Diagnostic imaging is a commonly utilised tool in the medical and chiropractic profession, which guides clinical decision-making and improves precision in the diagnoses of neuromusculoskeletal conditions and other soft tissue pathologies. However, chiropractic literature has reported overuse and misuse of imaging techniques for spinal disorders.
Current evidence suggests that without the presentation of red flag signs and symptoms in uncomplicated mechanical back pain, routine full-spine imaging is not indicated. Conservative diagnostic imaging should therefore take precedence, particularly when considering the involved cumulative health risks and resource allocation.
Risks and costs
The risks and costs of overprescribed imaging include:
- Exposing patients to potentially harmful ionising radiation
- Direct costs to the patient and healthcare system
- The biopsychosocial factors of inappropriate diagnosis, leading to a false sense of security
Clinical Practice Guidelines (CPGs)
CPGs aim to guide clinical decision-making by describing appropriate treatment procedures, which are determined by current evidence-based research and broad consensus, whilst also advocating efficient use of resources. Despite the wide availability of evidence-based diagnostic imaging guidelines for spinal disorders, routine imaging is an over-utilised tool in chiropractic.
Imaging in chiropractic
Historically, chiropractors have used routine full-spine imaging (spinography) to visualise biomechanical aberrations of the spine; however, current research indicates that there are no clear benefits for routine imaging, whilst others suggest that routine full-spine imaging may be clinically implicated to evaluate changes in structural scoliosis (fixed curve of the spine) in children and adolescents throughout their growth periods.
There are misconceptions about the clinical implications of plain film radiography (i.e., X-rays), for instance, radiographs reveal the diagnosis, or an unremarkable radiograph excludes serious pathology.
As primary healthcare practitioners, chiropractors are obligated to understand and apply evidence-based practice when managing patients, which is within their scope of practice. The Code of Conduct for Chiropractors Report by the Australian Health Practitioner Regulation Agency stipulates that chiropractors must comply with the provisions of the code of practice for radiation protection and the Application of ionizing radiation by chiropractors (2009) or any subsequent version as published by the Australian Radiation Protection and Nuclear Safety Agency Code.
Routine full-spine imaging provides little diagnostic information, particularly in patients without a structural scoliosis, so the risks of imaging outweigh the potential benefits. Chiropractors are obliged to practice evidence-based using recent CPGs, and this includes their role in taking and requesting diagnostic imaging.