There is a great deal of debate when it comes to taking x-rays in chiropractic clinical practice. The third party pay (insurance company) argument of course is that absent red flags they are not needed. But is that the best measure of necessity?

Consider a case where the chiropractor saw a 45 year old male patient following a work injury to his lower back. The chiropractor takes x-rays and sees nothing out of the ordinary other than some early degenerative changes. The patient goes through a course of care and his back pain resolves in about a month. Nothing out of the ordinary.

The patient does not continue with “maintenance care” but comes back a couple of months later saying he “did it again”. Our chiropractor examines him and determines that for all intents and purposes this looks just like the last time and places him on a course of care. He does not take a new set of films as his technique is not determined by structural findings on x-rays and he figures not much is going to have changed in 2 months.

So rather than bill the insurance company or expose the patient to more radiation he opts to forgo the films. A month goes by and this time the patient is not getting as good of a result as he did last time. Our chiropractor changes his technique and gets a little better result but still no resolution. On his own the patient goes to see his primary care physician who orders x-rays and lo and behold there is a neoplastic process evident at L5.

Guess who gets sued?

Here is the reality: insurance companies are generally not going to want to pay for your x-rays. But that is not how you decide clinical necessity. Clinical necessity is based on what is best for the patient. In this case its going to be hard to convince a jury that its okay that he didn’t take the x-ray. In our culture, the average person thinks you should do everything you can to make sure you don’t have cancer and if that means splurging on a couple of extra x-rays then let's go ahead and do it.