Point-Counterpoint: X-ray tech in chiropractic

Canadian chiropractors are going to court to retain the ability to use X-ray tech prior to and after chiropractic adjustments if necessary. Should chiropractors retain this right?

On February 4, 2021, the College Board approved amendments to the Professional Conduct Handbook (PCH) Part 2, Part 15 and Appendix L regarding diagnostic imaging. These amendments state that “Routine or repeat X-rays used as a regular protocol during the evaluation and diagnosis of patients 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 using X-ray tech

We believe that this is being used as a “template” or “proof of concept” to be initiated in other areas of Canada, and that it will eventually makes its way into other parts of the world. We have made contact with several of the vitalistic, principled chiropractors in British Columbia in an effort to step up and provide support for the resistance to these ideas, with the end goal of having these amendments nullified and/or removed entirely.

— Statement from the International Federation of Chiropractors & Organizations on using X-ray tech

X-ray prior to CMT makes sense per all the guidelines taught in school, R/O FX, tumor, post-injury, where to apply CMT, etc. However, re-X-ray post-CMT does not make sense. X-ray post-CMT is typically a technique related procedure, Pettibon, etc. This is NOT acceptable in the normal realm of care. Re-X-ray is only typically done to follow FX healing or if a new injury had occurred. Most states in the U.S. do not allow chiros to treat FXs and most insurance companies do not pay for X-rays if they are done per a specific technique protocol. This usually causes a peer review to be requested. Allowing Canadian chiropractors to maintain the ability to take X-rays for normal reasons should be allowed; however, the re-X-ray issue is an insurance issue, not a regulatory issue. If a chiropractor decides to re-X-ray post-CMT, per the specific technique protocols being used on the patient, this should be discussed with the patient and the patient should pay for these films.

— C. Gast, DC

Although X-ray analysis of the spine is a fundamental diagnostic tool of several chiropractic techniques, the proposed amendments eliminate the use of X-ray for anything beyond red flag (fractures, etc.) concerns. The amendments would severely restrict a chiropractor’s ability to take X-rays when evaluating bio-mechanical alignment problems. They would also eliminate follow-up X-rays that are often vital in evaluating and modifying treatment.

— Statement from the Canadians for Chiropractic health action network on chiropractors using X-ray tech

Simple answer is absolutely. It’s a matter of parity. If any other allied professions are able to be reimbursed then so should chiropractors. Sounds like a case of discrimination toward chiropractic.

— South Florida Medical and Wellness Clinic

Sherman College of Chiropractic follows an evidence-informed approach to the use of radiography in spine imaging … Radiology may disclose conditions requiring co-management or referral to another type of health care provider. X-ray examinations should only be conducted when clinically indicated. The decision to X-ray a patient is based upon the case history, examination findings, the best available external evidence, the judgement of the chiropractor, and the preferences and unique features of the individual … Clinical judgement cannot be reduced to regulations … Sherman College of Chiropractic appreciates the opportunity to offer comments on the PCH amendments, and strongly encourages the CCBC to rescind PCH Amendments 15.1 and 15.2. Issues relating to accreditation, risk management, standards of care, professional responsibility, ethics, and responsibility for patient outcomes are adversely affected by these amendments.

— Statement on the use of X-ray tech by doctors of chiropractic, Sherman College of Chiropractic