– Tyler Evans, DC., DCCJP., and Jeff Scholten, DC., FCCJP –
Most chiropractors are aware that the first x-ray image was created by Wilhelm Röntgen in Germany in 1895, and that same year DD Palmer gave the first chiropractic adjustment.
Within a short time, the medical profession realized its usefulness and started using x-ray to help diagnose and treat patients with more efficiency and better outcomes. In 1910, BJ Palmer not only introduced x-ray into the chiropractic profession, but he also championed its use for spinal imaging.
What is CBCT? Cone Beam Computed Tomography is a relatively new technology that provides a low dose, pulsed, cone-shaped beam. With one or two rotations around the patient taking 20-60 seconds, a high-quality 3D image is produced. Initially used for dentistry, collaboration between professions has made it possible for CBCT to find its way into the chiropractic profession in recent years.
Why is this a big deal? CBCT is a much lower dose form of 3D imaging that is quick and safe, and it gives the practitioner a high-resolution 3D picture of the hard structures of the skull and cervical spine. In this 3D imaging, boxes of data known as voxels replace pixels, and the depths of the data contained in each box can be increased or decreased depending on the needs of the clinician. The image avoids distortion and can be analyzed in any direction by slicing through any plane to create the desired projection; this allows for chiropractors to view and analyze not only the external structures of the spine, but the internal as well.
CBCT’s imaging files can be displayed as a 2D sagittal, coronal, and axial plane slice in standard x-ray views. More excitingly is the 3D multi-plane reconstruction (MPR) or anatomical reconstruction mode that allows a groundbreaking perspective when compared to typical spinal x-ray imaging. This imaging is not to be confused with typical medical planar CT which is higher dose (10-20X higher) due to its use of a constant, spiral beam that totals anywhere from 60 to 300 rotations around the patient. Believe it or not, CBCT technology doesn’t even require lead lining in the walls, just six feet of distance and a regular 110 volt plug to power the machine! This increased accessibility makes installation quite seamless as compared to the requirements of a
standard radiology suite.
Critical for the reader to know, is that this technology has not been approved for chiropractic use in all jurisdictions at the time of publication. If you would like to understand the status of approval for CBCT use in your geographical zone, please contact the authors of this article. We hope that soon enough, this amazing technology will be readily available to all clinicians.
CBCT may yet serve as a bridge within our profession to develop new ways of looking at things and closing the gap on the possibilities for preventative care in spinal health by allowing us to utilize sub-groupings of pathoanatomic clinical prediction markers that previously were not attainable.
One of our late great chiropractors, Dr. Robert Brooks, famously said: “Truth was put in a box, and holes were poked in it for us all to see it from different perspectives.” CBCT may yet serve as a bridge within our profession to develop new ways of looking at things and closing the gap on the possibilities for preventative care in spinal health by allowing us to utilize sub-groupings of pathoanatomic clinical prediction markers that previously were not attainable. The future is bright in a chiropractic profession that embraces a technology that lowers the dose to patients as well as allows for improved patient outcomes via better analysis.