Are Restrictive Medical Radiation Imaging Campaigns Misguided? It Seems So: A Case Example of the American Chiropractic Association’s Adoption of “Choosing Wisely”

Abstract

Since the 1980s, increased utilization of medical radiology, primarily computed tomography, has doubled medically sourced radiation exposures. Ensuing fear-mongering media headlines of iatrogenic cancers from these essential medical diagnostic tools has led the public and medical professionals alike to display escalating radiophobia. Problematically, several campaigns including Image Gently, Image Wisely, and facets of Choosing Wisely propagate fears of all medical radiation, which is necessary for the delivery of effective and efficient health care. Since there are no sound data supporting the alleged risks from low-dose radiation and since there is abundant evidence of health benefits from low-doses, these imaging campaigns seem misguided. Further, thresholds for cancer are 100 to 1000-fold greater than X-rays, which are within the realm of natural background radiation where no harm has ever been validated. Here, we focus on radiographic imaging for use in spinal rehabilitation by manual therapists, chiropractors, and physiotherapists as spinal X-rays represent the lowest levels of radiation imaging and are critical in the diagnosis and management of spine-related disorders. Using a case example of a chiropractic association adopting “Choosing Wisely,” we argue that these campaigns only fuel the pervasive radiophobia and continue to constrain medical professionals, attempting to deliver quality care to patients.

Correction of a double spondylolisthesis of the lumbar spine utilizing Chiropractic BioPhysics^® technique: a case report with 1 year follow-up

“…Although within the medical management of LBP, routine X-rays are not recommended as it does not usually change the course of treatment (e.g. pain, anti-inflammatory, and/or muscle relaxant medications) 28 , 29 ) , routine X-rays for LBP are recommended for manual therapy providers who specialized in methods that require biomechanical analysis for methods that are radiographically-guided much like spinal surgeons 30 , 31 ) .…”

5 Reasons Why Scoliosis X-Rays Are Not Harmful

“…Since the risks of radiocarcinogenicity from medical X-rays is low, if not non-existent, why are there such enthusiastic movements to reduce these exposures (e.g. American Chiropractic Association’s adoption of Choosing Wisely 111 )? The answer lies in the underlying assumptions regarding radiation carcinogenicity models.…”

X-ray Hesitancy—Response to Jargin and Sohrabi

“…3 We have presented this narrative in several publications recently in the arena of risk assessment from X-ray exposures in the manual therapies. 1,4,[12][13][14][15][16][17] Our article at hand 1 highlighted 3 main concerns fueling "X-ray hesitancy" stemming from the fear-mongering from outdated LNT ideology; namely that 1. All radiation is harmful; 2.…”

“…We celebrate with Sohrabi who reports that discussions held at a recent Joint American Nuclear Society and Health Physics Conference led to a consensus that the LNT was “unsupported by basic science and represents an overestimate of the risks of low-dose/rate.” 3 We have presented this narrative in several publications recently in the arena of risk assessment from X-ray exposures in the manual therapies. 1 , 4 , 12 - 17 Our article at hand 1 highlighted 3 main concerns fueling “X-ray hesitancy” stemming from the fear-mongering from outdated LNT ideology; namely that 1. All radiation is harmful; 2.…”