IMAGING IN CHIROPRACTIC

Dr. Scott Rosa and Dr. John W. Baird

Understanding the nature and extent of a patient’s condition is critical to achieving a positive clinical outcome. Current imaging systems are not only powerful for ruling out contraindications but enable us to make very specifi c distinctions in directing patient care. Whether it be for assessing spinal alignment or ruling out soft tissue injury, and disruption or pathology, imaging choices are an important tool when it comes to directing the best treatment, clinical outcomes at the right time and place. In 1895, while D.D. Palmer was discovering chiropractic, Wilhelm Roentgen through his research with cathode-ray tubes put a name to what Sir William Morgan in 1785 described as the glow emanating from high tension current running through a vacuum. Roentgen named it x-rays and he received the Nobel prize in 1901. The utility of x-ray was immediately apparent and it would eventually morph into three imaging modalities being x-ray, fl uoroscopy and tomography. In 1910 B.J. Palmer introduced x-ray to the chiropractic profession and brought the fi rst x-ray machine to the Palmer School of Chiropractic. With the coming of the digital age, x-ray would become clearer, more exacting and pose a much lower radiation burden on the patient. Fluoroscopy emerged after Roentgen’s discovery when Thomas Edison introduced the Edison Vitascope in 1896. The distinction between x-ray and fl uoroscopy is analogous to the difference between a photograph and a movie. The former is better to see structures in detail while the latter permits us to observe motion. The modern-day version of fl uoroscopy in chiropractic settings is best known by the trade name DMX. By observing the cervical spine in motion, it is possible to detect hypermobile, unstable motion segments and suspicions of “Cranio-cervical Instability.” In some instances, fractures can be detected that are not observable on x-ray or Computed Tomography (CT). The use of DMX can help direct a patient to the correct type of care, improving patient safety and clinical outcomes. The fi rst CT scanner was invented in 1967 by Sir Godfrey Hounsfi eld using x-ray technology. Essentially it is the use of two x-ray tubes such that three dimensional images can be obtained making it possible to see a slice through a tissue. CT is a great modality when suspension of fractures, or bleeds subsequent to trauma, might exist. Cone Beam CT (CBCT) allows for chiropractors to view and analyze not only the external structures of the spine, but the internal as well. While it is possible to see some soft tissue on CT, MRI has evolved into a more effective way to observe soft tissue in vivo. The fi rst MRI scan was performed in 1977 by Raymond Damadian, Larry Minkoff and Michael Goldsmith. Damadian went on to found the Fonar Corporation which provides scanning in weight bearing. The upright MRI is more sensitive than recumbent when assessing cerebellar tonsillar ectopia (CTE). Cerebrospinal fl uid (CSF) fl ow maps obtained on the Fonar MRI permit observation of the effects of CTE (cerebellar tonsillar ectopia) and craniocervical injury on brain health. A series of images incrementally moving from cervical fl exion through to extension can be put together into a cine loop permitting observation of the effects of abnormal motion upon the soft tissues unlike the DMX which does not demonstrate soft tissue. There has been an emergence in the chiropractic profession of imaging the spine in weight bearing as performed with Upright MRI technology. The benefi ts are numerous, and the diagnostic yield is of great value. MRI poses no radiation exposure and carries with it the ability to scan a patient in postures that can provoke pain such as fl exion, extension, rotation, lateral bending, etc. Upright MRI has further been found to be a superior way to image the “cranio-cervical junction” for identifying potential cranio-cervical instability and rotary misalignments that might be elusive on plain fi lm x-ray. Plain fi lm x-ray has been the cornerstone of chiropractic assessment of spinal misalignments since the early 1900’s. Now the use of DMX, CBCT and Upright MRI have been gaining greater acceptance by the chiropractic profession. MRI’s ability to provide 3-dimensional thin slice imaging through spinal joints provides diagnostic capabilities that can and should be embraced by the profession. “To See is To Know, To Not Know is To Guess!”

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