New X-Ray Guidelines Outline the Standard of Care in Chiropractic

There has been a great deal of talk in chiropractic circles over the past couple of months following the re-emergence of old, outdated guidelines for the use of x-ray in chiropractic. The history on this is pretty simple – in the early 90’s the Agency for Health Care Research and Policy came out with some recommendations for the treatment of acute low back pain. They included recommendations that x-rays not be taken absent red flags since only one in 2500 people would have something ominous show up on the x-rays so it was recommended that a course of conservative care be attempted before taking films. 

Just hope you are not that one in 2500! 

Those chiropractors making a living by denying other chiropractors insurance claims had a field day with these recommendations as it made it easy for them to deny claims – especially against chiropractors focused on vertebral subluxation. These recommendations also made their way into chiropractic guidelines and standard of care documents such as the now discredited Mercy Guidelines. These became a claim cutters playbook. 

The problem of course is that such recommendations are actually dangerous when it comes to the practice of chiropractic because generally speaking the chiropractor is going to do something to the spine to effect change and help the patient. This is opposed to an allopathic provider who is most likely going to just prescribe a drug. 

Likely part of its current "re-branding" effort, the American Chiropractic Association (ACA) decided recently to resurrect these old, outdated and dangerous recommendations. While they attempt to frame these new guidelines as "evidence based" they are anything but that. They include not taking films in acute cases absent red flags and shockingly, also include not taking follow-up films to assess structural changes following a course of care.

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Of course this puts every chiropractor who takes an x-ray to determine the biomechanical component of subluxation and a follow up film to determine outcomes into the cross hairs in malpractice complaints, board actions and insurance claims. 

While various assessment protocols may aid chiropractors in delivering beneficial care, a radiographic examination is vital for a variety of reasons. 

According to Dr. Christopher Kent in a recently published document outlining the standard of care titled: An Evidence-Informed Approach to Spinal Radiography in Vertebral Subluxation Centered Chiropractic Practice, these reasons include: 

1. Determining the safety and appropriateness of chiropractic care.
2. The detection and characterization of vertebral subluxations
3. Determination of congenital and developmental anomalies which may affect the selection of chiropractic techniques
4. Ruling out conditions which may contraindicate certain chiropractic adjusting methods.
5. Radiography may disclose conditions requiring referral to another type of health care provider.

For the record, ChiroFutures Malpractice Program rejects the radiographic recommendations made by the ACA as unsafe for patients as we believe chiropractors should practice with the best interests of the patient in mind. 

CLICK HERE to review the guidelines by Dr. Kent 

Matthew McCoy DC, MPH
CEO & Co-Founder
ChiroFutures Malpractice Program
drmccoy@chirofutures.org
http://www.chirofutures.org