Do I need x-rays?

Photo: Contributed - (Photo: Flickr user, neckandback)

This is a question I hear almost daily in my office from existing and new patients. Most current clinical guidelines recommend (and this is my clinical opinion) that the majority of back and neck pain patients do not require x-rays in order to help them with a complaint. As a graduate of chiropractic school, I have received hundreds of hours of training in radiology (x-ray) theory, positioning and interpretation. In fact, chiropractic students have much more of their curriculum based on radiology than medical students (360 vs 148 hours). Under the guidelines of the College of Chiropractors of BC, chiropractors are permitted to take and interpret x-ray imaging for patients. A big component of that training is also dedicated towards deciding if and when a patient requires x-rays.

In my practice, I have chosen to not have x-rays in my facility because of the tendency that if a chiropractor owns an x-ray unit in their clinic or a surgeon owns an MRI unit, their patient is more likely to get x-rays or an MRI simply because the unit is there, regardless of whether the patient actually needs the imaging.

In our office, if we feel a patient requires imaging of any kind, we refer them to their medical doctor. We do this for two reasons; the medical doctor is now involved with the process and the patient has another professional helping with a diagnosis. Our patients are referred to the imaging clinics in Kelowna and the x-rays are paid for with your medical services plan. Our patients are able to have the images copied to a disc and can be reviewed in depth in our office.

X-rays can be a very useful tool in aiding a proper diagnosis, however they should be used judiciously and in combination with a thorough history and physical exam. Based on the results of the physical exam a decision can then be made regarding the need to take x-rays. The x-rays do not provide information about a person’s function. For instance, a person with moderate to severe arthritis does not always have moderate to severe impairment.

Below are some accepted guidelines of when an x-ray may be appropriate for you as a patient:

• a significant traumatic injury (such as a motor vehicle accident)

• If the patient has experienced any type of trauma if over age 50. This is especially true of somebody with osteopenia or osteoporosis.

• For most patients over 70 years of age, especially if the patient’s history and examination suggests a possible bone disease (such as arthritis)

• If the patient has had long-standing complaint that has not responded or resolved with previous chiropractic or physical therapy.

This article is written by or on behalf of an outsourced columnist and does not necessarily reflect the views of Castanet.