A Tale of Specialization in 2 Professions: Comparing the Development of Radiology in Chiropractic and Medicine

Abstract

Objective: The purpose of this article is to describe the development of radiology as a specialty in chiropractic with a comparison to the development of the specialty of radiology in medicine. Discussion: Specialization in medicine has been notably successful, with advanced training and enhanced capabilities in specialized skills leading to better outcomes for patients and increased prestige for practitioners. However, with chiropractic, as with other complementary and alternative medicine professions, no specialization has been recognized within it. Specialist radiology training in chiropractic bears a resemblance to that of medicine, with competitive entry for residencies, certification exams, and the creation of a journal and specialist professional organizations. To facilitate the comparison, I have divided the development of radiology into 4 phases from the chiropractic perspective. Phase 1 started with the discovery of x-rays in 1895, in which medicine adopted them but chiropractic did not. Phase 2 began in 1910 when B. J. Palmer introduced radiography to show chiropractic subluxations. Phase 3 started in 1942 when Waldo Poehner advocated for the mainstream diagnostic use of radiography in addition to subluxation analysis. Phase 4 started in 1957 when an examining board for certification in diagnostic radiology was assembled and many chiropractors began to embrace the mainstream medical use of radiography. Conclusion: In this tale of 2 professions, radiology gained official specialty designation in the field of medicine. The medical profession had a monopoly on health care, and thus had few internal and external barriers to overcome. Chiropractic was oppressed by organized medicine, which helped to create the unofficial specialty of chiropractic radiology but which also later helped to limit the specialty. Chiropractic radiology has maintained its independence and autonomy, but also remains on the fringe of mainstream health care.

Words matter: the prevalence of chiropractic-specific terminology on Australian chiropractors’ websites

“…This lexicon reinforces the separation of chiropractic from other health care professions [8,9]. Promoting chiropractic as alternative rather than complementary or mainstream may be detrimental to patients by deterring or delaying referrals both to and from other health care professionals [10][11][12][13][14]. Barker, Reid, and Lowe [15] listed three different reasons common language was important when communicating information about back pain: 1) patients seeking information from health care professionals may encounter difficulty interpreting health care literature, 2) misunderstandings may arise among health professionals, and 3) a lack of standard definitions can make comparison of research studies challenging.…”

Factors affecting chiropractor requests for full‐length spinal radiography: A scoping review

“…A total of 21 of the 25 eligible articles (84%) examined in this review were written by authors with a background in chiropractic 2–6,11,12,15–28 . A total of 11 of the eligible articles were reviews of existing literature, which examined evidence surrounding the use of FLS X‐rays in chiropractic in isolation, or as a part of wider studies examining the utilisation of medical imaging by chiropractors 2–6,12,19,24,25,28 .…”

“…[2][3][4][5][6]11,12,[15][16][17][18][19][20][21][22][23][24][25][26][27][28] A total of 11 of the eligible articles were reviews of existing literature, which examined evidence surrounding the use of FLS X-rays in chiropractic in isolation, or as a part of wider studies examining the utilisation of medical imaging by chiropractors. [2][3][4][5][6]12,19,24,25,28 Seven cross-sectional studies were identified, which investigated knowledge of and adherence to established guidelines for the utilisation of medical imaging, including FLS X-rays in chiropractic and explored how knowledge of these guidelines impacted imaging referral patterns. 11,[16][17][18]21,26,27 Populations and perspectives were regionally diverse, with predominant author representation from Australia, North America and Europe.…”

“…Nine eligible articles addressed the historical integration of FLS radiography in chiropractic. 2,6,19,22,[24][25][26][27][28] Articles outlined the early uses of FLS radiography or 'spinography' by chiropractors to attempt to confirm vertebral subluxation theory. CVS was first described by chiropractic's founder, D.D.…”

“…A total of 13 articles described the use of FLS radiography as prescribed by contemporary chiropractic techniques or treatment systems. [2][3][4][5][6]11,12,15,20,[24][25][26][27][28] Six published techniques were identified which require the use of FLS radiography including the Gonstead, Chiropractic BioPhysics, Applied Spinal Biomechanical Engineering, Universal Chiropractic College, Pierce/Stillwagon, Spinal Stressology and Logan techniques. 4,5,12,24 Authors described a strong correlation between the use of these techniques and increased reliance on FLS radiography, suggesting incongruity between adherence to guidelines for spine imaging and the pressure placed on chiropractic practitioners to adhere to the requirements of a given technique system.…”