Palmer College of Chiropractic has sent its alumni a response to the American Chiropractic Association's "Choosing Wisely" recommendations regarding appropriate clinical use of X-rays. Here is the complete response, authored by Dr. Dennis Marchiori, Palmer chancellor and CEO:
The American Chiropractic Association (ACA) recently released recommendations to reduce "unneeded or overused (chiropractic) services" in support of its "Choosing Wisely®" campaign to improve doctor-patient communication and patient care. While the ACA should be lauded for its efforts to improve communication and care, I am compelled to respond to its recommendations regarding the use of plain film radiography.
Specifically, Palmer College does not support the narrow scope of plain-film use endorsed by the ACA, "In the absence of red flags, do not obtain spinal imaging (X-rays) for patients with acute low-back pain during the six weeks after the onset of pain" and "Do not perform repeat spinal imaging to monitor patients' progress." Neither would Palmer College support statements that convey the opposite extreme of clinical decision making. These decisions are not typically black and white, but contextual to clinical circumstances. Palmer College acknowledges and supports the latitude needed by clinicians to navigate the "shades of gray" encountered in clinical practice related to the use of diagnostic imaging.
Instead, we urge practitioners to consider carefully costs in terms of ionizing radiation exposure, financial burden, and patient time related to diagnostic studies, including all modalities of clinical imaging. Imaging examinations should be clinically indicated and expected to provide clinically relevant information.
The ACA's criteria overly simplify what are complex clinical decisions based on the patient's history, clinical presentation, physical examination, and therapeutic intent. Their criteria fail to consider fully the value of imaging studies to assess patient biomechanics, structure, and contra-indications related to chiropractic care.
Complex clinical decisions are best left to clinicians and their patients, guided by current best evidence, clinical experience, and patient values.
For a similar perspective on the ACA's recommendations, click here.
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