In direct opposition to the Choosing Wisely initiative that has been delivered by the American Chiropractic Association, Life Chiropractic College West believes firmly in the use of spinal imaging for patient safety and the detection of Vertebral Subluxation, at the doctor of chiropractic’s discretion.
The ACA states in its Choosing Wisely statement that physicians and patients should question routine use of spinal imaging for patients with acute back pain of less than six weeks, especially in the absence of certain red flags. It is Life West’s position that in addition to performing a patient history and diagnostic workup, it is both the duty and responsibility of the chiropractor to perform any further diagnostic tests, including X-ray if indicated.
Patients may have underlying conditions that are not readily explained by their consultative history and/or examination procedures. Adding X-ray results or other spinal imaging findings to the data available, when appropriate, may give a clearer picture of the patient’s internal health status and provide different potential avenues of care. The judgment of the chiropractor, when determining the appropriate approach to chiropractic care, is better informed by multiple points of data.
The ACA Choosing Wisely guidelines also fail to take into consideration the many practices and approaches of chiropractic, which employ manual as well as non-force techniques. Any guideline for chiropractic care must consider the diversity of techniques used, as well as the protocols and specificity involved in the care being delivered.
The decision to X-ray a patient must be based upon the case history, examination findings, best available evidence, professional judgment of the chiropractor and the unique features of the individual patient. This decision should be determined by the doctor of chiropractic, who takes responsibility for the safety of the patient and the appropriateness of care given. This should never be determined by a guideline that fails to consider, among other issues, the differences in individual patients and the differences in chiropractic techniques.
Dr. Ron Oberstein, DC
President, Life Chiropractic College West
Dr. Scott Donaldson, DC
Vice President, Clinical Operations
and the Life Chiropractic College West Radiology Department
Dr. Brian Gatterman, DC, DACBR
Dr. Jamie Motley, DC, DACBR
Dr. Savannah Shortz, DC, MS, DACBR