from new patients.

It is simply not true.  The chiropractor who x-rays every patient is no more helpful than the medical doctor who gives every patient an antibiotic.

A thorough chiropractor is one who takes a complete medical history, carefully examines the patient and formulates a logical diagnosis and treatment plan.  As part of the work-up, the patient may require diagnostic imaging such as x-rays or an MRI.  Patients in certain profiles, with specific medical problems or history of certain types of trauma absolutely require x-rays.  X-rays are used to rule out some types of medical problems, congenital conditions and deformities.

Routine x-rays of all new patients is not a thorough practice — it is criminal, a waste of money, time and needless exposure to radiation. 

You certainly may need x-rays…but if you come across a chiropractor whose practice is to x-ray all patients, you are probably in the wrong office.

 

Dr. Brett Kinsler is a chiropractor in Rochester, NY who does not routinely x-ray his patients – even if they ask really, really nicely….only if they need it.

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5 Comments

  1. cmnacnud said,

    July 8, 2008 at 11:15 pm

    I agree in principle. Chiropractors don’t need X-rays every time to be able to treat. It is kind of neat to be able to have a before and after picture, but it is not necessary. I don’t know where I stand on the issue of condemning people for doing it though. Most chiropractors that take them each time do it more to demonstrate to the patient what’s happening. Nice learning tool. It can even be a relatively useful screening tool. The question is whether the risk outweighs the benefit.
    Now I know radiation can cause cancer or worse, but honestly in all of my radiological studies I’ve found that with the modern technology you get less radiation from an x-ray film than being out in the sun for an hour or two. I know we should avoid the risk if we can, but really the dosage is, so low…
    I’ve also read studies that showed radiology techs, who likely receive the highest doses, are actually among the healthiest people with the lowest rates of cancer. I think our fear of radiation came from early experiments and nuclear reactors gone wrong. I think our current precautions are a bit overboard. Like with a lot of our modern precautions (honestly, why did our society ban merry-go-rounds:).
    Now, I don’t X-ray even 1/3 of my patients, but I can understand why a doctor would. I recommend moderation. If I ever even suspect the need I’d recommend it, because we can and it is useful, fairly cheap and safe. I don’t want to go overboard and scare patients away from a very useful diagnostic tool. I’m not saying that you are scaring them. Well you know.

  2. July 8, 2008 at 11:52 pm

    […] I saw a blog on fellow chiropractors site that I follow, and thought I’d point you all to it, as he has a good point. I also wanted to add my two cents and discuss it a […]

  3. July 9, 2008 at 10:45 am

    Of course x-rays are useful and the vast majority of the time, the risks outweigh the potential benefits. I do have a problem with overutilization. Who is paying the bill when patients are x-rayed needlessly? It’s not the practicing doctor, that’s for sure. It’s either the patient or the insurance company or some combination of the two.

    True, the radiation dose is minimal, but we’re talking about an ethical issue here and one that cannot be refuted with clinical evidence. There is nothing to back up the use of routine, universal spinal x-rays for chiropractic treatment and even less so for pre/post patient educational films.

    Sure, it’s nice to have the information. Heck, I’ve often said if it weren’t for the cost factor, I’d like to have an MRI of every patient walking in the door. But, MRI’s aren’t ionizing radiation and there is a cost factor — so we don’t do it.

    As for patients being scared of x-rays, no that is not my intention. Patients being scared of chiropractors who over x-ray? Yup….be afraid….be very afraid.

  4. July 9, 2008 at 1:40 pm

    http://chirotalk.wordpress.com/2008/07/09/radiation-good-bad-indifferent/trackback/

    Some of your information is a tad outdated. I believe the study of radiology technologists you mention eventually actually showed an increase in breast cancer rates when compared to the general population.

    http://www3.interscience.wiley.com/journal/104535521/abstract?CRETRY=1&SRETRY=0

    Also, thinking has changed concerning so-called safe doses of radiation. We used to use a term called maximum permissible dose to describe the maximum dose of radiation that was felt to be safe for an individual to receive. The term maximum permissible dose is no longer used today because no dose is considered permissible.

    The principle now is to keep each individual’s dose as low as reasonably achievable (ALARA). We need to leave our homes and go outside. Many of us need to travel by airplane. We need to see a chiropractor. We don’t need pre and post spinal adjustment x-rays on every patient.

    As you stated in a comment on my site, I applaud the fact that you x-ray less than 1/3 of your patients. This is probably a reasonable amount and shows prudence, forethought and care for your patients’ well-being.

  5. July 9, 2008 at 6:07 pm

    I fully agree that X-rays should be used specifically for those who may have more going on that a simple case of uncomplicated LBP. It makes me cringe when I get new patients in asking why I’m not taking films before adjusting them for a simple case of back pain.


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