A Tale of Specialization in 2 Professions: Comparing the Development of Radiology in Chiropractic and Medicine (original) (raw)
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Chiropractic & Manual Therapies
Background: It is known that not all chiropractors follow mainstream guidelines on the use of diagnostic ionising radiation. Various reasons have been discussed in the literature, including using radiography to screen for congenital anomalies, to perform postural analysis, to search for contraindications to spinal manipulation, and to document chiropractic subluxations, i.e., tiny anatomical displacements of vertebrae thought to affect nerves and health. The visualisation of subluxations was the reason chiropractic first adopted the x-ray in 1910. There has never been a study of the influence of this historical paradigm of radiography on the practices of chiropractic radiologists (DACBRs or Diplomates of the American Chiropractic College of Radiology). Methods: A survey was administered with a modified Dillman method using SurveyMonkey and supplemented by hard copies distributed at a professional conference. The target population was all active DACBRs. There were 34 items, which consisted of multiple choice and open-ended interrogatives on all three areas in which chiropractic radiologists work: education, clinical practice, and radiology practice. Results: The response rate was 38% (73 of 190 DACBRs). Respondents reported that the historical paradigm of radiography was found in all areas of practice, but not as a major aspect. The majority of respondents did not condone that historical paradigm, but many tolerated it, particularly from referring chiropractors. Radiographic subluxation analysis was reportedly perpetuated by private clinical practitioners as well as technique instructors and supervising clinicians in the teaching institutions. Conclusions: Within the chiropractic profession, there is a continuing belief in radiographically visible subluxations as a cause of suboptimal health. This situation is sustained in part due to the reticence of other chiropractors to report these practices to licensing and registration boards. Investigation into other structures supporting a vitalistic belief system over science in chiropractic is recommended. In addition, it may be useful to explore remunerative systems that move beyond the inherently conflicted fee-for-service model.
Chiropractic & manual therapies, 2014
Chiropractic technique systems have been historically documented to advocate overutilization of radiography. Various rationales for this have been explored in the literature. However, little consideration has been given to the possibility that the healthcare belief system of prominent early chiropractors may have influenced the use of the diagnostic modality through the years. The original rationale was the visualisation of chiropractic subluxations, defined as bones slightly out of place, pressing on nerves, and ultimately causing disease. This paradigm of radiography has survived in parts of the chiropractic profession, despite lacking evidence of clinical validity. The purpose of this paper is to compare the characteristics of the chiropractic technique systems that have utilised radiography for subluxation detection with the characteristics of religion, and to discover potential historical links that may have facilitated the development of those characteristics. Twenty-three cur...
Health and History, 2016
Chiropractic fi rst adopted the X-ray in 1910 for the purpose of demonstrating tiny misalignments of spinal bones, theorised to cause all disease, which they called chiropractic subluxations. This paper explores the apparent contradiction and resultant controversy of a system of natural healing adopting a medical technology. It centres on the actions of B.J. Palmer, the fi rst chiropractor to use X-rays. It also clarifi es details of Palmer's decision to incorporate the technology and interprets the change in the sociological context of boundary work. The continuing use of the subluxation paradigm for radiography by chiropractors has had a lingering effect on the profession, a metaphorical hangover of vitalism that is not consistent with modern healthcare practice. As a result of this confl ict, arguments within the profession on the use of X-rays contribute to the continuing schism between evidencebased and subluxation-based chiropractors.
Divergent beam: A history of the use of x-rays in chiropractic
2018
The use of diagnostic x-ray is controversial in chiropractic, due to different groups in the profession holding conflicting opinions on its main utility. This thesis is a historical study of the effects the x-ray has had on the practice of chiropractic from its introduction in 1910 until the present day. It examines the influence of the founders of the profession, other prominent chiropractors, medical and chiropractic professional associations, as well as the role of the state in defining the paradigms for diagnostic imaging. The study adopts a biomedical perspective which prioritises the use of historical evidence in contextualising epistemologies of healthcare methods. In doing so it questions traditional chiropractic depictions of health and disease, which have not changed significantly since the profession’s inception. Historically, chiropractic has been divided along traditional/biomedical lines, and the exacerbating effect of the adoption of x-ray technology on the schism in ...
Inside Chiropractic: Yesteryear and Today
Science-Based Medicine, 2018
The chiropractic profession in the United States continues to be defined by the vertebral subluxation theory that gave it birth and independence as an alternative to conventional medical care, resisting changes that would allow development of chiropractic as a conservative back-care specialty.
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)
Radiograph utilization and demographics in a chiropractic college teaching clinic
Journal of Chiropractic Medicine, 2012
The purpose of this study is to present radiograph utilization at a chiropractic college teaching clinic, the associated patient demographics, and the utilization rates by body region. Methods: Data for outpatient services over a 3-year period were extracted from a college clinic administrative software program. Radiographic data were matched with patient demographic information providing the age, sex, and financial class for all patients. Results: The overall radiograph utilization rate was 8%, with the highest frequency occurring in the spine in the order of lumbar, cervical, and then thoracic regions. Spinal radiographs made up 66% of the total radiographs taken. The utilization rate increased as the age of the patients increased. The average patient age was 46, and 48% were female. Conclusion: The radiograph utilization rate at this teaching clinic was lower than previous studies. This study provides new information regarding overall and regional radiography rates and associated patient demographics from an American chiropractic college.
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
Journal of Chiropractic Humanities, 2012
The purpose of this study was to track the graduates of the Los Angeles College of Chiropractic (LACC) radiology residency program, review their scholarly productivity, and report those involved in teaching and leadership positions. Methods: Former LACC residents' career information was identified through publicly available electronic documents including Web sites and social media. PubMed and the Index to Chiropractic Literature databases were searched for chiropractic graduate job surveys, and proportional comparisons were made between the career paths of LACC radiology residency graduates and those of non-residency-trained chiropractors. Results: Of 47 former LACC residents, 28 (60%) have or previously had careers in tertiary (chiropractic) education; and 12 (26%) have attained a department chair position or higher at tertiary teaching institutions. Twenty-two (47%) have or previously had private radiology practices, whereas 11 (23%) have or previously had clinical chiropractic practices. Often, residency graduates hold or have held 2 of these positions at once; and one, all 3. Chapters or books were authored by 13 (28%). Conclusion: Radiology residency LACC graduates are professionally active, particularly in education, and demonstrate scholarly productivity.