Do I need an X-ray?
This is a question that we get asked on a frequent basis and the answer is dependant on a number of very specific factors. Many patients like the idea of having an x-ray because they have formed the opinion that it will ‘show what has gone wrong’. You may not be aware but Chiropractors are trained in:-
- Radiography – the process of taking X-rays and getting the right pictures from the right position with the correct exposure.
- Radiology – the interpretation of the X-ray
These above qualifications along with the fact that the Chiropractor is the examining and diagnostic clinician helps to place your chiropractor in a unique position to decide on the merits of any imaging procedures. As these decisions are taken by a single person there is no loss of any continuity in this decision process.
We use our own X-ray and processing equipment at the clinic which is serviced annually and inspected every three years to comply with the relevant laws.
What does an X-ray show?
X-rays images can show a number of things but they cannot show pain. There may well be a number of things visibly ‘wrong’ e.g. wear and tear (osteoarthritis) or a narrowed disc but these do not have to hurt and can be clinical red herrings and not relevant to your pain.
Finding ‘abnormalities’ on a X-ray can be a little like a car that does not go and you discover one of the tyres is a little flat. This could affect how the car drives but if the real problem is that the car has run out of petrol this flatter tyre is not important at that point in time – but of course it may become a reason as to why the car does not not drive at later date.
So what are the reasons for taking an X-ray?
A decision about whether to take an X-ray is a cumulative process that generally starts from the case history. More or less weight is added this thought or taken away during the physical examination. There are a set of strict criteria that we adhere to and you have to have some of these criteria. The more criteria you have the greater the likelihood of you having an X-ray. They are:-
- Over 50 years old (this increases the chance of finding abnormalities compared to younger individuals)
- Significant trauma or injury (i.e. we suspect a fracture could be a possibility)
- Neurological abnormalities found on examination
- Unexplained weight loss (this can occur in for example cancer or chronic illness such as TB)
- Known or suspicion of inflammation. Arthritis present such Rheumatoid Arthritis (RA) or Ankylosing Spondylitis (AS)
- Drug or alcohol abuse (this can increase the chance of fracture or infections or chronic malnutrition affecting the bones and tissues)
- Cancer in the past
- Steroid use (steroids e.g. for asthma can over a long time produce brittle bone disease – Osteoporosis or thinning – Osteopenia)
- Unexplained temperature (over 37.8 degrees Celsius 100F may indicate infection)
- Previous surgery in the area ( e.g. spinal fusion, hip replacement)
- Inconsistent biomechanical findings (the signs and symptoms just ‘do not add up or conflict with our examination findings’)
- Failure to improve
- High blood pressure
- Legal proceedings/compensation
- Diabetes
- Limited examination due to pain
- Evaluation of complex postural or biomechanical disorders (e.g. spinal curves or scoliosis)
Other factors that can influence the decision making process are:-
- The area of interest e.g. it can be more routine to x-ray a hip if we suspect it to be arthritic and perhaps less so for an arthritic elbow
- Management of your condition – whether having an x-ray could change your treatment i.e. referral back to your GP
- If other diagnostic procedures would be more appropriate e.g. Blood tests or MRI/CT scans as more information would be gleaned without the need for x-ray radiation
Finding ‘abnormalities’ on a X-ray can be a little like a car that does not go and you discover one of the tyres is a little flat. This could affect how the car drives but if the real problem is that the car has run out of petrol this flatter tyre is not important at that point in time – but of course it may become a reason as to why the car does not not drive at later date.
