Table of Contents  

Preface

I.          Description of levels of evidence. Levels 1-5 and evidence based medicine guidelines.

A.                 Description of levels of evidence.

B.                 Review of Levels 1-4 and evidence based medicine guidelines.

C.                 Previous Chiropractic guidelines ignore case reports, cohort studies, etc…

D.                 Emphasis is in all types for evidence. Clinical decision/judgment of the treating Chiropractor is important.

II.         Chiropractic Guideline for Spine Radiography for Assessment of Spinal Subluxation in Children and Adults

A.                 Tables of conditions.

B.                 Post-Treatment x-ray utilization to document reduction of spinal subluxation.

C.                 Position on Follow-up x-ray imaging to ascertain stability of spinal correction.

D.                 Position on Radiography of Children.

E.                  Position on Computerized analysis of radiographs.

F.                  Position on Videoflouroscopy or Digital Motion X-ray Analysis.

III.       Spinal Radiography Back Ground and Utilization Costs

A.                 Summary of Need for these guidelines.

B.                 A Minority group of Policy makers, Chiropractic Academics, and a sub group of DACBRs are pushing Red Flag only S-ray guidelines on the profession.

C.                 Considerable scientific evidence refutes Red Flag only x-ray guidelines.

D.                 Natural history of spinal pain is not consistent with Red Flag only guidelines.

E.                  Chiropractic needs different X-ray guidelines due to unique analysis and intervention.

F.                  Radiography utilization costs.

IV.       Introduction (Historical Perspective)

A.                 Historical Prospective of radiology in Chiropractic Practice.

B.                 History of Technique Systems use of Radiology.

V.        Definition of Subluxation and Average Normal Spinal Alignment

VI.       Review of X-ray Usage and Guidelines by Orthopedic Surgeons, Family Practice Physicians, Medical Radiologists (ACR), and Chiropractic Radiologists (ACCR).

VII.      Radiation Safety: LNT Model versus the Radiation Hormesis Model

VIII.     Reliability of Geometric Line Drawing Radiographic Analysis

IX.       Reliability/Repeatability of Radiographic Positioning

X.        Description, Reliability, Validity & Efficacy of Chiropractic radiographic views.

A.        Reliability of Radiographic Positioning.

B.         Reliability of Geometric line drawing for typical chiropractic radiographic views.

C.        Validity of Radiographic line drawing for subluxation assessment.

D.        Radiographic outcome investigations of various conservative procedures.

XI.       Pediatric Radiographic Evaluation in Chiropractic

XII.      The Presence of abnormal posture and any axial pain or radicular pain requires

Radiographic evaluation

A.                 Where does the pain come from.

B.                 Why would there be pain (mechanoreceptor firing from abnormal loads).

C.                 Where do abnormal loads come from (abnormal postural & spinal alignment).

D.                 Wolff’s Law & Davis’ Law and DJD is a cause of pain and impairment.

XIII.     Legal Obligations of a DC for radiographic Use (Case Law, Judge’s decisions)

XIV.    Summary