A Patient’s Guide To Chiropractic Imaging
Clinical imaging has been a part of the Chiropractic profession since the early 20th century. Chiropractic was the first healthcare profession to use x-ray studies to analyse the spine and it allowed practitioners to increase the specificity of their work leading to better results for patients. Since then imaging modalities have become more advanced, becoming safer and higher quality with each development. This article will give some detail and clarity on some of the primary imaging technologies used in modern Chiropractic practice, and why they may be recommended for patients.
X-Ray
X-rays are the mostly common form of clinical imaging in Chiropractic practice and have been used for the longest time. These are often used to assess the full spine. This allows Chiropractors to assess for signs of pathology, degeneration and structural changes. It can also help us determine which vertebra may need an adjustment when combined with other physical testing during an examination.
There are many different views which can be used to assess the spine, the most common for the lumbar and thoracic spine are an A-P (front view) and Lateral (side view).
In the cervical spine the most common views used in Chiropractic are a lateral view and an A-P view. However, a standard A-P view doesn’t allow for a view of the upper cervicals as they are obstructed by the jaw. In this case an APOM (A-P Open Mouth) is used which allows us to see the upper cervical vertebrae (C1/C2).
In Upper Cervical Chiropractic other specialist views are often implemented to help determine the exact direction of misalignment of the upper cervical vertebrae. These views include base-posterior, blair protracto views, and lateral flexion APOM.
X-ray radiation dosages per view:
- Cervical spine - 0.08 millisieverts
- Thoracic spine - 0.7 millisieverts
- Lumbar spine - 1.3 millisieverts
(source referenced below)
Cone Beam Computed Tomography (CBCT)
CBCT is the one of the latest innovations in clinical imaging. This technology allows practitioners to view areas of the body in 3D making the analysis more precise helping us towards better outcomes for our patients. This has become very popular in the practice of dentistry as it allows for a more custom approach to care. This type of imaging has in recent years become increasingly widely used in Upper Cervical Chiropractic and is now considered the gold standard imaging in this line of practice. Aside from the obvious advantage of being able to view the cervical spine in 3D for an enhanced and more thorough analysis, it also mitigates the need for taking multiple views. This benefits the patient as the scan is very quick to take and mitigates the need for taking multiple views.
Another advantage of a CBCT scan is that the radiation exposure is much less than standard X-Ray series. A standard CBCT scan is 240 micro-sieverts, which is equivalent to about 1/10 the radiation exposure of a standard 4-view Cervical spine x-ray series. This is the equivalent to the exposure of a 5 hour aeroplane flight.
(source referenced below)
For these reasons this is the primary form of imaging we use at Top Chiropractic, as we get the highest quality imaging with a fraction of the radiation dose. CBCT scans are taken seated or standing so we can see the spine whilst it is under the load of the skull.
Magnetic Resonance Imaging (MRI)
MRI imaging is not currently widely used in Chiropractic but can be a valuable tool in assessing some specific cases or conditions. MRI is best for looking at soft tissues structures, whereas x-ray and CBCT are best for looking at bones and joints. Within Chiropractic MRI scans are used primarily to look at structures such as the vertebral discs, spinal cord, blood vessels in the neck, and sometimes the brain.
When utilising MRI in full spine practice Chiropractors often look for confirmation of disc bulges and whether they are impacting the nerves or spinal cord. This can help them determine the best course of care whether that be with a Chiropractor or another healthcare provider depending on the severity of the case. MRI also allows practitioners to assess for anatomical variants such as Chiari malformation which need to be considered before starting care. Depending in the individual case, patients we see may already have had MRI images taken in which case we can take these findings into consideration when conducting our physical examination.
In Upper Cervical Chiropractic, MRI has been used in research to assess changes in arterial and venous supply to the brain as well as changes in cerebrospinal fluid flow in the brain. This is an exciting branch of research as it demonstrates the impact that Upper Cervical Chiropractic can have on brain function.
MRI scans do not use radiation. There are now two types of MRI scanner, one which is performed with the patient lying down, the other is performed with the patient seated. Each has its benefits depending on the reason for the scan and which structured are being viewed.
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Whiplash and Whiplash-Associated Disorder - here
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CSF Flow - here
Vagus Nerve - here
Chiropractic Philosophy - here
Digital Content and the Brain - here
Cerebrospinal Fluid - here
Maintenance Care - here
Brain Blood Flow - here
Head Posture - here
