European Guidelines on Radiographic Image Quality in Chiropractic Practice – Proposal of a Cross-Sectional Graded Classification Reporting Principle (original) (raw)
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Chiropractor's use of radiography in Switzerland
Journal of Manipulative and Physiological Therapeutics, 2003
Objective: In this article, we investigate the use of diagnostic radiology by chiropractors in Switzerland, with the aim of determining their contribution to the annual radiation collective dose. Methods: We approached 138 chiropractors possessing radiologic equipment and asked them to provide, among other information, the frequency of radiographic examinations. The dose associated with each type of radiographic examination was established separately. The collective dose was determined by convolution of frequency and dosimetric information. Results: The number of chiropractic radiographic examinations performed in Switzerland in 1998 was 60,000, mainly spinal and pelvic examinations. The associated annual collective dose was found to be 144 Sv (an annual effective dose of 20 Sv per capita). The chiropractic contribution to the total dose due to conventional radiography in Switzerland is about 6%. Conclusions: Considering the number of chiropractors in Switzerland (less than 200), their contribution to the collective dose is relatively high. This is due to the high effective dose associated with the main types of examinations performed (eg, lumbar spine). It is therefore necessary to develop and apply guidelines for the use of this type of radiographic examination, as well as quality control programs, in order to optimize the radiographic technique and hence reduce the doses. (J Manipulative Physiol Ther 2003;26:9-16)
Chiropractic Journal of Australia, 2009
Objective: To enumerate the types of pathology seen on lumbar spine plain radiographs of patients reporting to private chiropractic clinics in the United Kingdom. Design: Retrospective analysis of radiology reports from a chiropractic radiology consultancy. Setting: Private chiropractic radiology practice. Patients/Participants: All lumbar spine radiograph reports from a chiropractic radiology consulting practice over the course of one year were reviewed and the diagnoses were noted. 276 reports were reviewed and 262 were included in the study. Reports were included if they had definitive diagnoses, contained all relevant clinical information such as patient age, and reported on the lumbar spine only (e.g. full spine and thoraco-lumbar reports were excluded). Intervention: None. Main Outcome Measures: The types of pathology and number of times each was encountered were entered on to a spreadsheet and totaled by type and category. Results: Postural alterations and degenerative arthro...
Journal of Clinical Medicine
Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value. Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of (PROTS) in practice. In this study, DCs were surveyed regarding utilization of PROTS in practice. The survey was administered to an estimated 50,000 licensed DCs by email. A total of 4301 surveys were completed, of which 3641 were United States (US) DCs. The Clinician Opinion and Experience on Chiropractic Radiography (COECR) scale was designed to analyze survey responses. This valid and reliable scale demonstrated good internal consistency using confirmatory factor analysis and the Rasch model. Survey responses show that 73.3% of respondents utilize PROTS in practice and 26.7% refer patients out for PROTS. ...
Chiropractic & Manual Therapies
Introduction: When indicated by signs or symptoms of potentially serious underlying pathology (red flags), chiropractors can use radiographs to inform their diagnosis. In the absence of red flags, the clinical utility of routine or repeat radiographs to assess the structure and function of the spine is controversial. Objectives: To determine the diagnostic and therapeutic utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. Investigate whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. The research objectives required that we determine the validity, diagnostic accuracy and reliability of radiographs for the structural and functional evaluation of the spine. Evidence review: We searched MEDLINE, CINAHL, and Index to Chiropractic Literature from inception to November 25, 2019. We used rapid review methodology recommended by the World Health Organization. Eligible studies (cross-sectional, case-control, cohort, randomized controlled trials, diagnostic and reliability) were critically appraised. Studies of acceptable quality were included in our synthesis. The lead author extracted data and a second reviewer independently validated the data extraction. We conducted a qualitative synthesis of the evidence. Findings: We identified 959 citations, screened 176 full text articles and critically appraised 23. No relevant studies assessed the clinical utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine. No studies investigated whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. Nine low risk of bias studies investigated the validity (n = 2) and reliability (n = 8) of routine or repeat radiographs. These studies provide no evidence of clinical utility. Conclusion: We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.
Chiropractic & Manual Therapies, 2021
Background Managing low back pain (LBP) often involves MRI despite the fact that international guidelines do not recommend routine imaging. To allow us to explore the topic and use this knowledge in further research, a reliable method to review the MRI referrals is needed. Consequently, this study aimed to assess the inter-rater reliability of a method evaluating lumbar spine MRI referrals’ appropriateness. Methods Four inexperienced students (chiropractic master’s students) and a senior clinician (chiropractor) were included as independent raters in this inter-rater reliability study. Lumbar spine MRI referrals from primary care on patients (> 18 years) with LBP with or without leg pain were included. The referrals were classified using a modified version of the American College of Radiology (ACR) imaging appropriateness criteria for LBP. Categories of appropriate referrals included; fractures, cancer, previous surgery, candidate for surgery or suspicion of cauda equina. Inappro...
Spine, 2015
A cross-sectional diagnostic accuracy study was conducted in two sessions. It is important to know whether it is possible to accurately detect "specific findings" on lumbosacral MRI scans and whether the results of different observers are comparable. Healthcare providers frequently use MRI in the diagnostic process of patients with low back pain. The use of MRI scans is increasing. This leads to an increase in costs and to an increase in risk of inaccurately labelling patients with an anatomical diagnosis that might not be the actual cause of symptoms. A set of 300 blinded MRI scans was read by medical radiologists, chiropractors and chiropractic radiologists in two sessions. Each assessor read 100 scans in round 1 and 50 in round 2. The reference test was an expert panel.For all analyses the MRI-findings were dichotomized into 'specific findings' or 'no specific findings'. For the agreement, percentage agreement and kappa were calculated and for validity, ...
The Journal of the Canadian Chiropractic Association, 2005
Radiography has been part of chiropractic diagnostics since shortly after its discovery in 1895, the same year D.D. Palmer discovered chiropractic. In fact, it was B.J. Palmer who brought x-ray to chiropractic in 1910. 1 This is what led to a very interesting and rich chiropractic history of technique innovators with their varied radiographic biomechanical analysis systems. Many different x-ray analysis systems are used today in clinical practice and research as well as taught in the chiropractic colleges around the world. In fact, use of radiography for structural data is an integral component to the practice of chiropractic. 2,3 With the recent concerns about the profession's future (i.e. to remain a separate entity or be incorporated into mainstream medicine), 4 there has been pressure to restrict the use of radiography in clinical practice. 5-10 In fact, recent proposed guidelines suggest that except for ruling out "red flags" (i.e. serious medical conditions such as cancer, infection etc…) no radiographic imaging should be taken for treatment management of patients presenting with uncomplicated low back pain. 11-15 To no surprise, the current practice trend is much higher than this. 15-18 This commentary is written to present to the profession, and specifically to the advocates of continued restrictive use of radiography in clinical practice and research (i.e. DACBRs), that at low doses of ionizing ra
BACKGROUND: Plain film radiography is the most common imaging technique requested by chiropractors to assist in the management of patients with musculoskeletal complaints. There is a paucity literature indicating that chiropractors’ interpretive radiographic skills are consistently able to achieve the same outcome given a particular set of radiographs. An important indication for the use of radiography in chiropractic is to exclude any possible contraindications to spinal manipulative therapy (SMT) that could cause serious injury to a patient if it is left unmodified or excluded as a treatment option. OBJECTIVES: The study aimed to investigate the inter- and intra-examiner reliability of chiropractor’s diagnosis on cervical spine radiographs. Additionally, the effect of clinical history added to the radiographs was assessed. METHODS: Inter- and intra-examiner evaluations occurred on two consecutive readings of 30 radiographs by six qualified chiropractors. No clinical history was gi...
Journal of Manipulative and Physiological Therapeutics, 2004
National Library l*l of Canada Bibiiitheque nationale du Canada Acquisitions and Acquisitions et Bibtiographic Services services bibliographiques 335 Wellington Street 395, nie Wellington Chtaw8ON K 1 A W m w a ON KlAûN4 Caneda canada The author has granted a nonexclusive licence allowing the Nationai Library of Canada to reproduce, loan, distribute or sel1 copies of this thesis in microform, paper or electronic formats. The author retains ownership of the copyright in this thesis. Neither the thesis wr substantial extracts fiom it may be printed or othedse reproduced without the author's permission. L'auteur a accordé une licence non exclusive permettant à la Bibliothèque nationale du Canada de reproduire, prêter, distribuer ou vendre des copies de cette thèse sous la forme de microfichelfilm, de reproduction sur papier ou sur format électronique. L'auteur conserve la propriété du droit d'auteur qui protège cette thèse. Ni la Wse ni des extraits substantiels de celle-ci ne doivent être imprimés ou autrement reproduits sans son autorisation. Implementing Evidence-Based GuideIines for X-ray Use in Acute Low Back Pain: A Pilot Study in a Chiropractic Community. Car10 Ammendolia,
Adherence to Radiography Guidelines for Low Back Pain: A Survey of Chiropractic Schools Worldwide
Journal of Manipulative and Physiological Therapeutics, 2008
Objective: This study describes instruction provided at chiropractic schools worldwide on the use of spine radiography and compares instruction with evidence-based guidelines for low back pain. Methods: Individuals responsible for radiology instruction at accredited chiropractic schools throughout the world were contacted and invited to participate in a Web-based survey. The survey included questions on the role of conventional radiography in chiropractic practice and instruction given to students for its use in patients with acute low back pain. Results: Of the 33 chiropractic schools identified worldwide, 32 (97%) participated in the survey. Consistent with the guidelines, 25 (78%) respondents disagreed that "routine radiography should be used prior to spinal manipulative therapy," 29 (91%) disagreed that there "was a role for full spine radiography for assessing patients with low back pain," and 29 (91%) disagreed that "oblique views should be part of a standard radiographic series for low back pain." However, only 14 (44%) respondents concurred with the guidelines and disagreed with the statement that there "is a role for radiography in acute low back pain in the absence of 'red flags' for serious disease." Conclusions: This survey suggests that many aspects of radiology instruction provided by accredited chiropractic schools appear to be evidence based. However, there appears to be a disparity between some schools and existing evidence with respect to the role of radiography for patients with acute low back pain without "red flags" for serious disease. This may contribute to chiropractic overutilization of radiography for low back pain. (J Manipulative Physiol Ther 2008;31:412-418) Key Indexing Terms: Public health; Chiropractic M ore than 90 000 chiropractors practice internationally, and this number is expected to grow to 150 000 by the year 2010. 1 Most practicing chiropractors are graduates of one of approximately 30