Radiography and Clinical Decision-Making in Chiropractic

Abstract

The concern over x-ray exposure risks can overshadow the potential benefit of radiography, especially in cases where manual therapy is employed. Spinal malalignment cannot be accurately visualized without imaging. Manual therapy and the load tolerances of injured spinal tissues raise different criteria for the use of x-rays for spinal disorders than in medical practice. Current regulatory bodies rely on radiography risk assessments based on Linear-No-Threshold (LNT) risk models. There is a need to consider radiography guidelines for chiropractic which are different from those for medical practice. Radiography practice guidelines are summaries dominated by frequentist interpretations in the analysis of data from studies. In contrast, clinicians often employ a pseudo-Bayesian form of reasoning during the clinical decision-making process. The overrepresentation of frequentist perspectives in evidence-based practice guidelines alter decision-making away from practical assessment of a patient’s needs, toward an overly cautious standard applied to patients without regard to their risk/benefit likelihoods relating to radiography. Guidelines for radiography in chiropractic to fully assess the condition of the spine and spinal alignment prior to manual therapy, especially with high velocity, low amplitude spinal manipulation (HVLA-SM), should necessarily differ from those used in medical practice.

Reliability Analysis of Vertebral Landmark Labelling on Lumbar Spine X-ray Images

“…Manual medicine is a field of complementary and alternative medicine. Clinical studies on manual medicine, including Chuna manual medicine, chiropractic, and osteopathy, often encounter challenges with inter-rater reliability due to a heavy dependence on imprecise palpation-based diagnostic techniques [ 36 , 37 , 38 ]. To overcome these limitations and ensure greater ease of evaluation in clinical settings, X-ray imaging is the most widely used method for the quantitative analysis of spinal structures in manual medicine.…”

Knowledge and Awareness of Radiographic Guidelines for Spinal Pain: a Cross-sectional Study Among Malaysian Chiropractors and Chiropractic Interns

“…The signi cant difference found could possibly be explained by the different adjusting techniques utilized. Studies have suggest that chiropractors who practised Gonstead techniques refer patients for radiographs prior to chiropractic manipulation to discover the pattern of biomechanical damage to the spine as compared to chiropractors who practised other techniques like Diversi ed or Activator (4,14,15).…”

Comparison of Concordance between Chuna Manual Therapy Diagnostic Methods (Palpation, X-ray, Artificial Intelligence Program) in Lumbar Spine: An Exploratory, Cross-Sectional Clinical Study

“…In addition, efforts have been made to apply imaging tests to enhance the objectivity of the diagnosis not only in CMT but also in other manual therapies [ 15 , 16 ]. In modern medicine, X-ray examination is commonly used to monitor treatment effects or to determine disease progression [ 46 ], and it is effective in identifying underlying diseases of the spine and contraindications of CMT [ 15 ]. Although it has a risk of radiation exposure, the effect is negligible [ 47 ].…”

“…However, several studies have reported problems associated with poor validity and reliability of these manual methods [ 10 , 11 , 12 , 13 , 14 ]. Therefore, X-ray images and ultrasound examinations have recently been used to overcome the limitations of manual diagnostic methods and enhance their objectivity [ 15 , 16 ]. A study on CMT spinal diagnosis using X-ray imaging was also conducted [ 17 ]; however, it presented only the diagnostic criteria.…”