MAY 2009 - Do I Need X-Rays?

Patients often ask me this question. Some even seem to expect x-rays to be taken as part of a proper diagnosis. It is true that most chiropractors get loads of training in taking and reading x-rays. Some of that training is specific to only chiropractors for finding and correcting slight misalignments called subluxations. The rest of the training is similar to medical doctors or x-ray technicians and involves how to take a proper x-ray, how to tell one diagnosis from another, and how to rule out or find serious situations such as aneurysm, fracture or cancer.

There are many different chiropractic techniques. In some techniques x-rays are essential to diagnose and treat each case. In other techniques diagnosis is achieved primarily by neurological and function based testing. X-rays are not necessary for every patient when using these techniques.

In our office we use several techniques depending on the needs of each patient. The notion that everyone needs an x-ray may be a good business plan, but in my opinion x-rays are not necessary in every case. The lawyers would argue that a properly read x-ray study limits the doctors' liability for missed diagnosis. I would answer that a thorough case history and hands- on patient exam should reveal the need for a follow-up x-ray study.

In todays' health care environment, profit motives often override concerns for patient welfare. If a patient has good insurance, it is common practice to perform unnecessary tests to run up the bill. I frequently see excessive x-rays taken because the technician didn't get the shot right the first time. Also medical x-rays are usually taken with the patient laying down. This will show fractures or other obvious problems, but does not reveal conditions brought on or aggravated by forces of gravity on the spine or any weight bearing joint. The majority of neck and back pain cases can be directly linked to these forces. Common sense would suggest that x-rays be taken in a weight bearing position to observe these forces at work.

While it is true that modern x-ray equipment poses minimal risk of excessive radiation exposure to the patient, I believe in taking all available precautions. Always ask the technician for a lead apron to protect reproductive organs, the thyroid gland (in the throat), and the thymus gland (upper chest). Remember, Americans lead the world in number of cancer cases, thyroid and autoimmune disorders. The thymus gland is important in a properly functioning immune system. The thyroid not only helps control metabolism, but is a factor in cholesterol control. When I was in chiropractic college in the 90's, two of my x-ray instructors came down with cancer. Coincidence or carelessness? Hard to know for sure, but sadly these links are usually ignored by mainstream health care. Lets err on the side of caution. Even with dental x-rays, the thyroid should be shielded.

Another aspect of x-ray procedures that continues to shock me, is the amount of missed diagnoses. I have had several dangerous and even fatal cases misdiagnosed by "experts" paid for their interpretations of the films. MRI's tend to get a higher level of scrutiny so less mistakes are made. Also, due to their high cost, MRI's are less likely to be ordered unnecessarily.

X-rays are a valuable diagnostic tool, but like many medical procedures, better case management is needed if we, as a country wish to make patient care a higher priority than quarterly profits!