A very good question that I am asked frequently.  As I’m sure you are aware technology changes every day the advances in medical imaging technology are no different. The main ones DC’s are concerned with are MRI, MR Arthrography CT, Fluoscopy, Ultrasound, Bone Scan, X-ray

Just a few of the headlines from a well know radiology website auntminne.com, Holography beckons as alternative to 3D printing, ISCT: The road to full automation in abdominal CT, Photoacoustic imaging could guide breast CA removal, CT detects frailty and predicts survival in elderly and June 21, 2017 — Brigham and Women’s Hospital (BWH) in Boston is making a considerable investment in the future of radiology and patient care with its recent installation of an investigational 7-tesla MRI scanner.
Granted these are out of reality for chiropractors but I think you get the idea. So lets focus on musculoskeletal imaging since that’s the bailiwick for most DCs

So do I go to MR or maybe MSKUS? Well first lets go back to basics a patient comes in with a common musculoskeletal complaint of _________

  • Initially, musculoskeletal issues should be simply imaged FIRST WITH X-RAY. It should be remembered that plain films remain the most reliable imaging method for assessment of both biological activity and probable diagnosis of an osseous lesion.  X-ray equipment is relatively inexpensive and widely available.
  • Plain X-ray therefore is used to arrive at a reasonable differential diagnosis or at least to categorize the lesion as to degree of aggressiveness.
  • To visualize structures natural contrast is used between the 5 radiographic densities- Air, fat, water, bone and metal.
  • You can visualize the area as a whole with relation to surrounding osseous and soft tissue structures

Advantage-fast, readily available, inexpensive, and noninvasive

Disadvantage-lack of soft tissue discrimination, ionizing radiation.

  • It is an absolute necessity to have a minimum of two views perpendicular to each other.
  • In summary, X-RAY first:
      • Provide initial investigation of abnormalities
      • Provide information on what additional imaging may be indicated or contraindicated
      • Diagnosis is frequently possible or provide short differential

So whats the down side?  Ionizing radiation used in the production of X-ray images is dangerous with continuous exposure to these rays over time may cause damage to the body. However, with the advances of modern digital technology and micro second imagining exposure times the benefits of an accurate diagnosis and treatment far outweigh the comparatively small risk involved in X-ray imaging.

As mentioned above, always take at minimum 2 views, so here is a case example of why always a minimum of 2 images: A 35yr old women complains of neck pain.

For purposes of this discussion only look at the AP, please DON’T CHEAT!. The referring doctor was very concerned with what he saw on the AP, What do you see? 

Strange looking area to right of the spine? Potentially aggressive looking? Possible soft tissue lesion?. Well as I mentioned above always, always take at least 2 views. Now lets look at the lateral I hope you didn’t cheat.