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January 11, 2019

 

RE: X-rays in Chiropractic

 

BACKGROUND:

On August 15, 2017 the American Chiropractic Association (ACA) released a press release entitled, “American Chiropractic Association Releases Choosing Wisely® List of Tests, Procedures to Question”. Among these tests, were the following related to spinal imaging:

“In the absence of red flags, do not obtain spinal imaging (X-rays) for patients with acute low-back pain during the six weeks after the onset of pain.  Do not perform repeat spinal imaging to monitor patients’ progress.”

Since this initial release, the ACA claims a large amount of support for this initiative within and outside the chiropractic profession.

 

CHIROPRACTIC SOCIETY OF TEXAS RESPONSE:

The CST opposes the ACA in this endeavor to assert control and oversight to the chiropractor in his/her care for the public for the following reasons:

  1. Chiropractic Technique: Currently practiced within multiple chiropractic clinics in Texas are techniques that utilize X-ray as part of a core method to assessing the Vertebral Subluxation. These techniques are foundational techniques that are taught in accredited chiropractic schools throughout the country. Removing X-ray from these clinics would be detrimental to the proper care of the patient, as well as detrimental to the proper teaching of these fundamental techniques within chiropractic schools.
  2. Public Health: Each individual patient deserves the best analysis, and clinical application based upon their individual needs. X-rays should be taken per discretion of the practitioner as clinically indicated, as a matter of public health, and based upon a thorough clinical evaluation within the lawful scope of the chiropractor in Texas.
  3. Clinical Outcome: Follow-up X-rays allow for oversight in a patient’s care. X-rays are a method of valid, reproducible, and scientific measurement of outcome, post-chiropractic care. Without this method to measure outcome, the practitioner is restricted from a reliable method of outcome measurement in practice. Restriction, suppression, and governance in this manner is not conducive to best patient health outcomes.
  4. Professional Control: There is a need for scientific evidence to support chiropractic care. The utilization of evidence‐based clinical guidelines are useful for clinical practice. However, practice guidelines should have scientific claim, and should not produce a mandate of care.

 

The Chiropractic Society of Texas (CST), is a professional organization that supports principled, neurologically-based wellness care in a vertebral subluxation centered model. Thereby, the CST tasks itself with supporting best clinical practices for the chiropractic profession.

 

The CST fundamentally rejects the ACA endorsement of the Choosing Wisely campaign as it relates to spinal imaging (X-ray).

 

Sincerely,

CST Board January 2019

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