Excuse Me, Doctor, Why Do I Need an X-ray?

Updated clinical guidelines reaffirm the position that radiographs are not warranted in all cases of lower back pain.

You can read the full article here.

This article is published recently in the Annals of Internal Medicine.  Consider the statement below which is copied from the full article.

“Because lumbar radiography is performed much more frequently than lumbar CT, it accounts for a greater proportion of the total radiation dose from medical imaging procedures in the United States (3.3% vs. 0.7%), despite having a lower average effective radiation dose (1.5 mSv) (44). The average radiation exposure from lumbar radiography is 75 times higher than for chest radiography (44). This is of particular concern in young women because of the proximity to the gonads, which are difficult to effectively shield. The amount of female gonadal irradiation from lumbar radiography has been estimated as equivalent to having chest radiography daily for several years.”

Unfortunately there are many clinics that require radiographs for all new patients regardless of examination findings.  This places the patient at risk of unnecessary radiation as indicated above.  This does not mean, however, that radiographs should never be obtained.  In cases where necessary (ie to rule out trauma, fracture, neoplastic growth, and/or to establish proper treatment plan) the pros outweigh the cons.  Radiographs would also be indicated in cases that do not respond to a conservative approach as would be expected.

Too many clinicians are leaving the value of a comprehensive history and thorough examination by the wayside and jumping into procedures that increase cost and cause potential harm.  Many chiropractic clinics x-ray all cases of acute low back pain when the research shows very clearly this is not beneficial.  Before you have x-rays taken ask you doctor why they are ordering the films, what part of the history and/or examination lead them to requesting the x-rays and what would be the potential detriment to continuing with a trial of care without x-rays.

In our office we adopt the current position as stated and are selective in who receives radiographs.  We are very careful to explain the pros and cons to our patients and to provide them with the alternatives and risks.

Steps You Can Take to Protect Yourself

Ask your doctor what part of your history and/or examination warrants the need for x-rays.

*  Make sure your doctor listens to your full history and provide them with all the details of your lower back pain.  Don’t withhold information from you doctor.  Tell them all the details, even things that may seem irrelevant to you.

*  Make sure your doctor performs a complete examination.  For lower back pain the minimum required parts of the exam would be to test your muscle strength, test your reflexes, perform a brief sensory examination and observe your gait.  They should also perform a series of orthopedic tests to compress, stretch, or stress the tissues to identify the underlying cause of your lower back pain.  If they are knowledgeable in their assessment of your low back complaints…find a new doctor.

*  If your doctor wants to take radiographs to just “show you what your back looks like” or to use them as an “educational tool”, then suggest that you would like to refrain from the x-ray exposure and would prefer to follow a trial of care that doesn’t involve unnecessary exposure.

*  If x-rays are warranted and necessary then ensure that the doctor uses the appropriate precautions and uses proper shielding and collimation to limit your exposure.  There are also a variety of nutrient interventions you can use to help protect your cells after radiation exposure.

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