Response to Letters From Anderson and Kawchuk et al: X-Ray Imaging Is Essential for Contemporary Chiropractic and Manual Therapy Spinal Rehabilitation: Radiography Increases Benefits and Reduces Risks

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 ) .…”

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

“…153 Since points 1 and 2 of the ACA’s interpretation of Choosing Wisely are anti X-ray use 48 and stem from a corporate entity’s (Spine IQ, IA, USA) attempt to define “good” clinical performance measures; this logically indicates that no or reduced imaging of a patient’s spine will be represented as the future standard for which chiropractic clinicians will be judged against. Problematically, as previously stated, this “good performance standard” is in direct opposition to considerable evidence 53,54,56, 154,155 and represents only one side of a controversial topic. 55,155 Problematically, this is one of the main critiques of the Choosing Wisely campaigns as “the motives of professional societies with Choosing Wisely lists has been questioned.” 156 Since the launching of the ACA’s Choosing Wisely campaign, over 30 chiropractic groups, technique organizations, state and national associations, foundations, colleges, and universities have formally rejected the ACA’s Choosing Wisely list 157 (Table 3).…”

“…X-ray restrictive guidelines and their supporters often ignore or dismiss the scientific evidence supporting structural-based spine care. 54 -56 Thus, the universal pressure to restrict X-ray use in spinal rehabilitation goes against the evidence-based practice of many patient-centered, spine-specific, biomechanical treatment approaches that are readily available, taught in graduate and postgraduate education, and practiced by a significant number of clinicians. 11 -45…”

Death of the ALARA Radiation Protection Principle as Used in the Medical Sector

“…149 To help physicians, many discipline-specific radiological guidelines have been created; however, sometimes duplicate guidelines can be conflicting 150 and often have a bias based on who created them (ie, for or against imaging in similar clinical scenarios). 83,151,152 Clinical guidelines are just that, a “guideline” for the purpose of assisting the clinician in navigating patient triage. The final decision to opt for radiological imaging always comes down to the doctor and patient.…”