Radiography and Clinical Decision-Making in Chiropractic

Area of Science:

• Chiropractic and Diagnostic Imaging
• Radiography Risk Assessment
• Evidence-Based Practice

Background:

• X-ray exposure concerns can outweigh benefits, particularly in manual therapy.
• Accurate spinal malalignment assessment requires imaging.
• Chiropractic spinal disorders present different criteria for X-ray use compared to medical practice.

Purpose of the Study:

• To advocate for distinct radiography guidelines in chiropractic care.
• To address the limitations of current risk assessment models (Linear-No-Threshold) in chiropractic.
• To align evidence-based guidelines with clinical decision-making processes.

Main Methods:

• Analysis of current radiography risk assessment models.
• Comparison of frequentist and pseudo-Bayesian reasoning in clinical practice.
• Review of evidence-based practice guidelines in chiropractic.

Main Results:

• Current guidelines may lead to overly cautious X-ray use, disregarding patient-specific risk/benefit ratios.
• Frequentist perspectives in guidelines can shift decision-making away from practical patient needs.
• Existing guidelines do not adequately account for the specific demands of chiropractic manual therapy.

Conclusions:

• Radiography guidelines for chiropractic must be tailored to the profession's unique patient population and therapeutic modalities.
• A shift towards patient-centered risk/benefit analysis is needed for chiropractic radiography.
• Guidelines should support comprehensive spinal assessment prior to manual therapies like high-velocity, low-amplitude spinal manipulation (HVLA-SM).